Prepare for the worst, hope for the best

What would you do if you were attending a basketball game and the bleachers collapsed? Or what would you do if you were watching a rodeo and a bull jumped over the railing and ran into the stands? Such are scenarios that could happen, and it’s important to know how casualties like those could be handled if they were to happen.

Robyn Gust, Trinity Sports Medicine manager, recently put together a plan that will help schools and communities prepare for a mass casualty event in an athletic environment. The idea for a plan arose from the North Dakota Athletic Trainers Association’s recent annual meeting at Minot State University that featured Wanda Swiger, associate professor of physical education at Keene State College in New Hampshire. Swiger was present at the finish line of the 2013 Boston Marathon bombing and was the featured speaker at a seminar on mass casualty response.

Swiger, who is also a medical provider, was a member of the medical team that provided coverage at the finish line in Boston. In her presentation, she discussed the bombing and gave insight on how to prepare for mass casualties. Also featured at the presentation was a panel discussion by personnel from the Minot Police Department, Minot Fire and Rescue, Minot Central Dispatch and Ward County Emergency Response. Gust concluded the presentation with an update on Trinity Sports Medicine’s efforts to implement a mass casualty preparedness plan for its athletic clients in Ward County.

During Swiger’s presentation, she asked if those people in attendance would be ready for a mass casualty at a sporting event, and Gust said she realized the answer was a definite no. Swiger noted that because they were so prepared in Boston, the casualties from the bombing were minimized.

“As sports medicine providers we constantly strive to prepare for anything that might happen at our events,” Gust said. “We realized that we weren’t ready if a mass casualty incident were to occur. This (presentation was) designed to help bridge the gap between those on site at the time of the incident and the emergency responders so that appropriate care can be immediate and organized.”

One such event that sparked motivation for implementing a mass casualty preparedness plan for Gust was when the lights went out at the state volleyball tournament this past year. The lights were off for an hour while athletes, coaches, spectators, and other personnel sat in the dark at the Minot State University Dome. “It was handled well, but it was an eye-opener,” she said.

Five people injured at the same time would be considered a mass casualty event, Gust said. Any event that takes three hours to take care of is also considered a mass casualty event.

“A huge light bulb went off because I was expecting the number to be in the three-digit zone,” Gust said.

Since January, Gust and Dr. Dawn Mattern, Trinity Sports Medicine medical director, have been working with Ward County Emergency Response personnel and local entities to implement mass casualty emergency plans at places or events where Trinity Sports Medicine provides services. Coming up with a plan was “eye-opening, frustrating, and (led to) the realization that we had a lot of work to do,” Gust said.

The big challenge in setting up a plan was getting the schools involved, Gust said. There are a lot of schools on board with the plan now, though, she added, and will have plans in place by fall of next school year. Schools will be provided with vests for the designated Incident Commander, as well as for other emergency responders to be kept in the schools’ AED boxes. The Incident Commander should be designated before a casualty would occur. “We want to plant the seed with the schools on how to prepare for a mass casualty so we can be as ready as we can,” Gust said. “We’re not prepared yet, but we’re getting there.”

Gust said the entity hosting the event should identify who the Incident Commander before the event takes place, Gust said. However, that might be troublesome for smaller schools, she said, since people already wear many hats and would be asked to wear another, bigger hat.

The mass casualty response plan would involve Trinity Health and the aforementioned first responder agencies. Gust said Minot Central Dispatch would hear verbal cues from the athletic trainer who called in the mass casualty and each entity would arrive and do their parts. Once those people have arrived, the athletic trainers would step back into the woodwork.

“We want to have this plan to have everyone prepared so that we have the least amount of casualties and the best possible care as fast as we can,” Gust said. “We want the injuries to be minimized. We don’t want to just save a limb, we also want to save a life.”

This has been a very overwhelming process, Gust said. “But I don’t want anyone else to be as overwhelmed as I was when putting the plan together,” she added.

Ward County is covered with a mass casualty preparedness plan, she said, but not the other surrounding counties.

“It’s nowhere near complete, but I feel more comfortable with it now than I did in January,” Gust said.

Gust said they prepare for the worst and hope for the best. “We walk into a building and think, ‘What’s the worst that could happen?’ as athletic trainers,” she said. “You just try to be as prepared as you can.”