On Wednesday, September 11, Dr. Mike Karch presented the Mass Casualty Seminar at the Mammoth Lakes Fire Department. The seminar was part of a three day training exercise. Dr. Karch is a surgeon at Mammoth Hospital, and also the co-inventor of the Smart Drill and a paid Clinical Instructor. The seminar was on Disaster Preparedness. The room was full of eager participants, including firemen, sheriffs deputies, police officers, EMTs and an EMT training class.

Dr. Karch spoke about 9/11 and his own experience in a mass casualty situation. He recalled how, after the terrorist attacks, he packed a bag and left for New York, arriving on scene at Ground Zero at 3 p.m., and was directed to Chelsea Pier. He said he was put to work at an ice rink, loading dead bodies onto the ice. Eventually, he heard an announcement that advanced medical personnel were needed at the “Site,” also known as Ground Zero. He said he grabbed some fireman’s clothing and left for Ground Zero.

Dr. Karch was one of the first three medical personnel in the wreckage, he said. Soon after, Martial Law was declared, and the team of three were not allowed out of the area. They worked for about 48-72 hours straight. On day two, officials determined that mistakes were being made, because responders had no breaks and were not properly dressed for the work at hand. A lot of aid was then given to the firemen, policemen and others for small injuries such as cuts and fractures. World Trade Center (WTC) Medical responders also suffered from the dust and debris, which caused eye irritation, respiratory dysfunction, and in some cases, permanent lung impairment (pulmonary fibrosis). Seventy five workers were later diagnosed with blood cell cancer. Thirty-two types of cancer were associated with the WTC dust exposure.

Dr. Karch also talked about the 2010 Haiti earthquake, 2012 events such as Hurricane Sandy, the Sandy Hook school shooting and the 2013 Boston Marathon bombing. He addressed the military combat extremity course AAOS (American Academy of Orthopedic Surgeons), mass casualty disaster preparedness courses, emergency war surgery, international committee red cross war and disaster surgery, ATLS (Advanced Trauma Life Support), and thoracic, general orthopedic trauma.

In disaster relief or war there are more injuries then medical teams can handle, Dr. Karch said. Triage centers are overloaded and have to use a color system to communicate with each other: red for immediate, life-threatening wounds; yellow for secondary, priority wounds, that can wait for surgery; green for the walking wounded, or those who can come back later after minor treatment; and black for severe to non-viable wounds, or patients who require supportive care, a quiet area and pain medication.

Dr. Karch said that earthquakes are the most prevalent natural disaster. Unlike most other disasters, there is no defined incident site. Earthquakes paralyze local and state infrastructure, and also limit patient transport, slow response times and exhaust resources.

He referred to the Iran earthquake on Aug. 11, 2012, describing effects of the 7.0 / 6.4 earthquakes, each 11 minutes apart, and the 80 aftershocks, the highest at 6.4. There were 3,000 injured and 306 found dead, he said. Responders stopped search and rescue at 24 hours because of the overload and exhausted resources.

Dr. Karch also addressed the taboo subjest of school shootings. Since 1992 there have been 387 fatalities from school shootings. Children ages 5-18 are 13 times more likely to die in a school shooting, than children of the same age in 19 other industrialized countries, he said, adding that on average there is a school shooting every 40 days.

One problem that Dr. Karch pointed out with the medical response to the Sandy Hook Elementary school shooting, which had 28 fatalities and two injuries, was that the medical triage was too far offsite. The triage center should have been set up right next to the school, not across a football field, Dr. Karch said. He added that time is a factor, and that the distance was too far to bring someone in critical condition.

“We need to be more prepared for events like this and have the proper medical attention on site,” Dr. Karch said. “We also need to create better knowledge on what to do in case of school shootings.” He noted that 21 out of 28 killed at Sandy Hook chose to hide; 3 out of 28 were shot at the front door and four were killed running away.

What I took away from Dr. Karch’s seminar is that America is ill-prepared for the mass casualties that result from natural disasters, terrorist attacks and school shootings. Responders may not be trained properly, but there are also never enough to help, no matter how prepared they may be. The public should be educated in what to do during natural disasters and terrorist attacks, so that they can aid first responders and medical personnel as well.

Photo: Pellegrini