Category - Training

Training day

The OBI played host to a two-part mass casualty training exercise for Class 1/2016 last November, writes Conor Forrest.

Last November, recruits from Class 1/2016 reported to the OBI as part of their paramedic training, having graduated earlier this year and spent the intervening time in their respective stations. They would be taking part in a mass casualty training exercise that day, a test of their skills in the field based on course objectives which have been set by PHECC (the Pre-Hospital Emergency Care Council) on gathering vital information, delivering a clear picture of the scene to control and command, and designating certain areas for casualty clearance, ambulance arrival, etc.

Several years ago I had the opportunity to attend a similar exercise held in the Phoenix Park, which featured the aftermath of a house party gone wrong. This one, however, was a little different in terms of scale. Though the recruits were told they would be taking part in a mass casualty exercise, they weren’t told what to expect. The brainchild of tutor Joe Brady, one of the first practitioners to reach the scene of the recent shooting in Whitehall, onlookers watched as two vehicles entered the yard at speed, screeching to a halt. A mass of armed gardaí tumbled from the vehicles and spread out, bearing down on the rear of the building where there were reports of shooters inside a nightclub. Following an explosion, several masked men emerged from the building and engaged in a shootout with gardaí. The armed unit then moved into the building, clearing it room by room, ensuring the scene was safe for first responders to enter.

Members of the ERU arrive on scene

Once they got the go ahead, DFB crews began to arrive – some began to assess the emerging casualties, while others entered the building to assess and remove the more critically wounded. With music pumping inside the club, the responders had to focus on the tasks at hand and ignore any distractions – their instructors were looking for mental strength in the face of disorientation and pressure. Outside on the quad a casualty clearance station area was set up, with patients brought in, assessed, and then transferred into the waiting ambulances. Though some might have been expecting a different scenario, a second exercise began with the shooting of the assembled crowd from the earlier incident.

“The exercise was designed to test their response to a mass casualty incident; we were looking at their role as first practitioners on the scene, their communication skills, their ability to do what is called a triage sieve – a first look at the patient and then allocate a triage card. If they’re really badly injured they get a red, if they’re not so badly injured they get a yellow, and then the walking wounded can be brought off to a separate area and then bussed off scene,” explains Paul Lambert, EMS training coordinator in the OBI. “It’s about getting into the practice of encountering something that they won’t come across that often, it’s not normal medicine, they don’t come and treat the first person they see – their job is to categorise all of the casualties and to find out which is the highest priority.”

Coordination

Understandably, organising this exercise was a complex process, liaising with An Garda Síochána and the Civil Defence. “Joe Brady decided that since it was in the news and something that there is a possibility of happening – an active shooter scenario – he decided on this format. He interfaced with a number of other agencies, the Civil Defence, An Garda Síochána and the Garda Emergency Response Unit,” Lambert explains. “Logistically it was a big ask, because there are a lot of factors to take into account to develop an exercise that will run well.”

Instructor Dan Fynes readies his crew to enter the building

The first thing to consider was health and safety – designing an exercise plan, conducting a risk assessment, mitigating any potential risks that arose during the planning stage and appointing a safety officer to oversee the process. Ensuring all of the necessary equipment was in place was another challenge – given the scale and scope of the exercise, the organisers needed additional trauma bags, spinal boards, field stretchers, scoop stretchers and defibrillators, and a casualty clearing station. A number of ambulances were also requisitioned from the workshop, placed on standby for use in the exercise.

As the scenario involved a shooting at a nightclub, casualties were also required, provided through the voluntary emergency response organisations. Their varied injuries were made more realistic by the work of makeup students from Dún Laoghaire. The talented students provided moulage [applying mock injuries for emergency services training purposes) – injuries such as eviscerations, penetrating injuries, everything from bruising to a major haemorrhage and eye avulsions, making for a more realistic scene and placing increased pressure on the responders.

“Our first practitioners on scene performed very well, and then our subsequent crews performed very well. It was quite arduous – we had 53 casualties and there were two separate exercises, so it was quite physically and mentally demanding on them. They had to make rapid decisions under pressure and then physically had to remove and treat the patients. It was a lot of pressure for them but we’re very happy with how they performed, and I think they found it to be a very valuable learning experience,” Lambert explains. Thanks are due to all who volunteered their time in coordinating the two exercises, totalling over 100 casualties.

Joe Brady deserves a special mention for his hard work in bringing his idea from concept to execution, liaising with outside agencies and with various elements within DFB, organising the moulage which provided a layer of added realism, and whose effort was vindicated at the end of the day. “I was also very impressed with the tutors in the OBI and the amount of hard work they have done,” says Lambert. “It was a very well thought out exercise, and very well executed.”

Tricky triage

Among the many skills being tested through the incident was the firefighters’ ability to perform a triage sort, a more in depth way of assessing a patient. “They assess the respiratory rate, their systolic blood pressure and their Glasgow coma score, and based on those three things they apportion them a score, and then those patients are moved to the hospital first – it’s like a filtering system,” Lambert explains. “We filter through the casualty clearing station, the people that need to get off scene quickest, and then we can designate those to the hospitals to make sure that the hospitals receive the most critical patients first.”

Firefighters were also tasked with relaying a methane message – declaring a major emergency, providing the exact location, the type of incident, hazards, access, the number and severity of the injured and any extra resources required.

Europe in the OBI

An EU Civil Protection Mechanism course was recently delivered in the OBI, focusing on coordination in the event of a disaster in Europe or further afield.

The EU Civil Protection Mechanism was established back in 2001, aimed at developing and enabling cooperation between national civil protection authorities across the continent. In the event of a natural or man-made disaster, EU member states can send assistance at short notice, with deployed teams undertaking specialised tasks including search and rescue, aerial forest firefighting and advanced medical posts. Any country in the world can request assistance, with over 200 received since its establishment, such as the 2010 earthquake in Haiti, the Ebola outbreak in 2014 and the 2015 earthquake in Nepal.

Alongside coordinating a pool of resources, the Mechanism provides members with the opportunity to train their civil protection teams, allowing for the exchange of best practice and learning to increase effectiveness when responding to an emergency. The cornerstone of this training programme is the Operational Management Course (OPM), the first course specifically aimed at future deployments inside and outside Europe. The eight-day course targets national experts and European Commission representatives who seek to become potential team members or liaison officers as part of a European Civil Protection team sent by the European Commission. The course focuses on coordination and course topics include internationally agreed guidelines and procedures, planning, information management, ethics, code of conduct and the basics of safety and security. Those who graduate are equipped with the skills to function as a full member in an On-Site Operational Coordination Centre (OSOCC – outside Europe) or coordination setting (inside Europe), which facilitates coordination between the various agencies involved.

Dublin delivery

There is a consortium of five organisations involved in the delivery of OPM training, the German Federal Agency for Technical Relief (THW), the Danish Emergency Management Agency (DEMA); Italy’s Protezione Civile (Civil Protection) department; the Icelandic police service and Dublin Fire Brigade. Ireland, Germany and Italy have been selected as course venues for this cycle of training.

Though the course is normally split into two – theoretical and practical – with each strand taking place in a different country, in 2016 (for the first time) both sections were delivered in Dublin in Dublin Fire Brigade’s O’Brien Institute in Marino. Assistant CFO Dennis Keeley was assigned the overall responsibility for the delivery of the seven day course, with D/O Derek Cheevers managing the logistical aspects of the course. A number of senior personnel from civil protection agencies across Europe took part in the course, which involved a fictitious emergency scenario in a country outside of Europe, known as a ‘third country’. During the exercise the coordination team was deployed to this outside country, met with the local emergency management authority and then coordinated the arrival of dedicated taskforce teams, or modules.

“There are a range of modules within the EU Civil Protection Mechanism, and their deployment to a country is dependent on the type of disaster involved. For earthquakes there are urban search and rescue (USAR) modules, for flooding there are high capacity pumping and flood containment modules,” D/O Cheevers explains. “If there are a large number of people that have been internally displaced and require shelter there are emergency temporary camp modules, if the drinking water supply has been affected there are water purification modules and if a large number of people require medical assistance there are advanced medical field post modules that can be supplied. These are just some of the modules available; there is an extensive list that can be applied to any disaster scenario.”

A member of the coordination team in the OBI.

Replicating field conditions is a big part of the course. Over time the exercise becomes more complex, testing the stamina and resolve of the team members, who sleep on camp beds and eat only MREs (meals ready to eat), as many affected countries will lack vital infrastructure. Course participants were required to develop a number of plans covering media queries, safety and security. The exercise also involved the coordination of a controlled evacuation, and meeting with people in the host country in positions of power. “It’s all about preparation, preparing them for a real incident. We try and replicate that as much as possible,” says D/O Cheevers. “They were not outside at any time, it all took place within the building, primarily around communications, meetings and coordination of incoming assistance.”

Though the number of Dublin Fire Brigade personnel who have been deployed under the EU mechanism remains quite small, D/O Cheevers notes that there is still a clear benefit in taking part in the course. Should Ireland find itself in the grips of a disaster beyond our control, and a request for assistance is made, those here who have completed the course could operate as host nation support officers with knowledge of the format of the incoming support – a member could be embedded within one of the incoming teams, acting as the liaison officer between, for example, Dublin Fire Brigade and a search and rescue team.

D/O Cheevers also notes a litany of people without whom the course would not have been such a success. Ably assisted by firefighters Troy Taylor and Darren O’Connor, he also highlighted the fantastic work of James McConnell and Dublin Civil Defence in providing much of the transport over the seven days.

“There are a number of people in the OBI that I need to thank – Brigade Training Officer Gerry Stanley and Assistant Brigade Training Officer Mark Wilson, Breeda Melvin and her colleagues in the office; Jim O’Brien who assisted with a lot of the transfers; Richie (Red) McDonnell who has been fantastic in preparing many of the exercise locations; S/O Martin Cooke who facilitated transport to Dublin city centre using our new double-decker bus for a walking tour of the city and social evening; Caroline Timmons from the IT department in Dublin City Council who worked with the IT experts from Germany in providing the extensive support required for such a course; and Lisa and her crew in the kitchen for the catering, with firefighter Simon Finglas also assisting in this area,” says D/O Cheevers. “We have two courses planned for next year, and the OBI will be a key part of that. It was very much a team effort – we worked long days, but overall it has been hugely successful.”

 

First on the scene

First aid

Firecall editor Conor Forrest recently took part in day one of the three-day Occupational First Aid (OFA) course at the O’Brien Training Institute, learning more than he had expected.

It’s not an entirely uncommon scenario. An ordinary member of the public is out walking through the city when they see a man collapsing to the ground, complaining of chest pain and discomfort along with shortness of breath. They might panic, unsure of what to do, apart from calling the emergency services. Or, if they have been instructed in how to give first aid, they could make the difference between life and death, stabilising the patient before the ambulance arrives.

Having been encouraged by a number of people over the past few months to undertake a first aid course, in the event anything might happen at Firecall HQ, I arrived bright and early at the OBI on a sunny morning last June alongside six other trainees, all of whom seemed to work in one of the city’s public libraries.

My first introduction to this new and nervousness-inducing world was courtesy of our instructor for the day, Hugh Keeley, who joined DFB in 1997 and currently serves on C watch in Donnybrook. Despite having studied biology to the Leaving Cert (not by choice), I wondered how I would manage to take in the amount of technical terms and medical information that I was sure would be fired my way throughout the day. I needn’t have worried.

Comprising a mix of practical and easily digestible information on the intricacies of patient assessment, respiratory emergencies and cardiac first response, the course was broken down in a manner that us ordinary folk on the street could understand without much difficulty. Hugh was full of interesting information and anecdotes throughout the day, including the possibility of using a crisp bag to stop air sucking in and to allow blood to drain out following a stab wound to the ribs or lungs, albeit in the absence of a more conventional medical solution.

First up was an introduction to the world of the first aider, from the responsibility of those practicing first aid to regulations and legislation, and we were warned about acting negligently and the need to secure a scene before you begin your work, a lesson which is undoubtedly part and parcel of everyday life in DFB, but may be less than second nature to us civilians. Next up was what we had all been waiting for, the practical demonstrations – checking for a response, carrying out primary and secondary surveys, hauling our makeshift patients into the recovery position, and best practice when dealing with a patient suffering from spinal injuries, among others.

Sobering lessons

Perhaps one of the more striking lessons learned that day was about fibrillation, and the actual use of the defibrillator. From the point of view of the general public, it’s probably fair to say that the defibrillator is seen as a tool to fix all manner of problems. One of the attendees (naming no names) was particularly shocked by the revelation that the heart itself is not restarted by the defibrillator; the defibrillator stops ventricular fibrillation which is a useless quivering of the heart that results in no output – blame Hollywood for that misconception.

First aid

The course includes both theoretical and practical aspects

Speaking to me afterwards, Hugh was very vocal on the need for people on the street with first aider skills, as they provide a vital stopgap while the emergency services are en route. “They are vital. They are the first three links in the chain of survival, and what we do adds to what they have done already. If they’ve got stuck in and they know first aid and they’re able to do as much as they can for the sick, ill or injured person before we arrive, it makes a massive difference to the outcome of the health and wellbeing of the patient. If nobody does anything for the patient or if they’re just left lying on the ground, when we arrive we have a hard job to make things right again,” he states. “The first aider is vital and it’s very important that [they are] in the workplace, in schools and community centres etc. And that they have the equipment – ideally, if the budget will run to it, if there’s a defibrillator in the centre or the school or the workplace, the first aider can start using that long before we even get there, and it might make the difference between life or death.”

As for the course itself, Hugh notes that anybody can do it, with just a few simple prerequisites. “You don’t need anything apart from an enthusiasm and a willingness to learn,” he adds. “So long as you come with the right attitude then we can show you all of the skills over the three days, and you’ll learn a lot.”

While the librarians continued their studies for another two days, my fi rst day was also unfortunately my last. However, it’s fair to say that in that day I learned more about first aid and life saving techniques than I have in my entire life, from the correct way to do CPR to the use of aspirin in cardiac cases. I hope to return some day in the not so distant future to complete the full three-day course and receive my certificate as a qualified first aider – from what I’ve seen and learned, it could be worth its weight in gold.

Revolutionary

The portable defibrillator was the brainchild of Professor James ‘Frank’ Pantridge, a doctor and cardiologist who was awarded the British Military Cross for his role in defending Singapore from the Japanese during World War II, and later became a prisoner-of-war. Appointed as a cardiac consultant to the Royal Victoria Hospital, Belfast in 1950, Pantridge introduced cardiopulmonary resuscitation (CPR) with his colleague Dr John Geddes by 1957. Recognising that thousands of deaths were occurring due to ventricular defibrillation, with many taking place in the first hour, Pantridge developed a portable defibrillator along with Geddes and a technician at the Royal Victoria Hospital, Alfred Mawhinney.