MCI & Evacuation Drills

MCI & Evacuation Drills

September 20: Friday

Annual Conference: California chapter of the American College of Emergency Physicians

I roadtripped to Anaheim, CA to present at the annual California chapter conference of the American College of Emergency Physicians. My talk is entitled ‘Writing for Wellness,’ and I focus on the psychological and physical benefits of keeping a journal. I’ve discussed how to start and keep a journal in this entry.

Here is part of my presentation:

“Starting with Hippocrates, the Hippocratic Oath states that physicians must not repeat any information that their patients tell them. More than not sharing these disclosures, physicians must treat their medical information as “sacred secrets” that are to be taken to the grave.

This sentiment was further woven into the fabric of medical education by Dr. Osler, father of modern medicine. In 1889, he gave his famous speech Aequanimitas to the medical students at Pennsylvania School of Medicine. The speech emphasizes the concepts of equanimity and imperturbability. Imperturbability refers to maintaining a calm, cool, and collected presence at all times. My interpretation of equanimity (as there are many) refers to the goal of always remaining emotionally detached from ones patients. He posited that a physician would provide better patient care if they incorporated the ideals of equanimity and imperturbability because they thought process would be objective and unbiased.

This has resulted in generations of physicians trained to not speak about what they see, to not think about what they experience, and to not process what they feel. A generation of physicians facing horrible injuries and illnesses, making life or death decisions, and being surround by the presence of death, yet not trained how to cope with the gravity of it all.

Physicians are burning out at record rates, especially in emergency medicine, yet we still systematically trained to keep our silence. Physicians are attempting suicide in alarming numbers. We've reached a breaking point, and things need to change. We need to start addressing the burnout, emotional erosion, and moral injury that working in medicine can cause.

Fortunately, the conservation is changing. Physicians are realizing that they need to talk about their experiences. It is possible to speak about a difficult case without revealing the identity of ones patient. It is possible to speak about exhaustion, emotional fatigue, anxiety, and depression, without breaking patient confidentiality laws. In addition to systemic changes within medicine, we need tangible methods to combat this crisis on an individual level.

Recent research has shown that journaling has not just psychological, but also physical benefits, which may help combat or stave off the pervasive effects of burnout. Medical schools and residency programs are even starting to incorporate journaling into their curricula...”

 

I go on to discuss the recent research about the benefits of journaling, and conclude with a section on how one can start keeping a journal. 

From a prepping standpoint, keeping a journal is a great idea. In additional to tracking events in my life, I use my journal to keep track of what I plant each season and how well (or poorly!) each plant grew. I write about new ideas for my website, new book ideas, as well as both short-term and long-term personal and professional goals.

At the end of the conference, my poster won the award for being the ‘Most Creative Poster.’

 

September 25: Wednesday

MCI drill

Today is a mass casualty training drill for the city of San Diego. Training drills help different agencies practice responding to a large-scale event, such as a terrorist attack, pandemic, or natural disaster, that would wreak havoc on the region.

San Diego is the second largest city in California, the eighth-largest city in the US, and has some unique features. The city is situated next to the Pacific, along an international border, and surrounding by an array of natural features from forest to mountain to desert. Participants included people from EMS, SD Fire Department, Law Enforcement, the Navy, the US Coast Guard, Border Patrol, the FBI, Joint Terrorism Task Force (JTTF), and various other agencies I’m forgetting. The drill is giving me a greater appreciating of just how many organizations get involved when a disaster occurs.

Watching the different teams work together during the drill was an eye-opening experience. My previous experience with MCI drills was when I worked for the National Park Service (NPS). Those drills took place in nature, in the forest and mountains, away from large buildings and dense populations. Running an urban MCI drill is a completely different beast. The teams each approached the drill with their own agencies agenda in mind, yet they all worked towards a common goal. Truly impressive to watch and I learned a tremendous amount about how San Diego responds to large-scale incidents. I’d say more about the specifics of the drill but I don’t think I’m supposed to.


 

Recipe: Evacuation

When I lived in Fresno, I worked as a resident Local Emergency Medical Advisor to Sequoia and Kings Canyon National Parks, which are part of the US National Park Service (NPS). National Parks are staffed by Park Rangers, who wear an impressive number of hats, including EMS, law enforcement, fire fighter, search and rescue, tour guide, and steward of the land. Some Rangers have EMT-B certifications, while others are certified as Parkmedics or paramedics. 

My main job, in addition to doing continuing medical education and chart review for the Park Rangers, was to run NPS MCI drills. I took over the job because I loved it. I helped grow their drills into 100-person events that people would travel from all over the state attend. I’ve now run drills in Yosemite, Sequoia, and Kings Canyon National Parks. I’ve run drills in forest and mountains, under blazing sunshine, and in the mist of rain, sleet, and snow. Because drilling one time is not enough – you’ve got to practice multiple times. Drills help highlight your strengths and weaknesses: the gaps in communication; the breakdown in order; the overlooked details.

Want to have your own drill? Well, instead of an MCI drill, try having an evacuation drill. Using the 72-hour bag that you assembled previously, stage your own evacuation.

We keep copies of our evacuation plan with our preps, and another copy in the Emergency Binder. Included on the evacuation plan are important phone number and account numbers, contact information for family members in various cities, as well as local and long distance addresses (with directions) of places we’d bug out to.

Information on the evacuation plan:

  • Electric and gas company account number, login information, and contact information

  • Water company account number, login information, and contact information

  • Local and city police and fire department addresses and phone numbers

  • Address and phone number for our dog’s Vet, and a 24/7 animal hospital

  • Family member phone numbers and addresses

  • Directions to several local and long-distance pet-friendly bug-out locations

 

Here is our actual evacuation plan:

Stephanie’s packing and to-do list

  • Get the dogs leashed and ready to go

  • Lock-box (small, waterproof, fireproof safe)

  • Portable filing cabinet

  • Emergency Binder*

  • First aid kit*

  • Glasses

  • Laptops and chargers

  • Journals and jewelry boxes (aka: pack the sentimental items!)

  • Turn off the water, gas, and electric to the house

  • Pack the cooler with last minute fridge items (if there is time)

    • Cabinet: bagels, bread, peanut butter

    • Fridge: leftovers, cheese, eggs, milk, wine & beer

Alex’s packing and to-do list

  • Alex’s 72-hour bag

  • Stephanie’s 72-hour bag

  • The dog’s 72-hour bag

  • 3- & 7-gallon water jugs

  • Plastic tub of camping gear*

  • Plastic tub of medical gear*

  • Fire extinguisher

*More on each of these later.

Both of our cars have been tested and fit the above items. The dogs go in the backseat of the car, while all the preps go in the trunk. The lists are split by location. My husband packs all the gear in one area of the house, while my list covers another area of the house. The list of items are in order of priority, as we may not actually have to grab everything we want. At the end of the day, nothing is more important that our dogs.

Now it’s your turn!

Come up with a plan and create an evacuation checklist that fits your family (or just copy ours). Don’t forget to include all pets and livestock – it could be deadly to leave them behind! If you take any medications, make sure to include those, too.

Time yourself. How quickly can you get out of your home? What did you forget? How could you improve?

If you really want to test yourself, try to evacuate for a whole weekend by using only what you’ve brought with you.

How’d you do?

In the trunk we’ve got both of our 72-hour bags, 7- and 3- gallon water storage containers, the plastic tub of camping gear, and the plastic tub of medical supplies. It takes about 3 minutes to put in the car, and there is plenty of extra room.

In the trunk we’ve got both of our 72-hour bags, 7- and 3- gallon water storage containers, the plastic tub of camping gear, and the plastic tub of medical supplies. It takes about 3 minutes to put in the car, and there is plenty of extra room.


 

A doctor and a patient walk into a bar...

A doctor and a patient walk into a bar...

72-hours of food

72-hours of food