It has been almost a year since my last submission- I guess things slow down a little after college. As a quick recap, after graduation I spent the summer working at Camp Tawonga as an EMT/Medical Assistant. Since August, 2011 I’ve been working as an EMT-B in Oakland.

Last fall took a week off work to visit Anniston, Alabama. Now other than the local Cooter Brown’s (yes that’s the actual name of a restaurant) and the Wal-Mart, there are very few reasons to hang around Anniston, especially if you’re not getting paid. But this was definitely one of them.

I flew out to the middle-of-nowhere Alabama to train at the Center for Domestic Preparedness (CDP). Built over the remains of a World War I training base, the CDP is FEMA’s baby, built to train responders how to approach and manage a chemical, biological, radiological, nuclear, or explosive (CBRNE) incident with multiple victims.

While I don’t expect to be rolling up first-on-scene to a WMD attack any time soon, the CDP’s program provided a fantastic opportunity to practice responding to mass casualty incidents (MCIs) and engage with responders at all levels from all across the country. It was also federally funded, with no cost for any of the response professionals or their agencies. Although I wasn’t getting paid to be in Anniston for a week, FEMA covered all my flight, food, lodging, and materials expenses from the moment I stepped out of my house till I was back safe and sound. The only things that weren’t free were my I Heart Alabama t-shirt and beer.

I arrived Sunday afternoon, flying in to the Atlanta airport and hopping on one of the buses the CDP had chartered to drive us the two hours to Anniston. The course I attended was a week long – the first half mostly classroom lectures, followed by two and a half days of scenario-based training. No one likes lectures, but the instructors were engaging and thorough. They covered all the stages of competently responding to a disaster: setting up incident command, determining protective equipment and decontamination needs, then rescuing, triaging, treating, tracking, and transporting patients exposed to a CBRNE hazard.

It was a lot of classroom time, but the scenario-based trainings that followed made it all worthwhile. The first exercise was devoted to recognizing and treating individual patients exposed to CRBRNE hazards. We rotated around twelve different stations in teams of four, and equipped with a jump bag and cardiac monitor, ran the call until “transport.” The scenarios were a little obscure, ranging from a camper with botulism to a policeman exposed to mustard gas, but they offered a great opportunity to work side-by-side with experienced responders and practice all those basic EMT skills I tend not to use doing BLS transport. The high-tech mannequins that “bled” from a poorly-done IV and responded to palpation with a robotic “Ow, you’re hurting me!” made it especially fun.

The weeklong seminar culminated in two days of MCI drills, designed to give civilian responders a taste of working a large-scale disaster. After an early breakfast on Thursday, my fellow twenty-five classmates and I took FEMA’s bus out to the training facility, where we donned OSHA Level B HAZMAT suit, and walked through the different stages of an MCI response. I quickly learned how difficult it is to do even the most basic tasks while suited up. In that heavy-duty plastic bag, fogged-up facemask, and oversized rubber gloves, I could barely tie a triage tag. By the end of the three-hour drill, the clothes under my suit were so soaked through with sweat that I might as well have gone swimming. That day we moved over one hundred patients through triage, cut-out, decon, treatment and transport, rotating every forty minutes to practice each stage of the process.

For our final exercise on Friday, our instructors brought us back to the training facility to don our suits. Zipped up and strapped down, we filed outside to the parking lot. The instructors gave us radios and left us standing outside a warehouse door.

Inside was what turned out to be four subway cars filled with smoke, one overturned and all filled with the screams of enthusiastic actors. We grabbed flashlights, sleds and triage tags, and got to work.

This was the Integrated Capstone Event, one big scenario designed to simulate an MCI response from the first responder on scene to the last patient through the ER. It incorporated each of the five ongoing classes into their roles as first responders, HAZMAT techs, ER staff, administrators, and ICS command personnel to get over sixty patients from the red zone to definitive care.

After a long day, we got our certificates of participation, patted ourselves on the back, and collapsed before a Saturday of travel back home.

One of the most important lessons I learned in Anniston was that for EMTs like me, responding to a CBRNE or mass casualty incident would have us doing the same things we do every day. Unless I was unlucky enough to be first on scene, one of Pro-Transport’s lovely Scheduling ladies would call me up for some overtime hours and my partner and I would shuttle patients from the incident’s green zone to hospitals with open beds. We would record vitals, monitor the patient, administer oxygen, control bleeding if necessary, and get the patient safely to a higher level of care.

What changes is how we organize our services at the municipal, county, and state levels to best absorb the impact of the disaster. While my job providing care and safe transport doesn’t change much, who gets treated, who gets transported and where they go becomes dependent on the resources at hand. At the command level, responding to a disaster requires shifting from a medical system focused on maximizing care for the individual patient to one dedicated to rationing care for the population and distributing it where it will make the most difference.

In the end, my week at the CDP challenged me to think about my job as an EMT in the context of our public health and safety system, that tangled mess of companies, departments, and agencies working at all different levels to provide people with the care they need.

Understanding our link in the chain of response is critical to being effective responders. I highly recommend any health/emergency worker to take advantage of the CDP’s free trainings. Not only do they provide an opportunity to learn some new skills and chat it up with other professionals from across the country, but they also raise some important questions about our healthcare system in this country. What makes people vulnerable to hazards that require costly interventions down the road? How do we ration healthcare when it needs rationing. Is prevention easier than response, and if so, how do we getter better at it?

These questions are not limited to disasters and MCIs, but apply to every patient we have in a normal day of BLS transport. They don’t have easy answers, but that makes them only more important to ask.

Here’s a link to a CDP video of their trainings: http://cdp.dhs.gov/news/video/emo.html

All in all, my trip to Anniston was well worth while.

Edit: A draft of this article was printed in ProTransport-1’s company newsletter Foreword! http://protransport.wordpress.com/2013/05/01/why-you-should-participate-in-mci-training/