Monday Morning Crisis Quarterback

There was a massive explosion at a Kleen Energy Services gas power plant under construction in Middletown, Connecticut at about 11 o'clock this morning.  Most recent reports suggest a gas leak may have been the cause, and that there were about 50 people working at the plant at the time.  Police officials said that this was a "mass casualty event."

If you don't do this sort of thing for a living, the term "mass casualty event" probably sounds pretty bad.  It probably sounds pretty bad if you do do this sort of thing for a living, too, but in a different way.  Most of us, when we hear "casualty" think "death," but of course that's incorrect.  Casualties include people who have been injured as well as people who have been killed.  A mass casualty event (MCE) is an incident that is of sufficient size that it will stress the first response and health-care system locally.  Different jurisdictions define how big something has to be to qualify as an MCE, and that also takes into account the capabilities of local responders.

Local hospitals in and around Middletown are reported to have activated their disaster plans.  On the face of it, this may sound odd.  We think of disasters as being earthquakes, tornadoes, floods and the like.  For the purposes of responding to them, however, there really isn't a big difference between a massive accident and a massive tornado.  If you work in the ER, you don't particularly care how all these people got hurt, but just that they did and how many of them there will be.  A disaster plan enables the hospital (or whoever) to plan for a situation that is going to tax their capacity.  It defines who does what when it's "all hands on deck."

Being injured in a mass casualty event as well as responding to one can have slightly different stressors.  The biggest difference that most people notice right away is the use of triage.  Responders have to choose who will get care first, and that means some people are going to have to wait.  If you are injured when your car hits a tree, for example, you are going to get the full attention of first responders.  If you are in a 50 car pileup, you will only get first attention if you are the most injured person that rescuers think has a chance of survival.  Anyone who has ever gone to the emergency room on a busy day has experienced triage.  You may be having the worst emergency of your life, but as long as someone else is having a worse one, you have to wait.

The triage involved in MCE's can become a predictable theme when responders and survivors work with crisis intervention personnel.  Survivors express the fear and frustration of being seriously injured and having first responders walk right by them without helping.  Responders report the horror of seeing multiple people in serious pain and having to leave them as they are rather than help.  There is nothing quite like having to step over a dying person without offering even comfort in order to save someone else.  These are choices none of us, even the highly trained, are used to making.

It will be a while before we know the full extent of the injuries at Kleen Energy.  That's also one of the hallmarks of an MCE -- helping comes before counting the people who need help.  As the dust begins to settle, this will be a big job for a CISM team, who will need to move in and help everyone recover from the difficult choices that had to be made today.