Triage: The Balance of Life and Death – Blog Post 8

For the hurt and injured, when it comes to natural or man-made disasters, medical triage puts them in four categories. They are ranked as follows: Minor, Delayed, Immediate, and Morgue. However, as a law enforcement or emergency medical personal, triage becomes a matter of deciding who may live and who may die. How does one decide whose life is more important between the 10 year old, lower class male who has no pulse from shock and or the 50 year old, upper class, father of two, who is suffering a severe heart attack?
Many First Responders like police officers and firefighter are trained in the use of the S.T.A.R.T. method when it comes to mass causality incidents. According to MedicineNet.com, S.T.A.R.T. stands for Simple Triage and Rapid Treatment and was developed in Newport Beach, California. The S.T.A.R.T. method is similar to triage but involves a quicker assessment of the injured subject. If you are talking and mobile, it is possible that you may be placed in the minor category for triage care. It is interesting to note that for the less experienced medical technician, it is hard to ignore subjects who are bleeding and screaming in pain but it is necessary to ensure that the most critically injured be prepped and stabilized for transportation to a hospital. Unlike the S.T.A.R.T. method, advanced triage surrounds the idea of the most critically injured are given priority for medical care and transportation.
In advanced triage, social and class factors do not matter, in caring for the subject. Medical care surrounds the idea that the dead are placed in the Morgue category. However, the people who are about to die are given priority medical care. It is possible that in a Hurricane Katrina or Loma Prieta drugs and medical supplies and care won't be given to those people who have minor injuries. Also in these extreme and severe conditions where medical transportation is rare, people who are given a quick preliminary exam in the S.T.A.R.T. method and placed as "Minor" may or may not see hospital care for hours and even days. It is possible if a subject cannot receive the professional care of a hospital and is in critical condition, professional care may be stopped on them. At that time, this medical judgment call is made by the highest medical professional in the field. It is important for medical personal to put aside their feelings and understand the difference between the living, the dead, and those who are about to die if they do not receive care.
With this idea in mind, medical personal must set aside favoritism, pre- conceived notions, and biases, as these may affect the natural decision making process. When one’s pre – conceived notions affect there judgments, as humans, medical personal tend to fall back on to their training. All emergency medical services have adopted a policy of resorting back to their fundamentals. In this idea, medical personal at the scene of an accident or disaster must follow strict protocol in treating a subject. So one’s race, gender, or sexual orientation does not affect that way they receive treatment. It is hard to ignore a person’s cries for help, but if personal feelings effects one’s actions, they comprise their job and the integrity of their department. This task is easier said than done but is a “necessary evil” in maintaining professionalism and order during critical disasters.
So medical triage can be analyzed many different ways. However, it is up to the individual, whether they be a paramedic or law enforcement officer to make the appropriate judgments when necessary. In simple terms, each individual is tasked with the ability to “play god” and may be called on to make a critical decision of who lives and dies during the duration of their career. Putting aside one’s feelings and ideas is un-human but is necessary to maintain order. For those called on to make the decision of who lives and dies, there is no protocol and standing orders helping them deal with the guilt that someone may not go home to their love ones that day. In the emergency medical field, as a first responder, one stands as the difference in the balance of life and death.


Works Cited
MedicineNet.com
Google Images

In times of natural disasters, how do you help the helpers? Blog Post 7

This video depicts officers of the New Orleans police department looting a Wal Mart days after the 2005 Hurricane Katrina. Looting can happen anywhere during a natural disaster and it is the job of all law enforcement officers to restore order to society but how can order be restored to society when the officer’s well being and that of his love one’s are on the line.
Although, media can be very liberal at painting officers in a bad light, one would have to agree with the reporters in this video. Law enforcement officers stand for law and order and if they are looting two days after the hurricane hit the south east coast, than what would law and order be like in a week, month, or year? These officers should be forced to resign, or be brought up on criminal charges, as this video shames the department and the officers that work for it.
Some may say that survival may behind the fact that police officers are looting because in desperate times, desperate measures must be taken in order to survive. However, law enforcement officers, whether they be local, state, or federal are mainly tasked with upholding the law at all cost. Instead of walking around inside the Wal Mart like they cannot catch a looter, they should be outside the front doors of the Wal Mart providing security. It is up to the drop of disaster relief organizations such as the Red Cross to provide support when people need it the most.
Currently, in the news, it is said that Hurricane Ida is about to follow in the steps of Hurricane Katrina and hit the south east coast line. In this time before the storm, police departments should beef up patrols in high risk neighborhoods. As well, they should make sure that they families and most prized positions are in a safe place to prevent looters and to ensure their personal safety. The actions of the officers were wrong, however, law enforcement officers should be allowed the supplies they need so survival is not an issue when trying to “protect and serve”. It is from learning from the mistakes made at Katrina that other states like California can better prepare for natural disasters.

Dead of a Mass Disaster and Law Enforcement - Blog Post 6

It is commonly said that one can tell how civil a society is by how they handle their deceased. For most western civilizations, death is an enigma because as a society, their ceremonies and customs do not require them to embalm the remains. From this separation, western societies have come to fear death instead of looking at death as a part of life.
According to the World Heath Organization from the California Mass Fatality Management Guide, more than 100,000 people die in natural disasters and millions of others are injured or disabled. With gruesome images of bodies found decomposing many weeks and months later, the initial focus of the media is to paint the government and law enforcement agencies as “not doing anything” or “not doing enough”. In a time of natural disaster for the state of California, when it comes to law enforcement and local government the question should be asked: “How should the dead be laid to rest?”
The 2005 Hurricane Katrina stands as a grime example of how not to handle the dead. When the hurricane hit the south - east coastline, it destroyed many cities. For those who did not flee the cities they either died from drowning in the rising waters or died of starvation, trapped in the attics of their houses. Due to the lack of local law enforcement and government personal, thousands of dead bodies were left out in the open to decay. As noted in a presentation by Robert Gerber, Deputy Chief of Coroners’ mutual aid program, in one instance, a decaying body was found in a busy intersection and marked with a traffic cone as a police officer conducted traffic control. Although law enforcement was under staffed and over worked, this image is both disturbing and paints a negative picture for officers and government officials. With these pictures in their minds, families were outraged that the remains of their “loved ones” weren’t returned to them in a timely and respectful manner.
Learning from the mistakes made at Hurricane Katrina, a procedure is outlined in the California Mass Fatality Management Guide. In this guide a portion of the book outlines what law enforcement and government officials tend to do with the decease. It should be noted in a case of an incident, local governments rely a heavy amount upon by the federal government. Local law enforcement should not have to rely on heavy federal support to act upon an incident.
Once the federal government comes to the assistance of local personnel, the Department and Health and Human Services enacts the National Disaster Medical team’s DMORT team. DMORT stands for Disaster Mortuary Operational Response team. This team consists of private citizens trained in performing autopsies, identification of remains through forensic pathology, dentistry, or anthropology. As well they assist in DNA retrieval, tracking of human remains, and ante-mortem data collection. The Department of Health and Human service’s DMORT team is a good idea but more local law enforcement and government officials should be trained in the capabilities of the DMORT team. Local law enforcement should do the preliminary work before federal assistance is needed.
The California Mass Fatality guide also outlines a family assistance center were families can receive death notifications of their love one, counseling, and receive medical assistance. As well, other federal organizations like the NTSB or the National Transportation Safety Board have outlined what to assist families in a swift recovery of the remains. More emphasis should be placed on local and statement support than federal support in the time of a disaster. Though the California guide is a good outline to a natural disaster, it should be worked to place more disaster support in the hands of local law enforcement and government officials instead of state and federal support.

During a natural disaster, it is by placing more emphasis on local and state functions and instead of federal support that law enforcement can better manage a critical incident. For the state of California to prevent a controversial incident like Hurricane Katrina and the number of dead, it should broaden the focus of local law enforcement to handle more tasks of the federal government. It is by learning how to manage the living that society can better handle the dead.

References
- California Mass Fatality Management Guide: A Supplement to the State of California Coroners’ Mutual Aid Plan
- Mass Fatality and Search and Rescue presentation by Robert Gerber
- Photos by Google Images