Mass Casualty Scenario

As the first Paramedic on scene, what should your initial actions be according to NARU/ECU guidance? 

Your crewmate (driver) also has responsibilities on arrival. What should they undertake according to NARU/ECU guidance? 

You have sufficient information to pass a METHANE report. What does METHANE stand for? 

An Ambulance Commander arrives on scene and you handover to them. They relieve you of your command duty and assign you and your colleague as the initial treat and triage team using Ten Second Triage (TST). They explain the Limit of Exploitation (LoE) is defined as the nightclub’s front door. In this context, what does LoE indicate? 

You assess a female casualty with a catastrophic bleed from a stab wound to the bicep. A tourniquet controls the bleeding. How would you triage this patient? 

Should you assess rapidly assess for further injuries or move on now? 

You identify a chest wound on the left side producing a sucking noise. What is the most appropriate initial management? 

You move to the next casualty — a female with a large thigh wound, minimal bleeding, unable to walk. What triage category is appropriate? 

Next, a male casualty presents with a heavily bleeding abdominal wound. Despite a pressure dressing, the bleeding persists. What is your next action? 

You pack the wound, apply a second dressing, and bleeding stops. The commander sends another crew to assist and requests you start to manage the patients you’ve triaged as Police are still trying to secure inside the building. What additional interventions could benefit this abdominal trauma patient? 

Police begin escorting and dragging additional injured bystanders out of the venue. What is your appropriate action? 

You apply TST to the group and identify two further P1 casualties. Can TST be used by any first responder, or is it exclusive to ambulance clinicians? 

HART arrives on scene with mass casualty treatment equipment and ballistic PPE. They quickly establish a Casualty collection Point (CCP) and assist you with moving your triaged patients to the treatment area. They then follow Armed Police into the building to help further treat and triage. The on-scene commander asks you to assist in the CCP with the care of the patients and asks they get re-triaged with the next triage tool. Which tool is likely to be used for re-triage? 

Following triage with MITT, your abdominal trauma patient deteriorates with increasing breathlessness, left-sided chest pain, and hypotension. The patient tells you they are struggling to get their breath and it feels like they cannot fill their lungs. What is the most likely cause? 

As you assess the patient more thoroughly, you auscultate the chest and find absent breath sounds on the left side. HEMS has recently arrived on scene, providing enhanced care. The hospital is 20 minutes away. What is the most appropriate course of action?