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required instructions, see COMNAVSURFLANT/PACINST 6000.1 series. The mass
casualty bill will list the medical responses, casualty receiving and treatment areas, and
casualty evacuation routes for each mass casualty scenario. This is tailored to your
ship s capabilities and is different for each type of scenario. Casualties are received in
different areas depending on how they arrive (by sea/land/air); casualty treatment areas
are different if the ship is at General Quarters versus just receiving casualties.
COMNAVSURRFLANT/PAC require that mass casualty drills be completed and graded
quarterly. If you plan your drills appropriately, you can test all the scenarios that you
have devised. It cannot be stressed enough to actually DO the drills for each
scenario so that you can find the problems during the drill and not the real thing.
An example of information that you would like to know ahead of time would be if you
have a problem with stretchers not fitting through the door of your designated casualty
treatment area. If your predecessor has a Mass Casualty Bill in place, all the scenarios
should have been tested to work out the bugs, but don t put your trust in that. Go
through the drills so you can see what the situation is for yourself and your people get
comfortable with the routes and locations. There isn t time to read the instruction in an
actual mass casualty situation.
In addition, you need to make sure there are provisions for setting up intensive care
monitoring and ward care for the injured. You must also make sure that charts and
records are accurate and maintained, that you have procedures for removing weapons
and valuables from patients safely, that adequate security is maintained on controlled
medicinals broken out for use, and that arrangements have been made for
MEDEVACing casualties requiring additional care. If patients have died, you must have
provisions for storing their remains. (Refer to the Decedent Affairs Manual,
NAVMEDCOMINST 5360.1.) As you can see, there is a lot to plan for ahead of time.
When a mass casualty drill or situation is imminent, the word will be passed, Ready to
receive casualties, man all battle dressing stations. At this point, each BDS will be
manned in accordance with the Watch, Quarter, and Station Bill. The corpsmen,
assorted phone talkers, and stretcher bearers will man their stations. The Medical
Officer will be in the main battle dressing station area, and the next senior Medical
Department representative will man the main triage area. If Dental Officers are
assigned, the senior Dental Officer will usually be the triage officer, though it should be
your best surgeon, at least initially. All dentists are trained in ATLS prior to assignment
aboard ship. If the casualties are received from off the ship, then the Commanding
Officer may order relocation of the main BDS if appropriate. (Personnel man the BDSs
initially so that they can get their equipment and supplies.)
With any luck, you will be provided with adequate phone talkers and extra personnel. If
not, it is your job to consult the ship s manning document for potential reinforcements.
Rest assured the other department heads are not going to lend any of their personnel
unless they must.
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Dental officers may also be assigned. An independent duty corpsman or Dental Officer
may man one of the battle dressing stations on the opposite side of the ship from the
Medical Officer. The best trained personnel will then be more available if damage
prevents transporting patients from one side to the other.
When casualties arrive, they are taken from the flight deck (or well deck if brought in by
boat) to the triage area by the stretcher bearers. Individuals specifically trained in first
aid and litter bearing must be assigned the task of moving the patients. If casualties are
received on the flight deck, they are first taken to a central point out of harm s way (the
mess decks on an LPD). If they are brought in by boat to the well deck, triage them
there. The triage officer will send less severely injured and ambulatory patients to the
battle dressing stations for treatment. More serious injuries should be transported to the
main BDS for treatment by the physician.
Remember not to send corpsmen out on house calls. It is the ship s responsibility to
get patients to your area where treatment can be given. Patients seen in the BDS will be
treated and sent back to duty or stabilized and held until they can be transferred to the
main BDS. Stretcher bearers go out and bring the patient back; your corpsmen do not
go out.
The main BDS is the staging area for patients requiring higher levels of care or
MEDEVAC. Unless overwhelmed, don t utilize BDSs as holding points for patients for
extended periods. Once a flood of patients has arrived and been treated, get the
remaining patients over to the main BDS, shut down the other stations, and get the
manpower to your area. Centralize the patient flow as quickly as possible to consolidate
manpower in one area. By the end of the mass casualty, all patients and staff should be
at the main BDS.
The situation is very similar when internal casualties are suffered during general quarters
and the ship is damaged. Patients will be routed to the nearest available BDS, as
determined by the damage control assistant in Damage Control Central. This control
system prevents injured personnel from going to areas that are damaged, flooded, or on
fire. Damage Control Central is informed of all inaccessible areas and directs all
movement about the ship during general quarters. Once casualties arrive at the local
BDS, they are triaged, treated, and, when possible, transferred to the main BDS. Stress
to your stretcher bearers, and the crew, that they MUST call DC Central to report all
casualties and to request routes to the nearest BDS, and, once at the BDS, to request a
route back to their station.
This is where that person in DC Central who is dedicated to tracking personnel
casualties comes in very handy. Remember that personnel casualties have third
priority behind fire and flooding, and if there is not someone specifically responsible
for tracking them, some of them have a tendency to get lost during the activity of a mass
casualty scenario. During drill and actual scenarios you are required to track each
casualty exactly.
You can also work with the DCA to come up with pre-established casualty evacuation
routes from areas of potential damage. This greatly decreases the turnaround time for
getting routes to stretcher bearers and, since these routes can be pre-printed and
distributed ahead of time to the stretcher bearers, they improve accuracy.
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Casualties may end up in a BDS run by an HM3. Phone communication between BDSs
and the main BDS is vital. Advice can be offered and instructions given to help stabilize
patients until you get to see them. (Note also the compelling need for corpsman training.
More on that elsewhere.)
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