CITY YARDS — On July 16, 2003, the peaceful Farmers’ Market on Arizona Avenue in Santa Monica was torn apart.
An elderly man lost control of his vehicle, sending it careening into the assembled shoppers. The toll: 79 casualties, with eight dead at the scene and two that were taken to the hospital but would never leave.
Emergency responders arrived to find a chaotic scene, but were aided by civilian bystanders. They worked their way through the bodies, applying tags to indicate the relative condition of each victim, moving swiftly to make contact with each of the injured.
The first patient was out of the scene in 12 minutes. The last was out in 70.
Suzanne Post, fire safety coordinator with the Santa Monica Fire Department, painted the terrible portrait of the Farmers’ Market tragedy, still fresh in the minds of those that dealt with it, even nine years later. It was, however, a perfect way to introduce the concept of triage, a rapid assessment of damage that categorizes victims based on the immediate severity of their injuries.
If the first of the Community Emergency Response Team training sessions was about reacting to the immediate threats after a disaster, the second was about preparing to mitigate the worst and picking up the pieces when it happens anyway. Triage is an essential, if depressing, part of that process.
Triage is a French word that means “to sort.” It stands for a fairly simple evaluation to determine how badly a person needs treatment, something that only becomes a factor when the number of casualties overwhelms the people there that can help.
First responders spend roughly 30 seconds evaluating and treating each patient and then assign them a green, yellow, red or black tag. Those with red tags get help immediately, yellow and green have a wait ahead of them and black means the patient could not be saved.
In English, I’d call that deciding who lives and who dies, but everything sounds better in French.
“You may have to sacrifice one to save many,” Post said. It’s about doing the most amount of good for the greatest number of people.
The triage process breaks people into the four color-coded categories. The least problematic is minor, which people in the community call “the walking wounded.” They get green-tagged, and cordoned off from those with worse injuries.
The next category is “delayed,” meaning the person has an injury that probably won’t kill them. That can include a baffling amount of things, like broken bones or being impaled on a sharp object, things that most in the class felt would push a person into the next category, “immediate.”
That category, denoted by a red tag, has already shown symptoms of one of three conditions that will turn a person from “immediate” to “dead” in no time flat — breathing difficulties, bleeding and shock.
The initial review and assessment of patients is fast, dirty and boils down to a five-syllable mnemonic — “30-two-can do.”
Is your patient breathing quickly? Does color return to their extremities quickly after applying pressure to the area? Do they know who they are, where they are and what happened?
Fail any of those three tests, and the patient needs attention. Now.
The immediate remedies, which all have to fit into those 30 seconds per patient, aim to stabilize rather than treat. That means propping up legs to improve circulation, applying pressure to a wound to keep a patient from bleeding out or lifting the chin to help the patient breathe.
CPR, or cardiopulmonary resuscitation, doesn’t fit into that category. If the person can’t breathe on their own after two attempts to open the airway, procedure dictates that they be left for dead.
Although the tests are simple and the results clear, human judgment and emotion can cloud the issue, and each of the instructors present could think back on a time where they or someone they knew made the decision to throw the rule book out the window.
Like the firefighter who broke ranks and took an injured infant to the hospital, with no expectation that it would survive.
From a disaster response point of view, there was no worse decision, said Paul Weinberg, Santa Monica’s emergency services coordinator. A trained firefighter was out of the picture, and so was a precious emergency response vehicle. Both might have been able to save many more lives.
In the end, you don’t know what you will do until confronted with the situation.
“We’re only human,” Weinberg said.