Before Medics Arrive

Responding to Mass Trauma Incidents

This article is based on the Safety Member Certification training module "Mass Trauma Emergencies" and is related to the Church Security Guide articles "Preparing Your Church for Natural Disasters" and "Church Safety Teams and Active Shooter Training."[1][2][3][4]

From the Bible

“Or those , upon whom the tower in Siloam fell, and slew them, think ye that they were sinners above all men that dwelt in Jerusalem?” (Luke 13:4)

And Abimelech chased him ... and many were overthrown and wounded ... (Judges 9:40a).

And [Aaron] stood between the dead and the living; and the plague was stayed (Numbers 16:48).

“... I was sick, and ye [took care of] me ...” (Matthew 25:36b).

Introduction

Firefighters, EMTs, paramedics, and law enforcement officers are often called "first responders." Certainly, many times they are the first on the scene to deal with an emergency. However, it does take some time, usually at least several minutes, for 911 to be called, a dispatcher to alert emergency services, then for personnel to arrive on the scene. When saving lives depends on timely treatment, it is better when persons already on the scene can treat the injured or ill immediately. If many are injured, then we need more people present who are trained to respond.

In the News

Incidents where multiple persons were injured (or could have been) at churches:

Sydney, New South Wales, Australia, April 15, 2024 (stabbing) - A 16-year-old male entered during the service at a congregation of the Assyrian Church of the East. He walked up the aisle to the altar, where the Iraqi-born bishop was officiating. There he pulled out a knife and began stabbing the bishop. Parishioners intervened and eventually pinned the attacker, who claimed in Arabic that the bishop had defamed "the prophet." During the intervention, at least four more persons were wounded.

Responding EMTs treated the wounded on the scene. The severely-injured bishop was taken to a hospital.[5]

Vestavia Hills, Alabama, June 13, 2022 (shooting) - A man who had infrequently attended the church came to a potluck for Boomers. During the event, he pulled out a pistol and began shooting randomly. Three persons were wounded. Someone there stopped the shooter, giving him a black eye. One victim died at the scene, one soon after being taken to the hospital, and the third the next day.[6]

Finleyville, Pennsylvania, May 11, 2024 (tornado) - There were 100 persons inside a church in Finleyville when a tornado hit without enough warning. Someone saw flying debris, and told everyone to go to the basement, which they did. Although the tornado damaged the steeple and took off part of the roof, there were only a few minor injuries. Considering they didn't know there was a tornado until it arrived, it was an immediate response in going to shelter that saved lives.[7]

Piedmont, Alabama, March 27, 1994 (Palm Sunday) (tornado) - During the Palm Sunday service a tornado - an early one in a series of several - hit and demolished Goshen United Methodist Church, just across the county line northeast of Piedmont. Twenty persons in the church were killed and ninety were injured.[8]

Sutherland Springs, Texas, November 5, 2017 (shooting) - Domestic violence spilled over into the wife's home church when the husband attacked with an assault rifle during the Sunday morning service. There were 26 persons killed and another 20 wounded.[9]

Pittsburgh, Pennsylvania, October 27, 2018 (shooting) - A gunman entered the Tree of Life synagogue during Sabbath services. He wounded several congregants. Eleven were killed. More would have died, but persons already present and responding police and medics used skills learned through "Stop the Bleed" training.[10][11]

Brooklyn, New York, March 31, 2024 (fire) - During the Easter Mass, a fire started in the attached rectory to a church in the Bushwick district of Brooklyn. Five people were injured, none seriously.[12]

Birmingham, Alabama, September 15, 1963 (bombing) - A bomb planted by members of the Ku Klux Klan at the 16th Street Baptist Church exploded. Five young girls in a basement restroom (one was 10 years old, one was 11, and three were 14) were injured, four fatally. More than 20 others persons in the church were injured.[13]

Multiple Kinds of Multiple Injuries

A mass casualty event (MCE) is one in which several persons have been injured. The MCE cause could be intentional, accidental, or natural. Therefore, the kinds of injuries suffered in one MCE could differ in another.

• An attack with an edged weapon would result in cuts, both slices and stabs. A shooting produces gunshot wounds. People trying to escape these attacks could trip and fall, run into walls, be trampled, etc.
• Tornadoes and other storms which damage or destroy structures induce impact injuries from falling or airborne materials and objects. Similar injuries could result from an earthquake or structural failure.
• Bomb injuries are mostly by impact, but if a bombing starts a fire, there could be burns or smoke inhalation.
• Most fire evacuations are successful, though sometimes there are burns and smoke inhalation as well as injuries from falls or collapsing structures (wall, roof, ceiling, etc.).

These injuries will vary in their severity, with those that cause bleeding (gunshot and stabbing wounds and some impact injuries) generally the most severe. Also, a severe crisis may induce heart attacks and strokes.

Questions about the Response

We should ask questions about the response to casualties in incidents which may and do result in several injuries, such as in the news stories above:

• In Sydney - The victims of the stabbing were treated by the state's ambulance service (EMTs). Were any of the church's members trained to treat stab wounds, at least to stop the bleeding?
• In Vestavia Hills - In Vestavia Hills, all three shooting victims died, one at the scene and two in hospitals. Apparently there were neither medical responders nor security persons at the potluck dinner. No mention was made in the news stories of the shooting victims being treated before police arrived. Could the life of any one of them been saved if they had received immediate treatment? We don't know.
• In Sutherland Springs - Besides the 26 persons killed in the attack, 20 more were wounded. At the time of the shooting, the church did not have either a security team or a medical team. Would any of those who died have been saved if they had been treated before the deputies arrived?
• In Pittsburgh - Here we do know that Stop the Bleed training did save lives.
• In Piedmont - More than four times as many people were injured as those who died in the tornado. This was before many churches had security & safety teams. Was anybody trained to treat injuries?
• In Finleyville - There were only minor injuries because everyone headed for the basement. If there had been serious injuries, could they have been treated?
• In Brooklyn - Again, no serious injuries, but were they ready if there had been?
• In Birmingham - News stories did not say when the injured were treated nor by whom. There have been more recent bombings when injuries were treated by church members.

Orderly Response

Any MCE response needs to be orderly. The first priority is keeping people safe during the incident. For instance, the location of wounded persons during a shooting should be safe for treating them. For instance, at First Baptist in Sutherland Springs, this could not have been done while the attacker was walking the aisle looking for targets. In a fire, first get people out. During a tornado, get everyone into safe places. Then they can be safely treated.

The next priority is triage (tree-AZH). First begin treating the most critically injured. Note that this is not always as precise as we would like. You're in a hurry to save lives. This is why we need as many persons as possible trained and equipped to respond. If some safety team or medical team members are among the injured, that reduces the number of available responders.

When the police or firefighters and EMTs arrive, they're in charge, and in that order.

Training to Respond

The Safety Member Certification class "Mass Trauma Emergencies" should be taken by as many persons in the church as possible. At the bottom of the training page is a link to Course Auditing. For those not familiar with college courses, auditing is taking a class without credit for a degree.

For Sheepdog Church Security, this means taking a class without going through the entire Safety Member Certification program. The purpose of this less expensive option is to train church staff and volunteers in areas related to their responsibilities in the church. As an example, all those working with children and youth should take "Protecting Children from Abuse."

For MCEs, auditing "Mass Trauma Emergencies" means training any and all who are willing to be first responders in case there are multiple persons severely injured. Additionally, these people should also train in Stop the Bleed, other First Aid skills, CPR, and AED use.

Mass trauma drills condition reflexes so the trainees can instinctively respond in an emergency. Hold a drill at least once a year. Make mass casualty response part of fire drills, tornado drills, and active shooter drills.

Equipped to Respond

It helps to have the right equipment and supplies when treating serious injuries. One key item has been in use for at least 2,000 years - the tourniquet. It was used by Roman armies to save the lives of wounded soldiers so they could fight again.

The designs may have been refined over the last two millennia, but the principle is the same: restrict blood flow to a wound to stop the bleeding. When a manufactured tourniquet is not available, makeshift ones can be used with rope, cords, belts, strips of cloth, etc. The North American Rescue C-A-T Combat Application Tourniquet is available on Sheepdog Church Security's Amazon store, Recommended Equipment for Safety Ministries as well as in The Mass Casualty Trauma Kit on Mountain Man Medical (M3). Also on M3 is the Sheepdog Belt IFAK (Individual First Aid Kit), which contains the TacMed SOF® TOURNIQUET.[14][15]

Also designed to stop bleeding is the DynarexEmergency Pressure Bandage (Israeli Type) on the SDCS Amazon store, in the Mass Casualty Trauma Kit, and on M3 (for restocking). The Trauma Kit also has chest seals and hemostatic dressings for head and torso wounds.

Depending on the nature of the MCE, you need dressings for burns and other types of injuries.

Supplies need to be replaced when used or outdated. Include supply restocking in the Safety Ministry budget. Have enough for the number of persons who may be injured in a MCE.

Equipment should include an Automated External Defibrillator (AED), evacuation chairs, and evacuation cribs.

Conclusion

Be ready in case of a mass casualty event at your church or during a church event. This means being trained, being equipped, and having trained persons on the scene.

References

1. Kris Moloney, "Mass Trauma Emergencies," Safety Member Certification, Sheepdog Church Security, © 2020 [https://sheepdog-church-security.thinkific.com/courses/safety-member-certification-2024].
2. Kris Moloney, Church Security Guide, The Sheepdog Sentinel, 2023 [https://sheepdog-church-security.thinkific.com/pages/security-articles?c=church-security-guide].
3. Kris P. Moloney, "Preparing Your Church for Natural Disasters," Church Security Guide, The Sheepdog Sentinel, posted June 9, 2023 [https://sheepdog-church-security.thinkific.com/pages/security-articles?p=preparing-your-church-for-natural-disasters].
4. Kris P. Moloney, "Church Safety Teams and Active Shooter Training," Church Security Guide, The Sheepdog Sentinel, posted June 9, 2023 [https://sheepdog-church-security.thinkific.com/pages/security-articles?p=church-safety-active-killer-response-strategies].
5. Sources: AFP, Reuters, AP, "Australia: 16-year-old arrested over Sydney church stabbing," Deutsche Welle (DW), April 16, 2024 [https://www.dw.com/en/australia-16-year-old-arrested-over-sydney-church-stabbing/a-68824569].
6. Jay Reeves and Kim Chandler, "Alabama church shooting kills 3; suspect detained," NPR, June 17, 2022 [https://www.pbs.org/newshour/nation/alabama-church-shooting-kills-2-wounds-1-suspect-detained].
7. Antoinette DelBel, "Tornado hits Washington County church, damages roof while 100 people are inside," WPXI, May 11, 2024 [https://www.wpxi.com/news/local/tornado-hits-washington-county-church-damages-roof-while-100-people-were-inside/VILI45AJPJCMFBA3NZLIZTPM6I/].
8. Staff under Elbert W. Friday, Jr., "Palm Sunday Tornado Outbreak of March 27, 1994," Natural Disaster Survey Report, Southeastern United States, NOAA (National Oceanic and Atmospheric Administration), August 1994 [https://repository.library.noaa.gov/view/noaa/7275/noaa_7275_DS1.pdf].
9. Jason Hanna and Holly Yan, "Sutherland Springs church shooting: What we know," CNN, Updated November 7, 2017 [https://www.cnn.com/2017/11/05/us/texas-church-shooting-what-we-know/index.html].
10. Matthew D. Neal, "Pittsburgh trauma surgeon: 'Stop the Bleed' training saved lives after shooting, but stopping the need must be next," WHYY, November 5, 2018 [https://whyy.org/articles/pittsburgh-trauma-surgeon-stop-the-bleed-training-saved-lives-after-shooting-but-stopping-the-need-must-be-next/].
11. "ACS Stop the Bleed Interactive Course," Stop the Bleed, American College of Surgeons [https://www.stopthebleed.org/training/online-course/]; "Use our class search to find a Skills-Only Course in order to receive your certificate of completion" [https://cms.bleedingcontrol.org/class/search].
12. Phil Taitt, "5 hurt after flames broke out during Easter Sunday mass in Bushwick," WABC (ABC7NY), April 1, 2024 [https://abc7ny.com/brooklyn-church-fire-during-easter-sunday-mass-leaves-five-people-injured/14601798/].
13. History.com Editors, "Birmingham Church Bombing," The History Channel, Originally posted January 27, 2010, Updated on April 16, 2024 [https://www.history.com/topics/1960s/birmingham-church-bombing].
14. Kris Moloney (Instructor), Recommended Equipment for Safety Ministries, Amazon [https://www.amazon.com/shop/instructor_moloney/list/1ERD68BB0JGWR].
15. Mountain Man Medical (Sheepdog Church Security affiliate link) [https://www.mountainmanmedical.com/?aid=18].