Mass Trauma Casualties
An article in a series on medical emergency response
From the Bible
The Bible records instances when many innocent people were killed by one or a few perpetrators, and not during a war. Whether it’s a natural disaster, a technological disaster, or violence, many innocent people are hurt in a mass casualty event.
And [Abimelech] went to his father's house at Ophrah and killed his brothers the sons of Jerubbaal, seventy men, on one stone. But Jotham the youngest son of Jerubbaal was left, for he hid himself (Judges 9:5).
Then the king [Saul] said to Doeg, “You turn and strike the priests.” And Doeg the Edomite turned and struck down the priests, and he killed on that day eighty-five persons who wore the linen ephod. And Nob, the city of the priests, he put to the sword; both man and woman, child and infant, ox, donkey and sheep, he put to the sword (1 Samuel 22:18-19).
[Obadiah told Elijah], "Has it not been told my lord what I did when Jezebel killed the prophets of the Lord, how I hid a hundred men of the Lord's prophets by fifties in a cave and fed them with bread and water?" (1 Kings 18:13)
Things happen. Bad things happen. And really bad things do happen, even to the best of people in the best of places. That’s the world we’re in, a fallen place where not all is good. People get hurt, sometimes many at one time. It could be caused by the weather, an earthquake, a fire, or human violence (such as a bomber or an active shooter).
Any of these named causes could result in several serious, even deadly, injuries (mass trauma casualties). The casualties might not be in the church itself, but in the community. Even though the likelihood of a mass casualty event is not great for any one time and place, the chance that it could happen at all is great enough that we need to be prepared with training and supplies.
In the News
Tornado Kills 20 in Church
Goshen, Alabama, March 27, 1994 (Palm Sunday) – Six tornadoes touched down in Alabama on Palm Sunday 1994. In Goshen, one hit the United Methodist Church during the morning service while an Easter play was in progress. One wall was knocked down and the roof collapsed. Of about 140 or so people in attendance, 20 were killed and 92 were injured.
Preparing for Refugees from a Catastrophic Quake
Jackson County Missouri, August 24, 2015 – Jackson County was one of several local and state governments in an eight-state area participating in an exercise to prepare for mass casualties and millions of evacuees in the event of a new New Madrid Earthquake.
It had already been more than 200 years since the New Madrid Quakes of 1811-1812, the strongest on record in the United States. According to seismologists, with a period of about 200 years between major quakes, the region is overdue for another one. A massive quake centered in the New Madrid Fault could cause major damage and affect several million people. Among facilities preparing to serve as shelters were churches.
Massive Quake in a Metropolitan Area
The quake that shook San Francisco Bay on Tuesday, October 17, 1989, killed 63 and injured another 3,757 persons. It is known as the World Series Quake because it interrupted the live broadcast of a game at 5:04 PM between the San Francisco Giants and the Oakland Athletics. If it had hit between 7 and 8 PM the next night or late Sunday morning, many people would have been in churches, increasing the number of mass casualties in several locations.
Pittsburgh, Pennsylvania, October 27, 2018 – Morning Sabbath services at the Tree of Life Synagogue (where three congregations meet) were interrupted by gunfire. The shooter killed eleven and wounded six more, including responding police officers. More people would have died, but there were people on the scene who used their Stop the Bleed training.
Our Sheepdog Church Security special free downloadable resource for this month is “Safety Member Training Record.” You can get it by clicking *HERE* If you’re not already subscribed, you’ll be signed up for the monthly newsletter (The Church Guardian) and a weekly update by email. The information and record template include training in First Aid, CPR, AED, and medical response in general.
Responding to Mass Casualties
If there is a mass casualty event at your church, whether from a natural disaster, a manmade disaster, or an active killer (shooter or bomber), you need to know what to do. No matter what else you are doing at the scene, someone should be calling 911 and letting them know what is happening and where the church is. That way, help is on the way while you are treating injuries.
A mass trauma incident has a high chance of serious bleeding. This is especially true with a shooter or an explosion. Explosions may also result in serious burns. All kinds of injuries result from windstorms and earthquakes, including concussions and spinal injuries. A flash flood can threaten drowning.
Stop the Bleed
The most needed skill is stopping severe bleeding. A shooting victim can bleed to death before medics arrive. What must first be done is applying pressure to the wound. This alone may work if the opening is not too big; just tie the gauze tightly onto the wound or use a pressure bandage. If this won’t work and it is on a limb or extremity, a tourniquet can be applied above the wound to cut off the blood supply. In a mass casualty event with several persons seriously bleeding, you can apply a tourniquet to one person and go on to the next, saving more than one life.
Gunshots often result in wounds to the torso and to junctions (where limbs or the neck intersect the torso). Since tourniquets do not work in these locations (one on the neck is definitely out of the question), the responder should also know wound packing. Combat medics, paramedics, and emergency room doctors are trained in this.
Care needs to be taken with spinal injuries. They can be made worse when the patient is moved without proper precautions. During a mass casualty incident, if a spinal injury is suspected, do not move the patient unless necessary to remove them from danger (such as a fire, an imminent building collapse, or an active shooter). Leave moving them to the medics, who are trained and equipped for that.
If you recognize the signs of a concussion, have the person sit down or lie down and be still. Since there are other serious injuries, go on to treat them. When medics arrive, let them know about the likely concussions.
Heart attacks are not uncommon in mass casualty events. Not as common, but still possible are strokes, ruptured aneurysms, and severe asthma attacks. All of these can be triggered in extremely stressful situations. Cardiopulmonary resuscitation (CPR) is our response to a heart attack to keep circulation and breathing going until the heart restarts. CPR can also be used to treat a severe asthma attack, especially if the person has stopped breathing.
A ruptured aneurysm is a life-threatening event. If a person has a brain aneurysm that is large, extreme stress which raises blood pressure may trigger a rupture, and so may a blow to the head. The Brain Aneurysm Foundation lists several signs of a rupture, beginning with a severe headache. These may also include nausea/vomiting, blurred or double vision, a seizure, drooping eyelid, pain above and behind the eye, and a few others. They advise you to not use a private vehicle to take the patient to the hospital, because medics may have to apply life-saving procedures in the ambulance.
Equipped for Mass Casualties
In the event of a mass trauma casualty incident, you will need supplies and equipment to treat the injured.
- Disposable gloves are indispensable for responding to injuries. Vinyl and nitrile gloves avoid triggering latex allergies. Nitrile is preferred over vinyl because it has most of the properties of latex without the allergen.
- CPR can be administered without supplies, but it is advisable to use a CPR Face Shield to protect both you and the patient.
- Wound dressings are essential for any cuts, punctures, and tears. This includes chest seals.
- Tourniquets will stop the bleeding in limbs and extremities.
- Israeli-style pressure bandages apply pressure directly to the wound.
- Trauma shears can cut through clothing and bandaging materials, etc. in an emergency.
- A permanent marker can be used many ways, such as marking the time of application on a tourniquet.
- If airways are blocked, a Nasal Passage Airway (NPA) will allow air to flow from the nostril into the trachea.
- A rescue blanket can keep patients warm and prevent hypothermia (which can happen to a severely injured person even in moderately warm air).
All of the listed items are in the Mass Casualty Kit by Mountain Man Medical (MMM). This is available as a Sheepdog Church Security affiliate item. SDCS partnered with MMM in selecting the products in the kit. How many kits your church needs depends on the attendance, as follows:
|Number Attending||No. of Kits|
|20-50 People:||1 Kit|
|51-100 People:||2 Kits|
|101-200 People:||4 Kits|
|200+ People:||6 Kits|
|Add 1 more kit for every 100 people|
Also available as a Sheepdog Church Security affiliate item is an Individual First Aid Kit, the Sheep Dog Belt IFAK. SCDS and MMM also collaborated on developing this kit.
Whether it is a natural disaster, a technological disaster, or violence, we need to be trained and equipped to treat many seriously-injured persons if and when a mass casualty incident happens in our church.
There Is More
There are two other articles in this series on responding to medical emergencies: “Mountain Man Medical” (Equipping Groups for Medical Emergencies) and “Code Blue” (Responding to Injuries and Illnesses). The last article of the month – “2005 Living Church of God Shooting” – is in the series Lessons Learned from Church Shootings.
- William Thornton, “20 years after Palm Sunday tornado, Goshen church members ‘just pray for sunshine’,” AL.com (Advance Local Media LLC), March 27, 2014, updated March 28, 2019 [https://www.al.com/news/anniston-gadsden/2014/03/palm_sunday_at_goshen_a_church.html].
- County Staff, “County Participates In New Madrid Quake Exercise,” Jackson County, Missouri, August 24, 2015 [https://www.jacksongov.org/806/3843/County-Participates-In-New-Madrid-Quake-].
- “1989 Loma Prieta earthquake,” Wikipedia [https://en.wikipedia.org/wiki/1989_Loma_Prieta_earthquake].
- “Pittsburgh synagogue shooting,” Wikipedia, October 28, 2018 to April 25, 2021 [https://en.wikipedia.org/wiki/Pittsburgh_synagogue_shooting].
- Kris Moloney, “Safety Member Training Record,” Sheepdog Church Security, © Copyright 2020 [https://sheepdog-church-security.ck.page/4bdb00c915].
- Scotty Bolleter (BS, EMT-P), “Wound Packing Essentials for EMTs and Paramedics,” Journal of Emergency Medical Services, April 1, 2017 [https://www.jems.com/patient-care/trauma/wound-packing-essentials-for-emts-and-paramedics/].
- Mike Shertz, “Junctional Hemorrhage: The next frontier for hemorrhage control,” Crisis Medicine, March 30, 2021 [https://www.crisis-medicine.com/junctional-hemorrhage-the-next-frontier-for-hemorrhage-control/].
- Anon, “Online CPR 101: 3 Invaluable Tips to Help a Person Having an Asthma Attack,” American Academy of CPR and First Aid, November 5th, 2018 [https://www.onlinecprcertification.net/blog/online-cpr-101-3-invaluable-tips-to-help-a-person-having-an-asthma-attack/].
- Staff Writer, “Brain Aneurysm Basics: Warning Signs/Symptoms,” Brain Aneurysm Foundation, no date [https://bafound.org/about-brain-aneurysms/brain-aneurysm-basics/warning-signs-symptoms/].
- “Mass Casualty Trauma Kit,” Mountain Man Medical [https://www.mountainmanmedical.com/product/the-mass-casualty-trauma-kit/?aid=18].
- “Sheepdog Belt IFAK,” Mountain Man Medical [https://www.mountainmanmedical.com/product/sheepdog-belt-ifak/?aid=18].