Mass Casualty Event

Responding to Multiple Injuries

An article based on the Safety Member Certification training module "Mass Trauma Emergencies."[1]

From the Bible

"Or those eighteen, 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, behold, there came a great wind from the wilderness, and smote the four corners of the house, and it fell upon the young men, and they are dead; and I only am escaped alone to tell thee" (Job 1:19).

... And Doeg the Edomite turned, and he fell upon the priests, and slew on that day fourscore and five persons that did wear a linen ephod (1 Samuel 22:18b).

Introduction

There are many kinds of situations in which several people may be injured, sometimes with a number of fatalities. The causes can be explosions, fires, severe weather, earthquakes, structural failure, bombings, active killers, hazardous materials, vehicle accidents, etc. The kinds of injuries can vary by cause, with a lot of overlap.

"Is there a medical responder in the house?"

A church or church-related institution (such as a school, daycare center, youth center, homeless shelter, etc.) needs people who are trained to respond to the numbers and kinds of injuries encountered in a mass casualty event.

• In smaller churches, the safety team is the medical response team.
• In larger churches, with hundreds of members, the addition of a medical response team increases the number of dedicated responders to injuries.

In a mass-injury incident, members of the congregation who are trained in medical response but are not part of a team can join members of the safety and medical teams in treating casualties. This redundant coverage will be vital if members of the teams are among the casualties.

In the News

Youngstown, Ohio, May 28, 2024 - A gas explosion ripped apart a bank on the ground floor of a 13-storey building in downtown Youngstown. One bank worker was killed and seven other persons were injured. The investigation has found so far that a gas line had been cut. Infrastructure work had been in progress on a side street next to the bank.[2]

Brooklyn, New York City, New York, March 31, 2024 - A fire started in a church during Easter Mass. Six persons were injured, including three firefighters.[3]

Antioch, Tennessee, September 24, 2017 - A shooting at an Antioch church left one woman dead and eight wounded, including the shooter.[4]

Birmingham, Alabama, September 15, 1963 - The bombing that killed four girls in a Birmingham church also injured 30 other church members.[5]

Finleyville, Pennsylvania, May 11, 2024 - One of three EF-2 tornadoes in Finleyville the day before Mother's Day interrupted a meeting at a church. Despite extensive damage to the church, the injuries were minor.[6]

Preparing for Mass Casualty Events

In an old bit of humor, the airline pilot was seen reading a flying textbook while boarding a plane. The point was that we should get ready before we need to be ready. So how do we get ready for a mass casualty event? Let's look at three ways:

• Mass Casualty Risk Assessment,
• Training for Mass Casualties, and
• Equipping for Mass Casualties.

Mass Casualty Risk Assessment

Basically, this is assessing the risks to your church of certain kinds of mass casualty events and the kinds of injuries which may be involved. For example:

• An earthquake in Ohio or Indiana is less likely to cause significant damage, let alone any injuries, than one in California or Alaska, while the reverse is true for tornadoes. Therefore, churches from Oklahoma to Ohio and from Minnesota to Alabama will prepare for tornadoes while those on the West Coast prepare for quakes. On the other hand, structural damage from these natural disasters may lead to similar injuries.[4]
• Churches in metropolitan areas are more likely to deal with a high incidence of local crime and gang shootings than those farther out from metropolitan areas.
• Hazardous material releases and their corresponding injuries to health depend on location, namely how close they are to railroads and certain industrial facilities. Take for example the East Palestine derailment in February 2023. In the village of East Palestine, there are six churches five blocks or less from the railroad. What if the accident had happened during Sunday morning services?[7]
• Some religious groups may face violent opposition to their beliefs, the stands they take, or the race/ethnicity of their membership. This increases the risk of a deadly-force attack based on bias. In cases like this, the attacker often intends to kill as many people as possible by whatever means are chosen. The weapons could be firearms, edged weapons, explosives, fire, or released toxins.[5]
• A church with natural gas service, or that is on a block with buildings that have natural gas, has the risk of a gas explosion. How high the risk is depends on several factors, such as the age or condition of the lines, how close the buildings are to each other, and whether there is construction nearby. A gas explosion can produce both impact injuries and burns.[2]
• Traffic accidents involving church and school vehicles (including chartered ones) have resulted in deaths and serious injuries. Two examples are the 1988 Carrollton Bus Collision and the 2023 Tusky Valley High School Band bus accident. In the Carrollton County, Kentucky accident, all 27 fatalities were by fire. Both impact and fire caused the six deaths and several injuries in the Tusky Valley crash. There have been several other church and school vehicle crashes with multiple injuries, some with fatalities.[8][9]

Mass casualty risk assessment also estimates the most likely number of injuries from each kind of event and the likely maximum number. Try to prepare for the maximum. The most likely number should be treated as a minimum, so get ready for more than the minimum.

Training for Mass Casualties

There are two kinds of training for mass casualty events. Online training and reading provide a knowledge base. In-person training is essential for certain skills, such as Cardiopulmonary Resuscitation (CPR), Automated External Defibrillator (AED) use, First Aid, and Bleeding Control. The last two should include major trauma, such as torso wounds, partially-amputated limbs, head injuries, etc., using dummies and volunteer "victims." Medical professionals in the church, especially EMTs and paramedics, may be able to train members in these skills. However, there is training available through the American Heart Association and the American Red Cross, and sometimes through local fire departments, schools, and/or the YMCA. In some places medical emergency training by the National Safety Council is offered through businesses and government agencies (such as fire and police departments). This is used for OSHA certification in workplaces, a valid consideration for a large church with many employees.[10][11][12]

Online training includes Sheepdog Church Security's certification course "Mass Trauma Emergencies." It can also include training videos at Worship Security Academy and other sources.[1][13]

As many in the church as possible should be trained in life-saving skills. This includes the "Mass Trauma Emergencies" class, since it covers triage, organization, and coordination. Periodically hold medical emergency drills and mass casualty drills. Besides honing skills, drills also provide an opportunity to evaluate how well responders coordinate with each other.

Equipping for Mass Casualties

If there is a mass casualty event in your church, what will you use for bandages, for tourniquets, or to treat burns? What if the stress of the situation triggers medical emergencies, such as strokes or heart attacks? Two factors dictate what equipment and supplies are needed: the number of casualties and the kinds and severity of injuries.

Structural failure and/or displaced material in a natural disaster can produce blunt-force injuries. Rapid-fire and large caliber firearms leave horrendous wounds. An incident involving fire (including a gas or oil explosion) can seriously burn the victims.

Sheepdog Church Security has two sources for emergency medical supplies: the SDCS Amazon store and our affiliate, Mountain Man Medical.[14][15]

Church Safety and Security Aids and Equipment Ideas

A key item of equipment for responding to mass casualty incidents is the Ergodyne Arsenal 5215 Large Medic First Responder Trauma Duffel Bag. This large-capacity bag has adjustable dividers to aid in organizing the contents. A few of the needed medical response supplies to fill the bag are also available on this site: CAT Combat Application Tourniquet by North American Rescue, Emergency Pressure Bandage (Israeli Type), and the Moore Medical Airway Kit with Nasopharyngeal Respiration Tubes. Amazon also has other medical response supplies.

The site also carries the Philips HeartStart Home AED Defibrillator. This heart restart device comes with a carrying case. It is recommended for mass casualty situations since the stress of the incident can trigger heart attacks.

Mountain Man Medical

Two kits sold by Mountain Man Medical were put together by Kris Moloney of Sheepdog Church Security: the Sheepdog Belt IFAK and the Mass Casualty Trauma Kit.

The Sheepdog Belt IFAK is an individual First Aid kit which can be worn on a belt. It enables a Safety Team or Medical Response Team member to respond to one or two injuries.

Kris worked with Mountain Man Medical in developing the Mass Casualty Trauma Kit. It comes with enough supplies for treating two to six critically-injured persons or more with lesser injuries. One kit is recommended for 20-50 persons in the church, two for 51-100, and so on.

Supplies to refill both of these kits are available on Mountain Man Medical.

Conclusion

Assess the risks of various mass casualty events for your church and plan accordingly. Train team members and others in the church for responding. Procure the needed equipment and supplies.

References

1. Kris Moloney, "Mass Trauma Emergencies," Safety Member Certification, Sheepdog Church Security, © 2020 [https://sheepdog-church-security.thinkific.com/].
2. Chelsea Simeon, Nadine Grimley, Dave Sess, Samantha Bender, Hanna Erdmann, Abigail Cloutier, Josh Frketic, Joe Gorman, Jacob Thompson, Kristy Regula, and Gerry Ricciutti, "NTSB investigate cut gas line in Youngstown building explosion," WKBN, May 28, 2024, Updated May 31, 2024 [https://www.wkbn.com/news/local-news/gas-explosion-in-youngstown-ohio/crews-respond-to-downtown-youngstown-for-report-of-explosion/].
3. Naveen Dhaliwal, "6 injured in Easter Sunday fire inside Brooklyn church, FDNY says," CBS News New York, Updated on April 1, 2024 [https://www.cbsnews.com/newyork/news/at-least-5-injured-in-easter-sunday-fire-inside-brooklyn-church-fdny-says/].
4. Nancy Hauskins, "1 dead, 8 injured in 'mass casualty' shooting at Antioch church," WKRN, September 24, 2017 [https://www.wkrn.com/news/1-dead-8-injured-in-mass-casualty-shooting-at-antioch-church/].
5. History.com Editors, "This Day In History - 1963 - Four Black schoolgirls killed in Birmingham church bombing," History Channel, September 15 [https://www.history.com/this-day-in-history/four-black-schoolgirls-killed-in-birmingham].
6. Ricky Sayer, Mamie Bah, Meghan Schiller, "EF2 tornado damages Washington County church; congregants suffer 'minor' injuries," KDKA (CBS News Pittsburgh), Updated on May 12, 2024 [https://www.cbsnews.com/pittsburgh/news/tornado-damages-washington-county-church-congregants-suffer-minor-injuries/].
7. "East Palestine, Ohio, train derailment,"Wikipedia [https://en.wikipedia.org/wiki/East_Palestine%2C_Ohio%2C_train_derailment].
8. American Heart Association, "CPR & First Aid Training Classes" [https://www.heart.org/en/cpr].
9. American Red Cross, "Find a Class" [https://www.redcross.org/take-a-class].
10. National Safety Council, "Learn First Aid from the Workplace Safety Experts" [https://www.nsc.org/safety-training/first-aid/first-aid-cpr-and-aed-courses].
11. Sheepdog Church Security affiliate link to Worship Security Academy [https://worshipsecurity.vhx.tv/?code=sheepdog].
12. Kris Moloney (Instructor), Church Safety and Security Aids and Equipment Ideas, Amazon, [https://www.amazon.com/shop/instructor_moloney/list/1ERD68BB0JGWR].
13. Mountain Man Medical (SDCS affiliate link) [https://www.mountainmanmedical.com/?aid=18].