Mass casualty exercise wraps up first-responder training in Guyana Published June 8, 2009 By Kevin Walston Operation Southern Partner Public Affairs GEORGETOWN, Guyana -- For Dr. Vindhya Persaud, the scenarios were all too real. "Buses are the major form of transportation for so many people, and they're always packed," the St. Joseph's Mercy Hospital emergency room physician said. "The probability of a major accident is always on the back of my mind, and today, I've seen just how chaotic it may be." Persaud , who's practiced medicine here the past eight years, was one of 30 Guyanese doctors, nurses and medical technicians participating Thursday in a mass casualty exercise simulating the collision of two buses, resulting in deaths and severe injuries to numerous people. The exercise, culminating a week-long first responder course taught by a team of Defense Institute for Medical Operations (DIMO) members from San Antonio, Texas, allowed the students to see firsthand the chaos and seriousness of accidents like this. In a nation that lacks sufficient equipment and ambulances to handle a large scale crisis like this, Persaud said this is just the type of training they needed. "In a normal day, there will be several cases of people brought to the emergency room suffering from various forms of injuries due to car accidents," she said. "More often than not, these patients are brought to the hospital in someone's car, or a taxi, so our actions have to be immediate in order to lessen the severity of the injuries." Dr. (Capt.) Adam Muck, Wilford Hall Medical Center emergency medicine physician, said the scenario presented the students with patients in different stages of trauma and allowed them to apply their training to treat them. "They realized the complexity of a real life situation...how difficult it is to communicate and control the situation," Muck said. "They also had to learn how to handle the news media, ensure command and control of the situation, and deal with bystanders. "Students were given tools and practical knowledge that they could implement into their own system to help them be successful if a mass casualty happens here," Muck said. "They've learned all the triage techniques that when applied correctly during an emergency, they'll know what to do, and will react instinctively." Marcian Gravesande, a nurse at St. Joseph's Mercy Hospital with more than 20 years experience, said many times, the hospital is short staffed, and the emergency room may have only one doctor and one nurse. This creates difficult situations when it comes to providing critical care. "This training has been extremely helpful because although we don't have the most modern equipment, or a large staff, we're able to apply the lessons learned to do what's best for each patient that comes through the door," Gravesande said. "In Guyana, only doctors are allowed to suture wounds...this was the first time I'd ever had a chance to do it, and I'm sure it's knowledge that I'll be able to use in the future." Chief Master Sgt. Jeffery Burgwin, DIMO team member assigned to WHMC's 59th Medical Operations Group, said a primary goal of the first responder triage exercise was to apply triage categories appropriately, and apply initial life saving treatments in the field. "We shared medical expertise on many levels and from the skills lab, where they learned everything from suturing to airway management, to the triage exercise where they were faced with immediate and expectant patients, we saw a gradual progression in their levels of confidence," he said. "Suturing is something they really loved since nurses and medical technicians don't get an opportunity to do it...they now have new skills that will allow them to save more lives."