By Diane Jakopovic
Having worked as a Registered Respiratory Therapist (RRT) in a pediatric hospital for over twenty years, over 10 years of which were in exclusively in the intensive care units, and 5 years working as a Registered Polysomnography Technician (RPSGT) in the Neuro/Sleep Lab, I felt qualified to address some of what was written in the official report of the Sandy Hook School massacre. I am also certified as a Specialist in Pediatric/Neonatal Respiratory Care. However, I am not a physician, a nurse, an emergency responder, and I don’t live in Connecticut, so I felt it necessary to defer my logic and opinions to what their guidelines and protocols were, prior to the Sandy Hook shooting. Unfortunately, I was not able to find information to fit the exact circumstances at Sandy Hook (pediatric mass casualty) other than their Triage algorithm. I also found information that dealt with gunshots, transporting, etc. so pulled that information into my comments. Whenever possible, I included a link to those online documents.
(Section 1 – Triage & Tagging)
I began by reviewing their START Triage Protocol and pulled out some pertinent information. My comments are at the end:
S.T.A.R.T – SIMPLE TRIAGE AND RAPID TREATMENT
A multiple or mass casualty incident can be defined as any incident in which more casualties are present than an initial response assignment can reasonably handle. More assets are required for triage, treatment, and transport than can arrive in a timely fashion.
SCENE SIZE UP
2. Take BSI (Bodily Substance Isolation – take precautions to avoid contact with bodily substances.)
3. Determine the number of patients. If there are multiple or mass casualties, communicate that fact through the proper channels, establish command, and establish a medical officer and triage officer.
I referred to their JumpStart algorithm, (for pediatrics, not adults):
From the final report:
Book 6 – –1 (Kullgren): “When the search was complete we determined it was safe to begin evacuating students and staff.”
Book 6 – 00002113 (Cassavechia (Paramedic)): “Cassavechia stated that four separate patient assessments were made to guarantee no one was resuscitatable. Cassavechia said that the victims were formerly triaged using the SMART triage program.”