Terrorists Strike Back at the Federal Courthouse An Exercise in Emergency Triage

A highly publicized trial of a suspect with possible terrorist links is set to take place in your community at the local Courthouse. On the day of opening arguments the courtroom is packed and overflowing. You are standing on the lawn in front of the Courthouse waiting with others who also could not get seats for the local “Trial-of-the-Century”.

Suddenly, an explosion is heard from inside the Courthouse. Soon after, people begin pouring from the exits. Many are panicked, wounded, and in obvious distress. Putting all of your previous training into action, you immediately set up a triage area.

In talking with the victims, you learn more about the events that have taken place. Not only did a bomb explode in the courtroom, but as people were exiting from a main hallway, a secondary device on a time delay, hidden inside a trash can, released an unknown gas. A few of the victims noted a smell similar to “bitter almonds”.

Patient # 1 Unconscious Profuse bleeding from laceration on temple Labored respirations

Patient # 2 Ambulatory Increased heart rate Visibly agitated Alert and orientated Respirations- 15 rpm

Patient # 3 Disoriented 30 respirations per minute Red skin tone N&V

Patient # 4 Unconscious No respirations for > 5 min No pulse present

Patient # 5 Ambulatory Mild headache Nausea Dizziness Superficial cuts on arms and hands

Patient # 6 Ambulatory Superficial lacerations on face and arms Moderate burns to <10% BSA Hyperventilation Headache

Patient # 7 Unconscious Irregular, rapid, shallow breathing Red tint to skin Capillary refill > 2 seconds

Patient # 8 Conscious Severed arm with profuse bleeding Severe burns to left side of body Disoriented

Patient # 9 Walking and talking Pulse present Respirations- 20 rpm Agitated, but orientated X 3

Patient # 10 Ambulatory Mild headache N&V Increased respirations

Patient # 11 Non-ambulatory Broken arm and wrist Penetrating leg wound profusely bleeding No change in mental status

Patient # 12 No pulse No respirations Cold extremities

Patient # 13 Ambulatory Oriented with visible agitation Complains of nausea and indistinct pain Patient is aggressive and demands treatment. He states he knows that he caught a whiff of the gas and is going to go into convulsions any minute.

Patient # 14 Ambulatory Heaviness of arms and legs Reddening of eyes Pupil dilation Headache N&V

Patient # 15 Contusion to head Severe burns over head, arms and chest Convulsions Respiratory distress

Patient # 16 Ambulatory Oriented Increased heart rate Physical “guarding” of abdomen Complains of severe stomach pain SOB

Patient # 17 Heart pains Irritation of nose, throat, and mouth Weak irregular heart beat Malaise

Patient # 18 Blue tint to skin Loss of consciousness Radial pulse not palpable

Patient # 19 Convulsions Minor burns to 15% of body Apnea Reddish skin tone

Patient # 20 Deep lacerations throughout body lacking profuse bleeding Capillary refill time > 2 seconds Shallow, intermittent respirations Non-ambulatory Delirious

Patient # 21 Ambulatory Mild headache Nausea Dizziness Superficial cuts on arms and hands

Patient # 22 Labored respirations Sharp chest pain radiating down left arm Difficulty talking

Patient # 23 Labored respiration with gradual improvement Dizziness Malaise Weak, irregular heart beat

Patient # 24 Ambulatory Minor abrasions to left arm and leg Moderate burns to right side of body Slight hearing impairment

Patient # 25 Walking and talking Oriented X 3 Radial pulse present- slightly elevated Respirations WNL

Patient # 26 Gasping breaths Convulsions Altered mental status Mydriasis

Patient # 27 Non-ambulatory Severe abdominal pain Loss of hearing Broken leg

Patient # 28 Not responsive No radial pulse present No respirations Cold extremities

Patient # 29 Convulsions Minor burns and lacerations Cherry red lips Rapid respirations

Patient # 30 Ambulatory Headache Hyperventilation Complains extremities feel “heavy”

Patient # 31 Infant Bleeding from ears Moderate burns over 15% BSA including face

Patient # 32 Major burns to >75% BSA Delirium Rapid, shallow respirations Multiple severe lacerations with little bleeding

Patient # 33 Minor abrasions and burns to forearms Dazed Ambulatory

Patient # 34 Irritation of nose, throat and mouth Labored respirations gradually improving without treatment Reddening of eyes Weak, irregular heartbeat N&V

Patient # 35 Unconscious Convulsions Cherry red lips and skin Deep breathing

Patient # 36 Short, gasping breaths Weak irregular heart beat N&V Mydriasis LOC

Patient # 37 Ambulatory Oriented with visible agitation 20 respirations per minute Capillary refill < 2 min Superficial abrasions to palms of hands

Patient # 38 Ambulatory Reddening of eyes Malaise HA Irritation of nose, mouth and throat

Patient # 39 Blue tint to skin Weak, intermittent heart beat Shallow, gasping intermittent breaths Convulsions Loss of consciousness

Patient # 40 Contusion to head Severe burns over head, arms and chest Convulsions Respiratory distress

Patient # 41 Ambulatory No altered mental status Minor lacerations on right thigh and right forearm with mild bleeding Minor contusion to forehead Intact hearing

Patient # 42 Brought in on stretcher Labored respirations Abdominal pain and guarding Profusely bleeding head wound Broken leg with bone protrusion through skin

Patient # 43 Non-ambulatory Apnea Reddening of eyes N&V Disoriented

Patient # 44 Ambulatory Weak, irregular heart beat Dizziness Headache Nausea

Patient # 45 Infant Deep laceration above eye with poor bleeding Blue tint to skin Not responsive Shallow breaths

Patient # 46 Ambulatory Irritation of nose, mouth and throat Deep, labored breathing Headache Sudden progression to convulsions and LOC during examination

Patient # 47 Ambulatory Minor abrasions to left arm and leg Minor burns to right side of body Slight hearing impairment

Patient # 48 Short, gasping breaths Weak irregular heart beat N&V Mydriasis LOC

Patient # 49 Non-ambulatory Gaping head wound spurting blood Unresponsive Broken arm Sprained wrist

Patient # 50 Non-ambulatory Broken leg Sprained ankle Minor abrasions to left shoulder and arm Alert and oriented

Patient # 51 Convulsing Major burns to right forearm and hand Severed right leg spurting blood Moderate abrasions to left side of body

Patient # 52 Ambulatory Oriented Improving headache Nausea Dizziness

Patient # 53 Deep lacerations throughout body lacking profuse bleeding Capillary refill time > 2 seconds Shallow, intermittent respirations Non-ambulatory Delirious

Patient # 54 Ambulatory Minor laceration on right leg N&V Hyperventilation Headache

Patient # 55 Convulsions Minor burns to 15% of body Apnea Reddish skin tone

Patient # 56 Non-ambulatory Severe abdominal pain Loss of hearing Broken leg

Patient # 57 Irritation of nose, throat and mouth Labored respirations gradually improving without treatment Reddening of eyes Weak, irregular heartbeat N&V

Patient # 58 Unconscious Irregular, rapid, shallow breathing Red tint to skin Capillary refill > 2 seconds

Patient # 59 Labored respirations with gradual improvement Dizziness Malaise Weak, irregular heart beat

Patient #60 Nonambulatory Very confused No physical injury apparent Smells of alcohol Slurred speech

Patient #61 Badly sprained ankle Deep cut on right shoulder, bleeding profusely Bruising on forehead

Patient #62 Legs badly crushed Unconscious Labored breathing

Patient #63 No physical injuries apparent Eager to help very emotional

Patient #64 Elderly patient with chest tightness Left arm tingling Complains of headache nausea

Patient #65 Minor burns Difficulty breathing Coughing

Patient #66 Shortness of breath Right leg hurts Limping

Patient #67 Shortness of breath Cannot see Minor scrapes and bruises

Patient #68 Missing 2 fingers on left hand Shortness of breath Rapid respirations Minor bruising on head

Patient #69 Blunt force trauma to head No bleeding Confused and agitated

Patient #70 Cradling right arm, apparent fracture Deep cut on right cheek Complains of severe pain

Patient #71 Hyperextended right knee Severe pain

Patient #72 Burns to upper face and torso Severe pain Shortness of breath

Patient #73 Pain in abdomen Minor burns to arms Difficulty breathing

Patient #74 >60 BSA covered with burns Patient reports feeling no pain Difficulty breathing

Patient #75 Bleeding from right ear Unconscious Barely breathing

Patient #76 Pencil stuck through right arm Bleeding under control

Patient #77 Minor scraps and bruises Complains of severe pain Demands pain medication

Patient #78 Unconscious patient now alert Very confused No bleeding or apparent injuries

Patient #79 Unconscious Bleeding from nose Swelling abdomen

Patient # 80 Unconscious Apnea Contusion to head above left eye Reddish tint to skin Pupil dilation Laceration of left arm with moderate bleeding