We are all sick

[Jeepluv77]

Okay, so I'm going to go out on a limb here. First off, how many victims are adults? Considering that all the reds are children, they are vegetarians, and they are a "wood loving family" I'm wondering if the kids went out into the woods to play and found some wild mushrooms. These can be toxic and if I remember correctly spring is the season for them because of the moist, mild weather. I would guess that the only adults that would be sick would the ones that the children presented their "gifts" to and didn't know not to eat them. Just an idea.

[Just Plain Ruff]

Ok start with at least ten transport ambulances the bus and 4 fire department engines. Set up a command post with the following over head IC, Operations Chief, Triage Group sup. Transport Group sup. Traffic Control Strike Team Leader. and a Public Relations Officer. Place some EMT"S in Triage group probably 5 and use firemen to help load ambus. Use FF's to set up a LZ or two. Put a FF and a EMT in charge of site analysis for contaminants make them a group if you like but i would merge them with triage so you dont exceed your span of control. After that its simply a matter of working threw the process.

ok, remember this

you are in a small town community. There is a total of 2 fire trucks in town. There are only 3-5 people who have actually went thru MCI training.

You can only get 8 total ambulances based on the surrounding services won't send their last ambulance to you because that would drop their coverage in their county to ZERO. They just won't do it.

You have 2 ambulances from your service area

1 amb from the next nearest service

2 ambulances from the north county, none from the south, 2 from the west county and 2 from the East.

That's all you get.

Plus all 5 helicopters have been ordered. If you need more you can ask for helicopters from 100 miles away.

So you have 9 ambulances and 5 helicopters and a city bus which turns out to be a Oats bus with 6 rows of seats.

Okay, so I'm going to go out on a limb here. First off, how many victims are adults? Considering that all the reds are children, they are vegetarians, and they are a "wood loving family" I'm wondering if the kids went out into the woods to play and found some wild mushrooms. These can be toxic and if I remember correctly spring is the season for them because of the moist, mild weather. I would guess that the only adults that would be sick would the ones that the children presented their "gifts" to and didn't know not to eat them. Just an idea.

Jeep you are right on.

So what kind of poisioning are we dealing with based on signs and symptoms and time of onset.

[FireMedic65]

What about the people who are not sick? What did they eat/drink. What did they do differently that the sick ones had not.

Was there tartar sauce with those fish sticks?

Get the sick kids cared for. Maintain their airways aggressively, run IV saline bolus's on them. Rapid transport ASAP on them.

Have a few people, if you can spare them to inspect the area for anything out of the ordinary, such as plants, weeds, mushrooms around around.

ok, remember this

you are in a small town community. There is a total of 2 fire trucks in town. There are only 3-5 people who have actually went thru MCI training.

You can only get 8 total ambulances based on the surrounding services won't send their last ambulance to you because that would drop their coverage in their county to ZERO. They just won't do it.

You have 2 ambulances from your service area

1 amb from the next nearest service

2 ambulances from the north county, none from the south, 2 from the west county and 2 from the East.

That's all you get.

Plus all 5 helicopters have been ordered. If you need more you can ask for helicopters from 100 miles away.

So you have 9 ambulances and 5 helicopters and a city bus which turns out to be a Oats bus with 6 rows of seats.

Jeep you are right on.

So what kind of poisioning are we dealing with based on signs and symptoms and time of onset.

Eating poisonous mushrooms is very serious. Depending on what mushrooms were ingested, will determine the effects. It can vary from GI problems (which we have here), neurological effects, hallucinations, liver/kidney damage, and death.

If I remember correctly, there is no direct antidote for mushroom poisoning. The only effective treatment is replacement of fluids, use of whole blood, and pumping the stomach to get out contents that have not yet been digested and metabolized into the blood stream.

Edited April 11, 2009 by FireEMT177959

[Jeepluv77]

When did the first victims start showing symptoms and was it sudden onset or gradual? Any symptoms besides n/v? Right now I'm looking at amatoxin poisoning, but hoping it's something less severe.

[Just Plain Ruff]

When did the first victims start showing symptoms and was it sudden onset or gradual? Any symptoms besides n/v? Right now I'm looking at amatoxin poisoning, but hoping it's something less severe.

you are not incorrect.

The kids ate the salad and the fish sticks but there are 8 other kids who did not eat the salad and who ate the fish sticks and they are fine.

Everyone who ate the salad are sick, anyone who did not eat the salad is not sick.

There are a few people who left on their own who ate the salad. What do you do about those people?

[FireMedic65]

you are not incorrect.

The kids ate the salad and the fish sticks but there are 8 other kids who did not eat the salad and who ate the fish sticks and they are fine.

Everyone who ate the salad are sick, anyone who did not eat the salad is not sick.

There are a few people who left on their own who ate the salad. What do you do about those people?

Did they add these found mushrooms to the salad?

[Chief1C]

I grew up in the woods, never eat man eater mushrooms, they'll kill ya. Man eaters, aka Amanita, toxic mushrooms. Never had the urge to eat a mushroom, even edible ones. Ick. Ate some wild onions once, it was like setting my mouth on fire.

Not related to this.. Ours involved everyone eating a "wild salad" consisting of things they found in the woods. Their expert woodsman knew all the plants, etc. He thought. N/V, unresponsiveness, chest pain, etc. Like an OD on Digoxin. Symplocarpus foetidus.

Not everyone who ate it was sick, but every who ate it was transported. Two were flown, the rest went in seven ambulances. Those who left, were tracked down, and also sought treatment.

Edited April 11, 2009 by 4cmk6

[Jeepluv77]

Transport any who ate the salad with the mushrooms, as the onset can be delayed. Prehospital care is supportive. O2, iv fluids, airway control, etc. The hospitals have a few options but according to the sources I found the most effective(silibinin-milk thistle extract) is not available in the United States. Our options apparently are limited to activated charcoal, N-acetylcystine or cimetidine to try to hinder uptake of the toxin. But I'm guessing at this point it might be too late for these measures to be effective too.

[Just Plain Ruff]

Yes the winner is the Amanita mushroom. Those woods loving people brought a large ziplock bag of sliced mushrooms that they found in the woods. They thought they were morels.

Once the children became unconscious it is a very ominous sign.

I've treated one victim of amanita poisoning in my career and by the time he made it to the ER he was already in fulminant liver failure and ended dying while on a liver transplant waiting list. He didn't last long.

The children are in BIG BIG BIG BIG trouble

Fly everyone of those kids to regional childrens hospitals.

Transport everyone who is sick to hospitals that can stabilize them and then get them to a higher level of care than a small rural hospital.

Amanita mushrooms are the deadliest of the mushrooms. Once symptoms start you need to be agressive in treatment and get them to a facility who can handle their care.

Here is the reference for the article I used as reference.

Some say the fatality rate for untreated or late treated amanita runs 50-60%. It's close to Marburg in fatality rates.

http://emedicine.medscape.com/article/167398-overview

[joesph]

Ok so I have enough transports but not enough ground crew what about mutual aid?

Then lets start using cops they can carry litters and do traffic control. Your shortage on resources is not uncommon. Lets not forget to use other local talent is there a local game warden or forestry division, search and rescue all of these agencies should be trained in ICS. Lets not forget that your helicopters coming in could be heavy one EMT or nurse even a doctor if requested. As far as Fire or EMS personnel being trained in MC if they are trained properly in ICS it is not a difficult job do fit them into the incident. And yes they should be trained in MC.