MSOC: Afternoon Skill Stations

See also:

• Report: The 2022 FDNY Medical Special Operations Conference
• Voices of MSOC: Quick Q&As With Top Leaders From the Show
• Bonus Photo Gallery: MSOC 2022

Arguably one of the most exciting and interesting parts of the MSOC conference is the opportunity for participants to engage in hands-on skills stations using rescue and medical skills in simulated incidents. All the scenes were highly supervised and guided by FDNY rescue and EMS personnel. All teams going through the simulations were given full complements of EMS gear, including BLS bags, 12-lead cardiac monitors, simulated drug boxes, airway tools, and immobilization and removal equipment. Below is a sampling of the stations and key lessons taught in each scenario.

Station: Rubble Pile

Scene setup: MVC in a collapsed structure. Multiple manikins represent victims with various injuries. 

Key lessons:

• Watch your step! All ground is unstable until it is made stable.
• Wear your PPE: helmet, eye protection, gloves, knee pads, rescue boots, and covered sleeves and legs. 
• PPE for the victim: Rescuers are geared up for protection. Don’t forget to protect the victim, especially during extrication and the use of tools.
• Rapid triage determines who gets treated first. 
• Control life threats. Deal with issues that could potentially kill patients first, such as massive bleeds or obstructed airways.
• For entrapped patients or lengthy extrications, ALS should use pain control early and often. If there is one in your system, get an EMS physician to the scene.
• Get EMS patient access and treatment started early while rescue work is ongoing.

Station: Airway Control in Confined Spaces

Scene setup: A simulated victim (airway manikin) in a confined space, like a drainage pipe or concrete void with limited access. The goal is to do both BLS and ALS airway control relying on limited movement and visualization. 

Key lessons:

• Get used to using hands and ears instead of eyes for airway management.
• Have a light source where possible, preferably head-mounted.
• You will most likely be engaging in blind insertion of airways (nasopharyngeal, oropharyngeal, LMA, ET tubes). 
• Know patient anatomy and what landmarks to feel for, such and oropharynx and teeth.
• When you practice airway skills, don’t practice in the perfect classroom environment.
• Manage a BLS airway before you manage an ALS airway.

Station: Rebar Impalement

Scene setup: Simulated patient (manikin) impaled on multiple pieces of rebar in concrete.

Key lessons:

• Stabilize the patient with a tripod (first choice). Ground cribbing would be your last choice due to ground contact but be as creative as you need to be.
• When cutting with saws, many will generate heat. Soak a trauma pad with sterile water and place it right by the cut to cool the rebar prior to cutting. Have a rescuer keep a bare finger on the rebar to monitor the heat the patient is getting.
• Utilize pain control early and often.
• Manage life threats: airway and massive bleeding control. 
• Rescue and EMS need to work together to know the size of the rebar cut needed to fit the patient with the impaled object in the ambulance. Leave the rebar in place and cut only what you need to free the patient and get them in the ambulance.
• The battery-powered band saw generated far less heat and vibration compared to a rotary saw or traditional K12 saw.

Station: Subway Entrapment

Scene setup:

Scene 1—Patient is entrapped in the gap between the train car and the platform. 

Scene 2—A 19-patient MCI in a simulated subway active-shooter scene. 

Key lessons:

• Always know and verify if the train car and tracks are powered up or not.
• Have lots of light sources. 
• Good communication and coordination is needed between rescue, EMS, police, and transit.
• Engage in simultaneous care under the subway car and on the patient between the platform and car. 
• Wear appropriate PPE: helmet, eye protection, hearing protection, dust mask (N95), knee and elbow pads.
• Wear SCBA or respirators if needed.
• Monitor air quality and have appropriate ventilation. 
• Utilize lots of cribbing for stabilization.
• Use low-pressure airbags to make space between the patient and car/platform.
• Have an EMS physician with ultrasound on the scene, if available. If not, establish telemedicine with medical control so they can see the scene and patient.
• Establish pain control and limb tourniquets early.