Families to the Left

When an emergency involves kids, it involves more than just kids.


The Attack One crew arrives at the junior high school and finds many of the students outside. The principal had set off the fire alarm to evacuate the building after a group of about 20 students and teachers had suddenly started coughing and choking near the school’s cafeteria. It’s just before noon, and media trucks are on scene almost as quickly as the hazardous-materials team. The Attack One crew is assigned to perform triage. They report to the front of the school and begin work on those with symptoms.

Three individuals are complaining of shortness of breath, coughing and burning eyes. All can speak in full sentences, and they report they were exposed to something near the school’s cafeteria that immediately caused irritation. One 12-year-old student has asthma, and she says she went to her locker and took several puffs on her inhaler, but it’s not relieving her symptoms. A teacher who stayed in the area to help move students away now complains of a persistent cough, and another student, 13, complains of coughing so hard “it made me throw up blood.”

The Incident Commander suspects a release of pepper spray and has instructed crews to close off the building, but not disrobe the exposed or lay out a decontamination area. There are no obvious smells on the victims’ clothes, so the Attack One crew sticks with that plan. They assemble the rest of those having symptoms and do a quick check on each. With a lot of students and faculty milling around, they cordon off an area of the front lawn upwind from the school for those feeling ill. One crew member is assigned to establish a separate area in the warm zone for performing a pre-suit evaluation of members of the regional hazardous-materials team. Hazmat team members will then enter the building in protective suits and analyze for hazardous substances.

The Attack One crew continues the triage process, gathering information from victims about where they were when their symptoms started. They relay this information to command, and then to the hazmat team leader—it is vital to locating the source area and establishing the incident’s cause. The crew leader contacts the regional poison control center to report the incident, the likely source and the victims’ symptoms. In combination with medical control, the crew decides to send the most symptomatic patient—the student who’s wheezing—to the hospital. The poison control center will coordinate any information exchange with other hospitals, if needed, and also with the broader healthcare community. The transport ambulance will take the girl to the local children’s hospital, and its paramedic leader will remain on the radio there to share information from the hospital and relay any questions between the scene and emergency department. The rest of the victims are not in distress, but the Attack One crew, medical control and Incident Command decide to keep them at the scene and provide symptomatic care until the nature of the exposure is identified by the hazmat team.

At this point, the triage area converts into the treatment area. The Attack One crew huddles with their counterparts from other ambulances assigned to the incident to organize a transport area and operation, should it be needed. The two victims complaining of difficulty breathing receive albuterol by nebulizer. The young victim who had been coughing and vomiting blood is carefully examined. There is no sign of blood in her mouth and no ongoing nausea, abdominal pain or signs of distress. Another student calls the paramedic aside and quietly reports that this student “gets nervous easily” and has a habit of “sticking her finger down her throat to make herself vomit when she wants to get out of class.” Knowing this allows a little extra reassurance for the girl from the treating EMTs and another teacher who is helping the ill students. All other victims receive assistance in rinsing their eyes with bottled water, drinking some fluids to soothe any sore throats, and eating a little food.

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