A Call to the Hall

Attack One responds to a report of persons ill at a bingo hall. Three individuals had reported suddenly feeling ill to the facility’s staff, which had called 9-1-1. The Attack One crew arrives on scene and enters the site, prepared to call for additional help and evacuate the building if any unusual substances are detected. They find their first victim outside the hall, complaining of shortness of breath. The other two persons are in an office just inside the front door, so the crew carefully enters the building, noting no unusual odors. Bingo activities are ongoing.

The Patients

The first patient is a 50-year-old female who complains of sudden onset of shortness of breath. She tells the crew she was playing bingo and abruptly felt an onset of wheezing and throat irritation. She began coughing, and now has a headache and some nausea. On exam, she has audible wheezes and decreased air movement.

The patients inside are a 55-year-old male and a 39-year-old female, both with cough, nausea and headache. The female has vomited once. Both were playing bingo and had similarly abrupt onsets of symptoms.

Scene Management

The first victim is assessed, then started on a nebulizer treatment with albuterol. Her wheezing begins to improve, and her oxygen saturation improves with supplemental oxygen and the nebulizer treatment. Her throat irritation clears, and her headache only occurs with coughing. No further symptoms develop.

The second and third victims are moved outside the building, and their coughing resolves. The female vomits once, then her nausea clears. The male becomes nauseated, but only after seeing the female victim vomit. He feels better after removal from the building.

As care is being administered to these patients, another nine victims emerge from the building, stating they are having problems with coughing and eye irritation. The Attack One crew calls for additional fire and EMS resources and the regional hazardous-materials team. The crew suggests that the bingo game be stopped immediately and all persons removed from the building. Initially, the management team rejects this suggestion, since there is a significant amount of money “on the table.” The crew insists, however, and the management team makes the announcement. The building is evacuated.

Organization of the Incident

Incident command is established. The hall is the only functioning business in an old strip mall. It measures 50´ x 75´. On this cool afternoon, the heating system is functional and there have been no recent problems or repairs. The business has been stable, no threats have been received by management, and no unusual events have occurred during the day. The crews press the 12 victims for information about the onset of their symptoms. All affected persons had been in one area of the hall, sitting at adjacent tables. Victim No. 1, the first to have symptoms, was near the middle of the victims’ positions.

Medical Decision-Making

There are no immediate threats to life identified. There are several reasonable explanations for victims’ symptoms, including irritant vapor exposure, carbon monoxide exposure or the release of another hazardous substance. The first three victims had headaches and nausea, but also respiratory symptoms. Others had coughing and eye irritation. This would suggest an irritant vapor exposure.

The first victim is transported to the hospital, accompanied by one member of the Attack One crew. The other Attack One crew member organizes the other victims and starts them on high-flow oxygen from a manifold. This exacerbates coughing in some of the victims, so he fits the oxygen manifold with a nebulizer, and the victims are treated with saline and albuterol.

The crew member who went to the hospital stays with the patient until the emergency-department staff evaluates her. They find no evidence of highly toxic exposure and no carbon monoxide in her blood. At about the same time, the regional hazardous-materials team completes a sweep of the building, finding no carbon monoxide or other toxic substances.