Crash course in emergency medicine

A mock-up of a ‘major incident’ in Dublin last week showcased Irish emergency services at their best

WITH OVERCROWDED emergency departments and trolley counts, emergency medicine in Ireland is rarely out of the news for all the wrong reasons.

At lunchtime last Thursday, a car crashed through the barriers at the Docklands railway station in Dublin city centre. It later transpired the driver had suffered a major heart attack.

As the car veered out of control and on to the train tracks, the driver of an oncoming commuter train did not have enough time to stop and collided with the car.

There were 17 passengers on board the train who suffered a range of injuries, from minor to life-threatening.

The driver of the car and a train passenger died at the scene. One passenger in the car survived, but had to be cut out of the wreckage.

Irish Rail immediately called 999 and a number of teams from the Dublin Fire Brigade (DFB) and the National Ambulance Service (NAS) of the HSE were deployed.

Although this was a demonstration exercise for delegates of the 2012 International Conference on Emergency Medicine, the mock-up was an opportunity to showcase emergency medicine in Ireland and the co-operation between the agencies, involved, namely Irish Rail, the DFB and the NAS.

This was the first time the world’s largest international emergency medicine conference had come to Dublin. The three-day biennial event attracted more than 2,000 delegates and numerous expert speakers in emergency and disaster medicine from around the world.

Before the exercise, the 19 “casualties”, all of whom were volunteers from the Tipperary Red Cross, were given instructions on their individual injuries. These ranged from serious conditions such as head injuries, internal bleeding and punctured lungs to broken ribs and fractured limbs.

Injuries such as open wounds from protruding shards of glass were realistically reconstructed with make-up and fake blood. Those in pain cried out for help in a most convincing fashion, with many performing to Oscar-winning standards.

At that stage, a major incident was declared. According to Dr Niamh Collins, consultant in emergency medicine in Dublin, the definition of a major incident is when “demands exceed resources”.

Once the fire service declared the scene safe, paramedics from the NAS were then permitted to board the train where they assessed and triaged casualties, prioritising those with life-threatening injuries.

Meanwhile, members of the fire brigade used cutting equipment to free the dead driver and badly injured passenger from the car, which lay upturned on the track in front of the train.

Paramedics then escorted the walking wounded off the train and brought them to the casualty clearing station, which was set up a safe distance away in front of the station’s ticket office.

They returned for casualties who could not walk and brought them on spinal boards to the clearing station. Once in the station the injured were reassessed and any emergency interventions that were needed were carried out, before they were prioritised for transport to local hospitals.