# MASCAL



## Muppet (May 19, 2017)

Found this under a facebook page called, Crisis Applications Group, a school run by a former SF/CAG dude, shooting and medicine, some of you may know the guy. Good video, many lessons....

M.


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## Diamondback 2/2 (May 19, 2017)

Didn't make past the kid with his guts hanging out.  Seen that bullshit few too many times. Always sucks when you see the kids fucked up.


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## Red Flag 1 (May 19, 2017)

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## Evans (Jan 29, 2018)

Little late to the party on this thread, but great video! It always amazes me to see people be so calm and collected when in a situation like this. Most would be losing their head, while he calmly gives instructions and treats his wounded. Beautifully done!


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## Muppet (Jan 29, 2018)

Evans said:


> Little late to the party on this thread, but great video! It always amazes me to see people be so calm and collected when in a situation like this. Most would be losing their head, while he calmly gives instructions and treats his wounded. Beautifully done!



It was run very well. The entire idea of MARCH and staying calm, can count for both military and civ world, especially these days. I have been involved in a few MASCALs in the Army and a couple in the civ world in 18ish years. Big thing is staying calm and sticking to basics.....

M.


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## Red Flag 1 (Jan 29, 2018)

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## Evans (Jan 30, 2018)

For the sake of conversation and learning, how do you all deal with this kind of situation? Either MASCAL or something like an OR as @Red Flag 1 brought up. I'm sure things like noise can play a huge part in these kinds of chaotic situations, but you can't just ask everyone nicely to calm down so you can concentrate. What are some way's you have controlled a normally uncontrollable situation?


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## Muppet (Jan 30, 2018)

As a paramedic now. So, on a MASCAL, think auto extrications. It's kind of difficult to control volume in that setting. Now, talking a cardiac arrest. In my AO, we have a double medic pull meaning, 1 medic truck has 2 medics. A second medic truck is dispatched, along with fire dept. This ensures, proper care is done on scene. As a crew chief, it's imperative that 1 person calls the shots with requested imput from the other providers. I will ensure seamless care is preformed, roles are assigned and the adrenaline is controlled. If I see a provider getting overly stoked, I simply redirect and get back on track, telling them to breathe, especially, something like a kid code, just had 1 a little bit ago.

I've seen trauma resuscitations that were loud and poorly run and I've seen resuscitations run like well oiled machines, case in point. My pop, as many know here is still in the ICU, I found him down on floor of his house, altered mental status. Medic unit called level 1 trauma and as a son, even though I was off work, the trauma staff knew me, allowed me to stay in the resuscitation.

I was able to watch as a son and not a medic, how control is important. I was in awe and I've been in medicine since 1995. Control is key to success and that means, 1 leader. I've been witness of trauma docs, 1 in particular, a nationally known doc, Sidney Vail, shut an entire trauma bay down with a loud "Quiet!!!!, I need quiet!".

M.


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## CQB (Jan 30, 2018)

In English it would be a spit infinitive; due the posting from the triage another thread. (Kid with severe wound; guts ets.) and that was reality for me was interesting. The noise quotient was disracting in the vid but I get thet people get upset &  also that medicos have to do their job.  From a laymans POV that was particularity interesting. Kudos...


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## Gunz (Jan 30, 2018)

Muppet said:


> It was run very well. The entire idea of MARCH and staying calm, can count for both military and civ world, especially these days. I have been involved in a few MASCALs in the Army and a couple in the civ world in 18ish years. Big thing is staying calm and sticking to basics.....
> 
> M.




It's kind of like combat. You force yourself to steady on, concentrate on the task at hand, being there for the team and not getting rattled by incoming.


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## Evans (Jan 30, 2018)

Just to poke the "learning" fire while it's still hot, what if you aren't in the leadership role? What if in one of those situations you are the junior member caught between following those orders and guidance given by the one in charge of the situation, but also maintaining composure in a highly stressful situation that you may not be accustomed to yet? What do you think is the best way to proceed in this role?


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## Devildoc (Jan 30, 2018)

Evans said:


> Just to poke the "learning" fire while it's still hot, what if you aren't in the leadership role? What if in one of those situations you are the junior member caught between following those orders and guidance given by the one in charge of the situation, but also maintaining composure in a highly stressful situation that you may not be accustomed to yet? What do you think is the best way to proceed in this role?



In the civvy world MCIs/MASCALs are (well, should be) well-organized with a semblance of ICS (Incident Command System).  Everyone has a place and apart to play.  If it breaks down, you default to turning to your immediate leader for guidance.  For people not in leadership roles, doing what you are asked to do, do it well, and communicate well are the keys to maintaining composure.

In our ED for trauma rescus, we have two 'teams' that must integrate, the ED team, and the trauma (surgery) team.  Then, each team has an attending, a senior resident, and at least two junior residents.  Add the primary nurse (charting, who is the nurse in charge), two procedure nurses, a circulating nurse, and at least two NCAs/ED techs, and a RT.  Even a dull murmur is loud.  It is our protocol that speaking is minimal (you have to talk) and at controlled "inside voices", the two people who are supposed to do the talking is the doc running the resuscitation and the primary nurse.  In vanilla trauma it goes pretty well; in weird trauma (I,.e., pregnant woman in MVC, had to do emergent C-section in our rescus bay) it can get nutty.  Now add multiple 'red tag' trauma patients from an MCI/MASCAL, 
it oddly enough calms after patients hit the door because there is just so much work to do.  By that time triage has mostly been done and it's just re-triaging, assessing, treating, and getting the patient out of the ED.

It is why you drill, in real, cosplay, with role-play, and with "table top" exercises.


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## policemedic (Jan 31, 2018)

Devildoc said:


> It is why you drill, in real, cosplay, with role-play, and with "table top" exercises.



THIS.

The only way to become comfortable within dynamic and fluid situations in a high stress environment is to become acclimated.  That means training in as realistic a way as possible.  That applies to medicine as much as clearing rooms or performing a RSP.


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## x SF med (Jan 31, 2018)

Muppet said:


> Sidney Vail,



Syd is a hell of a doc....  and it's Sydney...  he's corrected me before, and he's actually internationally known as one of the top trauma guys out there.  

(I had to check one of his contact cards to make sure the spelling was correct....  I'm not even going to try to put all of the letters after his name.)

If I ever need a trauma doc again, I hope to hell Syd is within spitting distance, no one better to keep you alive.  It would be nice if RF1 was the gas passer going into surgery too....


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## Devildoc (Jan 31, 2018)

x SF med said:


> Syd is a hell of a doc....  and it's Sydney...  he's corrected me before, and he's actually internationally known as one of the top trauma guys out there.
> 
> (I had to check one of his contact cards to make sure the spelling was correct....  I'm not even going to try to put all of the letters after his name.)
> 
> If I ever need a trauma doc again, I hope to hell Syd is within spitting distance, no one better to keep you alive.  It would be nice if RF1 was the gas passer going into surgery too....



He's definitely got a rep in the biz; the trauma docs that jump the fence and reach out to the tactical medicine community are few and far between.


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## x SF med (Jan 31, 2018)

Evans said:


> Just to poke the "learning" fire while it's still hot,
> 1.what if you aren't in the leadership role?
> 2.What if in one of those situations you are the junior member caught between following those orders and guidance given by the one in charge of the situation,
> 3.but also maintaining composure in a highly stressful situation that you may not be accustomed to yet?
> ...



1/2.  Every role in a mascal is a leadership role - even if it's self leadership... there are protocols, algorithms, follow ups and information transfers that you as even a junior medic must complete.  You just may not be the top dog, and what he top dog says goes, unless the pt is put further into harm's way.
3. You must rely on your training, and the knowledge of the most senior person, except as noted in 1/2...


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## x SF med (Jan 31, 2018)

Devildoc said:


> He's definitely got a rep in the biz; the trauma docs that jump the fence and reach out to the tactical medicine community are few and far between.



An overall good man, who likes real beer and real whiskey when he's off the clock. Not to mention a good steak, too.


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