A collapsed building with empty windows framing a blue California sky. A van tipped to one side. A plastic mannequin head atop a large cement block, with tubes hanging out of the neck, draping down to the ground.
The FEMA training ground at Moffett Field — just a few miles from Stanford — is desolate, apocalyptic and carefully orchestrated; what looks like a pile of discarded boards is a maze that took several days to construct.
Bill Mulkerin, MD, of Stanford Emergency Medicine is sequestered in that pile, along with six members of local fire departments, all members of FEMA's California Task Force 3. They wait in cramped, uncomfortable positions, covered in dust, careful not to shift or grab boards that could undermine the structural integrity.
Inside, two firefighters are preparing to move a 14-year old boy with a fractured leg who has, according to the scenario, been trapped for 48 hours. The boy, Ryan, is the son of medical team leader, Katie Roberts, a firefighter and paramedic with Santa Clara County Fire, and he has played the role of victim in simulations since he was a toddler. He knows how to respond to questions about his condition, his mental health, and about his friends trapped elsewhere.
Mulkerin passes several cc’s (cubic centimeters) of ketamine (commonly used in battlefield or prehospital medicine) along the chain to help the victim’s pain. He is one of a handful of Stanford emergency medicine physicians who volunteer their time to train to join a FEMA task force (they are paid once they join). Last year he went with a different rescue team to assist following Hurricane Irma. They spent 46 hours on a bus traveling across the country nonstop, with three drivers working in shifts. The bus stopped every few hours for the search dogs to relieve themselves. Humans were only allowed out every other stop; time was that valuable.
Task Force 3’s communication is constant and clear. They are from different organizations, but share a common language that includes “extraction,” “crush syndrome” and “I’m bumping up” (moving closer to the victim). It is professional and minimalist, except when they talk to the victim. “I’m not leaving you buddy… we’re gonna get you out of here,” one rescuer reassured Ryan.
Extractions are rarely simple and can present unforeseen medical complications, a key reason physicians are part of search-and-rescue teams. For example, if person is removed too quickly when limbs are crushed under a heavy object, "potassium could flood the body and result in death. You have to pre-empt the removal with an injection of calcium," Stanford emergency physician Marc Gautreau, MD told me.
Or, perhaps a limb must be sacrificed to extract an individual. Some members of the team have practiced their amputation skills on pig legs. Later, they will be asked to consider how they would proceed if a body blocked their path to a live victim.
Katie observes and offers insight. Every now and then, she leans over a cement block to check on her son, the victim. “Everything okay in there, monkey?”
It takes 90 minutes to extract Ryan, which is relatively short for this exercise. The team is crawling through a tunnel a foot wide, simultaneously climbing over one barrier and under another. And then they are doing so in reverse, with a boy in fragile condition, strapped to a board.
While this is taking place, Stanford emergency physician Justin Lemieux, MD, lies a hundred yards away, unmoving, under a low platform. A team member attempts to wrap him in a tarp and package him in a rescue basket; a challenging task given Lemieux’ 6’4” frame and the platform’s 16 inches of clearance.
Both groups convene for the next exercise: "windy room," a disarmingly pleasant name for an activity that takes place in a dark concrete bunker. There are two victims: Ryan, and his friend Kade are in separate corners, behind different obstacles. Soon there are seven rescuers inside in the dark and heat. They can barely hear themselves and they definitely can’t hear their teammates outside the bunker; overpowering noise machines drown out commands.
They extract the victims and then wrap up by reviewing videos of the earthquake in Haiti. It is gruesome, but the team is pragmatic. They are not immune to the horror; but they have an enviable understanding of the balance of life and death, the despair of the victims, their roles as rescuers, and the power of a team. Tomorrow, they will go back to their day jobs — where they also save lives.
Photo by Susan Coppa