In a proactive move to enhance emergency preparedness, first responders in Sanborn, Iowa, recently participated in an active shooter training simulation. The exercise, held at Sanborn christian School, aimed to refine the coordination and response capabilities of various local agencies.

Triage in action: A directors Outlook

Charity Verbrugge, the Sanborn Ambulance director, took a central role in the simulation, overseeing the triage system within the school’s gymnasium. Her duty was to quickly assess and prioritize victims based on the severity of their simulated injuries, assigning them color-coded designations: red, yellow, green, or black. These colors guided other first responders in determining the order of treatment.

Multi-Agency Collaboration

The active shooter simulation was orchestrated by Jared Johnson, the O’Brien County Emergency Management Agency coordinator. It involved a collaborative effort from multiple agencies, including:

• O’Brien County Sheriff’s Office
• Sanborn Police Department
• Sanborn Ambulance
• Sanborn Fire Department
• Sheldon Community Ambulance team (SCAT)

Community members, including teachers from Sanborn Christian school, volunteered as victims, adding realism to the exercise.The “shooter,” armed with two Nerf guns, moved through the school, simulating an active threat.

Simulation Dynamics

The simulation unfolded in stages. Deputies and officers were the first to respond, clearing the school and locating the shooter. Subsequently, ambulance and fire department personnel entered the scene to assess and transport victims. Firefighters assisted in carrying some of the injured to the gymnasium, where Verbrugge managed the triage process, and her colleagues provided necessary medical care.

Insights from the Exercise

The 45-minute exercise proved to be a valuable learning experience for the participating EMS members. It opened a lot of people’s eyes.We live in a very small community, and we think things are safe, Verbrugge noted. She emphasized the importance of such drills in preparing for potential emergencies: So having a practice exercise like this, how do we prepare for it so that we can minimize the risk and simultaneously occurring, EMS, fire department and our local police department, what are our roles?

Beyond Active Shooter Scenarios

While the simulation focused on an active shooter scenario, the skills honed are applicable to a wide range of emergencies. It’s something you can utilize in every aspect: A car accident, nursing home, natural disasters. It’s not just for something like a shooter, which we all hope never happens, Verbrugge explained. The triage protocols, in particular, offer a streamlined approach to managing mass casualty events.

Understanding the Triage System

The triage system employs color-coded bands to signify the level of care required by each victim:

• Red (Immediate/Emergency): Indicates life-threatening injuries requiring immediate intervention. You need to get them to the facility that is going to be able to handle them, Verbrugge stated.
• Yellow (Delayed): Signifies serious but not immediately life-threatening injuries. It can also look pretty bad. It might very well be a very big open leg wound, but it’s not something that needs immediate saving. It can be delayed for a little bit, Verbrugge clarified.
• green (Minimal): Represents minor injuries that will eventually require treatment; often referred to as “the walking wounded.” It’s somebody that is maybe anxious, panicked.It might very well be a bad scratch, anything like that. It’s something that can wait a long time, according to Verbrugge.
• Black (Expectant/Dead): Indicates injuries too extensive to be treated with available resources. The hardest part of our job is to deal with that, Verbrugge admitted.

Verbrugge emphasized that triage is a dynamic process: Then it’s making sure you are going back through because at any point in time, your green can get bad and it can go to a red. So just kind of constantly being in it.

Team Roles and Communication

effective communication is paramount in any EMS situation. Verbrugge highlighted the importance of clearly defined roles and responsibilities. You have incident command for a reason, so just making sure that we are all communicating very well, she said. The simulation revealed areas for enhancement in their communication processes,prompting plans for future training scenarios.

What we learned today is that we need a better process in how we communicate. for us, we will probably be running many scenarios for ourselves just to get used to that process.

Sanborn Ambulance Team: A Growing Force

Verbrugge acknowledged that most members of the Sanborn Ambulance team are relatively new. The team includes Mikayla Howe, cassie Schmidt, and Candy Cribb. Despite being the only full-time staff member, Verbrugge, who also works as an emergency room nurse at Palo Alto County Health System in Emmetsburg, is optimistic about the team’s growth. I’ve only been doing this for a year, but I’ve been an ER nurse for 30, she said. As far as Sanborn, we’ve been hurting, and we definitely need more help. We’ve been growing. We’ve got an amazing team,and our fire department has been phenomenal.

Howe, a dispatcher for the O’Brien County Sheriff’s Office since 2016, often faces the challenge of balancing her dispatch duties with the needs of the Sanborn community. A lot of times when there’s a call that goes out in Sanborn, she’s the dispatcher, and I’m at work. So, it leaves our community open to not having any providers, Verbrugge explained.

In situations where Sanborn Ambulance cannot respond, mutual aid agreements with SCAT or the Hartley and Primghar ambulance crews ensure coverage.

The team is set to expand with a new member, bringing the total to five, with hopes for further growth.Three years ago, basically none, Verbrugge said, reflecting on the team’s progress.It’s a slow process. I know everybody wants it to grow fast. I believe that you’ve got to get the foundation right in order to grow a really good, strong program.

The Value of Hands-On Experience

Verbrugge emphasized the importance of practical training, such as the active shooter simulation, for EMS crews. to hear the noises, to get it to be as real as possible, Jared does a great job with making it look real and having the vitals there, having the injuries set. It really is a very good representation of what could happen, she said. The more people that come to these, it’s just really good for experience.