By Eric Hrin
The Daily Review

TROY, Pa. — A member of the Western Alliance Emergency Services, Inc. team that helped out this past weekend with the Pope's visit in Philadelphia said the experience was "phenomenal".

EMTs Mark Steckiel of West Burlington, Mary Sturdevant of Herrickville, Rhonda Howell of Gillett and Bobby Johnson of Canton provided EMS support for the city of Philadelphia during Pope Francis' visit Saturday and Sunday.

According to Steckiel, they were stationed in the courtyard at City Hall in Philadelphia.

"It was non-stop," he commented to The Daily Review on Monday.

They were able to work with the city's fire department EMTs, on location.

The Western Alliance contingent was but one of many emergency services providers who were on duty.

Steckiel said there were 100 ambulances from around the state, as well as Ohio, West Virginia, Maryland and Delaware to assist Philadelphia.

Steckiel said their duties involved transporting people.

He said there were cases of everything from a twisted ankle to a cardiac situation.

"He came right by us on Saturday night," said Steckiel of the Pope.

Steckiel said Sunday had the bigger crowd.

He noted that security was "very, very tight."

And while the mood was hectic, people were "extremely polite" and "courteous", he said.

The Western Alliance EMTs left for Philadelphia at 6 a.m. Friday and returned to Troy at 3:30 a.m. Monday.

©2015 The Daily Review

By Justin Juozapavicius
Associated Press

STILLWATER, Okla. — A motorist plowed into a crowd of spectators Saturday during the Oklahoma State University homecoming parade, killing three people and injuring nearly three dozen others, police said.

Stillwater police Capt. Kyle Gibbs said the woman's sedan struck an unoccupied motorcycle of an officer who was working security at the parade, then went into the crowd. She was taken into custody on a driving under the influence charge, Gibbs said.

Gibbs said three people were killed and 34 were injured in the crash Saturday morning, including eight who were airlifted to hospitals with critical injuries.

Police said Adacia Chambers, 25, of Stillwater, was taken into custody on the DUI charge.

"We treat these like we would any homicide investigation," Gibbs said. "It'll probably take several days to get additional information as to the cause of the accident."

Oklahoma State University President Burns Hargis said there had been discussion about canceling the homecoming game Saturday afternoon against Kansas, but it was played as scheduled. The victims were remembered with a moment of silence before kickoff, and most of the OSU players knelt on the sideline in prayer.

"I just saw smoke and saw the panic in people's faces as they ran away from the scene," said Geoff Haxton, of Tulsa, who attended the parade with his children.

Another spectator, Konda Walker, from Anchorage, Alaska, told the Stillwater News Press that some people initially thought the crash was part of the show.

"People were flying 30 feet into the air like rag dolls," Walker told the News Press.

Phone calls to Oklahoma State officials were not immediately returned.

The university posted on Twitter: "Oklahoma State University is saddened by the tragic parade incident earlier this morning. Our thoughts & prayers are with those affected."

It's not the first tragedy to strike events connected to Oklahoma State sports programs. Ten people, including two OSU men's basketball players, were killed in a 2001 plane crash while returning from a game in Colorado. And Oklahoma State women's basketball coach Kurt Budke and assistant Miranda Serna were among four killed in a plane crash in Arkansas in 2011 while on a recruiting trip.

"The families, I know, and these victims will never be able to understand this, nor will we," Hargis said. "But the Cowboy family pulls together, unfortunately we've had to do it before and we're going to do it again."

Associated Press

STILLWATER, Okla. — A woman suspected of driving under the influence plowed into a crowd Saturday during the Oklahoma State University homecoming parade, killing four people — including a 2-year-old boy — and injuring dozens more in a collision that sent some spectators flying through the air.

Stillwater police Capt. Kyle Gibbs said the woman's Hyundai Elantra struck an unoccupied motorcycle of an officer who was working security at the parade, then went into the crowd. She was taken into custody, and Gibbs said investigators were awaiting the results of blood tests to determine if she was impaired by drugs or alcohol.

Oklahoma University Medical Center and The Children's Hospital announced in a statement Saturday evening that a 2-year-old was the fourth person to die from injuries suffered in the morning crash. Five children and three adults remained hospitalized with conditions ranging from good to critical, officials said.

Gibbs confirmed later Saturday that the 2-year-old was a boy and that the other three people who died were all adults. He also said the number of people injured had grown to 44.

Police said Adacia Chambers, 25, of Stillwater, was arrested on the DUI charge.

"We treat these like we would any homicide investigation," Gibbs said. "It'll probably take several days to get additional information as to the cause of the accident."

Chambers' father, Floyd Chambers of Oologah, told The Oklahoman newspaper he couldn't believe his daughter was involved and said she was not an alcoholic. He described his daughter as "timid" and said she had attended homecoming festivities Friday night with family but that her boyfriend had told him she was home by 10 p.m.

"This is just not who she is. They're going to paint her into a horrible person but this is not (her)," Floyd Chambers told the paper.

A woman who answered a call to a phone number listed for Floyd Chambers told The Associated Press no one was available to talk.

Oklahoma State University President Burns Hargis said there had been discussion about canceling the homecoming game Saturday afternoon against Kansas, but it was played as scheduled. The victims were remembered with a moment of silence before kickoff, and most of the OSU players knelt on the sideline in prayer.

Even as the game began, some of the bodies remained at the scene of the crash less than three blocks away from the stadium. National Guard troops kept watch as officials with the Red Cross and state medical examiner's office continued their work.

Hundreds of fans wearing the school's bright orange and black colors had to walk by the intersection as they headed to the game. Some lingered to look at the aftermath: water bottles, blankets, lawn chairs and other items strewn in the street. A gray car with a smashed side and shattered windshield remained at the scene, as did a crumpled motorcycle.

"I just saw smoke and saw the panic in people's faces as they ran away from the scene," said Geoff Haxton, of Tulsa, who attended the parade with his children.

Another spectator, Konda Walker, from Anchorage, Alaska, told the Stillwater News Press that some people initially thought the crash was part of the show.

"People were flying 30 feet into the air like rag dolls," Walker told the News Press.

It's not the first tragedy to strike events connected to Oklahoma State sports programs. Ten people, including two OSU men's basketball players, were killed in a 2001 plane crash while returning from a game in Colorado. And Oklahoma State women's basketball coach Kurt Budke and assistant Miranda Serna were among four killed in a plane crash in Arkansas in 2011 while on a recruiting trip.

"The families, I know, and these victims will never be able to understand this, nor will we," Hargis said. "But the Cowboy family pulls together, unfortunately we've had to do it before and we're going to do it again."

SAN FRANCISCO — Paramedics from the San Francisco Fire Department have completed training and begun bicycle-based patient response at the San Francisco International Airport in preparation for Super Bowl 50.

Fire department officials told the Daily Journal that the airport paramedics are learning to traverse the airport by bicycle to improve medical emergency response.

The paramedics are equipped with lightweight cardiac monitors for acquiring 12-lead ECGs and other equipment required to assess and treat patients before an ambulance arrives, Capt. Justin Schorr wrote in a blog post.

The paramedics will be deployed when airport authorities predict above normal passenger traffic, such as Super Bowl 50, which is scheduled to take place on Feb. 7.

Bicycle instructors from the San Francisco Police Department trained the airport paramedics on the unique challenges of operating bikes in crowded places. At this time paramedics are using bicycles on loan from the police department.

EMS Bike Program from the ground up https://t.co/cjvOQShWFu pic.twitter.com/RxcfOKJAov

— the Happy Medic (@theHappyMedic) December 20, 2015

FORT WAYNE, Ind.— Two paramedics were hurt by an out-of-control midget race car that struck a fence they were standing behind.

The incident happened during a preliminary race of the “Rumble in Fort Wayne” series Sunday, reported WANE.

"The accident occurred during a preliminary heat race when an oncoming car flipped over the tires of a spinning car," said race organizer Larry Boos. "The flipping car did go into the retaining fence near the area the paramedics were sitting. The catch fence and cables did the job of returning the car to the racing surface, but did appear to make contact with the paramedics resulting in their injuries."

One paramedic remains hospitalized with unknown injuries. A family member of the second paramedic – who was released from the hospital midweek, said he suffered several broken ribs and internal injuries.

"The entire racing community joins the Rumble staff enriching the injured parties a quick recovery," Boos said.

NEW YORK — The inaugural Mass Gathering Medicine Summit will be held in New York on April 21 and 22.

The specialized summit for medical professionals and risk managers will feature panels, workshops and keynote addresses from mass gathering emergency medical and health specialists.

Launched in 2015, the summit provides a forum in which physicians, paramedics, EMTs, nurses, risk managers, emergency planners, government officials, researchers and public health officials can discuss the most relevant topics facing mass gathering medicine today.

"I anticipate inspiring, thought-provoking dialogue and a unique focus on operational aspects of health and emergency response," said conference co-chair Dr. Adam Lund.

The summit will be highlighted by a keynote address from author Dr. Paul Arbon, as well as one-on-one conversations with Dr. Andrew Bazos and Steve Adelman.

For more information on speakers and registration, visit MassGatheringMedicine.org.

This special Bound Tree University guide brings together articles written by experts to help EMS providers, law enforcement officers and laypeople better prepare for mass casualty incidents — especially those involving severe bleeding.

Learn more about:

• EMS coverage for mass gatherings and public events.
• The role of law enforcement officers as medical first responders.
• Public access hemorrhage control programs.

Enter your information below to download the guide.

Although large scale multiple casualty incidents such as the Boston Marathon bombing and the San Bernardino shooting capture the nation’s attention smaller scale MCIs are much more common. The National Association of State EMS Officials provides one definition of an MCI as any incident "which generates more patients at one time than locally available resources can manage using routine procedures [1]. Using that definition, researchers estimate the yearly incident rate in the United States is about 13.0 MCIs per 100,000 population [2].

Hemorrhage is the second leading cause of death for patients injured in the prehospital environment, accounting for 30-40 percent of all mortality [3]. Many of the patients who hemorrhage do so after suffering vascular injuries in one or more extremities. The annual incidence of extremity vascular injuries in the United States ranges from a low of 12.4 injuries at a rural trauma center in Missouri [4] to a high of 55 lower extremity injuries at a high-volume urban trauma center in Houston [5]. In a study of isolated penetrating injuries to the extremities, 57 percent of the patients who died had injuries that might have been amenable to tourniquet application [6].

There is little debate about the value of rapid hemorrhage control for improving outcomes in critically injured trauma patients. The American College of Surgeons Committee on Trauma has stated that bleeding must be controlled by prehospital providers as quickly as possible. 

For maximum efficiency, health care providers must apply tourniquets before the patient has developed shock [7]. During Operation Iraqi Freedom, tourniquets applied in the field and before the onset of shock were strongly associated with survival [8].

Unfortunately, in cases of severe bleeding, trained professionals may not always arrive in time to prevent exsanguination. Researchers in Austria and Germany found that when traumatic injury occurs, bystanders with varying levels of first aid training are often present on scene before EMS arrives [9].

In addition, these bystanders often attempt to provide hemorrhage control for patients suffering from an exsanguinating injury. Although prior first aid training increased the probability of successful hemorrhage control by the bystander, the lack of first aid training did not prevent bystanders from attempting to control bleeding and a significant percentage were successful.

Can the public help
A central question is whether these bystanders who are present on the scene and are willing to help control severe bleeding can become part of a trauma chain of survival. There is very little data in support of this position. However, studies involving a cardiac arrest chain of survival demonstrate that trained bystanders can safely and effectively use defibrillators to resuscitate victims of out-of-hospital cardiac arrest [10-14]. Even sixth graders with no previous medical training can achieve performance goals similar to those achieved by trained medical responders [15].

Similarly, is it reasonable to think ordinary citizens would be able to safely and effectively apply tourniquets when indicated before the arrival of EMS personnel. Limited available evidence suggests it is. 

During a simulated explosion, one in five people with no medical training were able to correctly apply a commercially available tourniquet to a manikin’s leg in less than 60 seconds [16]. Providing instructions on a notecard with the tourniquet more than doubled the rate of successful placements.

During the Boston Marathon bombing, 29 patients with life-threatening limb exsanguination had 27 improvised tourniquets applied in the field [17]. EMS personnel applied one-third of those tourniquets and non-EMS personnel or an unknown person applied the remainder.

In a 10-year evaluation of isolated penetrating or blunt extremity injury requiring either arterial revascularization or limb amputation at Boston Medical Center, only 2 percent of patients had a tourniquet applied before arriving at the trauma center and all were improvised tourniquets applied by police officers or bystanders [18]. An additional 2 percent of patients had a tourniquet applied by emergency department staff within one hour of arrival. While a very small number of patients without a tourniquet exsanguinated, no patient with a tourniquet died.

During a seven-year period, researchers at Boston Medical Center identified 11 patients who had an improvised tourniquet applied in the field by EMS [19]. Only one patient died, however, that patient was in cardiac arrest when EMS arrived on the scene. Of the 10 patients who survived, all had complete neurologic function in the affected extremity despite having the tourniquet in place for as long as 167 minutes (mean 75 +\- 38 minutes).

One concern about bystander application of a tourniquet is whether the bystander will be able to apply the device tightly enough to be effective. Indeed, a manikin study involving non-medical trained bystanders found that 70 percent of the incorrectly placed tourniquets were judged to be too loose [16]. However, a battlefield evaluation found that although morbidity remained high with partially ineffective tourniquet application (persistent distal pulses), mortality actually improved when compared to totally ineffective tourniquets (continued bleeding) [20]. This suggests that even when tourniquets are not tight enough to be totally effective, they may still be better than no tourniquet at all.

Hemorrhage-control training courses for the lay rescuer
The American College of Surgeons convened a special committee to identify changes necessary to improve survival following active shooter and MCIs [21]. One of the major themes to emerge from these series of meetings, known as the Hartford Consensus, is that the public will act as responders to provide aid before the arrival of professional rescuers.

Another major theme of the Hartford Consensus, which was the focus of the second Hartford Consensus Conference, is the value of a comprehensive educational program for all members of this trauma chain of survival. Critical to this concept and the focus of third Hartford Consensus Conference, is educational campaigns targeting members of the general public, which should include training on how to apply direct pressure, how to use hemostatic dressings, and how to apply tourniquets [22].

In response to the Hartford consensus, the EMS Education Department of the Denver Paramedic Division, in cooperation with the Prehospital Trauma Life Support committee of the National Association of EMTs developed training program targeting ordinary citizens [23]. The 2.5-hour Bleeding Control for the Injured course combines didactic lectures with hands-on training to teach the lay rescuer important life-saving skills such as hemorrhage control and how to open an airway [24].

Also in response to the Hartford Consensus, the White House launched the "Stop the Bleed" campaign [25]. This campaign hopes to provide public awareness to the simple steps that anyone can take to slow life-threatening bleeding. The campaign also promotes the placement of Bleeding Control Kits in public spaces that would allow members of the general public access to life-saving supplies, similar to public access defibrillation programs.

In 2015, the Harvard School of Public Education and the Harvard School of Government began a bleeding control pilot program at Charlotte Douglas International Airport [26]. The team placed bleeding control kits inside of each AED cabinet in the airport. Each kit contained pressure dressings, hemostatic dressings, tourniquets, and personal protective gloves. After training the airport emergency staff on the contents, use and location of the kits, the pilot team in conjunction with airport police, conducted three active shooter scenarios. After-action reporting indicated the responders were able to locate and appropriately use the kits in a simulated incident.

Bystander action is a result of competence from training
The military experience has demonstrated that complications associated with tourniquet use are rare, even when the tourniquet is improvised. The limited civilian data supports the safety of the tourniquets

Bystanders are often present on the scene of a traumatic injury before professional rescuers. In some cases, bystander care may mean the difference between whether the patient survives or not. Experience with CPR and AEDs has demonstrated that bystanders will attempt to intervene especially if they are trained and have easy access to the equipment.

Bystanders who self-report a feeling of competence to provide emergency first aid are more likely to help victims of traumatic injury [27]. That feeling of competence is positively correlated to first aid training. Those with first aid training feel competent to provide care before EMS arrives on the scene to take over [28].

With untrained bystanders as part of the definition of a first responder, the Office of Health Affairs at the Department of Homeland Security recommends the availability of both tourniquets and hemostatic agents in the early management of severe bleeding [7]. Lay rescuers play a vital role in providing immediate bleeding control while awaiting the arrival of traditional first responders [29].

References

1. National Association of State EMS Officials. (2012). Extended definition document NEMSIS/NHTSA 2.2.1 data dictionary. Retrieved from  www.nemsis.org/v2/downloads/documents/Data_Managers_Council_-_Data_Definitions_Project-_Final_Ve..pdf.
2. Schenk, E., Wijetunge, G., Mann, N. C., Lerner, E. B., Longthorne, A., & Dawson, D. (2014). Epidemiology of mass casualty incidents in the United States. Prehospital Emergency Care, 18(3), 408–416. doi:10.3109/10903127.2014.882999
3. Kauvar, D. S., Lefering, R., & Wade, C. E. (2006). Impact of hemorrhage on trauma outcome: An overview of epidemiology, clinical presentations, and therapeutic considerations. The Journal of Trauma, Injury, Infection, and Critical Care, 60(6), S3-S11. doi:10.1097/01.ta.0000199961.02677.19
4. Humphrey, P. W., Nichols, W. K., & Silver, D. (1994). Rural vascular trauma: A twenty-year review. Annals of Vascular Surgery, 8(2), 179-185.
5. Feliciano, D. V., Herskowitz, K., O'Gorman, R. B., Cruse, P. A., Brandt, M. L., Burch, J. M., & Mattox, K. L. (1988). Management of vascular injuries in the lower extremities. Journal of Trauma, 28(3), 319-328.
6. Dorlac, W. C., DeBakey, M. E., Holcomb, J. B., Fagan, S. P., Kwong, K. L., Dorlac, G. R., Schreiber, M. A., Persse, D. E., Moore, F. A., & Mattox, K. L. (2005). Mortality from isolated civilian penetrating extremity injury. Journal of Trauma, 59(1), 217-222.
7. Department of Homeland Security. (2015). First responder guide for improving survivability in improvised explosive device and/or active shooter incidents. Retrieved from http://www.dhs.gov/publication/iedactive-shooter-guidance-first-responders
8. Kragh, J. F. Jr., Walters, T. J., Baer, D. G., Fox, C. J., Wade, C. E., Salinas, J., & Holcomb, J. B. (2009). Survival with emergency tourniquet use to stop bleeding in major limb trauma. Annals of Surgery, 249(1), 1–7. doi:10.1097/SLA.0b013e31818842ba
9. Pelinka, L. E., Thierbach, A. R., Reuter, S., & Mauritz, W. (2004). Bystander trauma care – effect of the level of training. Resuscitation, 61(3), 289-296. doi:10.1016/j.resuscitation.2004.01.012
10. MacDonald, R. D., Mottley, J. L., & Weinstein, C. (2002). Impact of prompt defibrillation on cardiac arrest at a major international airport. Prehospital Emergency Care, 6(1), 1-5. doi:10.1080/10903120290938689
11. O’Rourke, M. F., Donaldson, E. E., & Geddes, J. S. (1997). An airline cardiac arrest program. Circulation, 96(9), 2849-2853. doi:10.1161/01.CIR.96.9.2849
12. Page, R. L., Joglar, J. A., Kowal, R. C., Zagrodzky, J. D., Nelson, L. L., Ramaswamy, K., Barbera, S. J., Hamdan, M. H., & McKenas, D. K. (2000). Use of automated external defibrillators by a U.S. airline. New England Journal of Medicine, 343(17), 1210-1216. doi:10.1056/NEJM200010263431702
13. Valenzuela, T. D., Roe, D. J., Nichol, G., Clark, L. L., Spaite, D. W., & Hardman, R. G. (2000). Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. New England Journal of Medicine, 343(17), 1206-1209. doi:10.1056/NEJM200010263431701
14. Wassertheil, J., Keane, G., Fisher, N., & Leditschke, J. F. (2000). Cardiac arrest outcomes at the Melbourne Cricket Ground and Shrine of Remembrance using a tiered response strategy — a forerunner to public access defibrillation. Resuscitation, 44(2), 97-104. doi:10.1016/S0300-9572(99)00168-9
15. Gundry, J. W., Comess, K. A., DeRook, F. A., Jorgenson, D., & Bardy, G. H. (1999). Comparison of naïve sixth-grade children with trained professionals in the use of an automated external defibrillator. Circulation, 100(16), 1703-1707. doi:10.1161/01.CIR.100.16.1703
16. Goolsby, C., Branting, A., Chen, E., Mack, E., & Olsen, C. (2015). Just-in-time to save lives: A pilot study of layperson tourniquet application. Academic Emergency Medicine, 22(9), 1113-1117. doi:10.1111/acem.12742
17. King, D. R., Larentzakis, A., & Ramly, E. P. (2015). Tourniquet use at the Boston Marathon bombing: Lost in translation. Journal of Trauma and Acute Care Surgery, 78(3), 594-599. doi:10.1097/TA.0000000000000561
18. Kalish, J., Burke, P., Feldman, J., Agarwal, S., Glantz, A., Moyer, P., Serino, R., & Hirsch, E. (2008). The return of tourniquets. Original research evaluates the effectiveness of prehospital tourniquets for civilian penetrating extremity injuries. Journal of the Emergency Medical Services, 33(8), 44–54. doi:10.1016/S0197-2510(08)70289-4
19. Bulger, E. M., Snyder, D., Schoelles, K., Gotschall, C., Dawson, D., Lang, E., Sanddal, N. D., Butler, F. K., Fallat, M., Taillac, P., White, L., Salomone, J. P., Seifarth, W., Betzner, M. J., Johannigman, J., & McSwain, N. Jr. (2014). An evidence-based prehospital guideline for external hemorrhage control: American College of Surgeons Committee on Trauma. Prehospital Emergency Care, 18(2), 163-173. doi:10.3109/10903127.2014.896962
20. Kragh, J. F., Walters, T. J., Baer, D. G., Fox, C. J., Wade, C. E., Salinas, J., & Holcomb, J. B. (2008). Practical use of emergency tourniquets to stop bleeding in major limb trauma. Journal of Trauma Injury, Infection, and Critical Care, 64(Suppl 2), S38–S49. doi:10.1097/TA.0b013e31816086b1
21. Jacobs, L. M., Wade, D., McSwain, N. E., Butler, F. K., Fabbri, W., Eastman, A., Conn, A., & Burns, K. J.. (2014). Hartford consensus: A call to action for THREAT, a medical disaster preparedness concept. Journal of the American College of Surgeons, 218(3), 467–475. doi:10.1016/j.jamcollsurg.2013.12.009
22. Jacobs, L. M. Jr., & the Joint Committee to Create a National Policy to Enhance Survivability from Intentional Mass-Casualty and Active Shooter Events. (2016). The Hartford consensus IV: A call for increased national resilience. Bulletin of the American College of Surgeons, 101(3), 17-24.
23. Pons, P. T., Jerome, J., McMullen, J., Manson, J., Robinson, J., & Chapleau, W. (2015). The Hartford consensus on active shooters: Implementing the continuum of prehospital trauma response. The Journal of Emergency Medicine, 49(6), 878–885. doi:10.1016/j.jemermed.2015.09.013
24. National Association of EMTs. (2016). Bleeding control for the injured. Retrieved from www.naemt.org/education/B-Con.aspx
25. The White House, Office of the Press Secretary. (2015). Fact Sheet: Bystander: “Stop the Bleed” broad private sector support for effort to save lives and build resilience. Retrieved from www.whitehuse.gov/the-press-office/2015/10/06/fact-sheet-bystander-stop-bleed-broad-private-sector-support-effort-save
26. National Preparedness Leadership Initiative. (2015). Public access bleeding control: An implementation strategy.  Retrieved from http://cdn2.sph.harvard.edu/wp-content/uploads/sites/8/2015/10/Team-You-Can-Act-Team-Report.pdf
27. Thierbach, A. R., Pelinka, L. E., Reuter, S., & Mauritz, W. (2004). Comparison of bystander trauma care for moderate versus severe injury. Resuscitation, 60(3), 271-277. doi:10.1016/j.resuscitation.2003.11.008
28. Steele, J. A. (1994). The effects of first aid training on public awareness of the management of a seriously injured patient. Journal of the Royal Society of Health, 114(2), 67–68. doi:10.1177/146642409411400204
29. Jacobs, L. M. Jr., & the Joint Committee to Create a National Policy to Enhance Survivability from Intentional Mass-Casualty and Active Shooter Events. (2015). The Hartford consensus III: Implementation of bleeding control – if you see something, do something. Bulletin of the American College of Surgeons, 100(7), 20-26.

By Olga R. Rodriguez
Associated Press

SAN FRANCISCO — A white nationalist group's rally outside the California state Capitol building turned violent as fighting broke out with a larger group of counter protesters, leaving 10 people injured with stab wounds, cuts and bruises.

Fights erupted when about 30 members of the Traditionalist Worker Party gathering to rally around noon Sunday were met by about 400 counter-protesters, California Highway Patrol Officer George Granada said.

As people tried to leave the area, smaller fights broke out, Granada said.

Sacramento Fire Department spokesman Chris Harvey said nine men and one woman, ranging from 19 to 58 years old, were treated for stab wounds, cuts, scrapes and bruises. Of the injured, two were taken to the hospital with critical stab wounds, but they were expected to survive.

"There was a large number of people carrying sticks and rushing to either get into the melee or see what was going on," Harvey said.

Police were investigating two assaults that happened outside the Capitol grounds, but no arrests have been made, the Sacramento Police Department said in a statement.

The Capitol was on lockdown until protesters cleared the area.

Videos from the melee posted on social media showed mounted officers dispersing a group of mostly young people, some with their faces covered, while some throw stones toward a man holding a stick and being shielded by police officers in riot gear.

A KCRA-TV reporter and his cameraman were caught in an altercation with protesters who shouted "no cameras" as they tried to grab their equipment and shove them away from the crowd.

The victims were all present while the protest took place, said Sacramento Police spokesman Matt McPhail but he said it was still unclear whether and how they were involved.

The Traditionalist Workers Party had scheduled and received a permit to rally for two hours in front of the Capitol. Law enforcement was aware of the counter-protest effort and police deployed more than 100 officers to the Capitol, McPhail said.

The Southern Poverty Law Center has described TWP as a group formed in 2015 as the political wing of the Traditionalist Youth Network, which aims to "indoctrinate high school and college students into white nationalism."

Matthew Heimbach, chairman of the Traditionalist Worker Party, told the Los Angeles Times that his group and the Golden State Skinheads organized the Sunday rally. Heimbach said that in the clash, one of their marchers had been stabbed in an artery and six of the counter-protesters had also been stabbed.

Vice chairman Matt Parrott, who was not present at the Sacramento rally, blamed "leftist radicals" for instigating the violence.

A message left at a phone number for the Traditionalist Worker Party was not immediately returned to The Associated Press.

A post recently uploaded to site of the Traditionalist Youth Network said TWP members planned to march in Sacramento to protest against globalization and in defense of their right to free expression. They said they expected to be outnumbered 10-to-1 by counter-protesters.

"We concluded that it was time to use this rally to make a statement about the precarious situation our race is in," the Traditionalist Youth Network statement said. "With our folk on the brink of becoming a disarmed, disengaged, and disenfranchised minority, the time to do something was yesterday!"

The clash follows a confrontation in March between Ku Klux Klan members and counter-protesters in Anaheim, California in which three people were stabbed.

By Donald J. Mihalek, EMS1 Special Contributor

After Hurricane Katrina hammered the southeastern United States in 2005 and turned New Orleans into a vast, disaster area, the city of roughly 460,000 was largely dysfunctional. Once out of the threatened area, the next priority was treating the sick, wounded and injured. 

The 2010 earthquake that rocked the nation of Haiti left 2.3 million people homeless, destroyed an entire nation and caused massive catastrophic damage and injures, including an estimate 200,000 dead. The extent of the injuries was horrific and required an expertise that was beyond the Haitian government’s capabilities.

When tragedies strike and mass medical care is needed, the U.S. government makes one call to the U.S. Health and Human Services National Disaster Medical System (NDMS) — our nation’s medical tactical response team.

National Disaster Medical System
The NDMS “is a federally coordinated system that augments the nation’s medical response capability.” The idea was originally formed during the Cold War, to respond in case of catastrophic casualties. Since then, NDMS has retooled and primarily assists state and local agencies dealing with medical care during major disasters. 

Their mission is supported by the military and the Department of Veterans Affairs (VA) medical systems. Upon request, NDMS also will deploy to a foreign country to assist that government, as it did in Haiti and other locations around the world, to address major medical disasters. 

This 6,000 person civilian force is always “on call” according to Murad Raheem — also known as “Mojo.” Raheem is the regional emergency coordinator for the Office of the Assistant Secretary for Preparedness and Response (ASPR) for Region II, which covers New York, New Jersey, Puerto Rico and U.S. Virgin Islands.  

“The NDMS system is always ready and has teams pre-positioned and is able to respond anywhere within 12 hours of a request — similar to the way the National Guard responds when called out,” Raheem said. 

The teams will respond to disasters, major special events, like the Inauguration and Super Bowl, and support any state or local entity needing increased medical support. To mobilize these resources during an emergency, a state will ask the Federal Emergency Management Agency (FEMA) for a disaster declaration which includes medical assistance. FEMA then tasks HHS to fulfill that request and they mobilize a federal force that can cover all the medical assets and care one could think of in a tragedy from A to Z.

“NDMS has three main missions: the emergency medical response by NDMS medical teams including the equipment and supplies to a disaster area; movement of ill and injured patients from a disaster area to areas unaffected by the disaster; and the definitive care of patients at hospitals in areas unaffected by the disaster,” Raheem said. 

One of the leverage points for NDMS is its ability to partner with federal agencies including the Department of Defense (DOD), FEMA and the VA.

“These partnerships give us capabilities and resources to draw upon to help us accomplish our mission and handle any surge operations that we may be asked to support,” Raheem said. 

The Teams
Like any force, the NDMS system relies on the team concept to work efficiently and effectively. 

“When people apply for and are hired into the NDMS system, they are assigned to a specific team based on location, expertise and mission set,” Raheem said. 

Once hired into the NDMS, you could be assigned to any one of the following teams.

DMAT: Disaster Medical Assistance Team which is a fully functioning field hospital that can handle everything from minor injuries to bruises and broken bones. The team travels with a host of medical professionals and gear.

DMORT: Disaster Mortuary Operational Response Team which can handle mass-casualty situations. Once they set up, they handle the identification of remains by using scientific techniques as well as collecting information about the deceased from family members.

NVRT: National Veterinary Response Team is a team of veterinary professionals to care for both the working and victims animals in an affected area.

IRCT: Incident Response Coordination Team is deployed to keep track of and coordinate the multifaceted response.

IMSURT: International Medical Surgical Response Team essentially sends the operating room to the field — sort of a M.A.S.H. unit for disasters — to handle major trauma.

USPHS: U.S. Public Health Service will also send trained medical professionals to assist for one-stop manpower shopping.

HHS may ask for DOD support and to bring some major assets like the USNS Comfort, a floating hospital ship to the disaster zone.

The Gear
All teams have access to their own and pre-established caches of equipment and supplies, including all types of medical equipment to set up an emergency department in the field. They also come equipped with a host of support equipment including tents, cots, food, water, communications gear and generators for long term operations.

The equipment caches are stored at warehouses around the country, broken down by geographic response areas. All locations are discreet and kept that way to protect the capability. In addition to gear and medical supplies, these caches have medications of every variety. Due to the aforementioned partnerships, once the caches run low on medications, the NDMS can tap the VA for more medication from their stockpile or use commercial sources just like a hospital.

To get from one place to another, NDMS uses its partnership with the DOD for transportation. The different military branches airlift capabilities support the NDMS mission.

Ongoing training is part of a team’s requirement and members receive regular training on the nonmedical portion of their equipment, including how to package up their gear for rapid transport and deployment. The gear is packaged on pallets in deployment cases, designed for rapid shipment and set up. The typical deployment time is 12 hours from request to fully mission capable.

Joining the Team
To become a member of NDMS, they announce openings anyone can apply for on USAJobs.gov. The teams use doctors, nurses and other medical professionals but also communications specialist, logisticians and coordinators. Once hired, you’re assigned a team in your area and fulfill the duty rotations. 

Teams are on call in three parts of the country; west, central and east. If a mobilization order comes, those on-duty teams get the call first and respond where directed. Reserve teams are then placed on-call to respond if mobilized.

Disaster Planning
 “The most important thing anyone can do is prepare for a disaster. Preparation starts way ahead of the actual disaster and starts with developing a disaster plan, depending on where you are and what you may face,” Raheem said.

He noted that the main components of a good disaster plan include:
•    Stocking provision for three days
•    A method of communication, usually a cell phone
•    A plan to stay in place and another to evacuate
•    Preparing with essential clothing and prescription medications
•    Contact list for family and friends
•    Portable radio with extra batteries and wind up capabilities to stay informed
•    Flashlights and matches
•    Maps of the roads for your evacuation route

“If you evacuate, leave a note in your house with contact information which can be critical for search teams so they can clear your house and not waste time looking for persons that aren’t there. These and other items could be essential pieces of your survival plan,” Raheem said.

“At the end of the day, while NDMS and others will respond to save the day, it is up to each individual to plan, prepare and be ready to execute a plan if disaster strikes and the ability to survive rests solo on you.

By Doug Wyllie, PoliceOne Editor-in-Chief

The months of June, July, August, and September tend to bring a wee bit more of the crazy than is typical in the dead of winter. The Independence Day holiday in particular can increase exponentially the number of intoxicated patients and bystanders you’re likely to encounter on your shift. Here are 10 basic reminders as you head out for what is sure to be a long shift on July 4th.

1. Fireworks can be weapons. Don’t disregard that fact if you’re making contact with partiers.

2. Drunk drivers can hit you, too — both while working at a motor vehicle collision and when you’re driving to or from the station. Watch the road and use L.C.E.S.

3. The 4th can be hot. If you’re working, stay hydrated. Keep a water bottle with you in the ambulance and refill it regularly. 

4. Do the math on the potential for violence: Lots of people plus 4th of July alcohol consumption plus heat equals recipe for disaster. Stay sharp. Remember that drinking and a charged up crowd can inspire some people to be more confrontational with police and paramedics than they would normally be. Be ready for confrontation and to seek cover or concealment.

5. Crowds can quickly get unruly during mass celebrations. Be smart and wait for back-up if you predict you might need it.

6. Repeating #3, the 4th of July can be hot. Wear your body armor, if it is issued to you, anyway!

7. Bone up on your holiday-specific trauma care. Are you ready for treatment of amputations, burns, a bottle rocket to the eye, alcohol intoxication, opopid overdose and dehydration?

8. Don’t forget your own kids. You likely caution others about the dangers of screwing around with fireworks (and other explosives), drunk driving, or drinking too much. Make sure your own kids are included in that discussion.

9. Refresh yourself on water rescue protocol and procedures. Lots of people are in and around the water during the 4th weekend. Be ready if you’re called to a water-related incident. Before going in, on or near the water correctly don a department-issued personal flotation device.

10. Make sure you’ve got a fire extinguisher in your ambulance. With fireworks being lit, the potential for a fire is definitely there. If you’re prepared to act early, you can help avoid a bigger problem.

The Independence Day holiday always serves as a powerful reminder of why our country is great. Be proud of what you do to protect it. We certainly are. Stay safe out there, always.

About the author
Doug Wyllie is Editor in Chief of PoliceOne, responsible for setting the editorial direction of the website and managing the planned editorial features by our roster of expert writers. An award-winning columnist — he is the 2014 Western Publishing Association "Maggie Award" winner in the category of Best Regularly Featured Digital Edition Column — Doug has authored more than 900 feature articles and tactical tips on a wide range of topics and trends that affect the law enforcement community. Doug is a member of International Law Enforcement Educators and Trainers Association (ILEETA), an Associate Member of the California Peace Officers' Association (CPOA), and a member of the Public Safety Writers Association (PSWA). Doug is active in his support for the law enforcement community, contributing his time and talents toward police-related charitable events as well as participating in force-on-force training, search-and-rescue training, and other scenario-based training designed to prepare cops for the fight they face every day on the street. 

Download this podcast on iTunes, SoundCloud or via RSS feed

In this special episode of the Inside EMS podcast host Chris Cebollero and EMS1 Editor-in-Chief Greg Friese discuss the shooting deaths of five Dallas police officers during a protest Thursday night. Cebollero describes the lessons, success and mistakes he made as the Christian Hospital EMS chief during the violence and riots in Ferguson, Missouri. Cebollero makes important points about force protection, staging of ambulances and personnel, awareness of ingress and egress routes, stress management, utilizing unified command, and regularly briefing personnel. 

Listen to the show and share your comments and resources for EMS operations at mass gatherings that turn violent in the comments. 

Additional reading and resources

• What EMS crews experienced on Ferguson Day 1 
• Behind the scenes of Ferguson's mayhem  
• EMS managing stress and fatigue at Ferguson 
• EMS challenges and lessons learned from the Ferguson riots 
• During Ferguson crisis vision statement was foundation for successful leadership 
• Medic describes anger, heartbreak of Ferguson riots 
• EMS coverage for mass gatherings and public events 

What happened: Snipers shot and killed five Dallas police officers. Seven police officers and two bystanders were also shot and injured during a protest of officer-involved shootings in Minnesota and Louisiana earlier this week.

Why it's significant: This is the most deadly law enforcement incident since Sept. 11, 2001. Police officers are public safety brothers and sisters to EMTs and paramedics. They respond with us, call us for help and more than ever they begin medical care — AED use, naloxone administration and tourniquet application — before we arrive.

Top takeaways: This loss of life is heartbreaking and tragic. As we mourn their deaths, worry about the injured officers and try to understand the cowardice of the shooters, we also need to consider our own preparation for responding to incidents at protests, as well as our day-to-day responses to civilians in need of medical care.

1. Mourn and honor the dead
Take a moment, privately or with your colleagues, to pray or think about the loss of life in Dallas. Internalization or the impact of the stress from an event like this is unique to each of us. How you mourn, pay tribute and manage stress from the event is also unique. Manage stress in a way that helps you move forward as a paramedic, partner, parent or spouse.

2. Be conspicuous at all times
In too many response areas, paramedics in blue or black uniforms are indistinguishable from police officers. Be conspicuous in your uniform selection, donning of high-visibility outerwear and parking the ambulance.

As you enter a scene, especially a building, call out regularly, "paramedics coming in" or "paramedics, here to help." Or use some phrase that announces your presence as a caregiver. Repeat throughout the incident, especially if a crowd is gathering, that you are a paramedic and are there to help.

When posting in the ambulance, at protests or as part of normal operations, consider locations that offer cover or concealment. Or pick high-visibility locations.

Regardless of the location, at least one member of the crew has to have their head up, not buried in a smartphone, and their eyes open, scanning their surroundings. Agencies with a predictable posting routine — schedule and locations — need to add variability and randomness to the posting pattern.

3. Be cautious and calm
More and more agencies are making the decision to equip paramedics with body armor. This is a reasonable precaution for every response and especially important when responding to or staging at mass gatherings that are or may become violent.

If your agency is considering an EMS body armor purchase, be thoughtful to the color and lettering. Red, green or light blue with bold 'EMS' or 'PARAMEDIC' distinguishes personnel as caregivers and not combatants.

If you are staging at a protest, be aware that as the crowd moves, grows or disperses the ingress and egress routes for ambulances change. Be situationally aware of the options to drive right, left, forward or backwards.

Don't match the emotional intensity of the crowd or the police officers. Yelling, "Calm the f…' down," never works and your surging adrenaline narrows your field of vision and perception of risks in a volatile environment.

4. Constantly remind the public that medics are the helpers
Every day is an opportunity to remind the public through face-to-face interactions, social network postings and media appearances that paramedics are the helpers. When anyone, civilian or police officer, is sick or injured we will respond, assess and treat with all of the skills and resources we have.

Learn more about mass gatherings and EMS safety. And share your top takeaways in the comments for EMS response to violence at protests and mass gatherings. 

By Lauren Williams
The Orange County Register

SANTA ANA, Calif. — Although he remembers nothing of the night, Jesse Anderson knows he owes his life to four men.

Four months ago, Anderson’s heart stopped while at a hip-hop show at The Observatory in Santa Ana. Amid a crowd growing around them, a cadre of first responders worked to revive the Cypress resident, performing CPR while pleading with him to fight on.

With a heavy sigh on Wednesday, the 20-year-old walked back into the music venue alongside his parents and girlfriend and shook the hands of the four who worked ceaselessly to restore his pulse and breathing.

“What a beautiful day,” said the young man’s father, Jeff Anderson. “Thanks to these men my son is still alive. These are my heroes right here.”

Minutes before midnight on March 6 at a concert for hip-hop group Flosstradamus, Jesse Anderson collapsed onto his girlfriend, Jenna Wood, inside the Observatory. He had just asked for water when his body crumpled.

With the help of a dozen friends and strangers, Wood carried Anderson’s 6-foot 5 frame outside, laying him out in the parking lot. He would later learn, after 10 days in the hospital, that severe dehydration had created an imbalance in electrolytes and denied his heart what it needed to pump blood.

“It was just a complete failure,” Anderson said.

The Observatory’s medic, Ken Decou, pumped air into Anderson’s chest with a bag valve mask, and security guard Duane Lewis pounded on the man’s chest to revive his heart.

Santa Ana police Corporal Oscar Lizardi saw Lewis growing tired and took over chest compressions while Officer John Rodriguez kept the crowd at bay. Both Santa Ana policemen were posted at The Observatory for the concert.

They kept going – and kept going.

“I was so far gone people told them to stop CPR,” Jesse Anderson said. “I can’t thank them enough for sticking to their training.”

While concertgoers told the four to stop their efforts, Lizardi thought of his 14-year-old son.

“We did hear comments like, ‘Stop. Stop. He’s dead,’” Lizardi recalled. “The first thing that came to mind is, ‘This is someone’s son, and I’m not going to stop.’”

Decou gazed into Anderson’s glassy eyes and continued his efforts despite seeing a vacancy.

“The whole time I’m looking into his eyes thinking the worst,” Decou said. “He passed away in our minds.”

They continued lifesaving efforts until paramedics arrived and took Anderson to Fountain Valley Medical Center. He later was transferred to a Los Angeles hospital.

Now, months later, Anderson has recovered. He and his father set out to arrange a meeting with the four men who saved the 20-year-old.

“I owe everything to them right now,” Anderson said. “I can’t be happier to be here.”

The rescuers were pretty happy, too.

“It’s one of the happier moments of my career,” said Rodriguez, a 28-year veteran of Santa Ana’s force.

“It’s like winning the lottery,” Decou said.

Copyright 2016 The Orange County Register

By Megan Schrader
The Gazette (Colorado Springs, Colo.)

COLORADO SPRINGS, Colo. —  Thousands of people lined up for hours Friday to see Republican presidential nominee Donald Trump, and many went home disappointed after the campaign significantly over-ticketed the event and then blamed the Colorado Springs fire marshal for refusing to allow in more spectators.

"I have to tell you this is why our country doesn't work," Trump began his hourlong speech in the University of Colorado at Colorado Springs' Gallogly Events center. "We have thousands of people next door. We have a fire marshal who said, 'Oh, we can't allow more people.' And it really is so unfair to the people. I'm so sorry. I have to apologize, but it's not my fault."

Officials from the university and Fire Marshal Brett Lacey both fired back.

"We weren't the ones that picked the venue. I would say it was just poor planning," Lacey said. "All the facilities in town, when they're designed and built, they have an occupant load limit."

UCCS Chancellor Pam Shockley-Zalabak said the 1,500-person capacity of Gallogly Events Center was included in the contract signed by Trump's campaign. An overflow room was set up in nearby Berger Hall for 1,000 people to watch the speech on television.

"The campaign handled all the ticketing and more tickets were issued than the space available," Shockley-Zalabak said.

A source familiar with the campaign's plans said 10,000 tickets were issued online for the event.

Trump went to the overflow room and addressed the crowd. "If you get the worst report that you have diarrhea, if you have one week to live, I don't care. Get out and vote," he said, after his speech. "If everyone gets out and votes, we can't lose."
Trump accused Lacey of supporting Hillary Clinton.

Lacey took it in stride.

"I did get a phone call requesting an increase in the load, so we allowed a 10 percent increase," he said. "That's not a huge amount, but it allowed 150 more in the one building and 100 more in the other."

Brian Pharies, 54, raved about the presidential hopeful's decision to address people in the overflow room. "That was absolutely brilliant," Pharies said. "He's a very people person."

Others who waited in vain for hours to see Trump weren't as supportive of the campaign.

With both the main event hall and the overflow room at capacity, Victor Dirello, 21, stood next to Trump supporters as they argued with and yelled at protesters opposed to Trump's visit. He got tickets Wednesday to ensure he had a spot.

"I really wanted to see my man," said Dirello, of Colorado Springs. "I figured they would have done it in a better spot."

Asked if he still supported Trump despite being left out of the event, Dirello wasted no time.

"Oh yeah."
___
(c)2016 The Gazette (Colorado Springs, Colo.)

By Randy Ludlow & Catherine Candisky
The Columbus Dispatch

COLUMBUS, Ohio — After hundreds of people were turned away from his rally today, Donald Trump saw politics behind the decision to limit the size of his Columbus town hall to 1,000 people — and made sure the public and press knew it.

Fire and convention center officials say, however, the Republican presidential nominee's campaign knew on Friday that the space would be restricted to 1,000 people.

"We've had thousands of people outside, thousands, who were turned away for political reasons, purely political reasons," Trump told reporters before he spoke at the Greater Columbus Convention Center.

The fire marshal was "given orders — no more than a thousand people ... we could have had four, five, six thousand people ... that's politics at its lowest," said Trump, who later asked his audience, "Is the mayor a Democrat?"

Columbus Assistant Fire Chief Jim Cannell said fire officials met with Trump's staff on Friday to inform them audience capacity was restricted due to nearby exits being blocked by construction on the north side of the building.

He shrugged off Trump's criticism. "We don't get caught up in that ... we're just doing our job."

John Page, general manager of the convention center, confirmed what Cannell said and added that an earlier Trump rally was in a larger space before construction began.

"Initially, (campaign officials) suggested it would be by invitation only," said Jennifer Davis, spokeswoman for the convention center.

The Trump campaign offered tickets online beginning Saturday to the event, with no warning about restrictions on the crowd size. Hundreds — if not a thousand — were turned away disappointed after standing in line along High Street in the heat.

Kenneth Gray, 51, of Columbus, was among those upset, along with his two daughters. Gray said he had entered the convention center only to find that the event bar code on his smartphone would not be accepted. He was told he would need to go to a nearby kiosk to obtain a paper ticket.

"I was here at 1 p.m., I was in, at the front of the line. Now, it's closed," said Gray, who was upset with event organizers. "Why in 2016 would you not accept a bar code?" he asked.

Trump also criticized a fire marshal in Colorado Springs, Colorado last week. The fire marshal there capped the number of people allowed in the Trump rally. Trump then said the fire marshal didn’t know what he was doing and was “probably a Democrat," according to the Denver Post.

Copyright 2016 The Columbus Dispatch