My First Mass Casualty Incident (It’s ok to be ok)
“The day was uneventful until (…) One particular truck driving well in front of us, with its heavy 50+ passenger load, lost its brakes and went over the cliff.”
At 21 years old I experienced my first mass casualty incident, it the first time I’ve ever wished anyone to die with all my might. A child. I wished a child dead.
Let me explain…
In 1999, I left for a deployment to a country most Canadians have never heard of, and almost all Australians recognize. East Timor is a small island north of Australia that, at the time, was going through crisis and wanting to establish their independence from Indonesia. At 21 years old, I didn’t really have a clue what was going on from a political standpoint. I was once again augmenting at a regular force unit and was picked by our the team lead to deploy because of my no-nonsense work ethic, something I prided myself on. I saw the deployment as an opportunity to finally sit at the big kids table.
Politics aside, my team was in East Timor to provide satellite communications for the Canadian contingent. We hitched a ride with the Air Force on a C-130 Herc on an around-the-world trip and flew 36hrs in the rumbling, noisy, uncomfortable plane to reach our staging location in Darwin, Australia. We had one night at a hotel in Darwin, where I called home to my coworker and friend Kyle, crying. I admittedly had no idea what I was getting into, and the unknown was scary for this kid. After a few reassuring words, I hung up and pulled myself together since there was no turning around now. We flew on an Australian C-130 the next day into Dili, East Timor and set up our headquarters in a bombed out, filthy, barely liveable building - our home for the next 6 months.
This was over 20 years ago, yet, there’s one day that I can remember every single moment of. The next trauma on the timeline. The feelings, words, emotions, sights, and smells. The panic. Most of all, I remember her big brown eyes staring at me in fear as she took her last breaths. And to be brutally honest, when she did take that last breath, I felt relief.
East Timor, January 2000.
“In a split second realization set in and it became painfully clear. There were four of us, multiple wounded, no medics, help was hours away, and all we had was a satellite phone with crappy reception and my handy backpack of extras. This was a mass casualty.”
ONCE upon a time in a land far far away…
It was a beautiful sunny day and we were heading out on a vehicle patrol to another district for a reason I frankly can’t remember. It was refreshing as all get out to finally be allowed to spring free from our main camp. So I stuffed a backpack with all-the-extras which seemed necessary to me. It was a mix of experience, worry, and gut feeling that drove me to over pack. In went garbage bags, supplemental first aid kits, bottles of water, snacks, extra note pad, warm clothing, ranger blanket, and glow sticks. In hindsight, I think I would have made a damn good boy scout.
Oh, how the men gave me a few good jabs for bringing so much! Typical girl…blah blah blah. Is your makeup bag in there too? It was just a simple vehicle patrol out to a site and back. Easy peasy. No need for so much.
All in good fun, we were a great team and I didn’t mind the joking around.
The incident
The day was uneventful until we began our route back. The roads along the coast were narrow, curvy, and bordering on steep cliffs to the one side. We were in the rainy season, so the greenery was lush and lining the landscape. With the sun shining down, I was sitting in the back seat listening to Buffy the Vampire Slayer soundtrack and Pearl Jam on my walkman. Driving well in front of us, a truck with its heavy 50+ passenger load, lost its brakes and went over the cliff. Just. Like. That.
Coming up behind them, we spotted a man waving at us to slow down and drive around. It seemed odd and out of place. There were dark lumps along the road. No, not lumps. People. People were scattered everywhere. I remember thinking that it looked like another movie scene but still not processing what was going on as we approached. Where did all these people come from? Why is everyone lying down?! I turned off my music.
My eyes widened as realization set in and it became painfully clear. There were four of us, multiple wounded (over 30 people), no medics, help was hours away, and all we had was a satellite phone with crappy reception and my handy backpack of extras. This was a mass casualty.
“Mass Casualty Incident: An incident which generates more patients at one time than locally available resources can manage using routine procedures. It requires exceptional emergency arrangements and additional or extraordinary assistance.” ~ WHO
Well shit.
Although the guy on the road was trying to wave us through, it wasn’t a question, we were stopping and going to do everything we could to help.
The little girl
My coworker and I walked down the road to the far end quickly trying to identify who needed help first. There was a man and woman frantically waiving me over. A girl lay in front of them, she was young and her injuries, mostly internal from impact, were substantial. I assumed it was their daughter, their desperation and pleading near broke me. I kneeled down and started first aid. Except there weren’t many external injuries to address and after those were taken care of, there was nothing left I knew to do to help.
If these poor people only knew that I worked with radios for a living. I had no clue beyond basic first aid and maybe a little common sense. Her parents watched and pleaded with me to do more, over and over again. And what did first aid teach you about internal injuries?! Not a whole hell of a lot in those days. What I needed in that itty bitty first aid kit was a magic wand, or a surgeon maybe. I had no idea what to do and medics were still hours away. It was disheartening to say the least.
She was dying before my eyes and there was nothing else to do but let it happen. Maybe pray. Which I did, even though I’m not religious by any means. I held her hand, smiled as a means of comfort, and sang a lullaby. A fucking lullaby, an utterly ridiculous thing to do but I had no idea what else to do. My coworkers didn’t either when they came over to check before moving on the help others. She was wavering in and out of consciousness, crying from pain and likely fear. So I sat there humming softly and thinking in my oh-so-wise twenty one year old mind that this just sucks. I wasn’t praying for her to live, but for her to die swiftly. My mind was repeating “please die, die die die” over and over. She was suffering and I could barely handle it.
Time froze, the chaos faded away, and it was just her and I. A beautiful but scared brown eyed little girl on her way out of this world. When her hand gently let go of mine with that last moment, I took a long deep breath, looked her parents and shook my head to say she’s gone, and then got up and went to help the other injured.
The odds
Moving along, I stopped at a critically injured man with a skull fracture exposing his brain. It was 1.5 inches wide which seemed the same as it were 10 inches. How the hell were we going to fix this? The only thing we had to help clean out the dirt ridden wound was the bottled water, so that’s what I did. You just do what you can do. It was so incredibly surreal. Pretty sure we arranged a medevac by chopper for him, but again, it’s all a haze. I have no clue anymore. Surprisingly (and thankfully), he survived and we visited him days later at the Australian field hospital.
The rest is a bit of a blur, there was triage, the call over the satellite phone for a medical evacuation, the boys going down the cliff to help bring up the injured and eventually, field ambulances arriving. I remember feeling yet again, calm in the moment.
The Lessons
Listen, this experience was a gift. It was a gift because we were there to help and it could have been much worse. A gift because it enabled me to develop stronger coping skills, gave self-confidence in my ability to react in stressful situations, and forced an exploration of self and spirituality.
It was a moment of personal and professional growth that set the tone for how I’d react and adapt to similar situations in the future.
“Trauma is a fact of life. It does not, however, have to be a life sentence.” ~ Peter A. Levine
Looking back there are a few lessons that learned that day:
Feel all the feels in whatever way feels best (so long as it’s not destructive to yourself or others): We came back from that patrol exhausted and in silence. We did talk about it later and that made a difference. It was acceptable to cry and normal to be angry but I was neither. Instead I journaled the heck out of the event. The moment was acknowledged and I was able to feel all the feels through writing. All that energy and emotion also made for an epic workout the next day…and then it was done. Fait accompli.
Boy scouts are smart cookies: We used absolutely everything that I had stashed in the backpack earlier that morning. The bottled water to clean wounds, the notepad by writing injuries to help triage patients for the medics, extra food, and obviously everything in the extra first aid kits. Now a days I hike with a day pack that even MacGyver would be impressed with. Emergency everything. Extra everything. I don’t mind the added weight in exchange for peace of mind.
Reflection of reactions: Take the time to reflect on which coping skills you want to keep, want to chuck, and/or want to build on. What serves and doesn’t serve? Bursting out in anger…not so much useful. That energy and emotion has to go somewhere though so if it’s running or writing or peer support or therapy or cleaning (my go to) – roll with it. It’s amazing how clean my house gets during a rough week. That’s productive. Reflection tends take honesty though, a boat load of humble pie, and sometimes exposes an uncomfortable vulnerability. Ugh. That said, it is usually always worth it.
It’s ok to be ok
With so many mental help campaigns on the go lately, we are all starting to understand and respect that it’s ok to not be ok. It is part of our beautiful humanity to experience challenges and to be challenged from them. It is ok to not be ok. Definitely.
On the flip side, as long as you’ve processed the event and you’re not bottling up your experiences for a dark rainy day…it’s ok to be ok too. With so many friends and coworkers experiencing post-traumatic stress disorder (PTSD) – that one took me a while to figure out. I usually run into the misconception that if you’ve experienced trauma and you must have PTSD. Umm, no. We experience/process/feel/cope/heal differently which is part of the beauty. It is how we perceive the event and there are so many factors that come into play with that…well, a person with a much higher education than mine should explain it. That said, no one is unique in their experience/process/feelings/coping/healing. We are diverse but never alone.
Life is good
This experience doesn’t weigh me down and it doesn’t even make me sad to tell you the truth. Not that I don’t care mind you, a child literally died in my arms, of course I care. Its just that I’ve had time to process and came to terms with it. Mostly I’m thankful. What I learned served well in the years to come and I’m appreciative for this damn good life of mine.
The final thoughts swirling around in my head are that I think that trauma and tragedy are as much a part of life as the shining sun, that healthy coping skills are some of the most important gifts to teach/discover, and we’re really just all in this big mess called life together.