The reason I asked the question is that,even in the rather small scale events in which I have been involved, I have seen all the dedicated first aid items exhausted, making improvisation the order of the day. Improv can often be a necessary strategy.
As was noted in the article I posted upthread, most of the tourniquets used in Boston were, at least initially, improvised. One of the reasons I think that classes such as WFR are so valuable is that they stress improv and thinking outside the box.
Indeed. I think when it comes to mass casualty events they come in such numbers (hence the name) that they just run out of stuff.
Hospitals are well stocked, but I don't think they have on floor and in site enough supplies for around 200 people. In storage plenty of stuff. But not readily available.
And that is exactly why pre-planning and big training exercises are so usefull, and why it paid off big time in Boston. One key part of pre-planning for MCI is to develop (and practice) a system of triage and dispatch, so that the injured are spread out over a number of hospitals, to reduce the odds that any one ER becomes overwhelmed. From
Emergency Planning, Speed Saved Lives After the Boston Marathon Attack:
Rescuer reaction was so instantaneous that it appeared to be rehearsed, and it was: Two years ago, a citywide drill required Boston police, fire-department workers, hospitals and emergency-medical service personnel to react as if bombs had been detonated across the city.
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Dr. Conn praised Boston's emergency medical technicians for spreading patients across the city and not deluging any one trauma center with too many critical patients. Dr. George Velmahos, Mass General's chief trauma surgeon, said the hospital—from its janitors to highest management—had prepared for such an event, with ample blood supply and materials for an influx of near-death patients. The hospital had finished trauma drills before with mannequins, and several doctors, including Dr. Velmahos, have worked in war-torn nations.
One of my favorite quotes:
"Plans are worthless.....but planning is essential" - General Dwight EisenhowerYou can never know exactly what is going to happen, so things will never go exactly as you planned. But it is usually much easier to modify an existing plan to fit new circustances, than to create a plan totally on the fly under extreme stress.