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VOL. 40 | ISSUE 7 COVER REPORT: MASS-CASUALTY RESPONSE 15 Tornado Wreaks Havoc on Missouri Town St. John’s Medical Center evacuates after sustaining a direct hit from the May 23 tornado that devastated Joplin, MO By Susan Nicol 42 EMS Response to Active- Shooter Incidents How EMS can train to better respond to these inevitable unfortunate incidents By Jim Morrissey, MA, EMT-P 49 Body Count Defi ning EMS’ response to mass-fatality events By Raphael M. Barishansky, MPH, & Dennis C. Wood, MS, NREMT-P FEATURE 55 Does Your Patient Need a Trauma Center? Utilizing the CDC’s Trauma Triage Guidelines in the fi eld By Joshua Bucher, BA, EMT-P 15 Exclusive Supplement to (14'+)0 'ZEJCPIG FIND THE Foreign Exchange Supplement BETWEEN pages 34 & 35 TABLE OF CONTENTS U.S. EMS Leaders Visit the Front Lines of Israeli MCI Response: An Exclusive Report COLUMNS 24 EMS RERUNS Subservience By Thom Dick 26 BEYOND THE BOOKS Don't Forget Your Roots By Mike Smith, BS, MICP 28 CASE REVIEW The Gravity of the Situation By James J. Augustine, MD, FACEP 36 ASSESSMENT TIPS Assessing the Head and Neck By William E. Gandy, JD, LP, & Steven “Kelly” Grayson, NREMT-P, CCEMT-P 42 CE ARTICLE 59 Abdominal Pain in Females By Kevin Collopy, BA, FP-C, CCEMT-P, NREMT-P, WEMT, Jake Kleinman, MD, EMT-D, Sean Kivlehan, MD, MPH, NREMT-P, & Scott Snyder, BS, NREMT-P y ,, Sponsored by EMS World® 7598 or fax: (ISSN 1946-9365) is published monthly by Cygnus Business Media, 1233 Janesville 800/543-5055. The publisher reserves the right to reject nonqualified subscribers. Ave., Fort of Childbearing Years Management of the potentially pregnant female with abdominal pain can be broken down into simple steps 66 LIFE SUPPORT Social Not-working By Mike Rubin, BS, NREMT-P DEPARTMENTS 10 EMS World Online 12 From the Editor 15 News Network 51 Advertiser Index 58 EMS Product News 65 Classifi ed Ads Cover: A pile of cars tossed on each other rest in the parking lot of St. John’s Regional Medical Center after the devastating tornado that hit Joplin, MO, on May 23, 2011. The tornado directly hit the small Midwestern city’s main hospital. REUTERS/Ed Zurga. One-year subscriptions for nonqualified individuals: U.S. Atkinson, WI 53538. For subscription information or change of address call: 877/382-9187 or 847/559- $40; Canada and Mexico $55; all other countries $80. Payable in U.S. funds drawn on a U.S. bank. EMS World is published monthly. POSTMASTER: Please send change of address to EMS World, P.O. 3257, Northbrook, IL 60065-3257. Canada Post PM40612608. Return undeliverable Canadian Addresses to: EMS World, PO Box 25542, London, ON N6C 6B2. Printed in U.S.A. GST #131910168. CHANGE OF ADDRESS notices should be sent promptly. Provide old mailing label as well as new address; please include ZIP code. Allow 2 months for change to take effect. PUBLICATION OFFICES: Address all communications to EMS World, P.O. Box 7248, Mission Hills, CA 91346-7248. Telephone: 800/547-7377. Internet: EMSWorld.com. The views and opinions in the articles herein are not to be taken as official expressions of the publishers, unless so stated. The publishers do not warrant, either expressly or by implication, the factual accuracy of the articles herein, nor do they so warrant any views or opinions offered by the authors of said articles. © Copyright 2011 by Cygnus Business Media. All rights reserved. No part of this publication may be reproduced in any form or by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from EMS World. Periodicals postage paid at Fort Atkinson, WI, and additional mailing offices. EMSWORLD.com | JULY 2011 9 Photo courtesy Mercy Health Photo by Josh Kennedy Photo by Dan Limmer Photo by Dan Limmer