Mass CasualtyIncident

Preparation for EMS

Mass Casualty Incident (MCI)

• Definition– An incident which produces

multiple casualties such that emergency services, medical personnel and referral systems within the normal catchment area cannot provide adequate and timely response and care without unacceptable mortality and/or morbidity.

Chronology of a Disaster • Incident with multiple casualties reported to CCE

Central Dispatch– Police/Fire/EMS are dispatched by CCE.– Incident Command is established on scene– Size up identifies mass casualty event.– Incident Commander notifies Central Dispatch to activate the

Mass Casualty Plan– Incident Commander establishes staging area and requests

additional resources.

Flow Chart

911Call

911Call Fire

Fire

LawLaw

EMSEMS

IncidentCommand

IncidentCommand

Size-upSize-up

ActivateMassCasualtyPlan

ActivateMassCasualtyPlan

CentralDispatch

CentralDispatch

EstablishCommandPost

EstablishCommandPost

Chronology (continued)

• Central Dispatch Activates Mass Casualty Plan – Central Dispatch notifies

area hospitals of plan activation

– Central Dispatch obtains available EMS units from adjacent locations and directs them to staging

– Central Dispatch notifies County Coordinator of plan activation

– Central Dispatch requests channel priority

EstablishCommandPost

EstablishCommandPost

NotifyEMC

NotifyEMC

EMS Ground

StagingStaging

AmbulanceAmbulance

HelicopterHelicopter

EMS Ground155.295 VHF

CentralDispatch

CentralDispatch

AlternateAlternateTransport

Transport

KK

EMSCommand

EMSCommand

VictimCollectionArea

VictimCollectionArea

On-sceneTreatment

On-sceneTreatment

TriageTriage

MedicalControl

MedicalControl

NotifyArea Hospitals

NotifyArea Hospitals

DetermineCapacity

DetermineCapacity

ActivateHospitalEmergencyPlan

ActivateHospitalEmergencyPlan

ActivateHospitalEmergencyPlan

ActivateHospitalEmergencyPlan

AlertNearest Hospital

AlertNearest Hospital

TX or 800Mghz

155.340 VHF HERN

ActivateEOC

ActivateEOC Tracking

Tracking

AdditionalResources

EmergencyDeclaration

EmergencyDeclaration

StateEOC

StateEOC

PIOPIO

EMS RESPONSE• First arriving unit:

Senior EMS responder assumes Command role– Put on EMS Command EMS Command vest– Assist IC in locating staging– Establish victim collection area– Deploy Mass Casualty Kit– Strip rig for use at triage

EMS RESPONSE

• First arriving Unit:

Second EMS responder assigned role of Triage Officer

- Put on Triage OfficerTriage Officer Vest

- Triage and tag victims

- Use MFR or medically trained volunteers

EMS RESPONSE

• Second Arriving Unit:Third EMS person assigned role of

transportation officer- Put on Transportation OfficerTransportation Officer

vest- Establish communications with

Medical Control Hospital via HERN on 155.340

- Establish communications with staging on EMS Ground 155.295

- Strip rig of gear for use at victim collection point

EMS Response

• Second arriving Unit:Fourth EMS responder

assigned role of Treatment Officer

- Put on Treatment OfficerTreatment Officer vest- Supervise establishment of

victim collection area- Supervise treatment of

victims in collection area

Victim Collection Point

• Select secure area with protection from further injury

• Accessibility for transporting ambulances

• Use ground sheets from mass casualty kit

• Identify each Priority area with colored flag

EstablishCommandPost

EstablishCommandPost

NotifyEMC

NotifyEMC

EMS Ground

StagingStaging

AmbulanceAmbulance

HelicopterHelicopter

EMS Ground155.295 VHF

CentralDispatch

CentralDispatch

AlternateAlternateTransport

Transport

KK

EMSCommand

EMSCommand

VictimCollectionArea

VictimCollectionArea

On-sceneTreatment

On-sceneTreatment

TriageTriage

MedicalControl

MedicalControl

NotifyArea Hospitals

NotifyArea Hospitals

DetermineCapacity

DetermineCapacity

ActivateHospitalEmergencyPlan

ActivateHospitalEmergencyPlan

ActivateHospitalEmergencyPlan

ActivateHospitalEmergencyPlan

AlertNearest Hospital

AlertNearest Hospital

TX or 800Mghz

155.340 VHF HERN

ActivateEOC

ActivateEOC Tracking

Tracking

AdditionalResources

EmergencyDeclaration

EmergencyDeclaration

StateEOC

StateEOC

PIOPIO

Coordination

• Treatment Officer advises Transportation Officer when victim ready for transport.

• Staging sends ambulance and load patient

• Treatment Officer advises Medical Control of patient’s Priority Chief complaint Gender and age

• Medical Control assigns hospital destination

Coordination (continued)

• Transportation Officer verbally advises ambulance of destination

• Ambulance transports patient observing radio silence unless en-route emergency

• Ambulance monitors HERN on 155.340

• Once patient delivered, ambulance returns to Staging for re-assignment

NMHNMH

CAHCAH

CMHCMH

OtsegoOtsego

MunsonMunson

StraitsStraits

TreatmentTreatment

ReleaseRelease

TransferTo OtherFacility

TransferTo OtherFacility

MorgueMorgue

Flow Chart continued

Staff & Equipment

• Mass Casualty Kit

- Request from nearest EMS agency

• Fire and first responders– Move patients to established

Collection Points

• Arriving EMS units– Report to staging– Move up when directed by

Transportation Officer

Staging

• Staging area established by IC with advice from Medical Command

• CCE notified of Staging Location

• Staging and Transportation communicate on freg.155.295

• Assets and Resources are dispersed

General Considerations • Agency Responses

– Police– Fire – EMS

• Command Responsibility– Initial Agency on Scene

• Multiple Disciplines– Unified Command

Communication

• Obstacles– Terrain– Different Frequencies– Overloaded channels

• Hospital– Medical Control– Patient Routing– Transportation Officer– Staging Officer

Things to Remember…• Maintain strict radio procedures• Enroute communications must

be limited to urgent matters only• Transport patients in adequate

vehicles• Transport patients with

adequate escort staff• Maintain a log of all Patients

(PCR)

IN REVIEWIN REVIEW

Flow Chart

911Call

911Call Fire

Fire

LawLaw

EMSEMS

IncidentCommand

IncidentCommand

Size-upSize-up

ActivateMassCasualtyPlan

ActivateMassCasualtyPlan

CentralDispatch

CentralDispatch

EstablishCommandPost

EstablishCommandPost

EstablishCommandPost

EstablishCommandPost

NotifyEMC

NotifyEMC

EMS Ground

StagingStaging

AmbulanceAmbulance

HelicopterHelicopter

EMS Ground155.295 VHF

CentralDispatch

CentralDispatch

AlternateAlternateTransport

Transport

KK

EMSCommand

EMSCommand

VictimCollectionArea

VictimCollectionArea

On-sceneTreatment

On-sceneTreatment

TriageTriage

MedicalControl

MedicalControl

NotifyArea Hospitals

NotifyArea Hospitals

DetermineCapacity

DetermineCapacity

ActivateHospitalEmergencyPlan

ActivateHospitalEmergencyPlan

ActivateHospitalEmergencyPlan

ActivateHospitalEmergencyPlan

AlertNearest Hospital

AlertNearest Hospital

TX or 800Mghz

155.340 VHF HERN

ActivateEOC

ActivateEOC Tracking

Tracking

AdditionalResources

EmergencyDeclaration

EmergencyDeclaration

StateEOC

StateEOC

PIOPIO

NMHNMH

CAHCAH

CMHCMH

OtsegoOtsego

MunsonMunson

StraitsStraits

TreatmentTreatment

ReleaseRelease

TransferTo OtherFacility

TransferTo OtherFacility

MorgueMorgue

Flow Chart continued

QUESTIONS?QUESTIONS?