MCI/ Multi MCI/ Multi patient patient Emergencies & Emergencies & TriageTriage

Class ObjectivesClass Objectives

• Describe an Describe an MCIMCI• Develop and implement an initial Develop and implement an initial

action plan for the MCIaction plan for the MCI scene scene• Describe & demonstrate Describe & demonstrate proper size upproper size up

of an MCI sceneof an MCI scene• Describe the term Describe the term STARTSTART

Class Objectives Class Objectives continuedcontinued

• Describe & demonstrate Describe & demonstrate proper triageproper triage techniquestechniques & isolation procedures & isolation procedures

• Demonstrate the use of prioritized Demonstrate the use of prioritized tag tag colors for triagecolors for triage identification identification

• Demonstrate the proper Demonstrate the proper communications procedurescommunications procedures with with Medical ControlMedical Control

• Apply Apply MCI & START proceduresMCI & START procedures to table to table top exercisestop exercises

MCI DefinitionsMCI Definitions

MCI is defined as a medical incident MCI is defined as a medical incident that initially overwhelms the ability that initially overwhelms the ability

of responders to initially provide of responders to initially provide normal levels of care to injured normal levels of care to injured

victims.victims.

Initial MCI ProceduresInitial MCI Procedures

MCIMCI– A A Transportation Unit LeaderTransportation Unit Leader will be will be

assigned and will communicate START assigned and will communicate START color and accident mechanism to the DCHcolor and accident mechanism to the DCH

– DCH will direct DCH will direct EMS Transportation Unit EMS Transportation Unit LeaderLeader to appropriate destinations to appropriate destinations

– EMS crews EMS crews WILL NOTWILL NOT contact destination contact destination hospital with patient info while en route. hospital with patient info while en route.

Initial MCI ProceduresInitial MCI Procedures

– The initial arriving unit will notify The initial arriving unit will notify their dispatch center their dispatch center andand the DCH of the DCH of emergency type as well as a size-up emergency type as well as a size-up of the incidentof the incident

– DCH will contact other area hospitals DCH will contact other area hospitals to notify them of the incidentto notify them of the incident

Initial MCI ProceduresInitial MCI Procedures

– Once command is established the IC Once command is established the IC shall provide their DCH an shall provide their DCH an update of update of conditions conditions so they can so they can jointlyjointly determine determine if an MCI should be declared if an MCI should be declared

– The DCH will notify other area hospitalsThe DCH will notify other area hospitals– EMS crews WILL NOT contact destination EMS crews WILL NOT contact destination

hospital with patient info while en route.hospital with patient info while en route.

Update of conditions to the Update of conditions to the MCHMCH

ICS Title or the Unit NumberICS Title or the Unit Number Notification that a possible Mass Notification that a possible Mass

Casualty Incident exists.Casualty Incident exists. An estimated number of An estimated number of

patients.patients. Complicating circumstances (i.e. Complicating circumstances (i.e.

hazmat, safety hazards, etc.)hazmat, safety hazards, etc.)

Successful MCI Successful MCI managementmanagement

Paint a picture for incoming unitsPaint a picture for incoming units– Size upSize up

Communicate an action planCommunicate an action plan– By radio or on scene briefingBy radio or on scene briefing– Using Incident prioritiesUsing Incident priorities

Make assignmentsMake assignments– ICS positions as needed ICS positions as needed – Patient carePatient care

Carry out assignments to mitigate the Carry out assignments to mitigate the incidentincident

Scene Size upScene Size up

How many vehicles involved? How many vehicles involved? Or Or type of facility involvedtype of facility involved

Mechanism Mechanism (head on, rollover, rear-end, (head on, rollover, rear-end, T-bone, Explosion, derailment, etc.)T-bone, Explosion, derailment, etc.)

Speed Speed (if MVA- High, Medium, low)(if MVA- High, Medium, low) Special Hazards - Special Hazards - Chemicals, Explosion, Chemicals, Explosion,

Radiation, etc. Radiation, etc. Number of Patients if knownNumber of Patients if known Name & locate commandName & locate command

Scene Size upScene Size up

““E1711 is on the E1711 is on the scene of a one scene of a one car medium car medium speed rollover- speed rollover- car is upright, 4 car is upright, 4 patients, E1711 patients, E1711 is starting triage, is starting triage, this will be 240 this will be 240 command”command”

Developing an Action Developing an Action PlanPlan

Incident PrioritiesIncident Priorities

– Life safetyLife safety– Incident StabilizationIncident Stabilization– Property conservationProperty conservation– Environmental issuesEnvironmental issues

Developing an action Developing an action planplan

Using the Using the incident priorities incident priorities how will we how will we mitigate the mitigate the incident?incident?

MCI plan gives us MCI plan gives us a framework to a framework to operate fromoperate from

Initial on scene Initial on scene prioritiespriorities

• Establish Establish CommandCommand & & aa Command PostCommand Post• ID hazards and control or eliminate themID hazards and control or eliminate them• Perform Perform STARTSTART• Establish a Establish a treatment area & staging areatreatment area & staging area• Give an Give an updated reportupdated report on conditions to on conditions to

DCHDCH• Request Request additional resourcesadditional resources through the through the

fire coordinator or dispatch agency fire coordinator or dispatch agency • Establish Establish medical communicationmedical communication with with

medical control (Transportation Unit Leader)medical control (Transportation Unit Leader)

Secondary on scene Secondary on scene prioritiespriorities

• Establish a Establish a Staging AreaStaging Area for non- for non-ambulance resourcesambulance resources

• Establish an Establish an Ambulance Staging AreaAmbulance Staging Area for for ground ambulances ground ambulances

• Establish an Establish an Ambulance Loading zoneAmbulance Loading zone accessible to the treatment areaaccessible to the treatment area

• Establish aEstablish a Helispot Helispot in a safe and in a safe and appropriate area if neededappropriate area if needed

• Assign resources to Assign resources to build an organizationbuild an organization of sufficient size to deal with the situationof sufficient size to deal with the situation

Communication toolsCommunication tools

11stst call while en route - call while en route - HEAR HEAR radioradio

22ndnd call Size-up - Cell phone or call Size-up - Cell phone or HEAR. HEAR.

STARTSTART

SSimple imple

TTriageriage

AAnd nd

RRapid apid

TTransportransport

• Developed in early 1980’s by Newport Beach Fire & Hoag Hospital

• Rapid Approach to triaging large numbers of casualties

• Easy to remember

STARTSTART

Initial patient assessment Initial patient assessment and treatment should take and treatment should take less than less than 30 seconds30 seconds for for

each patienteach patient

STARTSTART First Step- Clear the walking First Step- Clear the walking

wounded using verbal instructionswounded using verbal instructions– Direct them to the treatment areas Direct them to the treatment areas

for detailed assessment and for detailed assessment and treatmenttreatment

– Tag these patients as MINOR Tag these patients as MINOR GreenGreen

Now check your Now check your RPM’sRPM’s

STARTSTART RRPMPMRRespirationsespirations

– None- Open the airwayNone- Open the airway Still none?- Deceased Still none?- Deceased BlackBlack Restored?- Immediate Restored?- Immediate RedRed

– Present?Present? Above 30?- Immediate Above 30?- Immediate RedRed Below 30?- Below 30?- CHECK CHECK PERFUSIONPERFUSION

STARTSTART RRPPMMPPerfusionerfusion

– RadialRadial Pulse Absent Pulse Absent

or Cap refill >2 seconds or Cap refill >2 seconds

Immediate Immediate RedRed

– Radial pulse present or Radial pulse present or Cap refill Cap refill <<2 seconds2 seconds

CHECK MENTAL STATUSCHECK MENTAL STATUS

STARTSTART RPRPMMMMental Statusental Status

– Can not follow simple commandsCan not follow simple commands

(Unconscious or altered LOC)(Unconscious or altered LOC)

Immediate Immediate RedRed

– Can follow Simple commandsCan follow Simple commands

Delayed Delayed YellowYellow

STARTSTARTIf the patient is immediate- If the patient is immediate- priority 1-priority 1-RedRed upon initial upon initial assessment, attempt only to assessment, attempt only to correct the airway blockage or correct the airway blockage or uncontrolled bleeding before uncontrolled bleeding before moving on to the next patientmoving on to the next patient

STARTSTARTWhen things get hectic with When things get hectic with multiple patients rev up your multiple patients rev up your RPMRPM’s’s

– RR - Respiration – 30 - Respiration – 30– PP - Perfusion – 2 - Perfusion – 2– MM - Mental status – Can do - Mental status – Can do

Start Start TriageTriageWalking wounded

Yes

Respirations

Over 30

Under 30

Perfusion

Cap Refill

Radial pulse

absentControl

Bleeding

Immediate

Under 2 sec.

No

Position Airway

Over 2 sec.

Mental Status

Radial Pulse Present

Follows simple

instructions

Cannot Follow simple instructions

Yes No

STARTSTART

Remember in START triage there Remember in START triage there are only are only 3 treatment options 3 treatment options during triageduring triage– Open the airway & insert an airwayOpen the airway & insert an airway– Apply pressure to bleedingApply pressure to bleeding– Elevate an extremityElevate an extremity

The The STARTSTART process permits a very few process permits a very few rescuers to rapidly triage a large rescuers to rapidly triage a large number of patients without specialized number of patients without specialized trainingtraining

After After STARTSTART is completed, patients are is completed, patients are moved to treatment areas where more moved to treatment areas where more detailed assessment and treatment detailed assessment and treatment are conductedare conducted

STARTSTART

STARTSTART Concept and Flow ChartConcept and Flow Chart

Property of Newport Beach Fire and Property of Newport Beach Fire and MarineMarine

From theirFrom their

START Simple Triage & Rapid Treatment-START Simple Triage & Rapid Treatment-

A race with timeA race with time