MULTI-CASUALTYINCIDENTS

A Review and Update for

EMS Command

MCI Overview

• General Purpose:– To review/refresh Multi-Casualty Incidents

and how they work in the Incident Command sequence

• Appropriate identification of an MCI• Initiation of the Incident Command System• Build-out of the Incident Command System for:

– Small scale incidents– Large scale incidents

MCI Overview

• Performance Objectives– At the end of this presentation, the

participants shall be able to:• Implement the Incident Command System for

an MCI• Correctly identify an MCI• Successfully navigate their assigned role in a

mock MCI

?Has this happened to you

OR

Maybe you did this……..

Patients are in units and no one knows anything about them.

The Medic left scene with the first patient he/she saw.

You arrive. No information available but….”See my cool Jimmie Jacks”.

Trauma patient count confused by communications issues.

Packaged patients waited 10 minutes for transport units that were requested one by one.

There has to be a better way!!!!!!!

You can do this!!!!

Initiate the Incident Command Sequence

• 1st arriving unit officer should:• Assume command• Declare the incident an MCI• Request additional resources• Perform triage

Initiate the Incident Command Sequence

• The following functions must occur:– Triage– Treatment area, if appropriate (small v.

large scale)– Transport/Communications

Command Designation Options

• IC retains EMS functions (triage, treatment, etc.)

• IC designates an EMS Group Supervisor – Build out based on incident scope/span of

control

TRIAGE/TREATMENT

• Small scale incident– Apply Triage identifier (ribbon, tag)

– Report patient count to EMS Group Supervisor or IC

• Regardless of Triage color

– Initiate treatment of patients in place– No formal treatment area

• Large scale incident– Apply Triage identifier– Patients moved to designated Treatment

areas (Triage Officer)– Patient information gathered in Treatment

area (Treatment Officer)

TRIAGE/TREATMENT

Treatment Areas

• Large scale event• Assign group supervisor

– Sub-divide into appropriate colors• Location Considerations

– Safety– # of patients – Removal of pts from scene

• Refine patient count– Re-assess/re-triage– #/color

• Update resource needs

Transportation/Communications

– HospitalCommunications• Sm v Lg scale• “Call Down” plan• High priority pts to appropriate hosp.• Dispatch center likely overwhelmed• Role of Communications Group Sup v

individual transport units

– Movement of Patients• Based on hospital availability?• Coordinate w/ Staging• Record keeping

Communication Options

• Communications Officer may:– make all communications with hospital(s)– designate ALS consults only. All others

via Communications Officer.

Suppression Group

ICS for the MCI

Incident Commander

Triage Supervisor

Treatment Supervisor

Transport/ Communications

EMS Group Rescue Group

Incident Commander

Communi-cations

Treatment

Triage

Transport

EMS Group

1st arriving unit officer

In place or designated areas

Consider ALS provider, EMS supervisor

(Can later be used in Transp/Comm)

Command Resources

• Position documents– Medical Group Supervisor– Transportation Group Supervisor

• Patient tracking documents– Transport Stubs– Treatment Supervisor– Treatment Disposition

Version 11/27/07

MED GROUP SUPERVISOR TRANSPORTATIONSUPERVISOR

MED SUPPLY COORDINATOR

TRIAGE UNIT LEADER TREATMENT UNIT LEADER

MINOR MANAGER

DELAYED MANAGER

IMMEDIATE MANAGER

TREATMENT DISPATCHMANAGER

PORTER UNIT(S)

TRIAGE UNIT(S)

MORGUE MANAGER

INCIDENT COMMANDER

EMS BRANCH DIRECTOR

OPS SECTION DIRECTOR

STAGING MANAGER

MED COM COORDINATOR

SITUATION STATUSINCIDENT LOCATION

TASK OR OBJECTIVETIME

COMPLETEDTASK OR OBJECTIVE

TIMECOMPLETED

APPOINT TREATMENT LEADERPROVIDE VEST & WORKBOARD

ESTABLISH PERIMETER/ZONES

DETERMINE THE CASUALTY COLLECTION POINT

ESTABLISH / IDENTIFY TRIAGE UNITS

ASSIGN PORTER UNITS

ACCOUNTABILITY & PAR CHECKS

IDENTIFY TREATMENT AREAS BOTHVISUALLY AND VERBALLY

APPOINT TREATMENT MANAGERSPROVIDE VESTS, WORKSHEETS

SET UP MEDICAL SUPPLY

DETERMINE TRANSPORTATION NEEDS OF PATIENTS

START TRIAGE COMPLETED

MONITOR PERSONNEL, REHAB

REASSIGN PERSONNEL AFTER TASK COMPLETION

CONTACT TRANSPORTATION GROUP

TRANSPORT IN ORDER OF SEVERITY

ASSIGN LOADER UNITS

DETERMINE IF EXTRICATION AND HAZMAT GROUPS ARE REQUIRED

MONITOR PERSONNEL, REHAB

PATIENT COUNT

TOTAL

IMMEDIATE

DELAYED

MINOR

DECEASED

MONTGOMERY COUNTY INCIDENT COMMAND SYSTEM WORKBOARD ©

MEDICAL GROUP SUPERVISOR3STAGING LOCATION RESOURCE STATUS

NOTES

TREATMENT UNITTRIAGE UNIT

ALPHA

BR

AV

O

CHARLIE

DE

LTA

TACTICALCHANNEL

COMMANDCHANNEL

MEDICALGROUP

MEDCOMMCHANNEL

TRANSPORTATION SUPERVISOR

INCIDENT COMMANDER

EMS BRANCH DIRECTOR

OPERATIONS SECTION CHIEF

STAGING MANAGER

MEDICAL COMMUNICATIONS COORDINATOR

GROUND AMBULANCE COORDINATOR

AIR AMBULANCE COORDINATOR

TASK OR OBJECTIVETIME

COMPLETED

APPOINT COORDINATORSPROVIDE VESTS, WORKSHEETS

ESTABLISH AMBULANCE STAGING

ESTABLISH LANDING ZONE

ACTIVATE MEDCOMM

REQUEST MORE TRANSPORTATION UNITS AS NEEDED

TRANSPORT IMMEDIATE PATIENTS

TRANSPORT DELAYED PATIENTS

TRANSPORT MINOR PATIENTS

MAINTAIN DOCUMENTATION

DEACTIVATE MEDCOMM

DETERMINE TOTAL PATIENT COUNT AND SPECIAL TRANSPORT NEEDS

DETERMINE HOSPITAL CAPABILITIES

DECLARE INGRESS/EGRESS FOR GROUND TRANSPORT UNITS

ASSIGN LOADERS

NOTES CHARLIE

ALPHA

BR

AV

O

DE

LTA

MONTGOMERY COUNTY INCIDENT COMMAND SYSTEM WORKBOARD ©

TRANSPORTATION SUPERVISOR4

MEDICAL GROUP

CHANNEL

LOCATION

TOTAL

MEDICAL GROUP

CHANNEL

LOCATION

TOTAL

MEDICAL GROUP

CHANNEL

LOCATION

TOTAL

MEDICAL GROUP

CHANNEL

LOCATION

TOTAL

SITUATION STATUS

SITUATION STATUS

SITUATION STATUS

SITUATION STATUS

SITUATION STATUSINCIDENT LOCATION STAGING LOCATION RESOURCE STATUS

TACTICALCHANNEL

COMMANDCHANNEL

TRANSPORTGROUP

MEDCOMMCHANNEL

TOTAL NUMBER OF PATIENTS TRANSPORTED

Version 11/27/07

1 2 3

4 5 6

7 8

MONTGOMERY COUNTY INCIDENT MANAGEMENT SYSTEM ©

TRANSPORT RECORDER PAGE OF

TRANSPORT STUBSMCFRS MCIWorksheet # 4Version 11/27/07

MEDICAL GROUP

RECEVING MEDICAL FACILITY

TREATMENT AREA

REQUEST & ASSIGN PERSONNEL TO PATIENT TREATMENT AREAS

ENSURE SECONDARY TRIAGE IS COMPLETED

COORDINATE TRANSPORTATION EFFORTS WITH THE TREATMENT DISPATCH MANAGER

ENSURE PROPER DOCUMENTATION IS COMPLETED

TARP, FLAG, TENT, AND/OR CONES ADMINISTRATION BOX PATIENT ASSESSMENT BOX AIRWAY BOX IV BOX AND IV FLUIDS TRAUMA / BULK BANDAGE BOX LITTERS AND BACKBOARDS OXYGEN MULTILATOR SYSTEM INDIVIDUAL PATIENT CARE KITS

RESOURCESTASKS OR OBJECTIVES

1

BAR CODESTIME

INTIME OUT

NOTES

2

3

4

5

6

7

8

9

10

MONTGOMERY COUNTY INCIDENT MANAGEMENT SYSTEM ©

TREATMENT AREA MANAGER PAGE OF

MCFRS MCIWorksheet # 1Version 11/27/07

AGE/ SEX

M F

M F

M F

M F

M F

M F

M F

M F

M F

M F

BAR CODESTIME

INTIME OUT

NOTESAGE/ SEX

IMMEDIATEMANAGER

DELAYEDMANAGER

MINORMANAGER

TREATMENT AREA

REQUEST & ASSIGN PERSONNEL TO PATIENT TREATMENT AREAS

ENSURE SECONDARY TRIAGE IS COMPLETED

COORDINATE TRANSPORTATION EFFORTS WITH THE TREATMENT DISPATCH MANAGER

ENSURE PROPER DOCUMENTATION IS COMPLETED

TARP, FLAG, TENT, AND/OR CONES ADMINISTRATION BOX PATIENT ASSESSMENT BOX AIRWAY BOX IV BOX AND IV FLUIDS TRAUMA / BULK BANDAGE BOX LITTERS AND BACKBOARDS OXYGEN MULTILATOR SYSTEM INDIVIDUAL PATIENT CARE KITS

RESOURCESTASKS OR OBJECTIVES

1

BAR CODESTIME

INTIME OUT

NOTES

2

3

4

5

6

7

8

9

10

MONTGOMERY COUNTY INCIDENT MANAGEMENT SYSTEM ©

TREATMENT AREA MANAGER PAGE OF

MCFRS MCIWorksheet # 1Version 11/27/07

AGE/ SEX

M F

M F

M F

M F

M F

M F

M F

M F

M F

M F

BAR CODESTIME

INTIME OUT

NOTESAGE/ SEX

IMMEDIATEMANAGER

DELAYEDMANAGER

MINORMANAGER

MCFRS MCI Worksheet #2 Version 11/27/07

2

1

BAR CODESTAG

COLORTIME OUT

AGE/ SEX

M F

M F

HOSPITAL/DESTINATION

TRANSPORTUNIT

MONTGOMERY COUNTY INCIDENT MANAGEMENT SYSTEM ©

TREATMENT DISPOSITION PAGE OF

4

3M F

M F

6

5M F

M F

8

7M F

M F

9M F

NOTES

10M F

11M F

12M F

PATIENTCOUNT

PATIENTCOUNT

PATIENTCOUNT

MCFRS MCI Worksheet #2 Version 11/27/07

2

1

BAR CODESTAG

COLORTIME OUT

AGE/ SEX

M F

M F

HOSPITAL/DESTINATION

TRANSPORTUNIT

MONTGOMERY COUNTY INCIDENT MANAGEMENT SYSTEM ©

TREATMENT DISPOSITION PAGE OF

4

3M F

M F

6

5M F

M F

8

7M F

M F

9M F

NOTES

10M F

11M F

12M F

PATIENTCOUNT

PATIENTCOUNT

PATIENTCOUNT

•A/C Mike McAdams

•A/C “Rusty” Rothenhoeffer

•B/C Mark Davis

•Capt. LeRoy Gross

•Capt. Vicki Fowler

•Capt. Beth Sanford

•Lt. Jon Fiedler

To the following persons who contributed to the success of this program: