Incident Command for EMS

Incident Command for EMS

• This course is not ICS 100 and will not cover the material.
• This course does not satisfy the NIMS implementation requirements.
• The course addresses the role of Emergency Medical Services in the ICS system.
• Examines the functional roles of the EMS Branch.
• Focus will be on command, operations, planning, logistics, and responsibilities of EMS personnel.

Modern Management Principles

• Modern disasters, including MVAs, structure fires, search and rescue, and mass casualty incidents, can and must be managed.
• Management principles used in routine functions should also be applied to emergency calls.

Mass Causality Incident (MCI)

• A MCI occurs when the number of patients exceeds the initial responders' resources.
• An MCI or major disaster overwhelms the EMS system and community response.
• The Incident Command System (ICS) is designed to control MCIs or major disasters, it eliminates duplication of duties and controls freelancing.
• an Incident Command System is essential in all small or large-scale incidents.

Unity of Command

• A Unified Command (UC) brings together major organizations' incident commanders.
• the purpose is to coordinate a response.
• UC enables agencies to jointly manage incidents.
• Agencies achieve this by establishing shared objectives, and strategies.
• Agencies achieve this by making joint decisions at a single command post.
• UC offers agencies a platform to exchange information.
• UC allows agencies to maximize resources, and improve response efficiency.
• Unified Command includes EMS, PD, and Fire services.
• Key roles include the Safety Officer, Information Officer, and Liaison Officer.
• Functional areas include Planning, Operations, Logistics, and Finance/Administration.

Gila River 911 Command Structure

• The structure includes GREMS, Safety, Staging, and Rescue services.
• It organizes functions such as Triage, Treatment, Transport, Extrication, Hazmat response, and Swift Water rescue.

Span of Control

• Span of Control is defined as the number of subordinates a leader is held responsible for.
• A Sector Leader should manage 5-7 subordinates.
• Managing five subordinates is considered optimal.

Chain of Command

• Chain of Command is a structured authority line.
• It illustrates how information moves through incident management or a business framework.
• Chain of Command is directly tied to the command structure and span of control.
• The Chain of Command promotes equilibrium between operational and support roles.

Incident Command Communication

• Emphasizes seamless communication flow from the 911 dispatcher to various units on scene.
• Key units include Command, Incoming Units, Treatment/Triage areas, Transport, and On-Scene Units.

Incident Commander (IC)

• The Incident Commander (IC) is typically the first arriving emergency unit, such as Fire Department (FD), Emergency Medical Services (EMS), or Police Department (PD).
• The IC coordinates and leads the scene rather than commanding.
• The IC ensures a smooth flow of information, personnel, and resources.
• The IC is responsible for the overall outcome of any incident.
• The IC delegates tasks rather than personally handling patients

IC Responsibilities

• Managing the emergency response to the incident.
• Establishing a command post.
• Working together with EMS, Fire, and Police.
• Ensuring the safety of all emergency responders.
• Designating sector officers.

Safety Officer

• The Safety Officer is appointed by the IC on a staff level, when necessary.
• The Safety Officer reports directly to the IC.
• They are authorized to halt operations if needed.
• They should also have extensive knowledge of safety operations and safety standards that are nationally recognized.

EMS Incident Management

• The key components of EMS Incident Command System (ICS) include triage, treatment, and transport.

EMS Operations

• Treatment of patients is the only mission during an EMS Incident Command System.
• Functions support treatment operations.
• Medical treatment operations involve triaging patients, treating the patient in a logical order based on RAMP Triage, and transporting them to the appropriate medical facility.

EMS Branch

• The EMS Branch is responsible for all EMS sectors, including triage, treatment, and transportation.
• The EMS Sector coordinates these activities with Incident Command.
• EMS Sector Leaders oversee all EMS and Fire personnel assigned to their sector.

Triage Officer

• The Triage Officer is responsible for counting and prioritizing patients.
• The Triage Officer's primary duty is to ensure that every patient undergoes an initial assessment.
• Treatment should not start until all patients have been triaged.
• If an EMS Branch is established, the Triage Officer reports to the EMS Branch Officer.
• In no EMS Branch is established, they report to the Incident Commander (IC).

Triage

• The purpose of triage is to receive patients and use the RAMP triage system.
• Goal is to determine triage categories of patients
• As patient numbers increase, the triage rules change.
• Best possible level of care is given at normal incidents.
• The goal in large-scale incidents is to achieve the greatest good for the greatest number of people.

RAMP Triage Parameters

• A is for Alert. Alert patients are marked with Y for yes.
• V is for Verbal.
• P is for Painful.
• U is for Unresponsive. Non-responsive patients are marked with N for no.
• All others are marked as Involved/Needs Assessment (INA).
• If there is no visible injury, but an assessment is needed, assess them last.
• Prioritize patients without obvious signs of death.
• Assess if patient follows commands; if not, assess AVPU.
• Check for radial pulse to determine if patient is delayed or immediate.
• Life-saving interventions include controlling massive hemorrhaging, opening the airway, and chest decompression.
• Patients should be reassessed as more resources become available.
• Patients are considered dead if they are not breathing after life-saving interventions.

Treatment Officer

• Responsible for all treatment activities, in coordination with triage and transport.
• If an EMS Branch is established, the Treatment Officer reports to the EMS Branch Officer.
• If an EMS Branch is NOT established, the Treatment Officer reports to the IC.
• Should not allow any one treatment area to be overwhelmed with patients.

Treatment includes

• Separating patients by priority category.
• Assigning crews to each priority category.
• Communicating with the transportation officer.
• Being responsible for the safety of all emergency personnel.
• Ensuring sufficient supplies and personnel are available.
• Giving updates to the appropriate command staff.
• Treatment may be assigned to incoming resources based on the triage report in a smaller scale incident
• A treatment sector may be needed in a larger scaled incident- using tarps to break down patient treatment
• These tarps seperate patients into the following categories: INA (Involved/Needs Assessment), Delayed, Immediate, or Black (Deceased)
• The psychological impact on responders, patients and bystanders.
• Be aware of the limitations of setting up a large scale treatment sector.
• Time consuming.
• Lack of personnel for treatment.
• Lack of familiarity and experience of setting up a sector.

Transportation

• Moves patients from the treatment sector to awaiting ambulances.
• Coordinates patient transportation to appropriate medical facilities based on priority.
• Coordinates and establishes a staging area for ambulances.
• Maintains record of available units and assigns ambulances based on transport requirements.
• If an EMS Branch is established, the Transport Officer reports to the EMS Branch Officer.
• If no EMS Branch established, they report to IC

Scene Size-up

• Helps ensure safety for incoming resources.
• Ensures the right resources are available.
• A scripted scene will ensure the appropriate information is given without using too much radio time.
• Helps determine appropriate strategy and tactics.

MVA Initial Radio Report Components

• Vehicle Description: Report the number and size of vehicles and type of MVA.
• Damage: Report the extent of the damage such as none, minor, moderate, or heavy.
• Problem Description: Report the number of patients, patient triage, entrapped patients, intrusions, ejections, and hazards.
• Initial Action Plan: Extrication, Medical Treatment.
• State whether to continue response, call for helicopter, or cancel response.

Fire Initial Radio Report

• Building Description: Size, height, occupancy type, and hydrant location.
• Problem Description: If smoke or flames are present and the location of the problem.

Minor Damage

• Characterized by being an event with less property damage in a MVA.
• Damage is minimal such as broken headlights or scratches.

Moderate Damage

• A car accident that causes more damage and injuries than a minor accident
• Visible damage that affects the vehicle's normal operations, i.e. the door may not open or tires will not turn due to body damage.
• Airbags may also have been deployed.

Heavy Damage

• An accident that causes serious injuries, fatalities, or significant property damage.