Mass Casualty Incident Management

• MCI (Mass Casualty Incident): depletes on-scene resources
• Low impact incident: local responders can manage
• Ex: MVC with multiple casualties
• High impact incident: stresses local emergency systems
• Ex: tornadoes, floods, structural collapses
• Disaster: overwhelms regional emergency response resources
• Ex: hurricanes, earthquakes, widespread flooding, terrorist acts
• Emergency Operations Center: officials direct and control during emergencies
• Incident Command: most important aspect of incident management
• The incident commander has full legal authority and liability
• Windshield Survey: observe the emergency scene from vehicle
• Triage Officer: sorts patients based on severity
• Open Incidents: uncontained incidents may generate more patients
• Closed Incidents: contained injuries have occurred and the incident commander must stabilize
• Singular Command: first arriving public safety personnel at small-scale incidents with limited jurisdictional issues.
• Unified Command: managers from several agencies coordinate activities and share command responsibility for incidents involving multiple jurisdictional levels
• Incident Command Post (ICP): command representatives make relevant decisions
• Finance Section: manages accounting, estimates cost, and handles procurement
• Logistics Section: operates a medical supply unit and distributes supplies
• Operations Section: executes tactical objectives at an incident
• Planning Section: provides incident information and formulates action plans
• Primary Triage: categorizes patient injuries into immediate, delayed, minimal, expectant
• Secondary Triage: ongoing patient categorization based on changing conditions
• Simple Triage and Rapid Transport (START): system for patient sorting
• JumpSTART Triage: pediatric MCI triage accounting for child-specific differences
• Morgue: area for black or expectant patients, controlled access
• Red Treatment Area: critical patient care zone with ample medical resources
• Yellow Treatment Area: stabilization zone for non-critical patients needing ALS interventions
• Green Treatment Area: for ambulatory patients needing minimal care and monitoring.
• Treatment Unit Leader: coordinates supply needs and patient care
• Staging Officer: supervises staging area and prevents premature resource use
• Transport Officer: coordinates patient transport with supervisors
• Rapid Intervention Team: ambulance crew dedicated for rescuer emergencies
• Mitigation: disaster prevention or limitation, e.g., avoiding building on floodplains
• Planning (Disaster Management): community hazard analysis and preparation
• Response (Disaster Management): alternative plans during a disaster
• Recovery (Disaster Management): return to normalcy post-disaster
• Pre-Planning: smooths response and removes problems
• Tabletop Drills: small-scale drills for MCI scenarios
• Local Drills: department-based drills for emergencies
• Large-Scale Drills: involves outside agencies simulating major incidents

Multiple Casualty Incident

• Multiple Casualty Incident (MCI): depletes on-scene resources
• Can be classified as low-impact, high-impact, or disaster

MCI Classifications

• Low-impact incident: local personnel manage; may tax local EMS
• High-impact incident: Stresses emergency resources
• Disaster: An even that overwhelms response resources

Emergency Operations Center

• EOC is used for controlling, directing, and coordinating emergency response resources

Incident Commander

• Individual who runs the entire incident and responsible for coordinating activities.
• Defined span of control, has full authority, and delegates functions

Incident Size Up

• Formal situational evaluation
• Ensures operational personnel have situational awareness
  • Life safety
  • Incident stabilization
  • Property conversation
• You must perform a windshield survey and not just jump out of the unit if your first on scene
• EMS practitioners should never exit their vehicles until they have identified any and all potential hazards of the incident to the extent possible from inside their vehicle.
• Triage officer sorts patients based on severity of injuries
• Differentiate open vs closed incidents
• Open incident (uncontained): potential to generate more patients; better to have too many resources called
• Closed incident (contained): injuries already occurred

Initial Scene Management

• Most MCIs are "won or lost" in the first 10 minutes
• Emergency personnel may begin to "freelance" without incident command
  • They might fail to prioritize patients
  • Underestimate the severity of the incident
  • Delay requesting additional resources

MCI Handling

• Successful handling involves coordination of key personnel, whether two people or twenty.
• Smaller scope than MCI and doesn't involve outside agencies for Singular Command
• Unified Command has managers who coordinate activities while maintaining control
  • Managers of agencies achieve balanced decision making and the incident commander determines need for info officer
• Incident Commander identifies the need for and directs the establishment of an Incident Command Post (ICP)
• The site should have; telephone, restrooms, and shelters
• The command post should be close enough to the scene that officers can easily monitor scene operations but far enough away so that they are out of the direct operation area.
• Staging area and ICP should be out of reach for fumes, smoke, water, chemicals, hazardous materials
• Primary site: organizes resources for deployment
• Secondary site: located in different area from primary staging area.
• FirstNET is the first responders network during disasters allowing responders to maintain effective communications
• Satellite Cells on Light Trucks (SatCOLTS) have increased network capacity
• Alternative Communication Methods include; planning and practicing regularly and runners to hand deliver messages
• 10 codes are detrimental over plain English during a MCI and the IC must eliminate unnecessary confusion with plain English communication

Incident Management System

• C-FLOP: Command, Finance/Administration, Logistics, Operations, Planning
• Each section has a place and all four areas may not be needed at every incident
  • Command staff: handle information, safety, outside liaisons, and mental health support
  • Staff functions include combination of command staff and section chiefs

Command Staff Roles

• Safety Officer (SO) monitors on-scene actions and ensures they do not create potentially harmful conditions with the authority to stop any action deemed immediate life threat, they may terminate any operations incident on their authority alone
• Infection control, personal protective equipment, crowd control, lifting of patients and equipment, and scene lighting
• Liaison Officer (LO) coordinates all incident operations that involve outside agencies
• Information Officer (IO) collects and releases data about incident while a public information officer (PIO) reports for coordination

Mental Health

• Mental health support is crucial during a MCI, especially an extended one
• Ensure the rotate personnel and are not exhibiting signs or symptoms of excessive stress
  • Persons exhibiting abnormal stress should be removed from service and should be provided "psychological first aid"
• Organizational response to stressful events includes; developing small incidents strategies and major incidents/disasters strategies Finance/Administration: rarely operates on small-scale incidents, with responsibility for accounting and administrative activities Logistics: operates medical supply unit; coordinates equipment distribution and selects areas for command and rehabilitation Operations: all work is performed, maintains discipline, and may have branches Planning: Planning/Intelligence has oversees changes in plan and ensures standard operating procedures
• Operate according to principle of "anything that can go wrong will go wrong"
• Know how to triage patients using START and JumpStart and understand primary and secondary triage

Triage

• START (Simple Triage and Rapid Transport) allows for rapid sorting of patients into categories and focuses on: ability to walk, respiratory effort, pulse/perfusion, and neurological status
• Less than 30 seconds to triage each patient and triage acts as IC
• Post-triage, officers are found in Red, Yellow, Green, and Morgue
• Morgue: Collect patients triaged “black” or expectant in area controlled. Disposition is determined working with medical examiner, coroner, law enforcement, and other agencies
• Treatment; when the number of patients exceeds number of ambulances supervisors controls action in group sector Red Treatment Unit: Care for critical patient; tagged "red" and supply system necessary for its operation

Treatment areas

• Yellow Treatment Unit:
• Care for noncritical patients, tagged "yellow", for stabilization; may require intravenous line and eventual surgical intervention
• Green Treatment Unit: Ambulatory patients; tagged "green"
• Prepared for minimal transport and monitoring
• If conditions deteriorate they will be retriaged.

Treatment Officers

• The treatment unit leaders report to the treatment supervisor
• Communication should be coordinated
• On-Scene Physicians provide direct supervision and direction over paramedics and can be high impact or long term
• Staging Officer supervise staging area supervise and keep ambulances staged to allow with proper egress with patients
• Drivers or crew members required to wait with vehicles until needed for transport
• Transport Officer coordinates with staging officer and treatment supervisor and facilitates transitioning patients into ambulances
• Communication center will contact hospitals to handle
• A tracking system for patients is kept for destination Extrication/Rescue Unit: provides proper equipment in dangerous area, and remove patients to carried to treatment areas.
• Rapid intervention team's importance includes: supporting on-scene responders, and an ambulance should be dedicated to stand by outside the staging area
• 4 stages of disaster management: mitigation, planning, response, and recovery
• Mitigation: prevention in the first place
• Planning: based on hazard analysis, devise relocation plans and provide communications in case primary system fails.
• Great disparity between casualties and resources exist in Response
• Recovery phase involves a return to normalcy, with variable actions, and guidelines set up by IMS
• Preplanning is important can anticipate and remove problems working towards fixing them for MCI with drills
• Examples of sites; chemical or nuclear plants, factories or mines, schools, jails, sporting arenas, entertainment centers, railroads, airports