Mass Casualty Incident (MCI) Standard Operating Guideline

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Questions and Answers

In a mass casualty incident, what is the primary responsibility of the Triage Officer?

  • Directing overall scene command in the absence of the Incident Commander.
  • Conducting initial patient assessment and prioritization. (correct)
  • Ensuring scene safety and security for rescuers.
  • Coordinating transportation logistics for all patients.

During triage in a mass casualty incident, which treatment is permissible, according to the guideline?

  • Administering intravenous fluids to patients showing signs of shock.
  • Performing advanced surgical procedures to stabilize critical patients.
  • Splinting fractures to prevent further injury during transport.
  • Opening the airway and controlling serious hemorrhage. (correct)

Which of the following is the MOST critical factor in determining patient priority during triage at a mass casualty incident?

  • The patient's potential to die within minutes if not treated. (correct)
  • The patient's level of consciousness and ability to communicate.
  • The patient's physical size and weight for ease of transport.
  • The patient's age and pre-existing medical conditions.

In a mass casualty incident, under whose direction is the overall scene command?

<p>The Incident Commander (D)</p> Signup and view all the answers

During a mass casualty incident, which role is responsible for communicating the nature and extent of the disaster to local hospitals?

<p>The Medical Sector (C)</p> Signup and view all the answers

What is the purpose of reassessment of remaining patients, in the context of mass casualty triage?

<p>To identify patients who were initially categorized as low priority but whose condition has worsened. (C)</p> Signup and view all the answers

What is the key application of the START system in managing a mass casualty event?

<p>To identify those victims at the highest risk of early death. (C)</p> Signup and view all the answers

According to the START triage system, what are the key assessment parameters used to categorize victims?

<p>Ventilation, Perfusion, and Mental Status. (C)</p> Signup and view all the answers

In a mass casualty incident, what would be the appropriate designation for a patient with traumatic cardiac arrest and massive head injuries?

<p>Priority IV (D.O.A./Non-Resuscitable/Grey/Black) (C)</p> Signup and view all the answers

What does 'START PLUS' add to the standard START triage system?

<p>Algorithm Regional EMS Protocols regarding spinal precautions, determination of death protocol and trauma center designation. (D)</p> Signup and view all the answers

During a mass casualty incident, what is the most appropriate initial action after establishing command and ensuring departmental safety?

<p>Performing a rapid scene size-up to determine the scope of the incident. (C)</p> Signup and view all the answers

In the context of a mass casualty incident, how should the need for additional resources be communicated?

<p>Through the Incident Commander, who assesses the overall needs. (D)</p> Signup and view all the answers

How does the START system categorize a patient who can respond to verbal commands but has a respiratory rate of 28?

<p>Delayed (Yellow) (C)</p> Signup and view all the answers

During triage, what is the rationale behind limiting treatment to airway management and hemorrhage control?

<p>To provide the maximum benefit to the greatest number of victims in a resource-constrained environment. (D)</p> Signup and view all the answers

What is the MOST important consideration when determining whether to delay transport for treatment during a mass casualty incident?

<p>The potential impact of delaying treatment on the patient's survival. (B)</p> Signup and view all the answers

Why is it important to reassess patients who have already undergone initial triage and categorization?

<p>To account for changes in patient condition and adjust priorities accordingly. (C)</p> Signup and view all the answers

In a mass casualty scenario, how does designating a Safety Officer contribute to effective incident management?

<p>By ensuring the safety of the scene for rescuers, bystanders, and patients. (C)</p> Signup and view all the answers

During a mass casualty incident, what role does the Medical Communications Branch have?

<p>To serve as a liaison between the incident command and local hospitals. (C)</p> Signup and view all the answers

In a mass casualty incident, what is the MOST likely initial role for the Medical Group Supervisor?

<p>To control the medical aspects of the scene focusing on patient care. (A)</p> Signup and view all the answers

What additional considerations are encompassed within 'START PLUS' beyond the standard START triage protocol?

<p>Specific Regional EMS Protocols regarding spinal precautions, death determination and trauma center designation (A)</p> Signup and view all the answers

What distinguishes a Mass Casualty Incident (MCI) from a regular emergency situation?

<p>The demand for resources overwhelms the available resources. (D)</p> Signup and view all the answers

Following the establishment of command and safety protocols during a mass casualty incident, what is the next immediate priority according to the guideline?

<p>Performing patient triage to prioritize treatment and transport. (C)</p> Signup and view all the answers

During triage, what specific interventions are permissible according to the guideline?

<p>Opening the airway and controlling serious hemorrhage. (A)</p> Signup and view all the answers

In the context of triage, which patients are categorized as 'Immediate' (Priority I)?

<p>Patients who will die almost immediately if not treated. (B)</p> Signup and view all the answers

What characterizes patients categorized as 'Delayed' (Priority II) in a mass casualty incident?

<p>Those whose injuries will result in death within a half-hour or more if not treated. (C)</p> Signup and view all the answers

What is the primary method of transport for 'Walking Wounded' (Priority III) patients?

<p>Transportation by some means other than ambulance. (D)</p> Signup and view all the answers

Under what circumstances would a patient be classified as 'D.O.A./Non-Resuscitable' (Priority IV) during a mass casualty incident?

<p>Those who are dead or so severely injured that death is certain within a short time. (C)</p> Signup and view all the answers

In what order should treatment be initiated for casualties during a mass casualty incident??

<p>Start treatment using specific treatment protocols, priority first, delayed second, and so on. (D)</p> Signup and view all the answers

How should the need for additional resources be communicated to the Incident Commander?

<p>As the needs become evident, those needs should be communicated to the Incident Commander. (A)</p> Signup and view all the answers

What additional elements are encompassed within 'START PLUS' beyond the standard START triage protocol?

<p>Utilization of spinal precautions, determination of death protocol and trauma center designation. (A)</p> Signup and view all the answers

Flashcards

Mass Casualty Incident

A situation where demand overwhelms available resources.

MCI Priorities

Establish command, size up, ensure safety, request assistance, triage, treat, transport, reassess.

IMMEDIATE (Priority I)

Highest priority, immediate treatment needed to prevent death. (RED)

DELAYED (Priority II)

Serious injuries needing attention, but treatment can be delayed. (YELLOW)

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WALKING WOUNDED (Priority III)

Minor injuries, treatment can be delayed and transported by other means. (GREEN)

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D.O.A./NON-RESUSCITABLE (Priority IV)

Dead, or injuries are so severe that death is certain. (GREY/BLACK)

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START Triage System

A primary triage plan to identify victims at risk of early death.

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Immediate Triage

Victims with hypovolemia, respiratory distress and altered mental status.

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Overall Scene Command

The direction of the incident commander.

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Medical Scene Control

Directed by the Medical Group Supervisor.

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S.T.A.R.T.

A rapid assessment and sorting method.

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Triage Treatment

Opening the airway and controlling serious hemorrhage.

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Triage Assignments

Used to categorize victims by ventilation, perfusion, and mental status.

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Safety Group

Directed by a Safety Officer to maintain safety for all personnel.

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Casualty Treatment Order

Begin treatment in order of immediate, delayed, and so on. Focus is on stabilizing life-threatening injuries.

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Medical Communications Branch

Provides hospitals with detailed information on patient status, priority, and injuries.

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Re-assessment of Patients

Continuous re-evaluation and re-categorizing of patients, based on new findings.

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START PLUS

Uses START triage for victims, also considers spinal precautions, death determination protocols, and trauma center designation.

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Rapid Evaluation Actions

Essential actions during triage. Simple hemorrhage control and airway protection techniques

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Patient Triage

The process of sorting patients based on the severity of their condition and their need for medical care.

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Study Notes

  • Standard Operating Guideline (SOG) provides a known approach for mitigating Mass Casualty Incidents (MCI), including Multiple Victim Incidents (MVI).
  • Effective Date: 08/01/2010
  • Revised Date: 01/01/2011
  • Guideline Number: 04-16A
  • Number of Pages: 02

Definitions

  • A Mass Casualty Incident is any situation where the demand overwhelms the available initial resources.

Guideline Priorities

  • Establish command/order.
  • Size up the situation.
  • Ensure the safety of department members.
  • Request additional assistance.
  • Triage patients.
  • Treat patients.
  • Transport the most critically injured/ill.
  • Reassess remaining patients.

Establish Command/Order

  • Overall scene command is directed by the Incident Commander.
  • Medical scene control is directed by the Medical Group Supervisor.
  • A Safety Group directed by a Safety Officer ensures the safety of the scene, rescuers, and bystanders.
  • Identify a Triage Officer and begin triage.

Triage

  • Conduct a primary survey on all patients using the S.T.A.R.T. (Simple Triage and Rapid Transport) method.
  • Treatment during triage is limited to opening the airway and controlling serious hemorrhage.
  • Casualties are prioritized based on the primary survey.
  • Patients are tagged according to priority and gathered into staging areas:

Immediate (Priority I) (Red)

  • Highest priority; these patients must be treated first.
  • They will die within minutes if not treated rapidly.
  • Examples: airway obstruction, massive bleeding, shock, open chest or abdominal wounds, severe head injuries, and severe cardiac problems.

Delayed (Priority II) (Yellow)

  • Injuries will result in death in a half-hour or more if untreated.
  • Injuries are serious and need attention.
  • Treatment and removal may be delayed until Priority I patients are stabilized.
  • Examples: burns, major multiple fractures, and spinal injuries.

Walking Wounded (Priority III) (Green)

  • Treatment may be delayed.
  • Generally transported by some other means than an ambulance.
  • Examples: minor fractures, lacerations with minimal blood loss, and chest injuries without breathing difficulty or minor burns.

D.O.A./Non-Resuscitable (Priority IV) (Grey/Black)

  • Patients are dead or so severely injured that death is certain within a short time, regardless of treatment.
  • Examples: traumatic cardiac arrest, massive head injuries with exposed brain matter, and massive body mutilation.

Treatment

  • Treat casualties in order of priority: immediate, delayed, etc. Begin with immediate, then delayed, and so on.
  • Follow specific treatment protocols.
  • Do not delay transport to stabilize life-threatening injuries.

Additional Resources

  • Manpower and equipment needs should be communicated to the Incident Commander.
  • Local hospitals should be notified by the Medical Sector about the nature and extent of the incident.
  • Medical Communications Branch provides individual hospitals with patient priority and major injury information (e.g., head, abdomen).

Transport

  • Transport the most critically ill first, based on severity, available equipment, and manpower.

Re-Assessment of Remaining Patients

  • Re-assess patients who remain after triage, treatment, and transport.
  • Re-triage based on new findings may be necessary.

START Plus

  • primary triage plan which identifies victims most at risk of early death
  • provides basic stabilization measures
  • designed for use by first responders/EMT at the scene of a mass casualty
  • In an MVI setting, START should be utilized.
  • Victims with hypovolemia, respiratory distress, and altered mental status are triaged as immediate.
  • Hemorrhage control and airway protection techniques are used during the rapid evaluation.
  • Assignments categorize the victims; ventilation, perfusion, and mental status.
  • Walking wounded are segregated and evacuated later.
  • START requires as little as 60 seconds per victim.
  • Adapted for use in Multiple Victim Incidents.
  • START PLUS can be described as START Algorithm Regional EMS Protocols regarding: utilization of spinal precautions, determination of death protocol and trauma center designation is recommended

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Mass Casualty Guideline (SOG) PDF

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