500-03 Mass Casualty Incident Standards

Mass Casualty Incident (MCI) Standard Operating Guidelines

• Definition: An MCI is an incident exceeding the capabilities of first responders. Levels are categorized by the number of patients (Level 1: 5-10, Level 2: 11-20, Level 3: 21-100, Level 4: 101-1000, Level 5: >1000).

• Types of MCI: Various types are possible, including shootings, explosions, collapses, plane crashes, vehicle accidents, chemical, biological, radiological, and nuclear incidents.

Incident Command Structure (ICS)

• Assignments: Depending on the MCI's scope, roles like Hazard Mitigation, Triage, Treatment, Transport, Staging, and Rehabilitation may be assigned.

• Specialized Resources: Specific resources (e.g., Tactical Command Unit (TCU), Area Command Team, Incident Management Team, Support 81 with medical supplies, Disaster Response Unit (DRU), Tactical 34 for technical rescue, Inventory Specialist) may be utilized based on the incident.

Emergency Scene Activities

• First Arriving Unit: Responsibilities include arrival report, scene size-up, exclusion zone identification, MCI level and type declaration, initial triage (START, JUMP-START, TECC), unit assignments per priority, additional resource consideration, and staging designation.

• First Arriving Chief Officer: Responsibilities encompass utilizing field guides, MCI vests, confirming and declaring the incident level/type, resource considerations, updating communications, and establishing assignments.

• Safety Officer: Responsible for requesting Law Enforcement for physical security within the Exclusion Zone.

• Hazard Mitigation: Incident-dependent responsibilities focused on issues like fire suppression, structural or vehicle stabilization, and hazardous material containment.

• Triage: Responsibilities include utilizing MCI vests, identifying and communicating exclusion zones, ensuring START, JUMP-START, and TECC triage according to protocols, carrying a trauma rapid response kit, escorting "walking wounded", checking all areas, utilizing litter bearers, and updating incident command.

• Treatment: Establishing a treatment area near transport, ensuring sufficient equipment, decontamination of contaminated patients, and priority movement from treatment to transport. The Treatment area must be close to transport, large enough, and clearly marked. Secondary assessment (Metag) and updating of status is important.

• Transport: Establishing an efficient transport area for patient entry/exit and transport staging, utilizing Law Enforcement, coordinating patient transports via priority order, adhering to Trauma/Bypass protocols, documenting on a transport log (including patient ID, destination, unit number), and utilizing a Medical Communications Coordinator if established.

Medical Communications Coordinator

• Responsibilities: Advise destination hospitals of incoming patient numbers, triage status, and transportation methods; advise the communication center of transport details. This role can default to the transport team if not established.

Communication Center

• Responsibilities: Contact and connect appropriate hospitals, direct communication/TAC channels for Transport or Medical Communications Coordinator (MCC), if applicable.

Post-Incident

• After Action Review: A formal review is required for MCI Level 3 or higher, referencing Critical Incident Stress Management and Crisis Mitigation.

Documentation

• Documentation: Procedures are in place for documenting incident specifics.