MCI Emergency Response Protocol

Management of Mass Casualty Incidents

• Five key steps to prepare for MCI:
  • Close ED walk-in and EMS entrances
  • Decompress Kimmel Core by rapidly admitting ED patients to inpatient units and moving Kimmel Core patients to Tisch Core
  • Move MCI equipment cards from storage to the triage area
  • Perform mass decontamination and triage patients using the START algorithm and colored acuity tags
  • Manage patient flow by separating immediate, delayed, and minor/ambulatory patients

Preparedness Activities

• Regular planning team meetings
• Hands-on mass decontamination trainings
• Discussion-based and operational exercises (e.g. April Radiation Injury Influx Tabletop, December MCI Full Scale, January 2023 Executive Tabletop)
• Special event planning (e.g. structured walkthroughs, proactive decon team staffing)

START Triage Training

• Rapid and streamlined triage with two goals: speed and identification of patients who need the most help
• Training for emergency department nursing staff, with quarterly 10-15 minute sessions on each shift
• Hands-on decontamination training open to all NYULH staff, with four trainings offered annually (half and full day)
• Structured walkthroughs for frontline staff in key departments, regularly and prior to high-risk events (30-60 minutes)

JumpSTART Pediatric Triage

• Slightly different START triage for pediatric patients, who have a higher degree of resilience and are more likely to survive with long periods of apnea

Drills and Exercises

• Operational exercises (e.g. decon team comms drills, functional exercise focusing on triage and decanting)
• Discussion-based exercises (e.g. HRO crisis management drills, Executive TTX in January)
• Full-scale decontamination scenario with donning, doffing, and decontamination of actors, testing all response components

Mass Casualty Incident Full Scale Exercise

• Record emergency department volume on December 6th (127 ED patients, 54 awaiting bed requests)
• Improvised explosive device (IED) scenario in Midtown, triaging and simulating placement of 30 patient actors, managing arrival of 12 actors portraying family and friends
• 27 participating departments, with takeaways including need for enhancements to triage, decanting, and surgery prioritization

Trauma

• Trauma team structure and roles, communication, and debriefing
• Trauma care progressively increases based on organism/pathogen, with need to inform high consequence pathogen hotline 24/7

Infectious Disease and High Consequence Pathogens

• Donning PPE, including visual inspection, disinfecting hands, inner/routine gloves, coverall, boot covers, N95 respirator, gown, provided hood, outer gloves/extended cuff, and face shield
• Verifying PPE, with measles addendum noting a recent case at NYULI resulting in canvassing over 100 staff, patients, and visitors due to possible exposure
• Top 10 countries for measles: Kazakhstan, Azerbaijan, Yemen, India, Iraq, Ethiopia, Kyrgyzstan, Russia, Pakistan, and Indonesia

Emergency Department Triage

• Objectives: identify patients who need immediate care and treatment, perform a brief primary assessment, assign an appropriate acuity level, and assign a location of care
• Primary goal: decrease morbidity and mortality for all ED patients
• Primary assessment: subjective data collection (brief one-line statement from patient, precipitating event/onset of symptoms, mechanism of injury, progression of condition from first symptom) and objective data collection (airway patency, breathing effectiveness, circulation effectiveness, disability, environmental exposure)

Emergency Severity Index

• 5-level triage instrument categorizing ED patients based on acuity and needed resources
• Algorithm uses 4 decision points to sort patients into one of the five triage levels:
  • Level 1: seen immediately
  • Level 2: seen within 15 minutes
  • Level 3: seen within 60 minutes
  • Level 4: seen within 120 minutes
  • Level 5: seen within 240 minutes
• Decision Point A: Is the Patient Dying?