Mass Casualty Guideline (SOG) PDF

Standard Operating Guideline (SOG) Mass Casualty Effective Date: 08/01/2010 Guideline Number 04-16A Revised Date: 01/01/2011 Number of Pages 02 1....

Standard Operating Guideline (SOG) Mass Casualty Effective Date: 08/01/2010 Guideline Number 04-16A Revised Date: 01/01/2011 Number of Pages 02 1. Overview To provide an effective, known approach for mitigating Mass Casualty Incidents (MCI) including Multiple Victim Incidents (MVI). 2. Definitions A Mass Casualty Incident will be defined as any situation in which the demand overwhelms the ability of the initial resources available to deal with the problem. 3. Guideline Priorities A. Establish command/order B. Size up C. Safety of department members D. Request additional assistance E. Patient triage F. Patient treatment G. Transport of the most critically injured/ill H. Reassessment of remaining patients Establish Command/Order A. Overall scene command is under the direction of the Incident Commander. B. Medical scene control is under the direction of the Medical Group Supervisor. C. Ensure the safety of the scene, rescuers, and bystanders by establishing a Safety Group directed by a Safety Officer. D. Identify a Triage Officer and begin triage. Triage A. Perform a primary survey on all patients using the S.T.A.R.T. (Simple Triage and Rapid Transport, refer to pg. 4 & 5 method of triage.) B. Treatment during this process shall be confined to opening the airway and controlling serious hemorrhage. C. Based on the primary survey findings, prioritize casualties. D. Tag patients according to priority and, if needed, gather into staging areas by priority: IMMEDIATE (PRIORITY I) (RED) These patients are of the highest priority and are removed and treated first. They are the ones that die within minutes if not treated rapidly. Examples may include: airway obstruction, massive bleeding, shock, open chest or abdominal wounds, severe head injuries and severe cardiac problems. DELAYED (PRIORITY II) (YELLOW) Patients in this category are those whose injuries will result in death within a half-hour or more, if not treated. These injuries are serious and need attention; however, treatment and removal may be delayed until the priority I patients have been stabilized. Examples may include burns, major multiple fractures and spinal injuries. 04-16A Mass Casualty Guideline (SOG), Page 1 of 2  WALKING WOUNDED (PRIORITY III) (GREEN) The patients in this category may have treatment delayed and are generally transported by some other means than ambulance. Examples may include minor fractures, lacerations with minimal blood loss, and chest injuries without breathing difficulty and minor burns. D.O.A./NON-RESUSCITABLE (PRIORITY IV) (GREY/BLACK) These patients are dead or so severely injured that death is certain within a short time, regardless of treatment given. Examples may include traumatic cardiac arrest, massive head injuries with brain matter exposed and massive body mutilation. Treatment Begin treatment of casualties, immediate priority first, delayed second and so on, in accordance with specific treatment protocols. Treatment should not delay transport unless absolutely necessary to stabilize life threatening injuries. Additional Resources A. As the needs for additional manpower and equipment become evident, those needs should be communicated to the Incident Commander. B. Local hospitals should be notified by the Medical Sector as to the nature and extent of the disaster. C. Medical Communications Branch will provide individual hospitals patient priority and major injury information, i.e. head abdomen, etc. Transport The most critically ill first and others as indicated by severity, available equipment and manpower allow. Re-Assessment of Remaining Patients As patients are triaged, treated and transported, re-assessment of those who remain is carried out. Re- triage based on new finds may be necessary. START PLUS The START system is a primary triage plan which identifies victims most at risk of early death and provides basic stabilization measures. It was designed for use by first responders/EMT at the scene of a mass casualty. In the setting of an MVI, it is recommended that START be utilized. Victims with signs of hypovolemia, respiratory distress and altered mental status are triaged as immediate. During the rapid evaluation, simple hemorrhage control and airway protection techniques are used. These assignments are used to categorize the victims; ventilation, perfusion and mental status. The walking wounded is segregated from other injured and evacuated at a later time. START requires as little as 60 seconds per victim. It has been adapted for use in a Multiple Victim Incident as well. “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. 04-16A Mass Casualty Guideline (SOG), Page 2 of 2