Bernalillo County Fire & Rescue Hostile MCI Incident SOG 3.10 PDF

**Deputy Chief Brian Rose, Chief Greg Perez** Purpose: To describe the best practice for a multi-agency response to a Hostile Multiple Casualty Incident (MCI) Scope: The scope of this guideline includes use on active shooter incidents, multiple patient responses where there is a risk to responde...

**Deputy Chief Brian Rose, Chief Greg Perez** Purpose: To describe the best practice for a multi-agency response to a Hostile Multiple Casualty Incident (MCI) Scope: The scope of this guideline includes use on active shooter incidents, multiple patient responses where there is a risk to responders by hostile actors, and any response in which the cause of multiple casualties is not immediately apparent. Definitions: **RTF**: Rescue Task Force: Comprised of 2 to 4 BCFD personnel with a Law Enforcement security team of at least two deputies. The highest ranking fire department company officer embedded with the team is the fire department team liaison with the combined rescue task force. If a company officer is not embedded with the team, then the highest level of licensure EMT will be the fire department liaison with the team. **CCP:** Casualty Collection Point: Located in the transition area or in the warm zone; casualties are extracted and triage and treatment are performed. **AEP:** Ambulance Exchange Point: The area, located in the Cold Zone where patients are loaded into waiting ambulances for transport. **Transport Officer:** Albuquerque Ambulance supervisor or BCFD officer that will coordinate transport units and destination facilities. **Hot Zone**: Any area in front of Law Enforcement that has not been "cleared" and is considered an IDLH to FD personnel. **Warm Zone:** Any area behind Law Enforcement that has been "Cleared". Only RTF personnel with a security team should enter. **Cold Zone**: Any area beyond the Warm Zone. Is considered Safe and Secured by Law Enforcement. **Medical Branch**: Branch of the Command System that is responsible for to RTF entry readiness, triage, treatment, and transportation of patients to waiting ambulances. **Refuge Area**: Secure area where non-injured casualties are brought before being transported by Law Enforcement for accountability, notification, and/or investigative purposes. **Go Bags:** Personal Medical Kit that each BCSO Deputy carries. General Guidelines: This practice is to be used to help all agencies understand the integration of fire department operations during a hostile MCI incident. Situational Awareness is the responsibility of all responders during integrated Law enforcement and Fire operations. **Roles, Responsibilities and Considerations:** I. **Emergency Communications Operator** A. Once Communications receives a call for an active shooter they will: 1. Dispatch the call as a first alarm (3 Suppression Units, 3 Rescue Units, 2 Battalion Commanders) 2. Ensure the regional Battalion Commander has been notified. 3. Operations for BCFD will be assigned to a regional TAC channel. 4. Keep track of all needed benchmarks for Command and may need to track these other benchmarks as necessary. - Unified Command Established - CCP Established - RTF Established and Entry - All casualties removed to CCP - All casualties Triaged at CCP - All Immediates Transported - All non-casualties moved to refuge area II. **BCSO Operations** B. See BCSO Unified Command Procedures for a Hostile MCI for familiarization. **THIS IS A PRIMARILY A LAW ENFORCEMENT EVENT.** III. **BCFD Operations** C. **Battalion Commander** 5. The first arriving Battalion will establish unified command. 6. Establish and notify all responding units as to the location of the Level II staging area. 7. Define and notify all responding units as to the location of the hostile zone boundaries. 8. Develop an IAP and deploy resources as necessary to fill functional roles. 9. The second arriving Battalion Commander will fill a support officer role. 10. The second arriving Battalion Commander will send a 'Command Page' notification. 11. The second arriving Battalion Commander will maintain BCFD personnel accountability with consideration to fact that units may be split. D. **Responding Personnel** 12. The initial units should stage in the area unless cleared to enter by BCSO or the regional Battalion Commander. In the event that the Regional Battalion Commander has an extended ETA, the first arriving engine will attempt to make contact with LE personnel and begin the process of setting up an RTF. 13. Responding personnel will switch to their assigned regional TAC channel to await assignment. The responding regional BC will advise on the location of the Level II staging area. 14. Once all units who are dispatched on the first alarm report to the designated Level II staging area, they will don required hostile MCI PPE and wait for an assignment from Command. 15. BCFD responders assigned to a RTF role must notify command upon entry and exit of the hazard zone. IV. **Command Considerations** E. The regional Battalion Commander will establish unified command with BCSO. Consideration will be given to the following: 16. Communications between BCSO, BCFD, and transport agency. 17. Response of appropriate 1^st^ Alarm: 3 Rescues, 3 Engines/Quint, 2 Battalion Commanders 18. Personnel Accountability and tactical assignments. 19. Overall Incident Action Plan (IAP) 20. ABC EMS MCI Protocol \[Response of transport agency Supervisor is required\] V. **Medical Branch/CCP Roles and Responsibilities** A. Upon the establishment of a CCP (either a company officer or the 2^nd^ arriving Battalion Commander will be the officer in charge of the Medical Branch) at least 1 Paramedic will be assigned to the CCP along with the necessary number of fire personnel and LE to conduct this operation as effectively as possible. 1. Coordinate entry of the RTF with the Security Team. 2. Advise Command if a secondary CCP will be required. 3. Establish a Triage area and assign personnel as needed using START Triage 4. Establish a Treatment area and assign personnel as needed 5. Establish an area of Refuge for non-injured casualties 6. Coordinate the transition from Treatment to Transport a. Medical Branch-BCFD MCI Protocol b. Refuge Branch- BCSO Protocol VI. **RTF Roles and responsibilities** F. The establishment of an RTF consists of 2 to 4 BCFD personnel. The RTF along with a BCSO security team will be considered a complete RTF in order to conduct this operation as effectively and safely as possible. 21. Collect forcible entry equipment at the breech-point. 22. Enter the Warm Zone and determine the approximate number of patients and advise the CCP officer if a secondary CCP will be required. 23. Triage, treat rapidly, tourniquet if necessary and remove casualties. 24. Move casualties to secured triage areas in the CCP VII. **Additional Resources** G. Any resources required by Unified Command to assist in mitigating the event. This may include the deployment of a 2^nd^ alarm or a request for mutual aid. VIII. **Equipment** H. BCFD 25. Each BCFD Rescue Apparatus will contain at least 2 sets of RTF equipment and at least one patient moving device. 26. Each BCFD Engine/Ladder will contain at least 3 sets of RTF equipment and at least one patient moving device. Specific procedures: 1. Establish early contact with the appropriate BCSO or APD unit in command. 2. Develop unified command with law enforcement counterpart. 3. Quickly identify quantity and severity of casualties. 4. Communicate number of patients back to unified command. 5. Quickly treat and transport patients to definitive care. 6. Maintain the integrity of the crime scene if practicable. References: New Mexico Law Enforcement Academy (NMLEA) Advanced Training Course -- Rescue Task Force, Certification ID: NM190038 Albuquerque/Bernalillo County EMS Protocols