Bonita Springs Fire Control and Rescue District Standard Operating Guidelines (PDF)

Bonita Springs Fire Control and Rescue District Standard Operating Guidelines Subject: Mass Casualty Incident - MCI Adopted: April 26, 2010 Effective Date: May 17, 2010 Last Revised Date: October, 2021 Revision Number: 3 Due for Revision Date: October, 2024 # 1053.09.00 Replaces: Table...

Bonita Springs Fire Control and Rescue District Standard Operating Guidelines Subject: Mass Casualty Incident - MCI Adopted: April 26, 2010 Effective Date: May 17, 2010 Last Revised Date: October, 2021 Revision Number: 3 Due for Revision Date: October, 2024 # 1053.09.00 Replaces: Table of Contents 1053.09.01 1053.09.02 1053.09.03 1053.09.04 1053.09.05 1053.09.06 1053.09.07 1053.09.08 Purpose Scope Definitions Apparatus Response Scene Arrival Responsibilities Standard Triage Methods Mass Casualty Patient Flow C:\powerdms\convert\Temp\f385260f-0bfb-4881-855b-25d864441656.doc Page 1 of 5 1053.09.01 Purpose The Multi-Casualty Branch Structure is designed to provide the Incident Commander with a basic expandable system for handling any number of patients in a multi-casualty incident. The degree of implementation will depend upon the complexity of the incident. Mass Casualty Incident Management Goals 1. 2. 3. 1053.09.02 Do the greatest good for the greatest number. Make the best use of personnel, equipment and facility resources Do not relocate the disaster. Scope This guideline will be used on all incidents where emergency responders have more patients than can be treated with the initial resources on scene. It will also be used whenever five or more patients are encountered. 1053.09.03 Definitions Level 1 MCI: 5 – 10 Victims Level 2 MCI: 11 – 20 Victims Level 3 MCI: 21 – 100 Victims Level 4 MCI: 101 – 1000 Victims Level 5 MCI: 1000+ Victims Strike Team: this is usually a group of five resources of the same kind and type and a Strike Team Leader; for example, ALS Transport Unit Strike Team consists of five ALS Transport Units with a leader and communications. Task Force: this is usually a group of five of resources of any kind and type and a Task Force Leader; for example, MCI Task Force may be two Transport Units, two BLS Transport Units, and one Suppression Unit with a leader and communications. Litter Bearer: is a team of personnel assigned to the Triage Officer to move victims from the incident site to the Treatment Area or Transport Units. C:\powerdms\convert\Temp\f385260f-0bfb-4881-855b-25d864441656.doc Page 2 of 5 1053.09.04 Response The minimum initial response to a possible or reported MCI shall consist of the Battalion Chief, Squad-21, two Engines, a Rescue unit, and on-call Chief. The general rule is one Engine Company or Rescue unit per every two packaged patients. Request additional Fire/Rescue units as based upon this formula. En route contact dispatch and have them ascertain hospital bed availability from the closest most appropriate facilities. The general rule for transporting ambulances is two down patients per unit, or three to four up patients. 1053.09.05 Scene Arrival Establish Command and accountability, as based upon the Department’s IMS and Accountability policy. 1053.09.06 Responsibilities All members: It is the responsibility of all members to exercise the appropriate control dictated by his/her rank in the implementation of this guideline. All responding units are to report to the staging area(s) unless otherwise directed. Incident Commander (IC): The first arriving unit will establish COMMAND. The IC will assess scene Safety, conduct a scene Size-up, approximate the number of victims and Forward this information to Lee Control. The IC will then assign personnel to conduct RAMP Triage using ribbon triage initially. Primary triage results must be reported back to the IC. The IC will then assign personnel to begin to set up (Triage, Treatment, and Transport areas). Other first arriving resources will be assigned to the Triage Group Supervisor and/or the Treatment Group Supervisor as appropriate. As personnel arrive, the IC will utilize the Lee County Common MCI Tactical Worksheet as applicable and assign the functional responsibilities listed below. Contact dispatch and have them ascertain bed availability from the closest most appropriate medical facilities. Medical Group Supervisor: The MEDICAL function is utilized in larger events to maintain span of control. MEDICAL will assign appropriate functions and maintain the Status Report section of the MCI Tactical Worksheet if not done by COMMAND. He or she will also determine the amount and type of any additional medical supplies needed and consider assigning a Medical Supply Officer. Triage Unit Leader: TRIAGE will direct "walking wounded" victims to a specific location or to decon area if needed. He or she will advise personnel to triage and ribbon tag victims where they lay if the scene is safe. TRIAGE, in coordination with TREATMENT, will direct Litter Bearers to move victims from the incident site to the Secondary Triage/Treatment Area. C:\powerdms\convert\Temp\f385260f-0bfb-4881-855b-25d864441656.doc Page 3 of 5 Treatment Unit Leader: TREATMENT will establish a centralized Secondary Triage/Treatment Area. He or she will ensure personnel perform a rapid trauma survey / secondary triage on patients and replace each ribbon with a DMS triage tag. If the incident size warrants, TREATMENT will designate a "Treatment Team Manager" for each color category. (RED, GREEN) TREATMENT will advise TRANSPORT of victim(s) requiring immediate transportation and COMMAND/MEDICAL as to any changes in the victim count. Transportation Unit Leader: TRANSPORT will maintain communication with MEDICAL and TREATMENT. TRANSPORT is responsible to document Hospital Bed Status and the Hospital Transport Log sections of the MCI Tactical Worksheet. He or she will establish a Victim Loading Area accessible to the Secondary Triage/Treatment Area and coordinate the loading of patients by priority to transport units. TRANSPORT will assign a hospital destination to each transporting unit and provide verbal and/or written travel instructions. He or she will request additional transport units from STAGING. Staging Area Manager: STAGING will maintain the Staging Area established by COMMAND or establish a location and notify Lee Control to direct all incoming units. He or she will coordinate with TRANSPORT the need for units and direct units to the victim loading area. STAGING will maintain the Ambulance Resources section of the MCI Tactical Worksheet and a reserve of ALS/BLS transport units. Should the reserve go down STAGING will advise COMMAND or MEDICAL as appropriate. 1053.09.07 Standard Triage Methods The method of initial field triage to be utilized is the RAMP Triage method for adult and pediatric patients. Patients who have been exposed to various HAZMAT or WMD may need to be triaged using guidelines that are specific to the agent to which they have been exposed. Patients who have been exposed, or who believe they have been exposed to chemical, biological, or radiological weapons have different triage needs than trauma patients. RAMP Triage the preferred tools for sorting trauma patients. Ambulatory patients are initially directed to a designated treatment area where they will be assessed and further triaged as personnel become available. For all remaining patients, triage personnel quickly move from patient to patient, using RAMP Triage to assess and apply color-coded triage ribbons (surveyor's tape). C:\powerdms\convert\Temp\f385260f-0bfb-4881-855b-25d864441656.doc Page 4 of 5 1053.09.08 Mass Casualty Patient Flow The Incident Scene Ambulatory patients are directed to a safe place as soon as one is identified. (Green Treatment Area)  Those who are able should be asked to assist with others.  Self treatment supplies should be distributed. All victims are accounted for; trapped victims are rescued or extricated.  Patients are accounted for and quickly triaged (RAMP).  Triage ribbons are applied. Patients are decontaminated (as needed) prior to arrival in the Secondary Triage/Treatment Area. Non-ambulatory patients are removed from the scene to the Secondary Triage/Treatment Area by litter bearers. Deceased victims are left as they are unless required to access live patients. The Secondary Triage/Treatment Area Patients are continuously reevaluated (re-triage). Patients arriving from the incident scene are prioritized for treatment using the more indepth Rapid Trauma Assessment method (Secondary Triage) and a DMS triage tag applied. Patients are placed in the Secondary Triage/Treatment Area and emergency medical care is provided on the basis of the triage priority.  Separate areas shall be created in the Treatment Area for Immediate (Red), and Minor (Green) injured patients.  A separate isolated area (Temporary Morgue) is created for victims who die in the Secondary Triage/Treatment Area. Personnel, equipment, and medical care resources are allocated to patients based on the triage priority. The Transportation Area Emergency Departments are contacted (early in the incident) to obtain information to assist with the most appropriate patient distribution to medical facilities. Transportation resources are assigned based on triage priority. Patients are transported to the most appropriate medical facility by the most appropriate means available. Emergency medical care is continued en route to the hospital. Patient movements are documented on the Hospital Transport Log and Hospital Bed Status Worksheet. C:\powerdms\convert\Temp\f385260f-0bfb-4881-855b-25d864441656.doc Page 5 of 5