500-03 MASS CASUALTY INCIDENTS.pdf

Palm Beach County Fire Rescue Standard Operating Guideline SOG 500-03 Mass Casualty Incidents Issue Date: 05/21/2018...

Palm Beach County Fire Rescue Standard Operating Guideline SOG 500-03 Mass Casualty Incidents Issue Date: 05/21/2018 Effective Date: 06/21/2018 PURPOSE: The purpose of this standard operating guideline is to provide guidelines to efficiently triage, treat and transport patients of mass casualty incidents (MCI). AUTHORITY:  Fire Rescue Administrator  Florida Incident Field Operations Guide SCOPE: This standard operating guideline shall apply to all Fire Rescue Personnel. ATTACHMENTS: Attachment A: MCI Dispatch Protocols Attachment B: MCI Levels Flow Chart Attachment C: MCI Responsibilities Check List Attachment D: Start, Jump Start, TECC Flow Charts Attachment E: MCI Blank Flow Chart PROCEDURE: These guidelines provide a basic framework for most Mass Casualty Incidents. 1. MCI Defined a. A MCI is defined as one that exceeds the capabilities of the first arriving units. b. An MCI is classified by different levels depending on the number of patients: i. Level 1 MCI is 5 – 10 patients ii. Level 2 MCI is 11 – 20 patients iii. Level 3 MCI is 21 – 100 patients iv. Level 4 MCI is 101 – 1000 patients v. Level 5 MCI is over 1000 patients c. MCI Type examples: i. Shooting vi. Chemical ii. Explosive vii. Biological iii. Collapse viii. Radiological iv. Plane Crash ix. Nuclear v. Vehicle Accident SOG 500-03 Mass Casualty Incidents Page 1 of 5  2. The Communication Center a. Refer to MCI Dispatch Protocols (SOG 500-03 Attachment A) for unit allocation and hospital notifications. 3. ICS a. Refer is SOG 200-02 Incident Command Sequence. b. Depending on the size and complexity of the MCI, the Incident Command Structure may include the following assignments (as needed): i. Hazard Mitigation ii. Triage iii. Treatment iv. Transport v. Staging vi. Rehab 4. Specialized Resources a. Depending on the cause of the MCI (i.e., plane crash, shooting, etc…), the Fire Operations Officer may contact the State Warning Point and/or request additional resources outside Palm Beach County. b. In addition, internal Fire Rescue resources may be requested (refer to SOG 200-01 Area Command, Fire Rescue Reservist PPM FR-O-703, etc…) to assist. c. The Fire Operations Officer maintains the list of all Fire Rescue (and non-Fire Rescue resources) that may be beneficial in MCI’s. These resources include; but are not limited to: i. Tactical Command Unit (TCU) – command bus ii. Area Command Team iii. Incident Management Team iv. Support 81 – contains approximately resources (backboards, ribbons, medical kits) for approximately 200 patients v. Disaster Response Unit (DRU) – Refer to SOG 700-08 Disaster Response Unit(s) vi. Tactical 34 – Technical Rescue Team equipment (specialized equipment) vii. Inventory Specialist (from the Medical Supply Warehouse, the person that stocks medical supply rooms at fire stations). 5. Emergency Scene Activities a. The below responsibilities are for the person in charge of the stated categories. b. Staging Responsibilities: i. Refer to SOG 110-02 Response to Violent Incidents and SOG 200-05 Staging Levels. c. First Arriving Unit Responsibilities: i. Arrival report and establish Incident Command according to SOG 200-02 Incident Command Sequence. ii. 360-degree size up iii. Identify any Exclusion Zone iv. Declare MCI “Level” and “Type” SOG 500-03 Mass Casualty Incidents Page 2 of 5  v. Begin initial Triage (START, JUMP-START, and TECC) follow Fire Rescue Medical Protocols. vi. Assign incoming units based on incident priorities (L.I.P.E.). vii. Consider additional resources. viii. Designate Staging (refer to 200-05 Staging Locations). d. First Arriving Chief Officer Responsibilities: i. Utilize laminated field guide(s). ii. Utilize MCI vests. iii. Ensure any Exclusion Zone is identified and communicated. iv. Follow SOG 200-02 Incident Command Sequence. 1. Consider Unified Command 2. Establish assignments (noted in 3b above) 3. Assign units to assignments 4. Consider Medical to oversee Triage, Treatment, and Transport 5. Consider the need for multiple TAC channels v. Confirm and Declare MCI “Level” and “Type” vi. Consider additional resources (noted in 4c above) vii. Update the Communication Center on the number of patients and categories e. Safety Officer Responsibilities: i. Refer to SOG 200-03 Safety Officer ii. If necessary, request Law Enforcement to provide physical security to ensure Exclusion Zone is isolated. f. Hazard Mitigation: i. These are incident dependent (examples include: Fire Suppression, Structural Stabilization, Vehicle Stabilization, Fuel Leak Containment, etc…). g. Triage Responsibilities: i. Utilize MCI vest ii. Ensure any Exclusion Zone is identified and communicated. iii. Ensure all patients are triaged (START, JUMP-START, and TECC) according to Fire Rescue Medical Protocols. 1. Carry Trauma Rapid Response Kit iv. Ensure “walking wounded” are escorted to Treatment. v. Ensure that all areas have been checked for patients. vi. Utilize Litter Bearers for movement of patients to Treatment (coordinate movement of patients based on priority). 1. Additional Backboards used to assist in patient movement can be requested from: a. Support 81 b. Rescues in Staging c. The Inventory Specialist vii. Update Incident Command (or Medical, if established) with: 1. Number of patients 2. Patient categories 3. Additional resources needed SOG 500-03 Mass Casualty Incidents Page 3 of 5  h. Treatment Responsibilities: i. Utilize MCI vest ii. Establish Treatment: 1. In close proximity to Transport 2. Large enough 3. Utilize high visibility tape, tarps, or cones to identify area. iii. Supervise medical care according to Fire Rescue Medical Protocols. iv. Ensure enough equipment is available. 1. Consider requesting Inventory Specialist. v. Ensure contaminated patients have been Decontaminated prior to entry into Treatment. 1. Consider utilizing DRU for decontamination. vi. Ensure patients are moved from Treatment to Transport in priority order. vii. Ensure secondary assessment of all patients. 1. Utilize Metag 2. Leave original triage ribbon in place to indicate improvement or deterioration of patient. viii. All Fire Rescue Medical Protocols apply in Treatment. ix. Establish communications with Medical and Transport (Medical Communications Coordinator, if established) to coordinate patient transport. x. Keep Incident Command (or Medical, if established) updated with frequent progress reports. i. Transport Responsibilities: i. Utilize MCI vest ii. Establish Transport in a location that allows for: 1. Efficient entry and exit of Treatment. 2. Efficient entry and exit of the Transport Staging location (utilize Law Enforcement to assist as necessary). iii. Establish communications with Landing Zone for utilization of Trauma Hawk. iv. Coordinate the transport of patients by priority order. 1. Patients meeting Trauma Alert status should continue to be transported to designated Trauma facilities until the facility goes on “bypass”. Once on “bypass”, the patient should be transported to the closets available facility. v. Utilize a “Transport Log” to record (Documentation Aid may be requested): 1. Patient Met Tag ID number 2. Destination Hospital 3. Transport Unit Number vi. Consider Need for Medical Communications Coordinator. vii. Keep Incident Command (or Medical, if established) updated with frequent progress reports. j. Medical Communications Coordinator Responsibilities: i. These responsibilities default to Transport should the Medical Communication Coordinator not be established. ii. Advise Destination Hospitals. 1. Number of incoming patients SOG 500-03 Mass Casualty Incidents Page 4 of 5  2. Triage status of incoming patients. 3. Mode of transportation to hospital. iii. Advise Communications Center 1. Transport Unit 2. Number of patients 3. Metag numbers 4. Hospital Name k. Communication Center Responsibilities: i. The Communication Center shall contact the correct number of hospitals and patch them together. The Communications Center will then advise Transport, or the Medical Communications Coordinator if established, to switch to the appropriate TAC channel(s). l. Rehabilitation Responsibilities: i. Refer to SOG 420-08 Rehabilitation. 6. Post incident a. Refer to SOG 430-01 After Action Review. b. Refer to Critical Incident Stress Management (PPM FR-T-501) and Crisis Mitigation Program (PPM FR-T-502). c. A Formal After Action Review is required for a MCI Level 3 or greater. 7. Documentation a. See Incident Reporting (PPM FR-M-201). Supersession History 1. SOG #2315, issued 01/01/2008 2. SOG #2315, issued 10/01/2012 3. SOG 500-03, clerical 05/01/2018 4. SOG 500-03, issued 05/21/2018 SOG 500-03 Mass Casualty Incidents Page 5 of 5