General Protocols -2022 (hyperlinked).pdf

Revision Date: December 22, 2021 Revision Date: December 22, 2021 BACK TO TABLE BACK TO TABLE OF OF CONTENTS CONTENTS Medical Emergencies 22 Table of Contents BACK TO TABLE OF CONTENTS Revision Date: December 22, 2021 Refusal of Care & Transport p. 4 BHAP & CISM Activation Process p. 7 Do Not Resuscitate Order p. 12 Determination of Death p. 14 Crime Scene Considerations p. 15 Helicopter Safety p. 16 Mass Casualty Incident p. 19 Table of Contents 3 Refusal of Care & Transport Revision Date: December 20, 2021 I. Purpose: Any and all individuals who are involved as patients or poten al pa ents should receive proper evalua on, treatment, and transporta on to the appropriate medical facility. There may be mes when this policy may not be carried out due to a refusal of care. The refusal of care procedure should be u lized in situa ons in which a pa ent refuses evalua on, treatment, and/or transporta on by pre-hospital personnel. Persons should be assessed for competency to make decisions aﬀec ng their medical care. II. Defini ons: A. Person can refuse medical care and/or transport based on the following guidelines: 1. Competent Adult PaƟent—defined by the ability to understand the risks and lack of poten al benefits of his/her ac ons by refusing medical care and/or transporta on 2. Adult ‐ eighteen (18) years of age or older, including: a. A competent emancipated minor b. A self‐suﬃcient minor c. A married minor d. A minor in the military 3. A legal representa ve for the pa ent (parent, guardian, health care surrogate) B. Pa ents not able to refuse care: A person may be considered incompetent to refuse medical care and/or transporta on if the severity of his/her medical condi on prevents the pa ent from making an informed, ra onal decision regarding medical care. Therefore, the individual may not refuse medical care and/or transporta on based on the following guidelines: (Incapacitated persons law—401.445) 1. Altered level of consciousness 2. Suicide (a empt or verbal threat) 3. Severely altered vital signs 4. Mental retarda on and/or deficiency 5. Not clinically sober (slurred speech, diﬃculty with balance or coordina on) 6. Younger than eighteen (18) years of age (except those persons outlined above) C. Refusal of care or transport for minors in the absence of parent or guardian: 1. If the parent or legal guardian whose child(ren) have trauma c injuries (e.g., due to an MVA, sports injury, etc.) and are unable to make it to the scene within a reasonable amount of me, the parent or guardian may request by phone that their child not be transported to the hospital. 2. If there is an adult present and willing to sign the pa ent refusal form, accep ng responsibility on behalf of the parent and the parent verbally consents to gran ng that responsibility to such adult, as well as leaving their child(ren) in the care of that adult. It is then acceptable to have the child stay on scene. 3. These interac ons should be well documented in the electronic pa ent care report (ePCR). 4. If there is no authorized adult to sign, the minor must be transported to the appropriate hospital. BACK TO TABLE OF CONTENTS Refusal of Care 4 Refusal of Care & Transport conƟnued… Revision Date: December 20, 2021 D. Refusal of transport or transport des na on: 1. Pa ents who refuse to be transported to the closest appropriate facility and are adamant about being transported to a diﬀerent facility should be considered to be refusing transport. The supervising oﬃcer should be contacted for further consulta on on the transport des na on according to opera onal availability. 2. When a pa ent refuses to be transported to any facility, Medical Direc on should be considered for further consulta on, when such refusal represents a significant risk to the pa ent or the EMS system/agency. E. Implied consent 1. If a person is determined to be incompetent, he or she may be treated and transported under the principle of “implied consent” and/or as an incapacitated person. 2. If the pa ent is transported and/or treated on the basis of implied consent, field personnel should use reasonable measures to ensure safe transport to the closest appropriate facility. F. Medical Direc on: The physician at the des na on facility or the agency’s Medical Director. G. High Risk Refusals: Contact with Medical Direc on should be considered for consulta on under the following high risk circumstances: 1. A pa ent who is under 18 years of age 2. A pa ent whose refusal of care represents a significant risk to the pa ent or EMS system/agency 3. A pa ent who is not his/her own legal guardian 4. A pa ent who refuses transport a er administra on of any IV medica on (excep on: Diabe c pa ent, see below) 5. Persons in custody of a LEO no longer have the legal right to refuse transport but CAN refuse treatment by EMS unless it is deemed life threatening. a. In EVERY case where EMS is requested by PD to evaluate a person in custody, whether for evalua on or treatment the pa ent WILL be transported to a proper medical facility and be accompanied by LEO. 6. If any ques ons on the assessment of competency or refusal of care occur, contact Medical Direc on for further guidance. 7. Diabe cs: Pa ents with diabetes who received treatment may sign a Pa ent Refusal Form provided all of the following condi ons are met: a. b. c. d. The pa ent is lucid and can understand the risk/benefits of refusal The pa ent has blood glucose levels that have returned to acceptable levels Has immediate access to food The pa ent otherwise meets the criteria to refuse as outlined in this protocol 8. If refusal of care or transport of a minor is in ques on based on paramedic judgement, contact Medical Direc on immediately BACK TO TABLE OF CONTENTS Refusal of Care 5 Refusal of Care & Transport conƟnued… Revision Date: December 20, 2021 H. Mul ple pa ents: The procedure does not allow for more than one refusal on a single EMS Run Report. However, individuals who refuse ALL assistance, including proper evalua on, can be combined on a single report (e.g., all par es deny injury). Once an examina on is begun on an individual, a separate EMS Run Report must be filled out to record the examina on. Also, any later refusal of care requires following the complete protocol outlined below. The use of mul ple refusals of care is primarily designed for incidents that have numerous par cipants (poten al pa ents) where it becomes evident that some par cipants are not injured at all or refuse to be examined when approached by EMS personnel. a. Use Sec ons A, B & C to determine if pa ent can refuse care or transport b. Document all names, addresses, and witnesses III. Refusal Procedure: All measures should be taken to convince the pa ent to consent, including enlis ng the help of family or friends. 1. Single pa ent a. Determine that the individual is involved in the incident. b. Determine that the individual is refusing to allow the proper evalua on, or necessary treatment, or necessary transport to the appropriate medical facility. c. Determine the mental status and extent and history of injury, mechanism, or illness. i. Ensure that the pa ent is conscious, alert, and oriented and understands (mental reasoning) his/her condi on (pa ent GCS = 15). ii. Unless the pa ent specifically refuses, do a complete physical assessment. d. Inform the pa ent and/or responsible party (parent or guardian) of the risk/benefits of the decision to refuse treatment and/or transport to a defini ve‐care facility (loss of life or limb, irreversible sequelae), and ensure that the pa ent and/or responsible party fully understands the explana on. 2. If the pa ent con nues to refuse, the pa ent and/or responsible party may then sign a “Refusal of Care” form. Ensure that the following informa on is provided to the pa ent: a. The release is against medical advice. b. The release applies to this instance only. c. EMS should be requested again if necessary or desired. 3. A er the “Refusal of Care” form is signed, it must be witnessed (including legibly printed name, contact informa on, and signature of witness). 4. If the pa ent or responsible party will not sign the release, then document this refusal on the EMS Run Report. If available, witness signatures should be obtained. 5. When possible, pa ents should be le in the care of family, friends, or responsible par es. 6. Carefully document the assessment and vital signs, including all issues and circumstances indicated. BACK TO TABLE OF CONTENTS Refusal of Care 6 BHAP & CISM AcƟvaƟon Process Revision Date: December 22, 2021 INFORMATION Behavioral Health Access Program (BHAP) is a mul component program for firefighter mental health/wellness and crisis interven on. BHAP is becoming a world standard of care for first responders and is recognized by the following:      Na onal fallen firefighter's founda on Na onal Fire Protec on Associa on (NFPA) Fire Service Joint Labor Management Wellness‐Fitness Ini a ve Interna onal Associa on of Firefighters (IAFF) Interna onal Associa on of Fire Chiefs (IAFC) The Fire Chief’s Associa on of Broward County (FCABC) has developed a Health and Safety commi ee which has embraced the BHAP model. The Health and Safety commi ee is designed to bring workers and management together to promote safety and health in the workplace in compliance with FL Statute 633.522 BHAP BENEFITS:  Reduc on in symptoms of PTS  Reduced worker’s comp claims  Quicker return to normal produc ve func oning  Reduced absenteeism  Increased job sa sfac on  Reduced Errors  Enhanced group cohesion  Increased personal confidence  Extended longevity Types of incidents for BHAP response are called Debilita ng Cri cal Incidents (DCI). Examples are:  Serious injury or death of a member of the department  Pediatric injury or death  Large Scale/Long Term Event with or without loss of life (natural disaster, ASHER event, etc.)  Mul ple youth fatali es or violence to a minor  Events with severe opera onal challenges  Line‐of‐duty death or line‐of‐duty injury  Oﬃcer involved in a shoo ng  Oﬀ‐duty death, suicide, homicide, or injury  Events with mul ple or mass casual es  Events when the vic m(s) is (are) known  Events with excessive media interest  Serious injury or death of a civilian resul ng from fire department opera ons (e.g., vehicle accidents or structure fires)  Any incident that could perceivably cause emo onal impact  Police oﬃcer or firefighter in an accident at or above Level 1 Trauma BACK TO TABLE OF CONTENTS BHAP AcƟvaƟon Process 7 BHAP & CISM AcƟvaƟon Process Revision Date: December 22, 2021 BHAP SERVICES  CISM  Family Support  Peer Support  Eﬀec ve Insurance Coverage  Chaplaincy  Trained Clinician Response Team (CRT)  Re ree Support Programs  Evaluated Recovery Centers  Culturally Competent Employee Assistance Programs CRITICAL INCIDENT STRESS MANAGEMENT (CISM) CISM is the Mitchell Model ICSF trained team. Below are the components of this model: Small group defusing: 1. Recommended within the first 12 hours a er a cri cal incident 2. Best delivered as soon as possible a er a cri cal incident occurs 3. Homogenous groups 4. Assessment and educa on with possible referral and follow up Small group debriefing: 1. 12‐72 hours post‐cri cal incident occurs 2. Prior to demobiliza on from extended deployment or upon return from extended deployment 3. Events of significant personal loss (expanded‐phrase defusing within 12 hours) Crisis Management briefing: 1. Appropriate for large incidents, incidents with high media involvement, respite/rehab centers and demobiliza on. 2. Best for large groups or mixed groups. 3. Primary focus on assessment and informa on. Florida Statute 401.30(4) (e) protects the discussions held during a CISM intervenƟon as being “confidenƟal and privileged communicaƟon under secƟon 90.503.” Therefore, all informaƟon shared during any part of a CISM intervenƟon is held in the strictest of confidence. BACK TO TABLE OF CONTENTS BHAP AcƟvaƟon Process 8 BHAP & CISM AcƟvaƟon Process Revision Date: December 22, 2021 PEER SUPPORT  Provides confiden al emo onal/mental wellness support and trained empathe c/ac ve listening for first responders and their families  Facilitates early educa on, interven on, and diﬀusing of behavioral/mental health problems to prevent or cope with personal crisis  Determines a member’s immediate needs with the ability to recommend appropriate resources  Fosters development of dual cer fied Peer/CISM members to par cipate in the peer role of CISM  Recommends organiza onal mental health needs of fire departments CHAPLAIN  Pastoral/Spiritual Crisis Interven on  Grief Counseling  Privileged Confiden ality with immunity from court tes mony CLINICIAN RESPONSE TEAM (CRT)  Trained in first responder specific culture and treatment  Oﬀer assessment, evalua on, educa onal services, treatment, referral, follow‐up, and crisis interven on EVALUATED RECOVERY CENTERS  Evaluated by various BHAP professionals  Fixed facili es that provide first responder specific treatment programs for substance abuse, PTSD, and other co‐occurring behavioral health issues  Must meet strict criteria developed by BHAP professionals FAMILY SUPPORT: Family caregivers (Spouses, Life partners, Parents, and Children) are in an ideal posi on to be a uned to and provide support toward iden fying need for professional care for their loved ones. Educa onal programs may be designed to enhance the caregiver’s knowledge of Stress injuries/mental health related issues specific to the first responder and develop strategies to manage conflict, prevent relapse, and promote recovery for themselves and their loved ones. RETIREE SUPPORT PROGRAMS: Mental wellness programs should be extended to include re rees who may con nue to suﬀer from job related stress and could benefit from posi ve BHAP programs. The re ree demographic can be a higher risk of depression, substance abuse, and suicidal idea on due to a mul tude of factors including but not limited to: loss of sense of purpose, decreased ac vity and involvement in fire department related func ons/ Opera ons, and perceived low levels of connec vity with others within the fire service community. Your re ree demographic can be an invaluable asset in areas such as peer support and other areas as pertaining to resiliency and mental wellness within your department. BACK TO TABLE OF CONTENTS BHAP AcƟvaƟon Process 9 BHAP & CISM AcƟvaƟon Process Revision Date: December 22, 2021 EFFECTIVE INSURANCE COVERAGE: Eﬀec ve insurance policies for first responders should be inclusive of first responder specific providers as well as provide the highest level of service while limi ng any poten al impedances to accessing clearly iden fied first responder specific resources. These programs should seek out and provide a current and detailed list of culturally aware providers that have tangible and validated experience working with first responders as well as fixed facili es that have first responder specific programs. CULTURALLY COMPETENT EMPLOYEE ASSISTANCE PROGRAMS: Employee Assistance Programs should be available to first responders and their families through a process that includes program managers knowledgeable in first responders mental health professional and eﬀec ve treatment op ons specific to the unique first responder culture and community. Resource portal for up to date BHAP providers: www.coralspringsstrong.org “The use of one intervenƟon does not preclude the use of others for the same criƟcal incident.” BACK TO TABLE OF CONTENTS BHAP AcƟvaƟon Process 10 BHAP & CISM AcƟvaƟon Process Revision Date: December 22, 2021 ACTIVATION OF CISM The Oﬃcer ini a ng the CISM request will no fy their Safety and Health Chief who will assist with the ac va on. The reques ng agency may call any of the 3 Broward Regional Communica ons Centers and ask for the Duty Oﬃcer to ini ate a BHAP Team response. Broward Regional Communica ons Center Numbers:  North – (954) 476‐4720  Central – (954) 476‐4730  South – (954) 476‐4740 When ac va ng the CISM, the duty oﬃcer will provide the following info: 1. Agency name 2. Type of incident 3. Number of members involved 4. Call‐back contact name and number The BHAP Team Coordinator receives the informa on and informs the BHAP Clinical Director of the incident. BHAP Team Coordinator contacts the incident contact person, receives details of the incident, and advises the contact person of the appropriate type and ming of response. The type of response is dictated by:  How early the BHAP is ac vated  The nature of the incident  BHAP Team Coordinator begins assembling a response team.  BHAP response team members assemble for a briefing with the BHAP Team Coordinator and then meet with the contact person or designee  All personnel receiving support shall be oﬀ‐duty or out of service  Interven on is done in a secure loca on without wri en, audio, or video recording  A er the interven on, the responding BHAP team gathers for a team debriefing ACTIVATION ADDITIONAL BHAP RESOURCES For ac va on of addi onal resources, contact the Safety and Health Chief. The most updated Coral Springs BHAP resources can be found: www.coralspringsstrong.org. This includes: Peer Support, Clinician Response Team, Chaplaincy, Re ree Support Programs, Eﬀec ve Insurance Coverage, Family Support, CCEAP, Evaluated Recovery Centers EAP may also be contacted @ 800‐554‐6931 BACK TO TABLE OF CONTENTS BHAP AcƟvaƟon Process 11 Do Not Resuscitate Order Revision Date: December 22, 2021 I. Purpose: All patients found in cardiac arrest will receive cardiopulmonary resuscita on unless an excep on is met as outlined in the following: II. ADVANCED DIRECTIVES/DO NOT RESUSCITATE ORDERS (DNRO) 1. Legisla ve authority Under Florida Administra ve Code (FAC) 64J‐2.018. Do Not Resuscitate Order (DNRO) Form and Pa ent Iden fica on Device. The Florida DNRO form is the only form approved in the State of Florida. If there is a DNRO/POLST/MOST/MOLST form from another State presented by the pa ent or family, contact Medical Control as soon as possible for direc on. 2. EMS shall withhold or withdraw cardiopulmonary resuscita on: a. Upon the presenta on of an original or completed copy of DH Form 1896, Florida Do Not Resuscitate Order Form, December 2004, which is incorporated by reference and available from DOH at no cost, or, any previous edi on of DH Form 1896; or 1.IV.2.1.2 b. Upon the presenta on or observa on, on the pa ent, of a Do Not Resuscitate Order pa ent iden fica on device. Upon the presenta on of a pa ent iden fica on device 3. The Do Not Resuscitate Order Form shall be printed on yellow paper and have the words “DO NOT RESUSCITATE ORDER” printed in black and displayed across the top of the form. DH Form 1896 may be duplicated, provided that the content of the form is unaltered, the reproduc on is of good quality, and it is duplicated on yellow paper. The shade of yellow does not have to be an exact duplicate. 4. PaƟent idenƟficaƟon device is a miniature version of DH Form 1896 and is incorporated by reference as part of the DNRO form. Use of the pa ent iden fica on device is voluntary and is intended to provide a convenient and portable DNRO which travels with the pa ent. a. The device is perforated so that it can be separated from the DNRO form. It can also be hole‐ punched, a ached to a chain in some fashion and visibly displayed on the pa ent. In order to protect this device from hazardous condi ons, it shall be laminated a er comple ng it. Failure to laminate the device shall not be grounds for not honoring a pa ent’s DNRO order, if the device is otherwise properly completed. 5. The DNRO form and pa ent iden fica on device must be signed by the pa ent’s physician. In addi on, the pa ent, or if the patent is incapable of providing informed consent, the pa ent’s healthcare surrogate or proxy as defined in Sec on 765.101, F.S., or court appointed guardian or person ac ng pursuant to a durable power of a orney established pursuant to Sec on 709.08, F.S., must sign the form and the pa ent iden fica on device in order for them to be valid. The form does not need to be notarized, once signed the form does not expire. BACK TO TABLE OF CONTENTS Do Not Resuscitate Order 12 Do Not Resuscitate Order Revision Date: December 22, 2021 6. EMS shall verify the iden ty of the pa ent who is the subject of the DNRO form or pa ent iden fica on device. Verifica on shall be obtained from the pa ent’s driver’s license, or photo iden fica on or from a witness in the presence of the pa ent. If a witness is used to iden fy the pa ent, this fact shall be documented in the EMS Run Report, which must include the following informa on: a. The full name of the witness b. The address and telephone number of the witness c. The rela onship of the witness to the pa ent 7. During each transport, the EMS provider shall ensure that a copy of the DNRO form or the pa ent iden fica on device accompanies the live pa ent. The EMS provider shall provide comfor ng, pain‐relieving and any other medically indicated care, short of respiratory or cardiac resuscita on. 8. A DNRO may be revoked at any me by the pa ent, if signed by the pa ent, or the pa ent’s health care surrogate, or proxy or court appointed guardian or person ac ng pursuant to a durable power of a orney established pursuant to Sec on 709.08, F.S. Pursuant to Sec on 765.104, F.S., the revoca on may be in wri ng, by physical destruc on, by failure to present it, or by orally expressing a contrary intent. 9. Oral orders from nonphysician staﬀ members or telephoned requests from an absent physician do not adequately assure EMS that the proper decision‐making process has been followed and are NOT acceptable. 10. In the near future, Florida will be adop ng POLST (Physician Orders for Life Sustaining Treatment Paradigm). The Na onal POLST Paradigm is an approach to end‐of‐life planning that emphasizes pa ents’ wishes about the care they receive. The POLST Paradigm is an approach to end‐of‐life planning emphasizing: (i) advance care planning conversa ons between pa ents, health care professionals and loved ones; (ii) shared decision‐making between a pa ent and his/her health care professional about the care the pa ent would like to receive at the end of his/her life; and (iii) ensuring pa ent wishes are honored. As a result of these conversa ons, pa ent wishes may be documented in a POLST form, which translates the shared decisions into ac onable medical orders. a. The POLST form assures pa ents that health care professionals will provide only the care that pa ents themselves wish to receive, and decreases the frequency of medical errors. POLST is not for everyone. Only pa ents with serious illness or frailty should have a POLST form. For these pa ents, their current health status indicates the need for standing medical orders. For healthy pa ents, an Advance Direc ve is an appropriate tool for making future end‐of‐ life care wishes known to loved ones. b. Several States use the POLST program and there several other forms used by these States, Medical Orders for Life Sustaining Treatment (MOLST), Medical Orders for Scope of Treat‐ ment (MOST) and the Physician Orders for Scope of Treatment (POST) form. Specific Authority 381.0011, 401.45(3) FS. Law Implemented 381.0205, 401.45, 765.401 FS. History–New 11‐30‐93, Amended 3‐19‐95, 1‐26‐97, Formerly 10D‐66.325, Amended 2‐20‐00, 11‐3‐02, 6‐9‐05, Formerly 64E‐2.031.5. BACK TO TABLE OF CONTENTS Do Not Resuscitate Order 13 DeterminaƟon of Death Revision Date: December 22, 2021 I. Purpose: The EMT or paramedic may determine that the adult or pediatric pa ent is dead/non‐salvageable and decide not to resuscitate the pa ent under the following guidelines: a. At least 1 of the following condi ons is present: 1. 2. 3. 4. Lividity Rigor mor s Tissue decomposi on A valid DNRO is presented or discovered OR b. If all of the following are present: 1. 2. 3. 4. 5. Suspected down me > 30 minutes Asystole Pupils fixed and dilated Apneic Without hypothermic mechanism for arrest c. Pa ents with suspected hypothermia, barbiturate overdose, or electrocu on require full ALS resuscita on unless they have injuries incompa ble with life or ssue decomposi on. d. EMS personnel may contact medical direc on for a “determina on of death” whenever support in the field is desired. Clearly state the purpose for the contact as part of the ini al hailing. e. Resuscita on on a TRAUMA vic m should NOT be a empted if pa ent has ALL 3 of the following presump ve signs of death present: 1. Apneic 2. Asystole 3. Fixed and dilated pupils OR 4. If the following conclusive sign is present: a. Injuries incompa ble with life (e.g., decapita on, massive crush injury, incinera on, etc.) 5. Prolonged extrica on me (more than 15 minutes) where no resuscita ve measures can be ini ated prior to extrica on. 6. SPECIAL CONSIDERATIONS IN PATIENTS with PENETRATING or BLUNT CHEST TRAUMA: a. Bilateral needle decompression may be performed in an a empt to achieve ROSC b. Resuscita on eﬀorts DO NOT need to be started if the pa ent did not regain pulses immediately following the bilateral needle decompression f. If there is any concern regarding leaving the pa ent at the scene, begin resuscita on and transport g. Considera on should be given for the possibility of organ harvest; however, this should not be the sole reason for resuscita on. h. The local law enforcement agency that has jurisdic on will be responsible for the body once death has been determined. The body is to be le at the scene un l a disposi on has been made by the Medical Examiner’s Oﬃce or the local jurisdic on. BACK TO TABLE OF CONTENTS DeterminaƟon of Death 14 Crime Scene ConsideraƟons Revision Date: August 19, 2021 This SOG is issued by the Fire Chief’s Associa on of Broward County, FCABC—SOG 301. Date: May 31, 2019 Link: FCABC I. Purpose/Intent: This procedure will be used when law enforcement personnel advise EMS that they are responding to a crime scene or EMS determines that a crime scene may exist. This below informa on is to ensure the protec on of pa ent welfare as well as to ensure the ability to conduct an eﬀec ve and thorough inves ga on. II. Response/on‐scene situa ons: a. Only those units assigned will respond to the call. b. When approaching a poten al crime scene that is being protected by law enforcement personnel, EMS may request entry into the area to determine the life status of the individual. c. If law enforcement personnel refuse access to the crime scene, do not become confronta onal. No fy the EMS Agency Supervisor and complete an incident report as required. d. When personnel are allowed access into the scene, the minimum number of required EMS personnel should enter to minimize disturbance of the crime scene. e. Do not a empt resuscita on if the pa ent has no pulse, has no spontaneous respira on, and meets criteria outlined the protocol, DETERMINATION OF DEATH f. If treatment and/or resuscita on are warranted, follow the appropriate protocol. g. When on scene: 1. Keep your medical equipment close to the vic m. 2. Stay close to the body. 3. Keep your hands out of any blood that has pooled. 4. Do not wander around the scene. 5. Minimize destruc on of the pa ent’s clothing. If the pa ent’s clothing has a puncture, do not use the hole in the clothing to start cu ng. Begin cu ng at another part of the garment. Removed clothing should be le with the pa ent or turned over to law enforcement personnel. 6. Do NOT go through the vic m’s personal eﬀects, clean the body, or cover the body with a sheet or other material (if expired). a. Do NOT move, take, or handle any object at the scene or li er the crime scene with medical equipment, dressings, bandages, or other supplies. b. If resuscita on eﬀorts are deemed necessary, transfer the vic m from the scene to the vehicle expedi ously and stabilize the vic m in the vehicle, when possible. c. If the pa ent relates any informa on rela ng to the crime while in transit to the medical facility, inform law enforcement personnel at once. BACK TO TABLE OF CONTENTS Crime Scene ConsideraƟons 15 Helicopter Safety Revision Date: December 22, 2021 I. Communica on Procedures: The standard dispatch for an Air Rescue assignment should be one (1) engine company and one (1) rescue. The need for addi onal units should be dictated by the incident circumstances. It should be kept in mind that the unit assigned as the heli‐spot (HS) group may need all of its personnel to properly secure the HS site. This may create the need for addi onal units to address pa ent care needs. Dispatchers should not take it upon themselves to modify this assignment, nor should they suggest modifica on of the assignment. As with any Fire Department assignment, the only personnel who can modify the assignment are Uniformed Fire Department Oﬃcers. II. Air Rescue Capabili es: The following represents incidents that may necessitate Air Rescue response: 1. Level 1 trauma pa ent with a ground transport me of greater than twenty (20) minutes to an appropriate trauma facility. 2. Level 2 trauma pa ent with a ground transport me of greater than thirty (30) minutes to an appropriate trauma facility. 3. The pa ent is located in an area inaccessible by ground. 4. Extrica on of a trauma pa ent is an cipated to exceed fi een (15) minutes. 5. Severe cardiac crisis, severe pulmonary crisis, stroke, drowning, or life threatening pediatric illness with a transport me of greater than twenty (20) minutes to an appropriate medical facility. 6. Dive emergencies. 7. Inter‐facility pa ent transfers that are me‐cri cal. 8. Search and rescue of lost or missing people in the Intra-coastal Waterway, ocean, lakes, canals, the Florida Everglades, or other large wilderness areas. 9. Aerial coverage for an overhead vantage point on brush fires, large industrial or commercial fires. III. Transport Guidelines: A. If it is determined that Air Rescue response may be necessary, the request should be made as soon as possible through Dispatch. B. All personnel who request Air Rescue for pa ent transport shall take the following safety considera ons into account: 1. Weather Condi ons – The helicopter is unable to fly in lightning, strong winds, heavy rain and fog. 2. Loca on of power lines. 3. Trees, signs, posts, debris or other obstacles in the landing zone (LZ). 4. Civilians and other pedestrian and/or vehicular traﬃc in the area. 5. Consider wet down of the area if the landing zone site is significantly dusty and/or dry. C. If it is determined that Air Rescue may be u lized for transport, a tac cal channel must be assigned for communica ons. BACK TO TABLE OF CONTENTS Helicopter Safety 16 Helicopter Safety Revision Date: December 22, 2021 D. On scene personnel must communicate the following information to Air Rescue as quickly as possible: 1. Patient status. 2. Patient weight. 3. Airway compromise and/or the need for rapid sequence intubation. 4. If the patient is combative, suicidal or is a prisoner. E. On scene personnel must secure a MedCom channel and supply an initial telemetry report to the receiving facility. F. Landing zone considerations should begin as soon as the request for Air Rescue is made. 1. Landing zones require a one hundred (100) feet by one hundred (100) feet area free from any potential safety hazards listed above. 2. Incident Command shall communicate the intended landing zone area to the Air Rescue flight medics. Flight medics will relay the information to the pilot and the pilot will confirm or deny the landing zone once arrival overhead. 3. Every landing zone must have a designated marshaller present at all times during helicopter landing, patient loading, and take off to ensure that no bystanders approach the aircraft. The designated marshaller cannot leave their post until the helicopter departs the scene. 4. On the helicopter’s final approach to the landing zone, the radio air traffic must remain clear and only emergency traffic shall be communicated. Ground crews should announce “Abort. Abort. Abort” over the radio if a hazard is identified. Once the helicopter has landed safely on the ground, normal radio traffic can resume. 5. It is not necessary to have a hose line pulled and charged. In the event of a catastrophic event involving the helicopter, tactics and strategy will be left up to the Incident Commander. G. Patient Preparation and Transport 1. When preparing a patient for transport by Air Rescue, the patient shall be secured to a long spine board using the cross-strap method. Personnel shall ensure that the patient’s feet and lower legs are strapped and are firmly in place. 2. Personnel shall inform the patient that they are about to be loaded aboard a helicopter and that noise, heat and wind levels will be high. 3. Upon Air Rescue’s arrival on scene, personnel shall not approach the aircraft. The patient must be kept inside of the rescue unit until flight medics meet with the crew for a briefing on the patient’s status and prior treatment. 4. Prior to approaching the helicopter, personnel shall remove all sheets and blankets from the patient and stretcher. High winds from the helicopter rotor may cause these items to become airborne hazards. IV poles should also be lowered as they may cause an additional hazard. BACK TO TABLE OF CONTENTS Helicopter Safety 17 Helicopter Safety Revision Date: December 22, 2021 5. When patient preparation is complete, a minimum of three (3) personnel, including the flight medic, will be utilized to move the patient to the helicopter. The flight medic will be at the left foot of the patient. No person may approach the helicopter without being accompanied by a flight crew member. a. All personnel directly involved with loading or offloading the patient should have proper head and eye protection in place. 6. Following patient loading, all ground personnel shall immediately leave the landing zone a area together as a unit, following the same route used when approaching the helicopter. 7. Upon the helicopter’s arrival at the designated receiving hospital’s helipad, all hospital staff must remain clear of the landing area until directed to approach by the flight crew. 8. The patient shall be offloaded from the helicopter with assistance from hospital staff and at the direction of the flight crew. VII. Inter‐Facility Transfers In some cases, a fire department may be requested to assist with a Landing Zone for an inter‐facility pa ent transfer from one hospital to another. When a request for an inter‐facility pa ent transfer is made by the hospital , the fire agency will operate as detailed in SecƟon F under Transport Guidelines. The flight medics of the aircra may also need assistance in commu ng from the LZ to the transferring hospital. BACK TO TABLE OF CONTENTS Helicopter Safety 18 Mass Casualty Incident Revision Date: August 19, 2021 This SOG is issued by the Fire Chief’s Associa on of Broward County, FCABC—SOG 203. Date: May 31, 2019 Link: FCABC I. Purpose: To eﬃciently triage, treat, and transport vic ms of mass/mul ple‐casualty incidents (MCIs). The following protocol is applicable to all mul ple‐vic m situa ons. This protocol is intended for the everyday MCI when the number of injured exceeds the capabili es of the first‐arriving unit as well as for large‐scale MCIs. II. Defini ons a. Ac ve Assailant(s) (AA) – An individual or individuals ac vely engaged in killing or a emp ng to kill people in a confined and populated area with means other than the use of firearms. b. Ac ve Shooter – An individual or individuals ac vely engaged in harming, or a emp ng to kill people in a populated area with the use of firearm(s). c. Ac ve Shooter Hos le Event Response (ASHER) – An incident where one or more individuals are or have been ac vely engaged in harming, killing, or a emp ng to kill people in a populated area by means such as firearms, explosives, toxic substances, vehicles, edged weapons, fire or a combina on thereof. d. Ballis c Protec on Equipment (BPE) – An item(s) of personal protec ve equipment (PPE) intended to protect the wearer from threats that could include ballis c threats, stabbing, fragmenta on, or blunt force trauma. Minimally consists of ballis c vest, helmet and/or shield. e. Casualty Collec on Point (CCP) – A temporary loca on used for gathering, triage, medical stabiliza on, and subsequent evacua on of nearby casual es. Where vehicular access might be limited and is usually occurring in the warm zone. Casual es can be transferred to an ambulance exchange point/loading zone from these loca ons. f. Complex Coordinated A ack – Frequently this is done using mul ple asymmetric a ack modes, such as firearms, explosives, fire and smoke as weapon and/or vehicle assaults. It will also o en involve coordinated and concurrent a acks on mul ple loca ons which will usually require mul ple a ackers. g. Concealment – The protec on from observa on. Anything that prevents direct observa on from the threat that might or might not provide protec on from the threat. h. Contact Team/Law Enforcement Entry Team – A team of law enforcement oﬃcers tasked with loca ng the suspect(s) and neutralizing the threat. i. Cover – The protec on from firearms or other hos le weapons. j. Extrac on Team/Li er Bearers – Personnel used to move the injured/uninjured to an area of safety. k. Force Protec on (FP): Is preven ve measures taken to mi gate hos le ac ons in specific areas or against a specific popula on, those protected by FP can include civilians and unarmed responders. l. Improvised Explosive Device (IED) – Per the Department of Defense (DOD), it is a device placed or fabricated in an improvised manner incorpora ng destruc ve, lethal, noxious, pyrotechnic, or incendiary chemicals and designed to destroy, incapacitate, harass or distract. An IED may be made with military or nonmilitary components. BACK TO TABLE OF CONTENTS Mass Casualty Incident 19 Mass Casualty Incident Revision Date: August 19, 2021 This SOG is issued by the Fire Chief’s Associa on of Broward County, FCABC—SOG 203. Date: May 31, 2019 Link: FCABC m. Rescue Task Force (RTF) – A combina on of fire and/or EMS personnel and law enforcement who provide force protec on. The RTF could provide the following tasks: threat based care, triage, and extrac ng vic ms to a casualty collec on point or other designated loca on. The law enforcement oﬃcers (LEO) are assigned as force protec on for this team, and should not separate from the fire and/or EMS personnel. There could be instances where the warm zone suddenly becomes a hot zone and the LEO must immediately respond to that threat to ensure the safety of the team. Based on the scene, number of vic ms, and available emergency personnel, there could be more than one RTF assigned. RTFs can operate in the warm zone. Once triage and treatment is complete, the RTF can assist with vic m movement. The RTF could also have tac cal objec ves such as breaching, u lity control, managing building systems, and fire control. These teams treat, stabilize, and remove the injured in a rapid manner, while wearing Ballis c Protec ve Equipment (BPE) and under the protec on of law enforcement oﬃcers. n. THREAT – Acronym from the Har ord Consensus highligh ng the importance of ini al ac ons to control hemorrhaging. T – Threat suppression H – Hemorrhage Control RE – Rapid Extrica on to safety A – Assessment by medical providers T – Transport to defini ve care o. Unified Command (UC) – An authority structure in which the role of the incident commander is shared by individuals from all responding organiza ons responsible for the incident, opera ng together to develop a single incident ac on plan. During an ASHER incident, Unified Command generally consists of law enforcement, fire and EMS representa ves at a minimum. p. Zones as they relate to Ac ve Shooter Hos le Events: The areas at ASHER incidents within an established perimeter that are designated based upon safety and the degree of hazard. Hot Zone – Area that has not been cleared by law enforcement personnel, an area where there is known hazard or direct and immediate threat. Rescue Task Force’s (RTF’s) should NOT be deployed in this area. Warm Zone – An area where there is the poten al for a hazard or an indirect threat to life. Where the perpetrator is not believed to be and is available for entry by a trained RTF to treat vic ms and extract them to the CCP. Cold Zone – Areas where there is li le or no threat due to geographic distance from the threat or the area has been secured by law enforcement (i.e., the area where fire/EMS may stage to triage, treat, and transport vic ms once removed from the warm zone). BACK TO TABLE OF CONTENTS Mass Casualty Incident 20 Mass Casualty Incident Revision Date: August 19, 2021 This SOG is issued by the Fire Chief’s Associa on of Broward County, FCABC—SOG 203. Date: May 31, 2019 Link: FCABC III. Procedure: A. The oﬃcer of the first‐arriving unit will establish Command and: 1. Perform a size‐up, es ma ng the number of vic ms. 2. Request a Level 1, 2, 3, 4, or 5 response, and request addi onal units and/or specialized equipment as needed. If the incident is an ac ve shooter/hos le event with unknown vic ms, request a MCI level 2 response un l a count can be determined and then upgrade or downgrade as needed. 3. Iden fy a staging area. 4. If it is an ac ve shooter/assailant incident or any tac cal environment MCI, establish a Unified Command (UC) with Law Enforcement (LE). Consider establishing Liaisons for FD and LE, the Liaisons can interact with each other allowing the transfer of info between agencies. Law Enforcement will make entry with their contact team and provide feedback to the UC. The decision may be made to establish a Rescue Task Force (team of LE May 31, 2019 304‐3 oﬃcers providing forced protec on for rescue personnel). The Rescue Task Force will ini ate triage and provide immediate lifesaving treatment (i.e. hemorrhage control). 5. If the area is deemed safe to enter, direct the remaining crew members and any addi onal arriving personnel to ini ate triage. 6. Triage will be performed in accordance with START or JumpSTART. Priori ze vic ms u lizing color coded ribbons: : Immediate care : Delayed care : Ambulatory (minor) : Deceased (non‐salvageable) 7. Locate and direct the “walking wounded” to one loca on away from the incident, if possible. These vic ms need to be assessed as soon as possible. Assign someone to keep the walking wounded together. 8. Ac ve shooter/hos le event considera ons: Be on high alert for suspicious individuals, packages, vehicles or poten al IEDs. Integrated ac ve shooter/assailant response should include the cri cal ac ons contained in the acronym THREAT. Threat suppression Hemorrhage control Rapid Extrica on to safety Assessment by medical providers Transport to defini ve care BACK TO TABLE OF CONTENTS Mass Casualty Incident 21 Mass Casualty Incident Revision Date: August 19, 2021 This SOG is issued by the Fire Chief’s Associa on of Broward County, FCABC—SOG 203. Date: May 31, 2019 Link: FCABC B. As addi onal units arrive, Command will designate the following oﬃcers: 1. 2. 3. 4. Triage (Ini ally the responsibility of the first‐arriving oﬃcer). Treatment. Transport. Staging. C. Addi onal branches/sec ons may be required depending on the complexity of the incident. These oﬃcers may include, but are not limited to: 1. 2. 3. 4. 5. 6. 7. 8. Medical Branch Landing Zone/Heli‐spot Extrica on Hazardous Materials (hazmat) Rehabilita on Safety Public Informa on Oﬃcer (PIO) Medical Intelligence ‐ to assist with suspected or known WMD (weapons of mass destruc on) events for decontamina on, an dotes, and treatment D. MCI: predetermined response plan 1. Considera ons: a. An MCI shall be classified by diﬀerent levels depending on the number of vic ms. The number of vic ms will be based on the ini al size‐up, prior to triage. b. Levels of response will augment the units already on the scene, and units enroute will be included in the assignment. The excep on would be in conjunc on with a Fire Alarm assignment i.e., a fire with mul ple vic ms may be a Second Alarm with an MCI Level 3 response; this will be two separate assignments. c. Command can downgrade or upgrade the assignments at any me. d. All units will respond to the staging area emergency response unless otherwise directed by Command. e. When announcing an MCI, specify the general category (e.g., trauma, hazardous materials, smoke inhala on). f. Any vic m mee ng trauma transport criteria must be reported to a state‐approved trauma center for determina on as to transport des na on. Trauma transport criteria will be determined during the secondary triage in the treatment phase. When the trauma center(s) are overwhelmed they will no fy MedCom of the need for units to transport to other trauma centers or non‐trauma centers g. Consider the use of air transport for pa ents with special needs, mass‐transit resources for mul ple “walking wounded” pa ents, and private BLS transport units. BACK TO TABLE OF CONTENTS Mass Casualty Incident 22 Mass Casualty Incident Revision Date: August 19, 2021 This SOG is issued by the Fire Chief’s Associa on of Broward County, FCABC—SOG 203. Date: May 31, 2019 Link: FCABC h. Consider the use of mobile command vehicles, medical supply trailers, and communica on trailers as needed. i. Upon no fica on of an MCI, Medical Control (Medcom/MRCC) will gather informa on about each hospital’s capability and relay this informa on to the Transport Oﬃcer or Medical Communica on Oﬃcer. j. On a large‐scale incident, consider sending a Hospital Coordinator to each hospital to assist with communica ons. k. Request law enforcement to set up a safety parameter. PRE—DETERMINED RESPONSE PLAN MCI Level 1 (5‐10 vic ms)  4 ALS Transport Units  2 Suppression Units  1 Shi Supervisor  1 EMS Supervisor Note ‐ The two hospitals and trauma center closest to the incident will be no fied by Medical Control (Medcom or local communica ons center). MCI Level 2 (11‐20 vic ms) (any ac ve assailant incident un l an accurate vic m count can be made)  6 ALS Transport Units  3 Suppression Units  2 Shi Supervisors  2 EMS Shi Supervisors Note ‐ The three hospitals and two trauma centers closest to the incident will be no fied by Medical Control (Medcom or local communica ons center). MCI Level 3 (21‐100 vic ms) 8 ALS Transport Units 4 Suppression Units 3 Shi Supervisors 3 EMS Shi Supervisors Command Vehicle MCI Trailer Opera ons Chief Note – The four hospitals and three trauma centers closest to the incident will be no fied by Medical Control (Medcom or local communica ons center). The Warning Point will no fy the Emergency Management Agency.        BACK TO TABLE OF CONTENTS Mass Casualty Incident 23 Mass Casualty Incident Revision Date: August 19, 2021 MCI Level 4 (101‐1000 vic ms)            5 MCI Task Forces (25 units) 2 ALS Transport Strike Teams (10 units) 1 Suppression Unit Strike Team (5 units) 2 BLS Transport Strike Teams (10 units) 2 Mass Transit Buses 2 MCI Trailers Command Vehicle Communica ons Trailer 5 Shi Supervisors 3 EMS Shi Supervisors,1 EMS Chief Opera ons Chief Note ‐ The 10 hospitals and 5 trauma centers closest to the incident will be no fied by Medical Control. The Warning Point will no fy the Emergency Management Agency. In an ongoing, long‐term MCI, the Metropolitan Medical Response System (MMRS) and the State Medical Assistance Response Team (SMRT), Medical Reserve Corp (MRC), Florida Advanced Surgical Team (FAST) Disaster Medical Assistance Team (DMAT) may be no fied. MCI Level 5 (more than 1000 vic ms)             10 MCI Task Forces (50 units) 4 ALS Transport Strike Teams (20 units) 2 Suppression Unit Strike Teams (10 units) 4 BLS Transport Strike Teams (20 units) 4 Mass Transit Buses 2 Command Vehicles 4 Supply Trailers Communica ons Trailer 10 Shi Supervisors 6 EMS Shi Supervisors 2 EMS Chiefs 2 Opera ons Chiefs Note ‐The 20 hospitals and 10 trauma centers closest to the incident will be no fied by Medical Control. The Warning Point will no fy the Emergency Management Agency. In an ongoing, long‐term MCI, the MMRS, DMAT, SMRT, MRC, FAST and the Interna onal Medical and Surgical Response Team (IMSURT) may be no fied. Strike Team: Five of the same type of units, including common communica ons and leader. Task Force: Five diﬀerent types of units, including common communica ons and leader. MCI Task Force: May be two ALS Transport Units, two BLS Transport Units, and one Suppression Unit, including common communica ons and leader. BACK TO TABLE OF CONTENTS Mass Casualty Incident 24 Mass Casualty Incident Revision Date: August 19, 2021 OFFICER RESPONSIBILITIES ‐ See Online Forms for Field Opera ng Guides A. Command 1. Established by the first arriving oﬃcer. Radio designa on “Command.” 2. Follow Field Opera on Guide (FOG) #1. 3. If ASHE, get briefing from LE, establish a Unified Command and co‐locate with LE. Consider establishing Liaisons for FD and LE, the Liaisons can interact with each other allowing the transfer of info between agencies. 4. Remain in a safe, fixed, and visible loca on, uphill and upwind of the incident. 5. Determine the MCI Level (1, 2, 3, 4, or 5). If unknown vic ms in an ASHE ini ate a MCI level 2 un l a count can be determined. 6. Designate a staging area. 7. Assign personnel to perform the func ons of Triage, Rescue Task Force (if needed), Treatment, Transport, and Staging. 8. Advise the Communica ons Center of the number of vic ms and their categories once triage is complete. 9. During large‐scale or complex MCIs (e.g., a fire with mul ple vic ms/tac cal environment incident), designate a Medical Branch to reduce the span of control. 10. Ensure proper security of the incident site, treatment area, and loading area; also provide for traﬃc control and access for emergency vehicles, including law enforcement. 11. If the incident is due to a known or suspected weapon of mass destruc on (WMD event), refer to WMD FOG #8 and designate a Medical Intelligence Oﬃcer to assist with decontamina on, an dotes, and treatment of vic ms. 12. If ASHE incident refer to FOG #9 B. Medical Branch. 1. Radio designa on “Medical.” Follow FOG #2. 2. Assure Triage, Treatment, and Transport has been established. If established by Command, Triage, Rescue Task Force, Treatment, and Transport will now report to the Medical Branch. 3. Work with Command, and direct and/or supervise on‐scene personnel from agencies such as the Medical Examiner’s Oﬃce, Red Cross, private ambulance companies, and hospital volunteers. 4. Ensure no fica on of Medical Control (Medcom/MRCC). 5. If the incident is due to a known or suspected WMD, refer to WMD FOG #8 and designate a Medical Intelligence Oﬃcer to assist with decontamina on, an dotes, and treatment of vic ms. 6. If ac ve assailant/ tac cal environment refer to FOG #9 7. Ensure proper security of incident site, treatment area, and loading area; also provide for traﬃc control and access for emergency vehicles, including law enforcement. BACK TO TABLE OF CONTENTS Mass Casualty Incident 25 Mass Casualty Incident Revision Date: August 19, 2021 C. Triage Oﬃcer 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. D. Treatment Oﬃcer 1. 2. 3. 4. 5. a. b. c. d. 6. 7. 8. 9. 10. 11. Provide periodic status reports to Command/Medical Branch. BACK TO TABLE OF CONTENTS Mass Casualty Incident 26 Mass Casualty Incident Revision Date: August 19, 2021 E. Transport Oﬃcer Reports to Command or the Medical Branch. Supervises the Medical Communica on Coordinator and Documenta on Aide(s). The Transport Oﬃcer is responsible for the coordina on of vic ms and maintenance of records rela ng to vic m iden fica on, injuries, mode of transporta on, and des na on. 1. Radio designa on “Transport”, follow FOG #5. 2. Assign a Documenta on Aide with a radio to assist with paperwork and communica ons. 3. Assign a Medical Communica on Coordinator to establish con nuous contact with Medical Control (Medcom or MRCC). 4. Establish a vic m loading area. Advise Staging of the loca on and direc on of travel. Consider reques ng law enforcement assistance for ensuring the security of the loading area. 5. Arrange for the transport of vic ms from the treatment area. Maintain a Hospital Transporta on Log #5B. Keep a piece of the triage tag for future documenta on. 6. Communicate with the Landing Zone (LZ)/Heli‐spot Oﬃcer and relay the number of vic ms to be transported by air. Air‐transported vic ms should be assigned to distant hospitals, unless the vic ms’ needs dictate otherwise (e.g., trauma center, burn unit). F. Medical Communica ons Coordinator Reports to the Transport Oﬃcer and is responsible for maintaining communica on with Medical Control to assure proper vic m transport informa on and des na on. 1. Radio designa on “Communica on.” Follow FOG #5A. 2. Establish communica on with Medical Control (Medcom or MRCC1). Advise Medical Control of the overall situa on (e.g., smoke inhala on, trauma, burns, hazardous materials exposure) and the number and categories of vic ms. Medical Control will survey area hospitals to determine their capabili es and capaci es and then relay this informa on to the field. Document this informa on on the Hospital Capability Worksheet #5C and maintain this document for the dura on of the incident. 3. When units are prepared to transport, advise Medical Control and supply of the following informa on: a. The unit transpor ng b. The number of vic ms to be transported c. Their priority: Red, Yellow, or Green d. Any vic ms with special needs (e.g., cardiac, burn, trauma) 4. The Medical Communica on Coordinator, in conjunc on with Medical Control, will determine the most appropriate facility. Ground‐transported vic ms should be assigned to hospitals on a rota ng basis. 5. Once Medical Control receives the informa on from the Medical Communica on Coordinator, Medical Control will no fy the appropriate hospital. Transpor ng units will not contact the individual hospital on their own, unless there is a need for medical direc on/care outside of protocols. 1 Medical Resource Coordina on Center (MRCC): The MRCC’s prime func on is to maintain status informa on—that is, the number of vic ms and the hospital readiness status to accept vic ms, to coordinate transporta on, and to direct pa ents to the appropriate hospital during a disaster or other situa on characterized by a high demand for medical resources BACK TO TABLE OF CONTENTS Mass Casualty Incident 27 Mass Casualty Incident Revision Date: August 19, 2021 G. Medical Supply Coordinator Reports to the Medical Branch and is responsible for acquiring and maintaining control of all medical equipment and supplies. 1. Radio designa on “Supply”, follow FOG #6. 2. Assure necessary equipment is available on the transpor ng vehicle. 3. Provide an inventory of medical supplies at the staging area for use on scene. 4. Assure support vehicles are requested. (Broward County has four MCI supply trailers and Region 7 has three large MCI supply trailers available for use during a large‐scale MCI.) H. Staging Oﬃcer Reports to Command and is responsible for managing all ac vi es within the staging area. 1. Radio designa on “Staging”, follow FOG #7. 2. Establish the loca on of a staging area and no fy the Communica on Center to direct any incoming units. 3. Maintain a Unit Staging Log #7A. 4. Ensure that all personnel stay with their vehicles unless otherwise directed by Command. If personnel are directed to assist in another func on, ensure that the keys stay with each vehicle. 5. Coordinate with the Transport Oﬃcer the designa on of a loca on for vic m loading and the best route to the area. 6. Maintain a reserve of at least two transport vehicles. When the reserve is depleted, request addi onal units through Command. DOCUMENTATION A. The Incident Commander will, at the comple on of the incident, coordinate the gathering of all per nent documenta on. B. A Post‐Incident Analysis (PIA) will be completed. BACK TO TABLE OF CONTENTS Mass Casualty Incident 28 Mass Casualty Incident Revision Date: August 19, 2021 MCI Kits For Responder Vehicles A. 2. 3. 4. 5. 6. 7. 8. 9. B. Fi One (1) pediatric face mask Colored ribbons (Red, Yellow, Green & Black) either rolls or ribbons. Trauma Tourniquets (2) Hemosta c Dressing (2) Chest Decompression Needles(2) Chest Seals (2) y (50) triage tags—Disaster Management Systems (DMS) All Risk Triage tags C. Pencils/grease pencils and pens D. Addi onal tourniquets, hemosta c dressing, chest seals & chest decompression needles (10) E. The following MCI FOGs, logs, and associated paperwork for each oﬃcer: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. A. B. C. D. E. F. 1. 2. 3. 4. 5. 6. 7. 8. BACK TO TABLE OF CONTENTS Mass Casualty Incident 29 Mass Casualty Incident Revision Date: August 19, 2021 A. 1. 2. 3. 4. 5. 1. 2. 3. START (modified 9/2015) Move the walking wounded No Respiration after head tilt GREEN BLACK Control Severe Bleeding Respirations over 30/min or Respiratory Distress Perfusion (No radial pulse) Mental Status (unable to follow commands) Stable RPM/Walking Stable RPM/Non-ambulatory RED RED RED GREEN YELLOW Conduct Secondary Triage in the Treatment Phase BACK TO TABLE OF CONTENTS Mass Casualty Incident 30 Mass Casualty Incident Revision Date: August 19, 2021 Physiological diﬀerences in children necessitate adapta on of the standard START triage method in children 8 years of age or younger, or in those vic ms with the anatomical or physiological features of a child in the age group. The same parameters (RPM) are u lized, with the adapta ons indicated here. JumpSTART (modified 9/2015) Move the walking wounded (access as soon as possible) No Respiration after head tilt/No peripheral pulse Respirations 45/min or 15/min (Work of Breathing)  No resp. w/ pulse, give 5 ventilations via barrier — respirations resume  No spontaneous respirations GREEN BLACK RED RED BLACK Control Severe Bleeding Perfusion (No radial pulse) Mental Status (AVPU) Alert/Verbal  Pain/Unresponsive  Stable RPM/Walking  Stable RPM/Non-ambulatory RED YELLOW RED GREEN YELLOW Conduct Secondary Triage in the Treatment Phase Note - Infants who are developmentally unable to walk should be triaged using the JumpSTART algorithm either during ini al triage or in the Green area if carried out by a non‐rescuer. During triage

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