San Antonio Fire Department Mass Casualty Incident SOG 2018 PDF

SAN ANTONIO FIRE DEPARTMENT Effective Date 1-26-2018 MASS CASUALTY INCIDENT SOG Policy# 2012 Approved by: Assist...

SAN ANTONIO FIRE DEPARTMENT Effective Date 1-26-2018 MASS CASUALTY INCIDENT SOG Policy# 2012 Approved by: Assistant Chief Brian O’Neill Review Date Reviewed by: Assistant Chief Michael Stringfellow 3-6-2026.01 INTRODUCTION SAFD personnel are dispatched to a variety of calls throughout their careers. We constantly train and prepare for fire operations, medical runs, MVC’s, special operations, etc. The day to day incidents provide the majority of our citizen’s perception of the SAFD. However, in terms of low probability/high impact incidents, the SAFD response and performance will shape public opinion for many years. One of these low probability/high impact incidents is a Mass Casualty Incident (MCI)..02 PURPOSE The purpose of this document is to establish guidelines for medical operations in MASS CASUALTY INCIDENTS. This SOG is designed to be integrated with all current local and regional procedures that may be in effect at an emergency scene. The basic system outlined here is applicable to all “mass casualty” situations and is to be used in such incidents. Furthermore, operations using this document fall under the purview of the National Incident Management System (NIMS)..03 DEFINITIONS A. Mass Casualty Incident: Any incident in which emergency medical resources, such as personnel and equipment, are overwhelmed by the number and severity of casualties. There is no set number of casualties that would indicate an MCI. It will be up to the first arriving unit to decide, based on Conditions, Actions, and Needs (CAN), whether an MCI response is necessary. B. MCI Tiers 1-3: A serious event that has more casualties than a customary response assignment can handle. This response will be handled with local entities in which we respond with regularly, such as SAPD, CPS, Public Works, etc. C. MCI Tier 4: A catastrophic event that is capable of overwhelming the available resources of the City of San Antonio. These situations require substantial coordination between local, regional, state and/or federal resources. A Tier 4 MCI would require the involvement of the EOC and other outside entities..04 OTHER SOPS In addition to this SOG, other SOPs will likely be utilized at an MCI. Several of them are listed below. It is critical that all personnel are familiar with these procedures: Incident Management SOP – Operations Manual, Vol. 2, #401 S.M.O.P.s – EMS Intraweb Site MSOU Integration SOP – Operations Manual, Vol.2, #708 SAN ANTONIO FIRE DEPARTMENT Page 2 of 7 Mass Casualty Incident SOG #2012 Incident and Training Rehab Policy – Operations Manual, Vol. 2, #1111 Active Shooter SOG - Intraweb.05 INITIAL RESPONSE A. In the event of an incoming call or calls to the SAFD Communications Center (Communications) indicating a possible MCI, Communications may choose to send the appropriate MCI Tier response. As per the Incident Management Standard Operating Procedure (IMS SOP), the initial IC will determine whether the response needs to be upgraded or downgraded. The following tiers will apply based on the number of patients present or believed to be accurately reported to dispatch: B. MCI TIER 1 (10-19 patients) Response: 2 Medic Officers 5 Medic Units 1 Battalion Chief 4 Engines, 2 Ladders 1 Safety Officer Dispatch will place Air Medical Transport and MPV-802 on standby. IC will determine if they are needed to respond. C. MCI TIER 2 (20-29 patients) Response: Tier 1 response plus: 1 Medic Officer 4 Medic Units 1 Battalion Chief 3 Engines, 1 Ladder MPV-802 MPV-801 (Schertz – staffed 24/7) D. MCI TIER 3 (30-39 patients) Response: Tier 2 response plus: 1 Medic Officer 3 Medic Units 1 Battalion Chief 3 Engines, 1 Ladder E. MCI TIER 4 (40+ patients) Response: Tier 3 response plus: 1 Medic Officer 3 Medic Units 1 Battalion Chief 3 Engines/1 Ladder MSOU to include all on duty MSOU members and a MSOU Medic Officer SAN ANTONIO FIRE DEPARTMENT Page 3 of 7 Mass Casualty Incident SOG #2012 MSOU MCI Truck and Trailer Rehab Bus Command Bus Supply van Depending on duration of incident, the SAFD fuel truck Medical Director D. Double companies should make every effort to take squads to the scene in order to facilitate movement of personnel. E. All on-duty Fire and EMS personnel not assigned to the MCI will be governed by the following: 1) Monitor normal Alert operations channel. 2) Selective calling WILL be suspended for an MCI Tier 3-4 and shall stay suspended for the duration of the event. 3) Avoid all unnecessary radio transmissions. 4) Remain at assigned station, location or area assigned by Communications..06 INITIAL ACTIONS A. Assume Command. B. Perform a rapid and accurate scene assessment taking note of: 1. Scale of the incident (i.e., number of potential patients, size of area affected, etc.) 2. Type of incident (i.e., building collapse, passenger train derailment, explosion, etc.) 3. Hazards to responders (i.e., hanging debris, electrical hazards, potential secondary explosions, hazardous chemicals, etc.) C. If the incident wasn’t dispatched as a MCI, declare the incident a “Mass Casualty Incident (MCI)” over the radio and advise dispatch of the estimated number of patients present. D. The initial IC can request a specific Tier response or advise dispatch of the estimated number of patients present. Dispatch will then dispatch the appropriate resources based on the requested Tier or corresponding number of patients. E. Begin developing incident organization as resources become available with an emphasis on establishing a Medical Branch that shall at a minimum include the following Groups: (1) Triage, (2) Treatment, (3) Transport, and/or (4) any other Medical Support Function. F. Concentrate initial efforts on directing walking wounded to a specific area and initiating the triage process on the non-ambulatory. G. Request additional resources based on incident needs (i.e., EMS Supply Van, TRT, HazMat, MSOU, ARFF, additional law enforcement resources, etc.). H. Establish Level 2 Staging.07 KEY CONSIDERATIONS FOR ONGOING INCIDENT SAN ANTONIO FIRE DEPARTMENT Page 4 of 7 Mass Casualty Incident SOG #2012 A. Continue developing the incident organization to suit the needs of the event as per the Incident Management SOP (General, Staff, Command Staff, Branches, Divisions, Groups, etc.). B. Develop and implement a Communications Plan to suit the needs of the incident organization. C. Subdivide large geographic areas and/or functions, assign supervisors and establish nomenclature (i.e., Alpha 1 Division, Alpha 2, Division, Delta 1 Division, Evacuation Group, Supply Group, etc.). D. Ensure that the Triage, Treatment and Transportation Groups are adequately staffed and effectively managed. E. This is a potential crime scene. All responders should be cognizant of that fact and try to minimize disturbance of the scene as much as possible. However, in no instance, should care be compromised to preserve evidence. F. Access to sufficient medical supplies is critical. Ensure that the Logistics Section has a person assigned as the EMS Supply Supervisor who can ensure that medical supplies and equipment are readily available to units on the scene and other field units. Utilize Fire personnel as necessary to assist EMS Supply personnel or the Supervisor. The Medical Supply Group will fall under the Logistics Section if established. G. Take advantage of support provided by the EOC, other City Department, state and federal resources, etc. Keep in mind that an appropriate, upgraded response, as established by the local/regional/state/federal jurisdictions, will be dispatched. Plan for the arrival of local, state and federal resources. H. Establish Liaison Officer as quickly as possible to identify all non-SAFD resources (SAPD, Public Works, state and federal resources, etc.) and ensure they are accounted for (who are they, where are they and what are they doing?) I. Fire Shift Commander and Medical Shift Commander will be notified of the MCI by dispatch. Response to the scene is at their discretion based on the circumstances and needs of the City. Consideration should be given to the establishment of Area Command. J. FSC/MSC should consider the calling of off-duty personnel to assist as needed..08 COMMUNICATIONS CENTER GUIDELINES The Communications Center plays a critical role during any MCI and may be responsible for any or all of the following: A. Receiving the initial notification of an event and the subsequent dispatching of the appropriate Tiered response. B. Notification of other individuals and support agencies as established by protocol. This must include notification of the San Antonio Office of Emergency Management (SAOEM). C. Notification of the on-duty Medical Shift Commander (MSC) and Fire Shift Commander (FSC) of the Multi-Casualty Incident. SAN ANTONIO FIRE DEPARTMENT Page 5 of 7 Mass Casualty Incident SOG #2012 D. Assign MEDCOM to conduct notification of hospitals or emergency care facilities of the occurrence of an incident and coordinating their continuous monitoring of status, bed availability, number of patients transported to each facility, and other such duties. MEDCOM will utilize EMSystem and WebEOC for this purpose and be responsible to accurately maintain patient tracking/destinations to allow for load-balancing of hospitals. E. Assign Medcom to the Transport Group Officer to assist in the assigning of hospital destinations and as necessary to assist with Tier 4 response resources beyond SAFD units (ie, Medical Strike Teams). F. Ensuring the Communications functions are properly staffed throughout the incident. This will include: 1. Notifying all off-duty Communications Officers to respond to the PSAP or other designated location as conditions dictate. 2. Contacting additional Communications Dispatchers that may be requested to report to Communications at the discretion of the Communications Chief. G. Monitor radio channel(s) as necessary. H. Assign tactical channels as needed and notify command of tactical channels assigned. I. Actively monitor the main Tactical Channel and provide information to responding units as necessary. J. Advise Staging or Logistics Officers of the availability of personnel and/or equipment or other related resources. K. Assist the Transport Group Officer with the coordination of air ambulance service. Prompt the IC to establish a Landing Zone. L. Contacting the “on-call” supply personnel who will respond to the scene with the EMS Supply Van. M. Notification of the media if notification is requested. Coordinate with the IC or IC’s representative on instructions on where personnel are to report. N. Upon request of the IC, identifying and assigning personnel to deliver Triage and/or Decon tents (located at Fire Station # 45 and the WMD warehouse) to the scene. O. Communications will acknowledge all communications directed to it by a brief statement of the message with particular attention to progress reports, requests for additional resources and information to be relayed to other groups or agencies. P. Upon activation of the EOC, if available, a Communications Supervisor will report to the EOC to act as a liaison for communications purposes. Q. Beginning at Tier 2, send notification over Alert and implement Closest Hospital Protocol. R. Beginning at Tier 3, notify all units that selective calling is suspended for the duration of the event. S. In the case of an MCI Tier 4, priority dispatching will be implemented..09 SAFETY GUIDELINES SAN ANTONIO FIRE DEPARTMENT Page 6 of 7 Mass Casualty Incident SOG #2012 A. All personnel on the scene of an MCI are expected to exercise prudent judgment and not engage in unsafe or hazardous acts. A Safety Officer will be assigned by the IC during an MCI to ensure scene safety. B. Safety at the scene will be governed by the following: 1. Survey incident areas and identify hazards and potential hazards and advise Incident Command. 2. Identify hazardous or potentially hazardous actions of personnel and advise Incident Command or other IC Staff member. 3. Immediately correct any unsafe act witnessed or made aware of. 4. Advise Incident Command or other Staff member of special equipment, procedures, or personnel needed to manage specific hazards. 5. All Groups/Divisions are to exercise authority to stop and prevent unsafe acts immediately. 6. Investigate and document accidents and injuries to emergency personnel and make recommendations to prevent or minimize future occurrences. C. Identification Vests – To avoid confusion on the incident site, personnel assigned any staff function under the ICS protocol shall wear an appropriate vest or other identification marker indicating for which job function he/she is responsible. The IC shall wear the “Incident Command” vest to signify that job function, the Safety Officer shall wear the vest marked “Safety”, etc. In addition, Fire and EMS personnel shall wear the department issued safety vests or structural firefighter gear (bunker gear) to clearly identify themselves to all other parties on the scene, especially law enforcement..10 FATALITY MANAGEMENT GUIDELINES The management of fatalities will be governed by the following: A. Deceased persons will not be moved from the scene until all viable patients have been removed. Bodies will only be moved if necessary to provide triage and treatment to viable patients. B. The deceased should be covered as soon as practical, however the covering of bodies should not take precedence over the triage and treatment of patients. C. The deceased will be moved as directed by Medical Branch or Incident Command in consultation with other required agencies; i.e., Medical Examiner, FAA, etc. D. The identity of deceased persons will be strictly confidential. E. In the case of Mass Fatalities the EOC will be contacted to implement Mass Fatality Plan..11 CRITICAL INCIDENT STRESS DEBRIEFING A Critical Incident Stress Debriefing (CISD) should occur following an MCI event. Use of the Debriefing will be determined by the Operations Section Chief or the Incident Commander. B. The San Antonio Fire Department psychologist or other mental health professional(s) shall carry out the CISD. SAFD has several personnel trained in stress debriefings and may assist the psychologist or mental health professional or may conduct debriefings if deemed appropriate by the Incident Commander. SAN ANTONIO FIRE DEPARTMENT Page 7 of 7 Mass Casualty Incident SOG #2012.12 REVISIONS AND CONFLICTS These guidelines are subject to revisions as needed. MCI TIER QUICK REFERENCE CHART TOTAL RESOURCE COUNT Resource TIER 1 TIER 2 TIER 3 TIER 4 10-19 patients 20-29 patients 30-39 patients 40+ patients EMS 5 9 12 15 MOF 2 3 4 5 BC 1 2 3 4 ENGINE 4 7 10 13 LADDER 2 3 4 5 AMBUS * 2 2 2 AIR MEDICAL TRANSPORT * FSC ** MSC ** SAFETY 1 1 1 1 * Air Medical Transport should be placed on standby. IC will determine need after making scene. ** FSC and MSC will be contacted by dispatch to advise of MCI.