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Multi-Casualty. Incident Plan. 2007 Training. FIRE-EMS TRAINING Contra Costa County EMS. Tim W. Hennessy MCI Plan. Tim W. Hennessy Communications Supervisor Contra Costa County Sheriffs Communication 1975-2007 This MCI Plan is dedicated to Tim.

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slide1

Multi-Casualty

Incident Plan

2007 Training

FIRE-EMS TRAINING

Contra Costa County EMS

tim w hennessy mci plan
Tim W. HennessyMCI Plan

Tim W. Hennessy

Communications Supervisor

Contra Costa County

Sheriffs Communication

1975-2007

This MCI Plan

is dedicated to Tim.

His expertise and commitment in developing this plan was invaluable.

history
History
  • 1979: First MCI Committee organized to develop plan following Yuba City bus crash in Martinez
  • 1983: Board of Supervisors approved the first MCI Plan
  • Several revisions to the basic plan since 1983
current mci working group
Current MCI Working Group
  • Appointed in 2005 to conduct a ground-up rewrite of the MCI Plan
  • Multidisciplinary
    • Fire
    • Emergency Ambulance Zone Provider (public and private)
    • Law Enforcement
    • Hospitals
    • Public Safety Communications
    • EMS Agency staff
why rewrite the plan
Why Rewrite the Plan?
  • Improve the usefulness of the document for first responders
  • Compare the Plan to the County’s current risk profile
  • Compare the Plan to the County’s current public safety and EMS resources
why rewrite the plan1
Why Rewrite the Plan?
  • Attempt to resolve weaknesses in the Plan experienced during previous incidents:
    • Incident command and control
    • Communication flow
    • Resource ordering and tracking
  • Ensure compliance with NIMS
mci plan objectives
MCI Plan Objectives

Objective #1:

Establish a common organization, management, and communications structure for the coordination of emergency response to a multi-casualty incident.

mci plan objectives1
MCI Plan Objectives

Objective #2:

Establish methods of triage and transportation that will provide the best medical outcome possible for the greatest number of casualties.

mci plan objectives2
MCI Plan Objectives

Objective #3:

Establish pre-defined responsibilities of all entities with key roles in achieving successful implementation of the plan.

mci plan objectives3
MCI Plan Objectives

Objective #4:

The Plan will be drilled regularly, and reviewed annually and following significant activations of the Plan as directed by the EMS Director.

key concepts
Key Concepts
  • Use of Incident Command System
    • Expansion and contraction of structure is dynamic and incident-driven
    • Use of single point ordering for resource requests
    • Emphasis on exchanging information
key concepts1
Key Concepts
  • Importance of Unified Command
  • The “Rule of 2 and 4”
mci tiers
MCI Tiers
  • Plan consolidates Expanded Medical Emergencies, Medical Advisory Alerts and MCIs into a single MCI Plan with 4 activation tiers
  • Use of tiered MCI Plan reinforces the scalability of the Plan
mci tiers1
MCI Tiers
  • Use of Tiers modeled after Community Warning System Levels
  • Consistent with best practices
tier zero
Tier Zero
  • Notification of incident with potential to escalate to a higher tier (Medical Advisory Alert)
  • CWS Level II and III Incidents
  • Report of Active Shooter incident
  • Attempted emergency landing of passenger aircraft
tier one
Tier One
  • 6-10 patients with scene contained, number of patients not expected to rise
  • Multi-vehicle collision
  • Multiple gunshot victims at contained scene and no ongoing active shooter
tier two
Tier Two
  • 10 –50 patients or less than 10 patients with substantial chance of increase in number of patients
  • Transportation resource ordering switches to EMSOACC
  • Petrochemical incident
  • Passenger train derailment
  • Active shooter with uncontained scene
tier three
Tier Three
  • More than 50 patients or reasonable expectations of large number of casualties
  • Actual or suspected WMD incident
  • Significant explosion in populated area
  • Emergency evacuation of hospital or SNF
plan components
Plan Components
  • Responsibilities matrix/checklists
  • Communications flowchart
  • Communications overview
  • ICS position checklists
  • ICS communications forms 205 and 217A
responsibilities matrix
Responsibilities Matrix
  • Review pertinent matrices
    • Pp 7 - 16
mci checklists
MCI Checklists
  • Common Responsibilities
    • Back of each checklist
      • Get Assignment
      • Check In
      • Get Briefed
      • Get work materials
      • Undertake mission safely
      • Organize and brief subordinates
      • Assure comms
      • Use clear text
      • Complete forms
      • Demobilize as required/practical
unit leader responsibilities
Unit Leader Responsibilities
  • Back of each checklist
    • Participate in planning as required
    • Get accurate SitStat/ReSTat of assigned units
    • Confirm arrival time of resources
    • Assign duties to subordinates as required
    • Develop accountability, safety and security
    • Supervise demobilization
    • Provide logistics with re-supply needs
    • Maintain unit log
packaging of mci plan
Packaging of MCI Plan
  • Standard Packaging
  • Hand out bundles
  • “You are the checklist until you delegate it”
  • Morgue Manager-Law enforcement
  • Certs/Quals determine who does what…not rank or position
personnel options
Personnel Options
  • Branch Director
    • Chief Officer(Fire)/Lieutenant/Captain (Law)
  • EMS/Pt Transport Group Supervisors
    • Captain (Fire)/Sergeant (Law)/Supervisor(EMS)
  • Triage/Treatment/Transport Unit Leaders
    • Captain(Fire)/Sergeant(Law)/Supervisor(EMS)
transportation group supervisor unit leader
Transportation Group Supervisor/Unit Leader
  • Only one per incident
  • If a Single EMS Group Supervisor
    • Reports to the EMS group supervisor
  • If multiple EMS Group Supervisors
    • Reports to the EMS Branch Director/Ops
  • Single Staging area for ground transport units
  • Single Helispot for air transport units
transportation highlights
Transportation Highlights
  • 2/4 Concept
    • Continue to disperse casualties as much as possible
    • Use farther hospitals first
      • Especially if potential exists for “walk ins”
    • Hospital polling whenever possible but certainly after 2/4 has been maximized
  • Coordinate with EMSOACC as much as possible
transportation highlights cont
Transportation Highlights (cont)
  • Emergency Ambulance Zone Providers still responsible for normal coverage too
  • If limited ambulances, minors can be transported by other means
  • Tier 2 & 3 suspend ambulance to hospital comms
  • PCRs
    • Whenever possible PCRs shall be completed
    • Tier 3 Branch( or designee) can suspend standard PCR protocol and replace with triage tag info
    • Triage tags are minimum level of documentation
predetermined staging areas
Predetermined Staging Areas
  • East/Central/West
  • Rallying point in case of loss of communications
example of tier 1 scenario
Example of Tier 1 Scenario
  • MVA with 7 patients in 3 vehicles
    • Single Medical Group
    • Transportation reports to Med Grp Sup
    • Triage patients and treat where they were found
    • Do not send all patients to same hospital
    • Can use close hospital due to lack of probability of self transporting patients to closest facility
example of tier 2 scenario
Example of Tier 2 Scenario
  • Shooting incidents with 21 patients
    • Single Medical Group
    • Transportation reports to Med Grp Sup
    • Triage patients where they are found
    • Litter bearers move patients to specific treatment areas
    • Patients re-triaged in treatment areas and assigned priority for transport
    • Avoid close proximity hospitals if possible due to potential private transport arrivals
example of tier 3 scenario
Example of Tier 3 Scenario
  • Large structural collapse with multiple victims trapped over a widespread area
    • Multiple Medical Groups (probably by Division) report to Medical Branch
    • Transportation reports to Medical Branch
      • Still just one transportation staging area
    • Triage patients where they are found
    • Litter bearers move patients where they are found
    • Patient’s re-triaged in Treatment areas and assigned priority
    • Maximize 2/4 concept as needed
triage considerations
Triage Considerations
  • START Triage system
    • BLS personnel perfect for this
    • Utilize teams whenever possible
    • Good mission for an Engine Company
    • Minimal Treatment
  • Do not re-triage at scene
  • Can re-triage in Treatment Areas
triage considerations cont
Triage Considerations (cont)
  • Patients can be upgraded or downgraded
    • New tag if not written on
    • Fold old tag and give new one if started writing patient info on it
  • ?Who providers litter bearers
    • PT TX Unit Leader
  • DOA’s stay where found unless need for movement necessitates taking them to a morgue location
  • Patients may not be moved to a Tx Area
    • MVA’s with limited number of victims
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