The National Incident Management System and Mass-Casualty Incidents

1. The National Incident Management System and Mass-Casualty Incidents Lesson 19

2. Introduction Organized approach needed to manage scene/treat patients on priority basis NIMS, through ICS, directs response Your role within NIMS may differ from your everyday role as a First Responder

3. National Incident Management System A large-scale emergency requires personnel/resources from multiple jurisdictions NIMS created to coordinate and manage this response

4. Benefits of NIMS Unified approach to incident management Standardized command and management structures Emphasis on preparedness, mutual aid, resource management

5. Administration of NIMS Administered by U.S. Department of Homeland Security Includes many other agencies such as FEMA NIMS has a National Response Plan (NRP) NRP continues to be refined

6. Elements of NIMS Prevention of emergencies and incidents Preparedness Response Recovery Mitigation 

7. Part of NIMS that focuses on response to: Acts of terrorism Wildfires and urban fires Hazardous materials spills Nuclear accidents Aircraft accidents Earthquakes, hurricanes, tornadoes, floods, and other natural disasters War-related disasters Other mass-casualty incidents The Incident Command System

8. First Responders in ICS All EMS personnel have crucial role Most First Responders will receive training related to their role in ICS

9. NIMS and ICS Training All personnel should receive training in NIMS and ICS Training is required to receive federal preparedness funding assistance Includes federal, state, and local government employees Different courses required at different levels

10. Mass-Casualty Incidents Emergency in which multiple patients need care MCIs can be stressful A large MCI can strain EMS resources Different EMS systems define MCIs in different ways

11. Large MCIs Small MCI may be handled within single EMS system, but larger MCIs require multiple jurisdictions ICS directs/manages emergency response ICS + triage

12. Incident Command System for Mass-Casualty Incidents Oversees all aspects of response Organizes, coordinates, controls resources/ personnel Similar functions grouped for maximum effectiveness Lines of authority clearly identified

13. Incident Commander Assigned overall supervisory responsibility for workers and resources Directs the emergency response First-responding unit announces to dispatcher that MCI exists, that they are “Command” Command may be transferred to another person Incident Commander functions from a command post

14. Sectors Rescuers assigned to section with specific responsibilities Each section supervised by Section Chief who reports to the Incident Commander. Common medical sections include: Triage Treatment Transportation Staging Supply Extrication

15. Smaller MCIs MCIs require different resources, smaller MCIs usually do not require all sections.

16. ICS Terminology NIMS continues to evolve/unify throughout the country NIMS is standardizing ICS terminology When NIMS is fully in U.S., unified terminology will be used

17. Role of First Responders in MCIs If you are first to respond, recognize emergency, report it, request assistance First knowledgeable EMS provider on scene becomes triage officer An initial assessment performed on all patients, and triage category is assigned Available personnel/ equipment are first directed to highest-priority patients First Responders may be assigned to different sections with different responsibilities

18. On Arrival at an MCI Report to the staging section or the command post Identify yourself, level of training, follow directions Report immediately to assigned section and individual in charge Perform only the task you are assigned If you complete the assigned task, report to the Section Chief for new assignment Act only on the direction of supervisory personnel

19. Differences in MCIs MCIs are stressful and may seem chaotic Accept your assignment without question unless you are inadequately trained for the task If asked to wait, be patient Some of your usual procedures will likely be suspended Perform whatever tasks you are assigned, regardless of your “normal” responsibilities

20. Triage

21. Triage Process of sorting patients by the severity of injuries Different triage systems have been developed with varying categories START system commonly used for rapidly triaging/treating large number of patients START requires only limited medical training =60 seconds/pt to complete

22. Triage Categories Each patient is tagged with a colored tag, indicating the triage category : Priority 1– Red – Immediate care needed Priority 2– Yellow – Urgent care needed Priority 3– Green – Delayed care Priority 4– Black – No care needed

23. Triage Process Quickly survey the scene With few patients, triage can proceed quickly and tags may not be needed When there are many patients, tags are generally used In scene with many patients, patients with minor injuries asked to walk to designated area, if they can walk without assistance

24. Triage Process

25. Remaining patients are triaged, each in =60 seconds. START system evaluates each patient’s breathing, circulation, and mental status to assign triage category. Triage a patient and move immediately to next When all patients triaged, personnel begin providing care for Priority 1 patients first.  Triage Process

26. START Triage Assessment Assess breathing Assess circulation Assess mental status

27. Step 1. Assess Breathing

28. Step 2. Assess Circulation For patient breathing without opening airway, next check pulse If pulse is strong, assess mental status If pulse is weak/irregular, tag Priority 1 (red tag) If pulse is weak/patient is bleeding severely, apply pressure dressing, tag Priority 1 (red tag)

29. Step 3. Assess Mental Status For patient breathing/has pulse, give simple command: “Open your eyes” “Squeeze my hand” Patients who follow are considered alert/responsive and tagged Priority 2 (yellow tag) Patients who cannot follow are considered unresponsive and are tagged Priority 1 (red tag) 

30. After Triage Re-evaluation is ongoing Observe or check the status of patients originally categorized as Priority 2 or 3 Priority 2 may become unresponsive, making patient Priority 1

31. Pediatric Triage

32. Pediatric Triage START system criteria less effective for infants and children Respiratory rate =30 breaths/minute may not be a problem in infant/child A child who has just stopped breathing may have a pulse A young child may not respond to command for other reasons or be too young to respond as expected

33. Jump START Triage for Pediatric Patients Assess same characteristics; follow different criteria and take somewhat modified steps First ask children who can walk to move to one side and tag them as green (Priority 3)

34. JumpSTART Pediatric Triage Process Assess breathing Assess circulation Assess mental status

35. Step 1. Assess Breathing Check whether child is breathing If breathing at a rate of 15 to 45 breaths/minute, move on to assess circulation If breathing =15 or =45 breaths/minute or if breathing is irregular, tag Priority 1 (red tag) If not breathing, open the airway

36. Step 1. Assess Breathing con’t If still not breathing, look in the mouth for a foreign body obstruction If now breathing, tag the child Priority 1 (red tag) If not breathing, check for a pulse If no pulse, tag the patient Priority 4 (black tag) Give a child with a pulse 5 ventilations; if breathing begins, tag red and move on If no breathing, tag black

37. Step 2. Assess Circulation For child breathing 15 to 45 breaths/minute without opening airway, check pulse in an uninjured extremity If you feel a pulse, assess mental status If no pulse, tag the patient Priority 1 (red tag)

38. Step 3. Assess Mental Status For child breathing/has pulse, assess mental status with AVPU assessment. A child alert and responding is tagged Priority 2 (yellow tag) A child not responding or responding inappropriately to pain is considered unresponsive and tagged Priority 1 (red tag)