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Unit Four. Hospital Incident Management System (HIMS) for Mass Casualty Incidents (MCI). Objectives. Define mass casualty incidents (MCI) Describe the Multi-casualty Branch structure Use of multiple Groups/Divisions under the Multi-casualty Branch Director Discuss MCI response procedures

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unit four

Unit Four

Hospital Incident Management System (HIMS) for Mass Casualty Incidents (MCI)

objectives
Objectives
  • Define mass casualty incidents (MCI)
  • Describe the Multi-casualty Branch structure
  • Use of multiple Groups/Divisions under the Multi-casualty Branch Director
  • Discuss MCI response procedures
  • Review emergency medical service role in MCI
  • Describe “START”

B461 Course

objectives cont d
Objectives (cont'd)
  • Identify the relationship of MCI Groups (triage, treatment, transport) to overall scheme of the HIMS
  • Prioritize patients using the START method of triage for:
    • Decontamination
    • Treatment
  • Identify considerations in transporting patients to area hospitals

B461 Course

mass casualty incidents
Mass Casualty Incidents
  • Multi-patient Incidents - exceeds normal first responder capabilities
  • Major medical emergency – any emergency that would require the access of local mutual aid resources
  • Mass Casualty Incidents - combination of numbers of injured personnel and type of injuries going beyond the capability of an entity’s normal first response
  • Disaster – State and/or Federal resources are required

B461 Course

mass casualty incident management
Mass Casualty Incident Management
  • Do the greatest good for the greatest number of patients
  • Make the best use of:
    • Personnel
    • Equipment
    • Medical and facility resources
  • Limit the spread of the contamination
  • Minimize the effects of the disaster, incident, or event

B461 Course

triage considerations
Triage Considerations
  • Triage - Term in early 1800s (derived from the French trier, meaning "to sort")
  • Immediate - Casualty requires lifesaving measures performed without delay if they are to survive
  • Delayed - Casualty whose treatment can wait without causing additional harm

B461 Course

triage considerations cont d
Triage Considerations (cont'd)
  • Expectant – Casualties that will not survive or will require extensive resources and time if they are to be saved
  • Minor – Casualties that are generally ambulatory and are injured only slightly

B461 Course

hospital triage
Hospital Triage
  • Use a triage system in an MCI that parallels normal routine
  • Practice regularly to ensure familiarity
  • Triage is a continual process
  • Re-triage all victimstransported by EMS
  • Set up triage area near the ED entrance
    • Shielded and secure
    • Readily accessible

B461 Course

triage
Triage
  • “Greatest good for the greatest number of casualties”
  • Psychological impact
  • Classification:

RedYellowGreenBlack

  • Limitations:
    • Time consuming
    • User variability
    • Lack of familiarity

B461 Course

start triage
TRIAGE CRITERIA:

Respiratory status

Perfusion and pulse

Neurological status

TRIAGE CATEGORIES:

Walking wounded - “Green” or minimal (relocate when told)

Normal findings - “Yellow” or delayed (unable to relocate)

Abnormal - “Red” or immediate

Non-salvageable - “Black” or expectant

START Triage

B461 Course

start respiratory status
START - Respiratory Status

Respiratory Status

Respirations

Normal

No Respiratory

Effort

> 30

Respirations

Go to

Expectant

Immediate

Next Step

B461 Course

start perfusion
START - Perfusion

Perfusion Status

Radial PulsePresent

Radial PulseAbsent

Cyanotic

Go to

Immediate

Next Step

Immediate

B461 Course

start neurological status
START - Neurological Status

Neurological Status

NormalMental Status

Change inMental Status

Unconscious

Move toNext Victim

Immediate

Immediate

B461 Course

nerve agent triage immediate
Nerve Agent Triage - “Immediate”
  • Unconsciousness or convulsions
  • Two or more body systems involved
  • Requires immediate antidote

Rapid intervention should

result in a good outcome

B461 Course

initial first aid treatment
Initial First Aid Treatment
  • Immediate removal from source of exposure
    • severity directly proportional to absorbed dose
  • Decontamination
    • Mild soap and water rinse
  • Antidote administration with airway management support as necessary
  • Must be provided by properly trained and equipped personnel

B461 Course

nerve agent antidote
Nerve Agent Antidote
  • Atropine
    • administered to block receptor sites of acetylcholine
  • 2-PAM Chloride
    • restores acetylcholinesterase
  • Mark I Kit or “Combo Pen”

B461 Course

first aid treatment
First Aid Treatment
  • Exit Agent Exposure Area
  • Minor Symptoms Administer:
    • One Mark I Kit
  • Major Symptoms Administer:
    • Three Mark I Kits
  • Diazepam Required for Severe Casualty
  • Monitor Patient’s Symptoms

B461 Course

nerve agent triage delayed
Nerve Agent Triage - “Delayed”
  • Initial symptoms are improving (miosis still present)
  • Recovering well from pre-hospital antidote therapy

B461 Course

nerve agent triage minimal expectant
Nerve Agent Triage -“Minimal” & “Expectant”

Minimal

  • Walking and talking which indicates intact breathing and circulation
  • Expectant
  • Apneic for more than 5 minutes
  • No pulse or blood pressure

B461 Course

mustard triage
Delayed

2 to 50% BSA burns by liquid

Eye involvement

Minimal

< 2% BSA burns by liquid in non-critical areas

Mustard Triage
  • Immediate
  • Moderate to severe pulmonary symptoms
  • Expectant
  • > 50% BSA burns by liquid; apneic/no pulse

B461 Course

triage of biological casualties
Triage of Biological Casualties
  • Triage of biological agent casualties is different:
    • Symptoms are delayed
    • Initial cases may go unrecognized
    • More difficult to detect
  • Epidemiological information becomes critical

B461 Course

triage psychological casualties
TriagePsychological Casualties
  • Disasters produce tremendous emotional and psychological stress, with large numbers of psychogenic casualties
  • Presenting signs could be confused with organic disease
  • Use of START triage system maintains focus on objective signs of disease & minimizes impact of subjective complaints on the triage process
  • Psychological casualties are usually triaged as “minimal”

B461 Course

triage hospital arrivals
TriageHospital Arrivals
  • Casualty arrival is uncoordinated
  • Arrival times vary
  • Closest hospital is typically overwhelmed
  • Medical needs of unaffected community continues
  • May present at distant hospitals to ensure treatment at clean facilities

B461 Course

contaminated human remains
Contaminated Human Remains
  • Problems are agent specific:
    • Decontamination
    • Containment
    • Refrigeration until definitive disposal
  • Follow local coroner and medical examiner protocols:
    • Establish cooperative agreements for fatality management
  • Secure personal effects:
    • Not all can be decontaminated

B461 Course

radiation protection for clinical staff
Radiation Protection for Clinical Staff
  • Fundamental Principles

- Time

- Distance

- Shielding

  • Personnel Protective Equipment
  • Contamination Control

B461 Course

slide26
Protecting Staff from Contamination
  • Use standard precautions (N95 mask)
  • Survey hands and clothing frequently
  • Replace contaminated gloves or clothing
  • Keep the work area free of contamination

B461 Course

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