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Multi-Casualty. Incident Plan. 2007 Training. Law Enforcement 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

Law Enforcement 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 plan6
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 objectives8
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 objectives9
MCI Plan Objectives

Objective #3:

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

mci plan objectives10
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 concepts12
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 tiers14
MCI Tiers
  • Use of Tiers modeled after Community Warning System (CWS) 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
  • Multiple agencies
    • Fire-EMS: ALS and BLS
    • Law Enforcement
    • Hospitals
    • Helicopter
    • Communications/EMSOACC
  • Defined tier specific responsibilities
  • Clear communication pathways
  • Resource Coordination
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 communications
      • Use clear text
      • Complete forms
      • Demobilize as required/practical
law enforcement responsibilities
Law Enforcement Responsibilities
  • Tier Zero
    • Broadcast information to field units
    • Make supervisory and command notifications per department policy
law enforcement responsibilities23
Law Enforcement Responsibilities
  • Tier One MCI
    • All Tier Zero responsibilities and
    • Respond to the scene
    • Establish unified command or assume appropriate position within ICS structure
    • Determine need for additional police resources
    • Handle traffic and/or crowd control as needed
law enforcement responsibilities24
Law Enforcement Responsibilities
  • Tier Two
    • All Tier 0-1 responsibilities
  • Tier Three
    • All Tier 0-2 responsibilities
    • Consider immediate activation of mutual aid resources, including Mutual Aid Mobile Field Force (MAMFF)
mci plan
MCI Plan
  • Know your responsibilities
  • Utilize ICS as needed
  • In ICS the certifications and qualifications determine who does what…not position
  • Resources will be requested thru chain of command
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 communications
  • 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
    • New tags
    • Contamination incorporated
      • Avoid exposure
      • Protective equipment
  • Law Enforcement may be assigned morgue management by triage unit leader thru ICS
triage tags

Contamination

Designation

Will be Standardized

Through-out

County

Triage Tags