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Multi-Casualty

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  1. Multi-Casualty Incident Plan 2007 Training FIRE-EMS TRAINING Contra Costa County EMS

  2. 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.

  3. 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

  4. 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

  5. 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

  6. 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

  7. MCI Plan Objectives Objective #1: Establish a common organization, management, and communications structure for the coordination of emergency response to a multi-casualty incident.

  8. 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.

  9. MCI Plan Objectives Objective #3: Establish pre-defined responsibilities of all entities with key roles in achieving successful implementation of the plan.

  10. 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.

  11. 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

  12. Key Concepts • Importance of Unified Command • The “Rule of 2 and 4”

  13. 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

  14. MCI Tiers • Use of Tiers modeled after Community Warning System Levels • Consistent with best practices

  15. 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

  16. 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

  17. 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

  18. 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

  19. Plan Components • Responsibilities matrix/checklists • Communications flowchart • Communications overview • ICS position checklists • ICS communications forms 205 and 217A

  20. Responsibilities Matrix • Review pertinent matrices • Pp 7 - 16

  21. 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

  22. 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

  23. 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

  24. 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)

  25. 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

  26. 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

  27. 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

  28. Predetermined Staging Areas • East/Central/West • Rallying point in case of loss of communications

  29. 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

  30. 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

  31. 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

  32. 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

  33. 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

  34. START and Tag Review .PDF