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Multi-Casualty. Incident Plan. 2007 Training. Hospital Emergency Room 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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Incident Plan

2007 Training

Hospital Emergency Room Training

Contra Costa County EMS

tim w hennessy mci plan
Tim W. HennessyMCI Plan

Tim W. Hennessy

Communications Supervisor

Contra Costa County

Sheriffs Communication


This MCI Plan

is dedicated to Tim.

His expertise and commitment in developing this plan was invaluable.

  • 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
hospital responsibilities
Hospital Responsibilities
  • Tier Zero
    • Make internal notifications and institute appropriate ED procedures as per facility protocol
    • Respond to ED capacity poll from EMSOACC (Sheriffs dispatch) if initiated
    • Monitor and use Reddinet
hospital responsibilities23
Hospital Responsibilities
  • Tier One MCI
    • Immediately prepare to accept 2 critical and 4 delayed patients
    • Assess ability to handle additional patients and respond to ED capacity poll from EMSOACC
    • Diversion status does not apply during Tier 1,2,3 MCI
hospital responsibilities24
Hospital Responsibilities
  • Tier Two
    • Rule of 2 and 4
    • Capacity Poll
      • Respond on Reddinet
    • No Diversion
  • Tier Three
    • All of above
    • Conduct damage assessment and report results to EMSOACC/EMS if necessary
    • Activate facility disaster plan if necessary
mci plan
MCI Plan
  • Know Reddinet
  • Know your responsibilities
  • Utilize HICS as needed
  • In HICS the certifications and qualifications determine who does what…not position
  • You might be asked to do things you normally might not do in MCI Tier III
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
  • MVC 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
  • Victims will not be re-triaged at scene
  • Victims re-triage in Treatment Areas
triage tags



Will be Standardized



Triage Tags