Multi-Casualty - PowerPoint PPT Presentation

Multi-Casualty

Incident Plan

2007 Training

Hospital Emergency Room Training

Contra Costa County EMS

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.

• 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

• 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

• 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

• 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

Objective #1:

Establish a common organization, management, and communications structure for the coordination of emergency response to a multi-casualty incident.

Objective #2:

Establish methods of triage and transportation that will provide the best medical outcome possible for the greatest number of casualties.

Objective #3:

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

Objective #4:

The Plan will be drilled regularly, and reviewed annually and following significant activations of the Plan as directed by the EMS Director.

• 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

• Importance of Unified Command
• The “Rule of 2 and 4”

• 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

• Use of Tiers modeled after Community Warning System (CWS) Levels
• Consistent with best practices

• 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

• 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

• 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

• 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

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

• Multiple agencies
• Fire-EMS: ALS and BLS
• Law Enforcement
• Hospitals
• Helicopter
• Communications/EMSOACC
• Defined tier specific responsibilities
• Clear communication pathways
• Resource Coordination

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• East/Central/West
• Rallying point in case of loss of communications

• 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

• 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

• 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

• START Triage system
• New tags
• Victims will not be re-triaged at scene
• Victims re-triage in Treatment Areas

Contamination

Designation

Will be Standardized

Through-out

County

Triage Tags