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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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Multi-Casualty

Incident Plan

2007 Training

Hospital Emergency Room Training

Contra Costa County EMS


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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.


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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


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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


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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


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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


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MCI Plan Objectives

Objective #1:

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


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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.


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MCI Plan Objectives

Objective #3:

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


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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.


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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


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Key Concepts

  • Importance of Unified Command

  • The “Rule of 2 and 4”


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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


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MCI Tiers

  • Use of Tiers modeled after Community Warning System (CWS) Levels

  • Consistent with best practices


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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


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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


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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


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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


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Plan Components

  • Responsibilities matrix/checklists

  • Communications flowchart

  • Communications overview

  • ICS position checklists

  • ICS communications forms 205 and 217A


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Responsibilities Matrix

  • Multiple agencies

    • Fire-EMS: ALS and BLS

    • Law Enforcement

    • Hospitals

    • Helicopter

    • Communications/EMSOACC

  • Defined tier specific responsibilities

  • Clear communication pathways

  • Resource Coordination


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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


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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


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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


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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


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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


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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


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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


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Predetermined Staging Areas

  • East/Central/West

  • Rallying point in case of loss of communications


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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


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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


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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


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Triage Considerations

  • START Triage system

    • New tags

  • Victims will not be re-triaged at scene

  • Victims re-triage in Treatment Areas


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Contamination

Designation

Will be Standardized

Through-out

County

Triage Tags


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