Introduction to Multiple-Casualty Incidents, the Incident Command System, and Triage

1. 26 Introduction to Multiple-Casualty Incidents, the Incident Command System, and Triage

2. Objectives • Define the following terms: • Incident Command System (ICS) • Incident Commander • JumpSTART pediatric triage system • Multiple-Casualty Incident (MCI) • National Incident Management System (NIMS) • START triage system • Triage (continued)

3. Objectives • Explain the criteria that defines a Multiple-Casualty Incident. • Describe common causes of Multiple-Casualty Incidents. • Explain the role of the Emergency Medical Responder in the multiple-casualty situation. • Explain the key principles and structure of an Incident Command System. (continued)

4. Objectives • Explain the key principles of triage at a Multiple-Casualty Incident. • Differentiate patient priorities related to triage. • Explain the assessment criteria of the START triage system. • Differentiate primary and secondary triage. • Demonstrate the ability to properly categorize patients of a simulated multiple-casualty situation. (continued)

5. Objectives • Recognize the importance of patient priorities during a multiple-casualty event.

6. Topics • Multiple-Casualty Incidents • Incident Command System • Triage

7. MULTIPLE-CASUALITY INCIDENTS

8. Multiple-Casualty Incidents • Multiple-Casualty Incident (MCI): any emergency that involves multiple victims and overwhelms first responding units. • Multiple vehicles • Earthquakes • Floods • Large explosions • Building collapses

9. Multiple-casualty incidents require the resources of many agencies.

10. Multiple-Casualty Incidents • Low-Impact Incidents • Manageable by local emergency personnel. • High-Impact Incidents • Stresses local EMS, fire, and police resources. • Disaster, Terrorism Incidents: overwhelms regional emergency response resources.

11. Think About It • You respond alone to a serious MVC. You find two patients. One is bleeding severely from a neck wound and the other is complaining of head pain. • Which patient do you treat first? • Would you consider this scene an MCI?

12. INCIDENT COMMAND SYSTEM

13. Incident Command System • Incident Command System (ICS) • Model tool for command, control, coordination of resources at scene of large-scale emergency involving multiple agencies. • Procedures for organizing personnel, facilities, equipment, and communications.

14. Incident Command System • Incident Commander • Responsible for all aspects of an emergency response. • Modules in Incident Command System: • Command • Operations • Planning • Logistics • Finance

15. The incident commander delegates duties to the various group officers.

16. Incident Command System • National Incident Management System (NIMS) • Developed so that federal, state, local, and tribal resources can respond more efficiently to natural disasters and emergencies. (continued)

17. Incident Command System • National Incident Management System • Teaches unified approach to incident management, standard command and management structures; emphasis on preparedness, mutual aid, resource management, common terminology among agencies

18. Incident Command System • The Medical Branch • Branch of ICS • Designates and coordinates three functional areas or groups: • Triage • Treatment • Transport

19. Incident Command System • Triage Group • Determines location of triage areas. • Conducts primary triage and ensures all patients are assessed and sorted using START triage protocol (or similar) • The triage group leader communicates resource requirements to the medical group supervisor. (continued)

20. Incident Command System • Triage Group • Communicates with treatment group leader to allow for movement of patients into treatment area for prehospital care.

21. Incident Command System • Treatment Group • Determines treatment group location. • Coordinates with triage group to move patients from triage to treatment areas. • Maintains communications with medical group supervisor. (continued)

22. Incident Command System • Treatment Group • Reassesses patients, conducts secondary triage to match patients with resources • Directs movement to transport group

23. Incident Command System • Transport Group • Coordinates transportation of victims to appropriate facilities for treatment • Manages patient movement and accountability from scene to hospitals • Works with treatment group to establish adequately sized, easily identifiable patient loading area (continued)

24. Incident Command System • Transport Group • Designates ambulance staging division • Maintains communication with medical group supervisor

25. Incident Command System • Medical Staging • Designates easily located site for resources to stage near incident area • Determines whether several staging divisions required • Determines whether staging will need to be relocated as situation evolves

26. Think About It • You are first on scene of a MVC involving 20 patients who have been ejected into the median after a bus overturned. • Should you immediately begin triage? • Do you have other immediate responsibilities?

27. TRIAGE

28. Triage • Triage • Method of sorting patients for care and transport based on severity of injuries or illnesses. • Used in hospital emergency departments, battlefields, emergencies when there are multiple victims and limited medical resources.

29. At the scene of a multiple-casualty incident, triage is the system used to identify victims who are most in need of immediate medical care.

30. Triage • EMRs first on scene; must be able to triage patients and initiate care rapidly. • Patients with serious medical- or trauma-related problems (heart attack, shock, major injuries, heat stroke) must be transported quickly. • Patients with minor injuries or illnesses are transported later.

31. Triage • START Triage System • START: Simple Triage And Rapid Treatment • Based on rapid assessment of patients using three criteria: respirations, perfusion, mental status (RPM) • 60 seconds or less per patient • Do not begin treatment during triage. (continued)

32. Triage • START Triage System • Patients classified into one of four categories; tagged with denoted color-coded tag indicator. • Immediate (red) • Delayed (yellow) • Minor (green) • Deceased (black)

33. An example of a standard triage tag, front and back.

34. The START triage algorithm.

35. Triage • Primary triage • When patient is first identified and triaged. • Secondary triage • When patient is relocated to treatment area, he will immediately be re-triaged by treatment team.

36. START Triage System

37. Triage • JumpSTART Pediatric Triage System • Specialized pediatric triage system designed for patients from one to eight years of age. • Assessment categories for JumpSTART system are the same as for START system: respirations, perfusion (peripheral pulses), mental status (AVPU).

38. The JumpSTART pediatric triage algorithm.

39. Triage • Be aware of your mental and physical stress levels. • Critical Incident Stress Debriefing (CISD) sessions or other qualified psychological support should be available after a disaster or unusual emergency to address needs of rescuers.

40. Think About It • You respond to an MCI following an explosion at an outdoor café. You are assigned to the triage group and are given tags. You see significantly injured patients everywhere. A woman with a localized ankle fracture screams out to you for help. • What do you do? • How will you proceed?

41. SUMMARY

42. Summary • While rare, Multiple-Casualty Incidents (MCIs) can easily overwhelm first responding units at scene. • First units quickly request additional resources and begin to establish command over incident.

43. Summary • Incident Command System (Incident Management System): tool used to manage overall control of large scenes involving many resources and multiple agencies.

44. Summary • Triage: sorting of patients based on severity of injuries or illnesses • Goal is to save as many patients as possible using available resources.

45. Summary • Triage Categories • Immediate: for most critical but salvageable patients • Delayed: for less critical but still in need of care • Minor: for those ambulatory at scene • Deceased: who show no signs of life

46. Summary • START System—Simple Triage And Rapid Treatment program that uses respirations, perfusion, and mental status assessments to categorize patients into one of four treatment categories.

47. Summary • Variation of START Triage System designed specifically for pediatric patients is the JumpSTART system. • Takes into account unique needs and presentation of pediatric patients.

48. REVIEW QUESTIONS

49. Review Questions • What are the criteria that define a Multiple-Casualty Incident? • What are common causes of Multiple-Casualty Incidents? • What is the role of the Emergency Medical Responder in the multiple-casualty situation? • What are the key principles and structure of an Incident Command System? • What are the key principles of triage at a Multiple-Casualty Incident? (continued)

50. Review Questions • What are the assessment criteria of the START triage system? • What is the difference between primary and secondary triage?