Incident Command Fundamentals in Managing Multiple Casualty Incidents

1. Unit 49 Incident Command and Multiple-Casualty Incidents

2. Overview • Multiple patient encounters • National incident management systems • Multiple-casualty incidents • EMS operations sector

3. Introduction • Multiple-casualty incidents require management of multiple patients, emergency responders, response vehicles, elements of environment, and incident itself • Understanding fundamentals of incident command and multi-casualty incident will help EMT competently treat patients

4. Multiple Patient Encounters • Patient care approach for a hundred patients is the same as for one patient • A leader is needed to direct activities of others on arrival and throughout call • First: determine priority of patient • Next: treat patient • Finally: notify communications center and hospital of patient transport

5. National IncidentManagement Systems • Events of September 11, 2001: highlighted need for developing national standards for incident operations • National Incident Management System (NIMS): established management criteria for all responders • Goal of NIMS: ensure interoperability between various groups and agencies

6. Components of NIMS • Command and management • Incident command system (ICS) • Multiagency coordination system • Public information system • Preparedness • Planning, training, exercises, personnel qualifications, standards, equipment, etc.

7. Components of NIMS (cont’d.) • Resource management • Standardized requirements for resources • Communication and info management • Effective interoperable communications • Supporting technologies • Data, display, records, tracking systems • Ongoing management and maintenance • Strategic oversight and direction

8. Multiple-Casualty Incidents • Event overextending EMS resources • Incident command system • Standardized command structure • Small incident: only one incident commander (IC) needed • Large incidents: several ICs share joint command at centralized location • Leadership rotates according to incident needs

9. Incident Command System (cont’d.) • Chain of command: hierarchical reporting system • Command personnel • Safety officer (SO): responsible for safety of all personnel • Public information officer: meets with media and reports state of affairs at incident

10. Figure 49.2 The Incident Management System provides for both command and control

11. Role of the EMT in Incident Management • EMTs should be familiar with their roles during an incident • Objective of EMT: • Understand when to activate incident management system (IMS) • How to participate in IMS as a provider

12. EMS Operations Sector • Five tasks in a disaster: • Take control or command of situation • Assemble resources and personnel • Locate and sort patients according to severity of injuries • Render needed medical care according to severity • Transport patients

13. EMS Director • Responsible for EMS operations and interfacing with other emergency services commanders • Must establish command post and make a declaration (problem present and resources needed) • Tactical command sheets: instructions for how to proceed with specific incident

15. EMS Director (cont’d.) • Transfer of command • Whenever another person assumes EMS command, he will need briefing • EMS commander must provide most up-to-date info about current state of affairs • Tactical command sheets and status boards reviewed

17. Staging Officer • Staging area: off-scene location where personnel and vehicles assemble and await assignment • Staging officer: manages staging area, assembling and assigning equipment and personnel • Equipment staging • Equipment manager maintains supplies

19. Triage Officer • Patient survival depends on effective utilization of limited resources • Triage: distribution of patients into treatment classifications according to injury severity • Triage officer: oversees triage process

21. Triage Systems • Evacuation triages determine which patients require immediate removal • Following evacuation, color-coded system signifies treatment priority • Red: immediate medical care required • Yellow: medical help can be delayed • Green: minor injuries • Black: dead or dying

22. TriageSystems (cont’d.) • START triage system • Simple triage and rapid treatment • JumpSTART pediatric triage • Specific assessment techniques for infants and children to differentiate from adults • Triage tags • Allows for quick identification of patient condition and prevents duplication of effort

23. Figure 49.8 START stands for Simple Triage And Rapid Treatment

24. Treatment Officer • Field hospital • Temporary on-site treatment facility • Managed by treatment officer • Morgue • Area set aside for deceased patients, overseen by morticians or funeral directors

25. Transportation Officer • Responsible for overall movement of patients from scene to hospital • Maintains communications with hospitals • Tracks patients’ whereabouts • Most patients will require ambulance from staging area • For minor injuries, buses may be used

26. Conclusion • Major incident need not be disaster for EMT • EMTs need to ensure personal safety while delegating tasks • Standard approach to major incident much the same as standard approach to any patient, only on much greater scale