Region X

1. Region X Multiple Patient Management Plan 2008

2. An accident has occurred.

3. Rescue crews arrive on the scene.

4. The patients may all require transportation to a hospital, but sometimes there are simply too many patients to be cared for at a single facility.

5. The revised Region X Multiple Patient Management Plan offers clear guidelines for the transportation of multiple patients. Region X MULTIPLE PATIENT MANAGEMENT PLAN Effective May 1, 2008 Last Revised – April 2008 (Formerly known as: Region X Multiple Victims and Mass Casualty Plan)

6. The purpose of the plan is to safely move patients from the field to the most appropriate hospital in an efficient and cooperative manner.

7. A Brief Review of the Basics

8. REGION X There are over one million people living in Region X.

9. A pre-established communication system links all of the hospitals located within Illinois. ILLINOIS DEPARTMENT OF PUBLIC HEALTH (IDPH) PODHOSPITAL RESOURCE HOSPITAL ASSOCIATE HOSPITAL

10. MABAS Region X MABAS stands for Mutual Aid Box Alarm System. Divisions I, III, and IV are located within Region X Illinois is a national leader in pre-established agreements between fire departments. Many other states are following their example.

11. INCIDENT MANAGEMENTSYSTEM ORGANIZATION

12. The Revised Plan

13. The revised plan is presented in an improved format.

14. This Patient Management Plan is based on four different classes. ‘Business as Usual’ Note that the line between the third and fourth columns is darker

15. The specifics for each class are clearly identified in a table format.

16. Classifying an Incident

17. CLASS 1 ‘Business as Usual’ During a Class 1 Multiple Patient Incident field providers are able to provide their ‘normal level of care’. In a Class 1 Incident EMS providers now contact their CLOSEST HOSPITAL A few areas make Class 1 unique. Hospitals MAY NOT divert ambulances transporting from a multiple patient incident.

18. In the past…. EMS Resource Hospital Receiving Hospitals Resource Hospital EMS Now…. EMS Closest Hospital IN REVIEW:Contacting the closest hospital during a Class 1 incident to discuss patient disbursement is a new approach in Region X. ‘Business as Usual’

19. CLASS 1 This is the most unique addition to the Region X plan. ‘Business as Usual’ 1 2 3

20. Occasionally, situations may arise during a Class 1 incident when field personnel want to take more than two patients to the same hospital. Two patients in this car have been classified as Category I trauma patients. Three patients in this car have been classified as Category III trauma patients. They are a mother and two small children.

21. What if… EMS is on the scene of a auto accident with two Category 1 trauma patients. A Level Two is 8 minutes away. A Level One is 15 minutes away. WHICH HOSPITAL SHOULDBE CONTACTED BY FIELD PERSONNEL? Two Patients Both Category I Trauma Patients 8 min 15 min LEVEL ONE TRAUMA CENTER LEVEL TWOTRAUMA CENTER

22. CLASS 2 During a Class 2 Multiple Patient Incident, field providers are UNABLE to meet their ‘normal level of care’. In a Class 2 Incident, EMS providers contact their RESOURCE HOSPITAL. Because resources and information will likely be limited, providers give the hospital an estimated number of patients and their levels of acuity. During a Class 2 Incident, providers will communicate to their Resource Hospital using traditional triage colors of red, yellow and green based on the START Triage Method.

23. It is important to compare the difference in communication between Class 1 and Classes 2 or 3. CLASS 1 CLASSES 2 and 3 ‘Business as Usual’ FIELD COMMAND FIELD COMMAND RESOURCEHOSPITAL RESOURCEHOSPITAL CLOSEST HOSPITAL POTENTIALRECEIVING HOSPITALS

24. Communication Structure Class 2 and Class 3 SCENE COMMAND RESOURCE

25. CLASS3 During a Class 3 Multiple Patient Incident responders are OVERWHELMINGLY unable to meet the ‘normal level of care’. The POD Hospital may be activated for assistance with communication Transporting ambulances will not have any communication with receiving hospitals. NO PATIENT CARE REPORTS

26. A Class 3 incident could involve an enormous number of patients. Outdoor Concert Amusement Park Political Rally College Stadium

27. EMERGENT EVACUATIONOF HEALTHCARE FACILITY It is important to include the administration of the facility in making some decisions. Charity Hospital New Orleans Note the different types of triage.

28. WHAT IS REVERSE TRIAGE? Patients that are able to exit the building on their own are removed first. Patients that require assistance in a wheelchair are next. Patients that are extremely ill and require intensive manpower to move are moved last. A small fire occurs in the electrical room of a large hospital. Only a few patients have been injured, but the hospital needs to be evacuated. As the patients arrive at a collection area, the process is reversed. The most critical patients are transported first. The patients requiring a moderate amount of care are sent next. Patients requiring minimal medical care leave the facility last.

29. Typical Scenario: ‘EMERGENT EVACUATION OF AHEALTHCARE FACILITY’ Hospitals Patients injured in fire. CommunityCenter A FIRE OCCURS IN ONE WING OF A NURSING HOME Ambulatory nursing home residents not affected by fire. Bed-ridden nursing home residents not affected by fire. Alternate Nursing Home

30. An After-Action Report should be generated following any activation of the Region X Multiple Patient Plan. A copy of this form is found in the plan.

31. TRIAGE

32. The State of Illinois has adopted the START triage method in partnership with the SMART® Incident Command System as a state-wide standard. SMART® Tags to be used when doing START Triage.

33. START TRIAGE RED Light Sticks are found in each pack to visually identify critical patients in a dark environmental ADULTS Pediatric Patients Under 32 kg

35. All ambulances in Illinois have receiveda SMART® Triage Pack. • Components of the Triage Pack: • Folding SMART® Triage Tags • Mini-light sticks to identify • RED patients at night • DEAD tags • SMART® Tape • (to prioritize injured or sick • children up to 32 kg) • Triage prompt card • (to prioritize adults) • Dynamic record of casualties • already triaged • Pencil

36. SMART® equipment is also being given to hospitals, fire departments and MABAS Divisions. • SMART® MCI Bag • Includes: • Four SMART Triage Packs • One SMART Command Board Command Board

37. The Region X Multiple Patient Plan includes other important information. • Summary of O’Hare Disaster Plan • Summary of State Disaster Plan • Summary of National Disaster Plan • Training guidelines • Guidelines for sending medical personnel to the scene of a disaster • Post-incident recovery services (CISM) • After-action Report Forms • Hospital / Field log forms (template)

38. Putting the Plan to Work ‘Business as Usual’ Scenarios OR

39. Truck Driver: 57 year old male Complains of Chest Pain prior to accident Denies trauma, able to ambulate Pale, cool and diaphoretic Respirations = 32/min Car #1 - Driver 25 year old male Ambulatory at the scene Air bags deployed / seat belt worn Complains of wrist pain with deformity Car #2 – Driver 84 year old male Unresponsive, Respirations = 24/min Bilateral femur fractures Car #2 – Passenger 82 year old female Laceration to forehead Respirations = 32/min Deteriorating mental status -What Class? -Which hospital do you call? -Where should the patients be transported? -Specifics 1

40. The owner of this house has called to report that he returned home from work to find his family unresponsive and his carbon monoxide alarm going off. • Patient #1: 50 year old unresponsive female • Patient #2: 20 year old unresponsive female • Patient #3: 17 year old unresponsive male • Patient #4: 16 year old unresponsive female • Patient #5: 15 year old unresponsive male -What Class? -Which hospital do you call? -Where should the patients be transported? -Specifics 2

41. 10-12 patients 4 Red 5 Yellow 1-3 Green All adults – All trauma patients -What Class? -Which hospital do you call? -Where should the patients be transported? -Specifics 3

42. Patient #1: 24 year old male Ambulatory at the scene Driver of this car Appears stable Patient #2: 20 year old male Unresponsive Thrown from a vehicle This picture is a simulation. Patient #3: 18 year old male Front seat passenger – unrestrained Unresponsive -What Class? -Which hospital do you call? -Where should the patients be transported? -Specifics Patient #4: 18 year old female Back seat passenger - restrained Unresponsive 4

43. An earthquake has occurred in Illinois. This building is located in Region X and contained over 100 people. Many other buildings have been damaged. The New Madrid Fault line runs through Illinois. An 1811 earthquake involving this fault line was the most destructive in U.S. history. The Mississippi River actually ran backwards. Some researchers contend that a ‘mega-quake’ of this fault is long overdue. -What Class? -Which hospital do you call? -Where should the patients be transported? -Specifics 5

44. Patient #1: Driver 18 year old male Unresponsive Still restrained Patient #2: Front Seat Passenger 18 year old female Crying in pain Open Skull Fracture -What Class? -Which hospital do you call? -Where should the patients be transported? -Specifics 6

45. Patient #1: Driver FATAL INJURY (in accordance with Region X guidelines) No transport Patient #2: Back Seat Passenger Still restrained Denies Complaints No trauma noted Patient #3: Front Seat Passenger Thrown from vehicle Unresponsive -What Class? -Which hospital do you call? -Where should the patients be transported? -Specifics 7

46. This is a small nursing home. Eight elderly people and two caregivers live here. It is 2:30 a.m. The temperature is below zero. -What Class? -Which hospital do you call? -Where should the patients be transported? -Specifics 8

47. QUESTIONS? We welcome your questions: Jill Ramaker, RN, EMT-P Chairman – Region X DMSC EMS Coordinator, Evanston Hospital 847-570-2166 jramaker@enh.org