Mass Casualty Incidents

1. Mass Casualty Incidents

2. What is an MCI ? It is any incident where the number of patients and/or the severity of their injuries prohibits immediate patient care provided to all at that moment.

3. Multiple Casualty Incident It will never happen to me right ? High Risk/Low Frequency events

4. MCI Events in King County: • Highland Ice Arena, Shoreline: 76 patients from a CO leak . • Chlorine leak at a County Pool, 26 Patients • School bus accident in Redmond 60 patients • Several MVA’s ranging from 5 to 10 Patients • Seattle Aurora Bridge Bus Incident. 33 Patients.

5. Common Problems at an MCI • Personnel not fully understanding their roles in an MCI setting. • Failure to identify the incident as an MCI • Failure to triage properly • Improper numbering of treatment tags /Pt’s • Inappropriate, time consuming treatment • Clogging at the transportation site.

6. Problems… • Scene access problems • Ineffective response plan for the size of incident. • Lack of a large equipment cache on hand • Congested treatment areas • Transport vehicles left unattended

7. Misconceptions of MCI: • Every MCI requires a Medical Group to be set up. • I.C. does not need an “Medical Group Supervisor” in a large event. • You cannot down grade a patient once they have been triaged. • All Immediate or red patients must be transported first. • Patients have to go the the closest Hospital. • Yellow patients equal BLS patients always.

8. Ambulance Staging Staging Manager Colored flagging Tape Funnel Point Hospital Control Medical group Supervisor or Branch director Medical Support Unit Morgue area Plan C Triage Tracking Boards Treatment Area Transport Area Treatment Tags Triage Belt Multiple Casualty Definitions:

9. Incident Management System • MCI plan is based on the same principles of the IMS system. • Allows for creation of an organizational structure for the most effectiveness of resources, personnel and equipment. • Span of control 3 to 7 with optimal being 5 • Is a “Medical Group” or “Medical Branch” needed to effectively manage the incident ?

10. Activation of an MCI • Incident Commander’s responsibility to declare an MCI and provide a verbal size up of the incident. • Additional resources should be requested early on by the I.C. • The I.C. or designee is responsible for initial “Hospital Control” contact and plan activation.

11. Activation of Hospital Control • Request “Activation of the MCI Hospital Control Plan” done by the I.C. • Transportation Team Leader communicates with Hospital Control • PRIMARY: Harborview Medical Center • Ask for the “Charge Nurse” • This will result in notification of HMC E.R. staff, HMC Physician portable 55, and area Hospitals if necessary. • Is a “Lock Down” needed at local Hospitals ?

12. Secondary Hospital Control • Overlake Medical Center • Request Charge Nurse and provide the same information as you would to HMC.

13. Incident Commander • Develop a “Incident action plan” necessary to control the incident. • Establish a Medical Group or branch if needed. • Ensure that adequate resources are requested for both incident manpower and transport capabilities. • Direct incoming resources • Establish Command post/location and necessary staging /base areas

14. Incident Management Considerations: • Is “Gross Decon” and “Lock Down” notification for hospitals needed ? • Buses for shelter and patient transport. • Crowd control, separating injured from non. • Separate walking wounded from non ambulatory patients. • Separate tactical channel for medical

15. Gross Decon Procedure • I.C. establishes “gross decon group” • Location: prior to funnel point. • Once clean, patient is given a Tyvek suit. • Disposable blanket if Back Boarded. • Attach white flagging tape to wrist. • Proceed to funnel point or green holding area.

16. Medical Group/Branch Supervisor • Filled by a “Medical Services Officer”or first in Medic Unit officer. • Responsible for the over all coordination of the medical group and Hospital control • Recommend early activation of Hospital control • Ensure proper resources and manpower for the medical group. • Responsible for accountability

17. Medical Branch vs. Medical Group Medical group supervisor Triage Team Leader Treatment Team Leader Transportation Team Leader / ambulance staging manager Morgue Team Leader Medical Group

18. Triage Team Leader • Filled by a Company Officer • Accountable for litter barriers and equipment for back boarding. • Responsible for setting up a funnel point • Responsible for proper triage including numbering/flagging of patients • Responsible for clearing Patients after gross deacon needs are complete prior to treatment area.

19. Funnel Point Procedure • V shape set up with saw horses, and a white flag to identify the funnel point. • Pre number treatment tags prior to Patients arriving. • Use division numbers for multiple funnel points. • Re-triage “ Safety Net” • Mark the treatment card, and patients forehead, cheek or arm. • Attach the tag to the colored tape

20. Treatment Team leader • Filled by driver of first in medic Unit • Sets up Treatment area using supplies from Medic Units and MSU vehicles. • Responsible for the over all treatment in all areas. • Appoints treatment area leaders. • Ensure adequate resources and proper documentation is complete on each tag. • Coordinates Pt. Loading with Transport.

21. Transport Team Leader • Filled by experienced EMT, Medic or MSO • Responsible for the loading, transporting and accountability of all patients. • Coordinates the destination with Hospital Control. • Ensures proper transport resources. • Documents all information on a tracking form using an aid. • Consider using an ambulance supervisor

22. Hospital Control • Utilize cell phones or 800 radios • Make contact with HMC Charge nurse. • Transport Team leader advises them of the condition of the patient. Hospital control advises to which hospital to transport to. • Hospital controls calls ahead, not the unit transporting.

23. Communication Problems • If no phone access, use the following guidelines. • First 10 patients go directly to HMC • 1 or 2 red patients may be sent to other regional level 3and 4 trauma centers. • Use caution transporting to local hospitals. They may be inundated with self-directed patients.

24. Ambulance staging • Separate from manpower staging. • Assign a Staging manager. Consider using the Ambulance supervisor for that. • All personnel stay with their vehicles • Position units in staging to allow easy access to the transport post.

25. Morgue Team Leader • Filled by an EMT, P.D. or KC M.E. • Responsible for scene security of the deceased. i.e.. personal effects • Coordinates duties with Police and the Medical Examiner. • Documents Morgue activities • If body is moved, mark the spot with a flag.

26. First Arriving Unit • Size-up the incident. MCI Yes or No? • Announce you have an MCI to incoming resources • Call for additional resources. Consider the need for specialty equipment such as an MSU vehicle. • Establish command. BE Command • Make assignments for incoming companies. • Base units. Secure ingress and egress routes. • Initiate triage

27. Triage Equipment • Triage Belt with triage tape with red, yellow, green, black/white rolls. • First Aid Bag attached to belt to provide 5 pressure dressings. • Two inch Tape • Marker “water resistant”

28. Triage Criteria • 30 seconds per patient • Using the ABC or RPM approach. • Awake / Airway • Breathing • Circulation, “presence of a radial pulse” • Attach the proper triage colored tape to the wrist. Document onto a piece of 2” tape.

29. Harvesting Patients: • Recommended four litter barriers per back board for an adult patient. • Recommended two litter barriers per back board for a pediatric patient • Three straps per board for an MCI • Duct Tape may be used in place of cloth straps. • Large resources needed for litter barriers. Labor intensive.

30. Remember… • The Key to the success of an MCI is early recognition that you have an MCI and to respond the appropriate resources early on. • Be Familiar with your own Departments polices/procedures. Know your equipment. • Train on MCI. BE PREPARED !!