ualty Training

1. ZONE 4 MASS CASUALTY TRAINING ualty Training 1

2. OBJECTIVE To assure all crews within Central Zone understand the roles and responsibilities of operating in the framework of a MCI incident. 2

3. RESOURCE GUIDLINES • FIRESCOPE • COUNTY SAN DIEGO • CENTRAL ZONE POLICY • ZONE TRAINING OFFICERS 3

4. Course Overview • Review MCI vs MPI • Review ICS Positions and Responsibilities • Review DMS “New” Triage Tag • Review START Guidelines • Table Top Exercise • Debrief 4

5. MPI vs MCI MPI - Multi-Patient Incident • MPI is any number greater than one patient. • Agency has sufficient resources to handle • Patients often numbered in sequence • Most common system used each day

6. MPI vs MCI MCI – MASS CASUALTY INCIDENT • MCI is an incident with multiple patients which will overwhelm the resources of the responding agencies or the area hospitals. • This can and will differ from agency to agency depending upon the size and scope of their respective resources. 6

7. MPI vs MCI • Often confusion between the two modes. • The difference between MPI and MCI is “AGENCY” driven. • Resource driven • Different Radio Formats 7

8. MPI vs MCI Example • A six patient accident place in San Diego City may be determined by the IC to be a MPI. • While the same six patient incident in a rural setting would most likely be deemed a MCI due to lack of relative resources.

9. MPI Radio Format • Med Com must supply clear and concise report. • Requires a more comprehensive radio report than an MCI per policy S-140 • PAMSCATEformat (Pt. Number, Age, Mechanism, Sex, Chief Complaint, Abnormal Findings, Transporting Unit and ETA)

10. MCI Radio Format • Patient Triage Tag Number (Last 4 digits) • Patient Status (WW, Immediate, Delayed) • Transporting Unit • ETA

11. Med Com Radio • Specialty patients, such as Burn or Pediatric should be communicated to the base in an effort to get those patients to the best location for those types of patients. • Med Com must be disciplined and avoid extraneous radio information.

12. Roles: IC • Size up (Scope of the incident) • Safety • Determine and order Resources • Establish Traffic Flow (early) for incident • Declare MCI (Annex D) • Make Assignments • Establish Staging • Clear Direction • ICS Vests (if possible) 12

13. Roles: Triage • Goal of triage is to sort patients rapidly • Use START Guidelines • ID Walking Wounded • Begin with closest patient • Consider Recon to get better understanding of scope. • Tag patients • Relay number of patients in each category to Transportation and Med Com 13

14. Roles: Litter Bearers • Provide extrication and patient movement to either Transport Area or Treatment Area • Consider using Triage Team after they have completed Triage assignment. 14

15. Roles: Med Comm • Responsible for communication between incident and the CLOSEST BASE HOSPITAL • (not necessarily the trauma center unless they are closest) • Initial contact with hospital uses unit number • Additional contacts use ICS terminology IE: “Greenfield Med Com” • Must be able to relay scope and size of incident to hospital. 15

16. Roles: Med Comm • The Med Com and the Transportation Unit leader or Group Supervisor should be co-located near the patient loading zone for effective communications. • Scribe is highly recommended 16

17. Roles: Scribe • Med Com can quickly get overwhelmed • Highly recommend a scribe • Scribe works as a buffer • Information should be funneled through scribe

18. Roles: Scribe • Med Com and Scribe should work side by side • Scribe fields information • Scribe maintains accurate records ( bed counts, Patient acuity, Unit ID with destinations

19. Roles: Staging • Establish early • Ambulance Staging Manager reports to the Transportation Group Supervisor • Responsible for organizing the staging area, resource accountability, briefing units on the situational awareness and maintains unit documentation. 19

20. Roles: Staging • Staging should organize the available supplies from waiting ambulances in the staging area • Load up one ambulance with supplies collected in staging and send to scene • When organizing the staging area, the staging manager should separate the transportation resources by patient care capabilities when possible 20

21. Roles: Staging • The Staging Manager should monitor the number of units in staging and advise Operations or the IC when resources fall below minimum levels • The Staging Manager should also coordinate resource levels with the Transportation Unit Leader 21

22. Roles: Transportation • Assign early • This role requires leadership and organization skills to perform the critical tasks required for this position • ID best location (ingress/egress) • Communicates with Med Com 22

23. Roles: Transportation • Transportation Group supervisor use natural barriers, cones or banner tape to identify and create a funnel where patients move though. • Transportation Group supervisor should request a scribe early to assist with the documentation. • In a coordinated process the Transportation Group supervisor will request an ambulance from the ambulance staging manager 23

24. Roles: Transportation • Transportation Group supervisor will request a destination from Med Com and assign the patients to the transporting ambulance • The County’s Annex D policy requires that every receiving hospital will accept a minimum of 1 Immediate and 1 Delayed patient and every Trauma Center to accept a minimum of 2 Immediate patients 24

25. Roles: Treatment • An important but not always necessary position • Set up areas, (WW, Immediate, Delayed) • Assure Treatment Areas have sufficient supplies • Communicates with Triage, Med Com and Transport 25

26. --Patient Flow --Comm Flow

28. If you don’t plan ahead early enough, All routes may get blocked

29. Establish Staging and traffic flow EARLY For success

30. START TRIAGE

31. Overview • A simple approach • Where to START • One patient at a time • START Triage Algorithm • Patient scenarios

32. A Simple Approach SimpleTriageAndRapidTreatment In the early 1980’s the START method was developed in California by Hoag hospital and Newport Beach Fire and Marine. It provided rescuers with an easy, simple step-by-step approach to assessing and treating a large number of patients with varying degrees of injuries.

33. A Simple Approach SimpleTriageAndRapidTreatment The Initial assessment and treatment of each patient is accomplished within 30 seconds.Initial treatment is limited to correcting immediate life-threatening conditions (i.e. opening an airway and controlling severe bleeding)

34. A Simple Approach The Triage Tag SimpleTriageAndRapidTreatment A Tag is placed on each patient once they have been assessed. The tag displays the patient’s current status and advises those providing treatment with one of the four possible treatment priorities: Minor Delayed Immediate Deceased

35. A Simple Approach The Triage Tag Each tab is distinctly color-coded allowing fast patient priority identification from a distance SimpleTriageAndRapidTreatment DECEASED IMMEDIATE DELAYED MINOR

36. A Simple Approach SimpleTriageAndRapidTreatment Triage Tags are designed with tear-offtabs. There is two tabs per category. One tag gets torn off by Triage Team and one tab is left with the patient.

37. Where to START Start where you stand - begin the triage process with the patient closest to you. Solicit the help of bystanders and/or uninjured victims. They can be utilized to control bleeding, help maintain an open airway or hold c-spine traction. Do not spend too much time on any one patient. Move quickly from one patient to the next. Assess each patient’s RPMs Respirations Perfusion Mental Status

38. Where to START Upon your arrival, first make sure the scene is safe. Then begin by directing the walking wounded away from the immediate scene to a pre-determined evaluation and treatment area. Tag them as MINOR (GREEN)

39. One Patient at a Time RPM ASSESS RESPIRATIONS If the patient is not breathing then Open the Airway If the patient is still not breathingthen tag them as DECEASED (BLACK) Move on to the next patient...

40. One Patient at a Time RPM ASSESS RESPIRATIONS If breathing is present then Assess the Rate If the rate is greater than >30then tag them as IMMEDIATE (RED) Move on to the next patient…If the rate is less than <30then assess PERFUSION

41. One Patient at a Time R P M ASSESS PERFUSION If a radial pulse is absent (or)the capillary refill is greater than > 2 seconds then tag them as IMMEDIATE (RED) Move on to the next patient…If a radial pulse is present (or)the capillary refill is less than < 2 seconds then assess MENTAL STATUS

42. One Patient at a Time RP M ASSESS MENTAL STATUS If the patient cannot follow simple commands (or)has an altered mental status (or)is unconscious then tag them as IMMEDIATE (RED) Move on to the next patient… If patient is able to follow simple commands then tag them as DELAYED (YELLOW) Move on to the next patient…

43. START Triage Algorithm

44. Patient Scenario #1 SimpleTriageAndRapidTreatment This patient states he cannot move or feel his legsHis respirations are 24He has a radial pulse of 100He is awake are orientedHow would you triage this patient?

45. Patient Scenario #1 SimpleTriageAndRapidTreatment This patient states he cannot move or feel his legsHis respirations are 24He has a radial pulse of 100He is awake are orientedDELAYED (YELLOW)

46. Patient Scenario #2 SimpleTriageAndRapidTreatment This patient has a blood soaked shirt onHis respirations are 36His capillary refill is less than 2 secondsHe is awake are orientedHow would you triage this patient?

47. Patient Scenario #2 SimpleTriageAndRapidTreatment This patient has a blood soaked shirt onHis respirations are 36His capillary refill is less than 2 secondsHe is awake are orientedIMMEDIATE (RED)

48. Patient Scenario #3 SimpleTriageAndRapidTreatment This patient has some minor abrasions on his foreheadHis respirations are 16His capillary refill is less than 2 secondsHe is very slow in recalling his name and whereaboutsHow would you triage this patient?

49. Patient Scenario #3 SimpleTriageAndRapidTreatment This patient has some minor abrasions on his foreheadHis respirations are 16His capillary refill is less than 2 secondsHe is very slow in recalling his name and whereaboutsIMMEDIATE(RED)

50. Patient Scenario #4 SimpleTriageAndRapidTreatment This patient appears to have no injuriesHer respirations are 20Her capillary refill is less than 2 secondsShe is unconsciousHow would you triage this patient?