Chief Officer Training Curriculum

1. Chief Officer Training Curriculum Operations Module 4: ICS for EMS

2. Objectives • Identify positions and responsibilities in the ICS organization for EMS incidents • Identify elements of S.T.A.R.T. • Identify potential problems for an EMS incident • Identify resource needs at EMS incidents • Develop a command and organizational structure at an EMS incident

3. Overview • Who is in charge at EMS incidents? • Roles and responsibilities of the IC, division/group leaders, and unit leaders • S.T.A.R.T. system • Basic and expanded ICS organization for EMS incidents • Multicasualty ICS branch at EMS incidents

4. Benefits of an ICS at EMS Incidents • Controls, organizes, and directs responders • Provides common terminology and position titles • Provides chain of command • Groups common functions and responsibilities

5. Benefits of an ICS at EMS Incidents (continued) • Provides for responder accountability and safety • Provides for accurate patient accountability and structure to deliver appropriate care • Provides for efficient use of regional resources (hospitals, transports, trauma centers, etc.)

6. Levels of EMS Incidents • Often defined by local guidelines • Multiple casualty incident: • May have minimal number of casualties but unusual events • May hinder normal operations at local hospitals • May draw down system resources, or number of patients outnumbers resources or rescuers

7. WHO IS IN CHARGE AT EMS INCIDENTS ?

8. Role and Responsibilities of the IC • Ensures life safety of responders and citizens • Determines objectives and strategies, sets immediate priorities • Determines/approves tactical objectives • Establishes an Incident Command Post (ICP)

9. Role and Responsibilities of the IC (continued) • Coordinates activities of assigned staff • Authorizes release of information to the news media • Establishes an ICS organization to meet incident needs, both current and projected

10. Incident Commander Initial Response Basic Organization

11. Incident Commander Rescue/ Extrication Group Rescue/Extrication Group Supervisor

12. Rescue/Extrication Group Supervisor (continued) • Implements assigned incident objectives • Provides tactical direction and supervision to assigned resources • Determines resources needed to extricate patients • Communicates resource requirements to IC as necessary • Ensures safety of members operating in area

13. Rescue/Extrication Group Supervisor (continued) • Coordinates with treatment unit leader for patient care during rescue operation • Ensures efficacy of rescue/extrication operations • Coordinates patient transportation to triage area • Provides frequent progress reports to IC • Maintains incident documentation

14. Incident Commander Rescue/ Extrication Group Medical Group Medical Group Supervisor

15. Medical Group Supervisor (continued) • Implements assigned incident objectives • Participates in multicasualty branch/operations section planning • Establishes medical group/division • Requests additional personnel and resources • Designates unit leaders and treatment areas

16. Medical Group Supervisor (continued) • Isolates morgue and minor treatment from immediate and delayed treatment areas • Requests law enforcement/coroner involvement • Establishes communication and coordination with transportation • Ensures activation of hospital alert system

17. Medical Group Supervisor (continued) • Directs on-scene personnel such as Red Cross, coroner, medical teams • Ensures safety and security of treatment and morgue areas • Directs medically trained personnel to appropriate unit leader • Maintains incident documentation

18. Incident Commander Rescue/ Extrication Group Medical Group Triage Unit Triage Unit Leader

19. Triage Unit Leader (continued) • Determines location of triage area(s) • Ensures all patients assessed and sorted in accordance with appropriate triage protocols • Determines resources required for triage operations

20. Triage Unit Leader (continued) • Communicates resource requirements to medical group supervisor as necessary • Develops triage organization sufficient to handle assignment • Ensures safety and security of all members operating in area • Ensures efficacy of triage operations

21. Triage Unit Leader (continued) • Provides frequent progress reports to medical group supervisor • Establishes initial morgue operations • Coordinates movement of patients from triage area to treatment area • Maintains incident documentation

22. S.T.A.R.T. • Uses vital signs instead of mechanism of injury • Takes less medical expertise • Uses basic vital signs • Uses standard triage tags

23. Triage Tags

24. S.T.A.R.T. (continued) Algorithm • Assess ventilation • Assess perfusion • Assess mental status

25. Incident Commander Rescue/ Extrication Group Medical Group Triage Unit Treatment Unit Treatment Unit Leader

26. Treatment Unit Leader (continued) • Identifies and establishes suitable area(s) for treatment operations • Identifies and requests additional resources as needed • Coordinates with triage unit leader the movement of patients from the triage area to treatment area(s) • Receives patients in the treatment area

27. Treatment Unit Leader (continued) • Establishes communication and coordination with patient transportation group supervisor • Assigns, supervises, and coordinates personnel within the area(s) • Ensures safety of members operating in area

28. Treatment Unit Leader (continued) • Ensures efficacy of treatment operations • Directs movement of patients to ambulance loading area • Provides frequent progress reports to the medical group supervisor • Maintains incident documentation

29. Incident Commander Rescue/ Extrication Group Medical Group Patient Transportation Group Triage Unit Treatment Unit Transportation Group Supervisor

30. Transportation Group Supervisor (continued) • Establishes adequately sized, easily identifiable patient loading area • Establishes communication with area hospitals • Designates ambulance staging area • Identifies and requests additional resources

31. Transportation Group Supervisor (continued) • Directs transportation of patients in coordination with treatment unit leader • Requests air and ground ambulance • Coordinates air ambulance transportation • Establishes air ambulance helispot(s) • Maintains patient tracking records

32. Incident Commander Rescue/ Extrication Group Medical Group Patient Transportation Group Triage Unit Treatment Unit Basic Organization

33. Incident Command Patient Transportation Group Rescue/ Extrication Group Medical Group Treatment Triage

34. Incident Command Staging Area Manager Patient Transportation Group Rescue/ Extrication Group Medical Group Helibase Manager Treatment Triage

35. Staging Area Manager Assembles, coordinates, and controls resources assigned to staging • Ensures unimpeded access to and egress from staging area • Establishes an accurate inventory system for all responding units • Provides routing instructions for resource assignments

36. Staging Area Manager (continued) • Requests maintenance services for staged resources as needed • Safeguards staging • Determines required reserve level(s) for assigned resources • Advises operations section chief when resource at or near minimum reserve level

37. Staging Area Manager (continued) • Coordinates access to EMS vehicles with ground ambulance coordinator • Ensures safety of members operating in the staging area • Evaluates staging area operations for efficacy • Provides frequent progress reports

38. Helibase Manager • Locates safe and adequately sized Landing Zone (L/Z) • Advises command and the transportation officer of L/Z location • Ensures L/Z site safety • Maintains communications with helicopters

39. Helibase Manager (continued) • Secures safe routes for ground ambulances entering and exiting the L/Z • Requests and supervises resources as needed • Maintains incident documentation

40. Operations Section Staging Area Manager Medical Group Patient Transportation Group Treatment Unit Triage Unit Triage Personnel Immediate Treatment Manager Delayed Treatment Manager Minor Treatment Manager

41. Treatment Team Managers • Request and assign resources for patient needs • Ensure continuous triage of patients in area • Prioritize patients for transport • Coordinate and notify treatment dispatch manager of readiness and priority of patients for transport • Ensure patient information documented

42. Treatment Dispatch Manager • Establish and maintain communications with treatment managers and medical communications coordinator • Verify with treatment managers any special transport needs • Assure tracking of patient information

43. Medical Supply Coordinator • Responsible for procuring, maintaining, and distributing medical supplies • In fully expanded ICS, communicates with logistics section—supply unit leader

44. Morgue Manager • Coordinates activity with law enforcement • Identifies and secures suitable area for morgue • Coordinates with medical examiner regarding removal of deceased • Ensures completion of all documents related to deceased

45. Morgue Manager (continued) • Ensures safety of members operating in area • Communicates progress reports to IC as required • Keeps identity of deceased confidential • Maintains appropriated incident documentation

46. Operations Section Staging Rescue/Extrication Group Medical Group/Division Supervisor Helibase Manager Patient Transportation Group Supervisor Medical Supply Coordinator Medical Communications Coordinator Ground Ambulance Coordinator Triage Unit Treatment Unit Air Ambulance Coordinator Treatment Dispatch Manager Morgue Manager Treatment Teams Lines of communications

47. Medical Communications Coordinator (continued) • Establish and maintain communications with medical facilities or local medical resource control point • Maintain current status of medical facility availability • Coordinate with treatment dispatch manager and ambulance coordinators • Coordinate off-incident patient destinations • Maintain appropriate incident documents

48. Air/Ground Ambulance Coordinators • Establish ambulance staging area and log units in and out as assigned • Coordinate with helibase manager or air operations branch director • Establish and maintain communications with medical communications coordinator and treatment dispatch manager • Provide ambulance resources

49. Air/Ground Ambulance Coordinators (continued) • Provide inventory of medical supplies available at ambulance staging area • Assure necessary equipment available in ambulances • Establish contact with ambulance agencies at scene • Request additional resources • Maintain incident documentation

50. Activity 4.1: Liberty County Vehicle Accident