I’ve Arrived at an MCI!

1. I’ve Arrived at an MCI! Now what?!?!? Created by: Jess Fulkerson EMT-P Mason County EMS Council Training Coordinator

2. OBJECTIVES • Identify what positions need to be filled and their roles, in order to successfully manage an MCI. • Identify the actions of the people on the first two arriving units and how they can fill the initial supervisory positions. • Review the ICS of a Mass Casualty Incident.

3. Arrival and Size-Up • BRIEF description of what type of incident exists • State the number of suspected patients • Declare this an MCI! • Take command and name your command • Name your staging areas for units to report to. • Request additional specialty units (haz-mat, Fire suppression, Police, etc) if needed

4. Dispatch • Will probably tone units to an incident based on standard “first alarm” response • MVA = Medic/Aid unit(s), Engine/Rescue, Command, Sheriff/State Patrol • Dispatch is awaiting your size up to further dispatch adequate resources! • They may direct you to an alternate frequency for this incident. Communicate with them about additional frequency needs (Transport, RedNet for out-of-county responders, LGS OR MATAC for other “ops” talk.

5. Size upMight go like this: • “MACECOM this is Medic 21, we’ve arrived at a 6 car MVA with a tour bus on its side at the HWY 106 and Hwy 3 intersection. We’ll be establishing “Belfair command”. This is an MCI with possibly 25 patients. Staging areas will be Belfair Mini storage, the PUD 3 building and JR’s Hideaway. We’ll be starting triage. Command will be on channel 3, all other ops will be on LGS.”

6. Or…something like this: • Macecom, Aid 44. We’ve arrived on Southbound 101, in the area of the Little Creek Casino exit. We have 7 vehicles involved, blocking southbound 101 and the exit ramp. This will be “101 Command”. This is an MCI…possibly 6 patients at this time. Staging will be a quarter mile away from the incident in the unit’s direction of travel. We’ll be starting triage and going to RedNet for MCI operations.

7. Now…go to work! • The Driver becomes the Triage officer • Uses S.T.A.R.T. triage and places colored tape on patients. • Returns to his/her partner: the Incident Commander, with pieces of tape for updating MACECOM with patient count/severity. • Incident Commander continues to survey the scene and calls additional units as needed. • WSP/MCSO for traffic control, Airlift, etc • Work with incoming units to keep ingress/egress lanes free of obstruction for transport units

8. Basic Ideas • Only the First-In and Second-In Units (might be Ambulances, Engines, Rescues…doesn’t matter) AND the First-In Command Officer go directly to the scene. • EVERYONE else goes to STAGING. • Thus the need for named STAGING areas • If not named, stay ¼ mile away in your direction of travel, and report your location.

9. Only Exceptions • There is Fire involvement at the incident site and an Engine/multiple Engines are needed to extinguish • There is obvious need for mechanical extrication. The unit with the tools can be advised to go directly to the scene.

10. So far ICS looks like this:

11. Now let’s say a Command Unit arrives (one person) • This person will either: • 1) Relieve the first-in Commander and then the first-in commander will become the Medical Branch Director … or … • 2) Become the Medical Branch Director “Med-Comm”

12. Option #1

13. Option #2

14. Another unit arrives (2 more people) • The Officer/Passenger becomes the Treatment Area Supervisor • The Driver becomes the Transportation Supervisor

15. Now ICS looks like this

16. Now the Function Areas are filled! • If they are filled by transport unit personnel, then at the earliest time possible, those people will be relieved by command officers, engines, rescues, POV responders, CALLED UP FROM STAGING. • This will allow those transport units and crews to begin TRANSPORTING patients.

17. Supervisor’s Responsibilities • TRIAGE Group Supervisor • Stay Calm…take a deep breath • Retrieve the MCI kit and don Triage vest and Triage kit • Use S.T.A.R.T. triage, placing colored TAPE bands on patient’s limbs, and advise Command of patient number and severity • Create a Funnel Point to the Treatment Area • Supervise all “litter bearers” moving their patients to the Treatment/Transport Area(s).

18. Supervisor’s Responsibilities • MEDICAL BRANCH DIRECTOR“Medical Command” • Don Medical Command Vest and checklist/clipboard • Report Directly to I.C. or Operations as the case may be. • Contact MGH • Advise of the incident, with number of patients and severity • Give them your cell phone number and get an alternate cell phone number for Base Station or their Command Center • Ensure backup radio channel is operational (H.E.A.R.) • Appoint and Supervise Triage, Treatment, Transport • Request resources to support Triage, Treatment, and Transport from the Incident Commander

19. Supervisor’s Responsibilities • TREATMENT Area Supervisor • Don “Treatment” Vest and checklist/clipboard • Establish a Treatment Area • Create a funnel point if still needed • Locate Treatment area adjacent to the Funnel Point and a usable Transport Area (ambulance loading). • Strip all incoming units of excess supplies for use in the Treatment Area (apparatus operator can help with this) • Perform Secondary Triage at the Funnel Point • Using S.T.A.R.T. Triage, place a “Triage TAG” on the patient • Begin a Treatment Area log, indicating each patient by number, and their triage status • Assign Leaders of Red, Yellow, Green Areas as needed • Request additional resources for Treatment Area through Medical Command

20. Supervisor’s Responsibilities • TRANSPORT Supervisor • Don Transport Vest and checklist. • Create an Ambulance Loading Area if still needed. • Coordinate with TREATMENT regarding patient transport priorities. • Maintain Radio/Cell phone contact with receiving hospital(s) or Base Station. • Maintain a record of: • Each patient’s number, triage class, triage tag number, destination, transport unit number, and transport unit’s cell phone number if available. • Contact the destination(s) and advise of incoming patient(s), or contact Base Station “Command Center” and have them contact destination hospitals with patient info. • Advise STAGING to send ambulance(s) as needed to pick up patients. • If needed: designate an Air Operations Manager to set up LZ(s) for Helicopter Transport. • Route appropriate ambulances to the LZ’s and advise Air Ops of incoming ambulances.

21. Another position to fill… • STAGING Officer • Filled by the crew leader of the first unit arriving at Staging. • If this person is a member of a transport unit: • The second arriving command officer to the incident will become relieve and become STAGING • OR>>>>>>> • The crew leader of the first arriving Engine or Rescue unit which isn’t needed for fire suppression or extrication at the scene…becomes STAGING.

22. When in STAGING… • Report to the STAGING Officer • Sit there patiently. Stay IN YOUR RIG, and stay OFF THE RADIO. • Wait to be directed to the scene by either STAGING after a request has been made from “Command” or “Transportation”.

23. Another position to fill… • SAFETY Officer • Assigned as soon as manpower allows. • Usually a command officer but can be anyone • Tasked with: • Evaluating for, interceding with, or advising command of any potential threats to the well-being of on-scene operations and operators.

24. Mass Casualty ICS Chart

25. In Summary • If you’re the first-in or second-in response unit, or the first-in command officer…go directly to the scene • If you’re not one of the above…go to staging and wait patiently and quietly. • When in a supervisory position…don’t get sucked in to patient care. Remain detached to keep the big picture in mind. • Stay calm. Be professional. This is a stressful, bad day … but these people need our help.