Multi-Casualty

1. Multi-Casualty Incident Plan 2007 Training Hospital Emergency Room Training Contra Costa County EMS

2. Tim W. HennessyMCI Plan Tim W. Hennessy Communications Supervisor Contra Costa County Sheriffs Communication 1975-2007 This MCI Plan is dedicated to Tim. His expertise and commitment in developing this plan was invaluable.

3. History • 1979: First MCI Committee organized to develop plan following Yuba City bus crash in Martinez • 1983: Board of Supervisors approved the first MCI Plan • Several revisions to the basic plan since 1983

4. Current MCI Working Group • Appointed in 2005 to conduct a ground-up rewrite of the MCI Plan • Multidisciplinary • Fire • Emergency Ambulance Zone Provider (public and private) • Law Enforcement • Hospitals • Public Safety Communications • EMS Agency staff

5. Why Rewrite the Plan? • Improve the usefulness of the document for first responders • Compare the Plan to the County’s current risk profile • Compare the Plan to the County’s current public safety and EMS resources

6. Why Rewrite the Plan? • Attempt to resolve weaknesses in the Plan experienced during previous incidents: • Incident command and control • Communication flow • Resource ordering and tracking • Ensure compliance with NIMS

7. MCI Plan Objectives Objective #1: Establish a common organization, management, and communications structure for the coordination of emergency response to a multi-casualty incident.

8. MCI Plan Objectives Objective #2: Establish methods of triage and transportation that will provide the best medical outcome possible for the greatest number of casualties.

9. MCI Plan Objectives Objective #3: Establish pre-defined responsibilities of all entities with key roles in achieving successful implementation of the plan.

10. MCI Plan Objectives Objective #4: The Plan will be drilled regularly, and reviewed annually and following significant activations of the Plan as directed by the EMS Director.

11. Key Concepts • Use of Incident Command System • Expansion and contraction of structure is dynamic and incident-driven • Use of single point ordering for resource requests • Emphasis on exchanging information

12. Key Concepts • Importance of Unified Command • The “Rule of 2 and 4”

13. MCI Tiers • Plan consolidates Expanded Medical Emergencies, Medical Advisory Alerts and MCIs into a single MCI Plan with 4 activation tiers • Use of tiered MCI Plan reinforces the scalability of the Plan

14. MCI Tiers • Use of Tiers modeled after Community Warning System (CWS) Levels • Consistent with best practices

15. Tier Zero • Notification of incident with potential to escalate to a higher tier (Medical Advisory Alert) • CWS Level II and III Incidents • Report of Active Shooter incident • Attempted emergency landing of passenger aircraft

16. Tier One • 6-10 patients with scene contained, number of patients not expected to rise • Multi-vehicle collision • Multiple gunshot victims at contained scene and no ongoing active shooter

17. Tier Two • 10 –50 patients or less than 10 patients with substantial chance of increase in number of patients • Transportation resource ordering switches to EMSOACC • Petrochemical incident • Passenger train derailment • Active shooter with uncontained scene

18. Tier Three • More than 50 patients or reasonable expectations of large number of casualties • Actual or suspected WMD incident • Significant explosion in populated area • Emergency evacuation of hospital or SNF

19. Plan Components • Responsibilities matrix/checklists • Communications flowchart • Communications overview • ICS position checklists • ICS communications forms 205 and 217A

20. Responsibilities Matrix • Multiple agencies • Fire-EMS: ALS and BLS • Law Enforcement • Hospitals • Helicopter • Communications/EMSOACC • Defined tier specific responsibilities • Clear communication pathways • Resource Coordination

21. MCI Checklists • Common Responsibilities • Back of each checklist • Get Assignment • Check In • Get briefed • Get work materials • Undertake mission safely • Organize and brief subordinates • Assure communications • Use clear text • Complete forms • Demobilize as required/practical

22. Hospital Responsibilities • Tier Zero • Make internal notifications and institute appropriate ED procedures as per facility protocol • Respond to ED capacity poll from EMSOACC (Sheriffs dispatch) if initiated • Monitor and use Reddinet

23. Hospital Responsibilities • Tier One MCI • Immediately prepare to accept 2 critical and 4 delayed patients • Assess ability to handle additional patients and respond to ED capacity poll from EMSOACC • Diversion status does not apply during Tier 1,2,3 MCI

24. Hospital Responsibilities • Tier Two • Rule of 2 and 4 • Capacity Poll • Respond on Reddinet • No Diversion • Tier Three • All of above • Conduct damage assessment and report results to EMSOACC/EMS if necessary • Activate facility disaster plan if necessary

25. MCI Plan • Know Reddinet • Know your responsibilities • Utilize HICS as needed • In HICS the certifications and qualifications determine who does what…not position • You might be asked to do things you normally might not do in MCI Tier III

26. Transportation Highlights • 2/4 Concept • Continue to disperse casualties as much as possible • Use farther hospitals first • Especially if potential exists for “walk ins” • Hospital polling whenever possible but certainly after 2/4 has been maximized • Coordinate with EMSOACC as much as possible

27. Transportation Highlights (cont) • Emergency Ambulance Zone Providers still responsible for normal coverage too • If limited ambulances, minors can be transported by other means • Tier 2 & 3 suspend ambulance to hospital communications • PCRs • Whenever possible PCRs shall be completed • Tier 3 Branch( or designee) can suspend standard PCR protocol and replace with triage tag info • Triage tags are minimum level of documentation

28. Predetermined Staging Areas • East/Central/West • Rallying point in case of loss of communications

29. Example of Tier 1 Scenario • MVC with 7 patients in 3 vehicles • Single Medical Group • Transportation reports to Med Grp Sup • Triage patients and treat where they were found • Do not send all patients to same hospital • Can use close hospital due to lack of probability of self transporting patients to closest facility

30. Example of Tier 2 Scenario • Shooting incidents with 21 patients • Single Medical Group • Transportation reports to Med Grp Sup • Triage patients where they are found • Litter bearers move patients to specific treatment areas • Patients re-triaged in treatment areas and assigned priority for transport • Avoid close proximity hospitals if possible due to potential private transport arrivals

31. Example of Tier 3 Scenario • Large structural collapse with multiple victims trapped over a widespread area • Multiple Medical Groups (probably by Division) report to Medical Branch • Transportation reports to Medical Branch • Still just one transportation staging area • Triage patients where they are found • Litter bearers move patients where they are found • Patient’s re-triaged in Treatment areas and assigned priority • Maximize 2/4 concept as needed

32. Triage Considerations • START Triage system • New tags • Victims will not be re-triaged at scene • Victims re-triage in Treatment Areas

33. Contamination Designation Will be Standardized Through-out County Triage Tags