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Section 800: Special Operations

Section 800: Special Operations. MCI Levels Level I Incident = 3-5 patients Level II Incident = 6-10 Level III Incident >10 patients. Major Incident –.

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Section 800: Special Operations

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  1. Section 800: Special Operations • MCI Levels • Level I Incident = 3-5 patients • Level II Incident = 6-10 • Level III Incident >10 patients

  2. Major Incident – Any Federal, State or local situation that ties up BVA’s on-duty resources or requires the to use of additional resources beyond the ability of the Duty Crew to provide.

  3. Ambulance Response One ambulance for every two patients should be the minimum 5 or more patients contact ECD (911) to declare an MCI Both Driver and Medic to carry portable radios Driver assumes overall EMS command until higher trained personnel arrive on scene The Medic assumes Triage/Treatment until relieved by more senior personnel or equivalent level provider arrives.

  4. Primary Call Back Procedure Duty crew will attempt to contact, or have ECD contact, the Duty Ops, OM, DOM, or VP- Operations upon a declaration of a Major Incident or MCI.. The Duty Ops, or designated Operations Officer, will make the additional senior staff notifications, as time permits.

  5. The Duty Ops, or designated Operations Officer will proceed to the scene to assist the crews and assume medical sector command, if needed. • The IC will instruct ECD to page all BVA pagers about the incident and have all available personnel report to the base.

  6. At NO TIME will BVA personnel report directly to the scene of an incident unless specifically requested by the Medical IC. First priority is to staff additional rigs and hit the digital pagers to bring in more resources, if that was not already done. • Level III or, if deemed necessary by designated authority, other Major Incidents will additionally have a senior Ops Officer report to the scene for command (see Appendix 6)

  7. Level III incidents will have the PIO notified, as well as the President and VP of the BOD • Level III incidents will involve a mandatory call back of all BVA personal. Crews reporting to quarters will designate one person to man the base and initiate the call back from the phone tree list. This call back is considered a priority even if it means that a crew cannot respond out the door. It is imperative to get resources flowing in.

  8. On Level III, or other designated Major Incidents, the base will be put on the air and the Supply Officer will be called to report into the base. A Base Operations Officer will be designated at that time. On any Level III incident, or any incident that will tie up all available BVA resources for a prolonged period of time, a fill request will be made to ECD. ECD will use the run card to find an appropriate agency.

  9. On Major Event Standbys a designated Mobile Command Post will be set up and staffed. This can alleviate the need to place the base on the air. • Operations will request CISM activation for large-scale, or stressful incidents.

  10. MCI Plan – Based on NYSDOH MCI Plan Model • Purpose: • This plan is designed to bring order to situations that are typically chaotic. A systematic structured approach to multiple casualty incidents (MCI’s) promotes optimal patient care, efficient use of personnel and resources and limits confusion. Although a guide, the essential aspects of command structure, scene organization and triage must be followed. • The goal is to get patients to hospitals in the most expedient and efficient manner. Flexibility in adjusting to real situations is essential.

  11. Definition: • A MCI is any situation requiring more than two (2) ambulances, or a potential of more than four (4) patients. This is a fairly small number and was chosen for a reason. The more this plan / structure is implemented on a small scale, the better the chance of it being carried out smoothly on a large scale. The difference between multiple and mass situations is a matter of degree, but the essential aspects of scene management apply for any size MCI. The ability to correctly handle eight patient MVA’s will carry over to the 100 patient incidents.

  12. Mutual Aid Activation • Mutual Aid activation will be determined by the size of the incident, availability of local resources and the type of incident. • Mutual Aid will follow the Monroe County Mutual Aid / MCI Plans.

  13. Basic Organization EMS Command

  14. Responsibilities of EMS Command: • Establish command post • Confirm incident using first in report • Determine the need for ambulances, personnel, supplies and other resources • Oversee operation of all medical sectors • Designate officers as needed (triage, transport, Etc)

  15. Triage Officer • Establish the extent of First stage triage • Assign personnel to move patients to treatment area • Assures the only procedures done are Airway maintenance, bleeding control, and whole body immobilization • Monitor site radio frequency

  16. Treatment Officer • Select a safe, suitable site for treatment area • Establish priority sectors within the treatment area • Assign personnel to sectors • Coordinate with transport officer the proper transport of critical patients first • Monitor site radio frequency

  17. Transport Officer • The Transport Officer coordinates the loading of patients into transporting EMS units. • Establish contact with local hospitals • Communicate patient information to receiving hospital • Tell crews what hospital they are going to • Document all patients in transport log

  18. Other Officers Staging Officer Base Operations Officer (BOO) Public Information Officer (PIO) Communications Officer/Safety Officer

  19. Staging Officer • Establish safe staging area for EMS personnel • Inform EMS of location of staging area and best access route • Ensure vehicles are have proper egress from scene • Instruct drivers to remain with vehicles • Dispatch vehicles to the Transport Area as requested

  20. Base Operations Officer • Function as Supply Officer if none available • Ensure base is manned and “on the air” • Relieves IC of multiple channel monitoring • Call back of Personnel • If all rigs out, ensures fill-in company set in place • Coordinate with ECD and other agencies • Support the Units in the field

  21. Public Information Officer • Handles Public and Media relations • Assists the BOO or IC with local government notifications and any additional items in the purview • Reports to the base unless requested by the IC to report to the scene

  22. EMS Response Sequence “First In” Ambulance at Scene • Assumes IC with the crew filling the appropriate roles, based on qualifications • Initiates immediate contact with fire and police • Assess the scene, scene size up, advise ECD

  23. Primary triage using SMART system • Non-EMT drivers may be needed to patients to the treatment area or for immediate transport • May be used for transport, assure easy egress from the scene

  24. Second Ambulance in: • Park ambulance where directed by EMS Command • Report to EMS Command for assignment • Expect roles of Triage and/or Transport Officer and Transportation/Staging • Non-EMT drivers should stay with rig and prepare for immediate transport of seriously injured patients unless otherwise assigned by EMS Command

  25. Third in Ambulance • Park ambulance where directed by EMS Command • Expect roles of Triage and/or Transport Officer and Transportation/Staging • Non-EMT drivers should stay with rig and prepare for immediate transport of seriously injured patients unless otherwise assigned by EMS Command

  26. Additional Ambulances • Park ambulance at staging area • Drivers must stay with ambulance • Other crewmembers report to EMS Command for assignment • Unload needed equipment and place in designated area • Keep stretcher with ambulance

  27. Respond to hospital in emergency mode unless otherwise specified • Do not contact receiving hospital unless the patients condition worsens and need for new orders • Expedite turn around at hospital • Dispatch will advise if rig to return to scene or base

  28. Principles of SMARTSTART Triage • Triage is the process of sorting patients by medical need. This is a simple, step-by-step method for rapid identification of those victims who are at the greatest risk for early death. Victims that can walk should be directed to a safe place, ideally the Green Treatment Area. Evaluate the non-ambulatory victims where they lie.

  29. Managing Incidents with Multiple Casualties

  30. AIM TO SAVE THE LARGEST NUMBER OF SURVIVORS FROM A MULTIPLE CASUALTY INCIDENT

  31. MANAGING INCIDENTS WITH MULTIPLE CASUALTIES • Understanding the multiple casualty scene • Triage • Practicals (outdoor and indoor) • Management

  32. The MCI Scene

  33. THE INITIAL PROBLEM. Casualties Resources

  34. THE OBJECTIVE. Casualties Resources

  35. THE OBJECTIVE. Casualties Resources

  36. THE OBJECTIVE. Casualties Resources

  37. THE OBJECTIVE. Casualties Resources

  38. THE OBJECTIVE. Casualties Resources

  39. THE OBJECTIVE. Casualties Resources

  40. THE OBJECTIVE. Casualties Resources

  41. TIME IS IMPORTANT THE GOLDEN HOUR “The critical trauma patient has only 60 minutes from thetime of injuryto reach definitive surgical care, or the odds of a successful recovery diminish dramatically”. Pre-Hospital Trauma Life Support, Second Edition, Patient Assessment and Management, page 42. 1990.

  42. Casualties Resources + = Maximum survivors.

  43. TIME The Scene Definitive Care YOUR SCENE MANAGEMENT Command Safety Assessment Communication Triage Treatment Transport

  44. TRIAGE “Large scale triage is the hardest job anyone in pre-hospital care will ever do”. A.J Heightman, Mass Casualty Incident Management. A practical approach to solving complex operational dilemmas.

  45. TRIAGE To get the right patient in the right place at the right time. WHY ?

  46. TRIAGE Casualties exceed the number of skilled rescuers. WHEN ?

  47. TRIAGE By a system which is : HOW ? • Dynamic • Quick • Safe • Reproducible.

  48. TRIAGE CODING Priority Treatment Color Immediate 1 Red Urgent 2 Yellow Delayed 3 Green Dead Black

  49. PATIENT ACCOUNTABILITY

  50. Nuclear, biological, chemical incident organization Triage, Treatment Holding Rescue Decontamination Triage, Treatment Transport to definitive care The Scene WARM HOT COLD Dirty zone Clean zone

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