Chapter 47 Incident Management and Multiple-Casualty Incidents

Chapter 47Chapter 47

Incident Management and Multiple-Casualty Incidents

National EMS Education Standard CompetenciesNational EMS Education Standard Competencies

EMS Operations

Knowledge of operational roles and responsibilities to ensure patient, public, and personnel safety.

National EMS Education Standard CompetenciesNational EMS Education Standard Competencies

Incident Management

Establish and work within the incident management system.

National EMS Education Standard CompetenciesNational EMS Education Standard Competencies

Multiple-Casualty Incidents

• Triage principles

• Resource management

• Triage − Performing

− Retriage

− Destination decisions

− Post-traumatic and cumulative stress

IntroductionIntroduction

• Multiple-casualty incidents (MCIs) and disasters can be overwhelming.

• Response should use the principles of the incident command system (ICS).

IntroductionIntroduction

• The National Incident Management System (NIMS) encourages organized response from all agencies.− Homeland Security Presidential Directive

requires students to complete certification and understand NIMS.

The NIMSThe NIMS

• Provides consistent nationwide template for emergency response− Key principles:

• Flexibility

• Standardization

• Interoperability

Major Components of NIMSMajor Components of NIMS

• Command and management

• Preparedness

• Resource management

• Communications and information management

• Supporting technologies

• Management and maintenance

The Incident Command SystemThe Incident Command System

• Common language and “clear text” ensures better communication.

• Creates a modular organizational structure

• Controls duplication of effort and freelancing

• Limits span of control

The Incident Command SystemThe Incident Command System

• Organizational divisions:− Sections

− Branches

− Divisions and groups

− Resources

The Incident Command SystemThe Incident Command System

• Responders should find out:− Does ICS exists?

− Who is in charge?

− How is it activated?

− What will be your role?

Incident Command System Roles and ResponsibilitiesIncident Command System Roles and Responsibilities

• Command− Incident

commander (IC)• Evaluates incident

• Creates plan of action

• Number of duties depends on size of incident

© FirePhoto/Alamy Images

Incident Command System Roles and ResponsibilitiesIncident Command System Roles and Responsibilities

• Command (cont’d)− Unified command system

• Used when incident requires multiple organizations/jurisdictions

− Single command system• Used when one agency has the majority of

responsibility for incident management

Incident Command System Roles and ResponsibilitiesIncident Command System Roles and Responsibilities

• Command (cont’d)− IC should be easy to identify.

− Transfer of command should be directed by standard operating procedures (SOPs).

− Termination of command and demobilization procedures should occur at the end of an incident.

Incident Command System Roles and ResponsibilitiesIncident Command System Roles and Responsibilities

• Finance− Responsible for documenting all expenses that

should be reimbursed.

− Roles include:• Time unit

• Procurement unit

• Compensation/claims unit

Incident Command System Roles and ResponsibilitiesIncident Command System Roles and Responsibilities

• Logistics− Responsibilities

include:• Facilities

• Food and water

• Equipment and supplies

Incident Command System Roles and ResponsibilitiesIncident Command System Roles and Responsibilities

• Operations− Manage tactical

operations job.

− Oversee responders.

• Planning− Problem-solve as

issues arise.

− Predict next steps.

− Develop:• Demobilization

plan

• Incident action plan

Incident Command System Roles and ResponsibilitiesIncident Command System Roles and Responsibilities

• Command staff− Safety officer

• Monitors for hazards

− Public information officer (PIO)• Presents information to the public and media

− Liaison officer (LNO)• Relays information between command, general

staff, and other agencies

Communications and Information Management

Communications and Information Management

• All agencies should be able to communicate easily and quickly by radio. − Maintain professionalism.

− Communicate clearly and concisely.

Mobilization and DeploymentMobilization and Deployment

• Check-in with finance section.

• Check-in with supervisor.

• Keep records.

• Keep your supervisor up to date.

• IC will decide on demobilization.

PreparednessPreparedness

• Written disaster plans should be located in every EMS vehicle.

• EMS facilities are stocked with supplies.

• Mutual aid agreements are made with nearby organizations.

• Make sure you have immunizations.

Scene Size-UpScene Size-Up

• When you arrive on the scene, ask yourself:− What do I have?

− What do I need to do?

− What do I need?

Establish CommandEstablish Command

• Notify other responders and request necessary resources.

• Establish command early on.

CommunicationsCommunications

• Use face-to-face communication when possible.− If you are communicating by radio do not use

codes or signals.

• Communication should be reliable, durable, field tested, and have backups.

Medical Incident CommandMedical Incident Command

• Medical branch director oversees roles of medical team.

Triage SupervisorTriage Supervisor

• Counts and prioritizes patients

• Ensures each patient receives an initial assessment

© David Crigger, Bristol Herald Courier/AP Photos

Treatment SupervisorTreatment Supervisor

• Designates an area where patients are treated by their priority

• Sees that each patient has secondary triage

• Assists with moving patients

• Communicates the request for supplies

Transportation SupervisorTransportation Supervisor

• Coordinates the transportation and distribution of patients

• Tracks and records: − Number of vehicles transporting

− Patients transported

− Destination of both

Staging SupervisorStaging Supervisor

• Designates location for the staging area

• Plans for access and exit from the site

• Prevents traffic congestion

• Releases vehicles/supplies when needed

Physicians on ScenePhysicians on Scene

• Assist with triage decisions

• Provide on-site medical direction and treatment

Rehabilitation SupervisorRehabilitation Supervisor

• Creates a rehabilitation area during an incident that will last for a while

• Monitors personnel for stress signs

Extrication and Special RescueExtrication and Special Rescue

• Supervisor coordinates the equipment and resources needed

• Typically work under the EMS branch © Courtesy Everett Col/age fotostock

Morgue SupervisorMorgue Supervisor

• Works with medical examiners, coroners, disaster mortuary assistance, and law enforcement

• Coordinates body removal

Multiple-Casualty IncidentsMultiple-Casualty Incidents

• MCI is defined as: − Having three or

more patients

− Stress on resources; requires mutual aid response

− An incident that can create one of the above

Courtesy Michael Rieger/FEMA

Multiple-Casualty IncidentsMultiple-Casualty Incidents

• Open incident − Unknown amount

of casualties

− May need to search for patients

− Incident may be ongoing

• Closed incident − Number of

patients not expected to change

− Patients are triaged and treated as they are removed

Multiple-Casualty IncidentsMultiple-Casualty Incidents

• The following questions will help you determine whether an incident is an MCI:− How many injured/ill patients can you care for?

− What happens when you have three patients?

− How long will it take for help to arrive?

− What do you do when you have eight critical patients and only three ambulances?

Multiple-Casualty IncidentsMultiple-Casualty Incidents

• Never leave patients without other assistance.

• Declare an MCI if there are more patients than resources.

• Always follow local protocol.

© Nancy G Fire Photography, Nancy Greifenhagen/Alamy Images

TriageTriage

• Sorting patients by seriousness of injury− Primary triage

takes place at the scene.

− Secondary triage takes place in the treatment areas.

Courtesy of Journalist 1st Class Mark D. Faram/U.S. Navy

Triage CategoriesTriage Categories

Triage TagsTriage Tags

• Should be:− Weatherproof

− Easy to read

− Color-coded

− Identify category

Triage TagsTriage Tags

• Digital photos are sometimes used in identification of victims.

• Another alternative: Assign 20–25 tags at a time with a scorecard to mark patient category and priority.

START TriageSTART Triage

• Simple Triage and Rapid Treatment (START) − Limited evaluation of:

• Ability to walk

• Respiratory status

• Hemodynamic status

• Neurologic status

START TriageSTART Triage

© L

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JumpSTART Triage for Pediatric Patients

JumpSTART Triage for Pediatric Patients

• Used for children under 8 years old or who appear to weigh less than 100 lbs

© L

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Triage Special ConsiderationsTriage Special Considerations

• Hysterical or disruptive patient

• Injured or sick responder

• Hazardous materials or weapons of mass destruction

• Multiple teams or areas of triage

Destination DecisionsDestination Decisions

• Refer patients to trauma centers using:− Physiologic criteria

− Anatomic criteria

− Mechanism of injury

− Special considerations

Destination DecisionsDestination Decisions

• Consider which hospital has the appropriate means to help a patient.

• Transport patients that are categorized as immediate by ambulance or air ambulance.− Walking wounded can be transported by bus if

needed.

Destination DecisionsDestination Decisions

• Transport immediate patients two at a time.

• Transport delayed two or three at a time.

• Transport slightly injured last.

• Expectant patients are treated once all patients have been transported.

Critical Incident Stress Management

Critical Incident Stress Management

• Emergency workers may suffer from psychological impact of MCI.

• Disaster plan may include a resource for debriefing or defusing of responders.

Critical Incident Stress Management

Critical Incident Stress Management

• Critical incident stress management (CISM)− Should be available to all

− Participation not required

• Record psychological impact in post-incident evaluation.

After-Action ReviewAfter-Action Review

• Include what worked and what didn’t work

• All observations should be written down.

• Never accuse someone of doing something wrong during the incident.

SummarySummary

• Major incidents require the involvement and coordination of multiple jurisdictions, functional agencies, and emergency response disciplines.

• The National Incident Management System (NIMS) provides a consistent nationwide template to enable federal, state, and local governments to work together effectively and efficiently.

SummarySummary

• The major NIMS components are command and management, preparedness, resource management, communications and information management, supporting technologies, and ongoing management and maintenance.

• The purpose of the incident command system (ICS) is to ensure safety, achieve incident management goals, and ensure the efficient use of resources.

SummarySummary

• Using the ICS gives you a modular organizational structure that is built on the size and complexity of the incident.

• Preparedness involves the decisions and planning done before an incident occurs.

• Your agency should have written disaster plans.

• General ICS staff roles include command, finance, logistics, operation, and planning.

SummarySummary

• At incidents that have a significant medical factor, the incident commander should appoint someone as the medical branch director.

• A multiple-casualty incident refers to any call that involves three or more patients, any situation that would require a mutual aid response, or any incident that has a potential to create one of the previously mentioned situations.

SummarySummary

• The goal of triage is to do the greatest good for the greatest number.

• The four common triage categories are immediate (red), delayed (yellow), minimal (green), and expectant (black; likely to die or dead).

• It is vital to tag each patient during triage.

SummarySummary

• START triage uses a limited assessment of the patient to triage patients.

• JumpSTART triage modifies the START triage system to take into account the differences of pediatric patients.

• Consider critical incident management before, during, or after an event.

CreditsCredits

• Chapter opener: © David Crigger, Bristol Herald Courier/AP Photos

• Backgrounds: Orange—© Keith Brofsky/Photodisc/Getty Images; Red—© Margo Harrison/ShutterStock, Inc.; Gold—Jones & Bartlett Learning. Courtesy of MIEMSS; Blue—Courtesy of Rhonda Beck

• Unless otherwise indicated, all photographs and illustrations are under copyright of Jones & Bartlett Learning, courtesy of Maryland Institute for Emergency Medical Services Systems, or have been provided by the American Academy of Orthopaedic Surgeons.