Emergency Medical Response Incident Command and Multiple-Casualty Incidents

Emergency Medical Response

Incident Command andMultiple-Casualty Incidents


You Are the Emergency Medical Responder

A school bus carrying 30 students is involved in a collision and is severely damaged near the front of the bus. The students are scared and some are injured. People are starting to crowd around the area, and the local fire department already is on scene. You arrive as an EMR on scene.

Lesson 45: Incident Command and Multiple-Casualty Incidents


Incident Management Systems

National Incident Management System (NIMS) Systematic, proactive approach to guide

organizations responding to incidents Provides a template for the management of

incidents National Response Framework (NRF)

Guide to how an all-hazards response is conducted

Incident Command System (ICS) Organizes who is responsible for overall

direction


Incident Command System

Management system originally developed to help manage fighting forest fires

All-hazards management system Incident commander—

Establishes incident objectives Scene safety, identify the MCI, patients

Manages resources Fire, ambulances, HZMAT

Supervises use of resources


Common Roles in the ICS Triage officer

Initial triage of patients Treatment officer

Sets up area/medical care Transportation officer

Transport vehicles Staging officer

Distributes resources Safety officer

Maintains scene safety


Multiple-Casualty Incidents

Motor-vehicle crashes

Transportation accidents

Flood Fire Explosion Structure collapse

Train derailment Airliner crash HAZMAT incidents Earthquake Tornado Hurricane


Triage

French for separate, sift or select The process for identifying which patients

require urgent care in a multiple-casualty incident

Triage officer performs triage on all patients Primary and secondary triage Each patient is tagged and identified by a

tag/tape Green, yellow, red, and black


Types of Triage

Primary Used on scene to rapidly categorize the condition

of the patients, including the number and location of the patients and what transportation is needed

Secondary Often performed after patients are moved to the

treatment area or before entering the treatment area


The START System Simple Triage And Rapid Treatment

START is a triage system used only in situation in which your assessment and care-giving skills are modified

The system requires you to assess and base you treatment level on three factors Breathing Radial pulse (Circulation) Level of consciousness


Triage Categories

Ambulatory (walking wounded): Green

Immediate care: Red Delayed care: Yellow Deceased/non-

salvageable/expectant: Black

Hold: White


Other Methods for Triage

SALT Mass Casualty Triage Priority 1: Still/obvious life threat Priority 2: Waving/purposeful movement Priority 3: Walking

JumpSTART Used with children Not for use with infants younger than 12

months


Activity

You are assisting with triage at the scene of a multi-vehicle collision involving several automobiles and a tractor trailer. One of the patients, a 35-year-old woman, is alert and responsive with a small cut on her forehead and forearm and is complaining of a headache. An 8-year-old child has a fractured leg with the bone protruding through the skin with significant bleeding. A third victim, a 65-year-old male is not breathing, even after attempting to open and clear his airway.


Stress at a Multiple-Casualty Incident

Patient More then just visible injuries Cognitive, emotional, physical and

behavioral Children and elderly with increased risk for

severe stress reactions EMRs and the need for debriefing

Adequate rest/down time Talking with colleagues about their

experience


You Are the Emergency Medical Responder

A number of students from the bus are yelling at you to help them, and one of the firefighters asks you to come over and check the coach, whose pain in his abdomen and chest seems to be getting worse.

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Emergency Medical Response Incident Command and Multiple-Casualty Incidents