July 2009 CE Site code #107200E-1209 Region X Multiple ......• Flail chest • Limb paralysis and / or sensory deficits above the wrist or ankle • Open and depressed skull fractures

July 2009 CE

Site code #107200E-1209

Region X Multiple Patient Management Plan

Prepared by: Steve Holtz FF/PM

Libertyville Fire Department Review/revision by: Sharon Hopkins, RN, BSN, EMT-P

To view on the website visit: www.condell.org/emsce/

Date: July 2009 Topic: Region X Multiple Patient Management Plan Time Frame: 3 Hours Level of Instruction: All department members at all levels Behavioral Objectives

Upon successful completion of this module, the EMS provider will be able to:

1. Explain the purpose of the Region X Multiple Patient Management Plan. 2. Define Class 1, Class 2, and Class 3 incidents. 3. Identify responsibilities of the fire department for each class. 4. Define criteria for Category I, Category II, and Category III trauma patients. 5. Define primary, secondary, and reverse triage. 6. Identify the components of the Ems Division of the Incident Management System. 7. Identify the communication process for Class 1, Class 2, and Class 3 incidents. 8. Describe documentation requirements for Class 1, Class 2, and Class 3 incidents. 9. Describe the purpose of the After Action Report. 10. Define triage 11. Identify the principles of START and JumpStart triage. 12. Identify when primary and secondary triage techniques should be implemented. 13. Identify components of the SMART Triage Packs. 14. Identify the role of critical incident stress management (CISM) in MCI. 15. Given a simulation, correctly triage patients using START triage. 16. Given a simulation, correctly perform secondary triage. References: Bledsoe, B. Porter, R., Cherry, R. Paramedic Care Principles and Practices. Region X Multiple Patient Management Plan, 2009. Region X SOP’s. March 2007, Amended January 1, 2008 Smartmci.com (TSG Associates Ltd 2004 -2008.)

REGION X

MULTIPLE PATIENT MANAGEMENT PLAN

FIELD PROVIDER LOG FORM

Date: ________________________ Time: _______________________ Fire Department: _______________

Hospital you are contacting: ___________________________________ ED Phone #:___________________

CLASS 1: “Business as usual”

Field personnel call the closest appropriate hospital

“Hello. This is the __________________________

Fire Department. We are on the scene of a Class 1

multiple patient incident. The incident is a

__________________________________________ (describe the event to the ECRN).

Our total number of patients is ________________.

We have: (fill in the specific numbers of patients) _____ Category I Trauma _____ Category I Medical

_____ Category II Trauma _____ Category II Medical

_____ Category III Trauma _____ Category III Medical

How many patients can you take?” ____________

If patients will be transported to other hospitals report those destinations to the

ECRN and record below. NO MORE THAN TWO PATIENTS MAY BE

SENT TO HOSPITALS WITHOUT PRIOR APPROVAL FROM THE

RECEIVING HOSPITAL.

Complete table

with specific

hospital name(s),

#’s and patient

acuities.

Ho

spital:

Ho

spital:

Ho

spital:

Ho

spital:

Cat I Trauma

Cat II Trauma

Cat III Trauma

Cat I Medical

Cat II Medical

Cat III Medical

TOTALS

NOTE:

1) Complete an After-Action Report (critique form) 2) Fax both this form and the After-Action Report to the EMS Office

of the Resource Hospital IMMEDIATELY following the incident.

CLASS 2 or CLASS 3 Field personnel call their Resource Hospital for Transportation Management

“Hello. This is the __________________________

Fire Department. We are on the scene of a Class __

multiple patient incident. The incident is a

__________________________________________ (describe the event to the ECRN).

Our estimated number of patients is ___________.

We estimate that we have the following types of

patients:

RED: _____ YELLOW: _____ GREEN: ______ DECEASED: _____

Our closest hospitals are:” (IMPORTANT: List in order of proximity to the incident)

1. ________________________________________

2. ________________________________________

3. ________________________________________

4. ________________________________________

5. ________________________________________

“MY CALL BACK TELEPHONE

NUMBER IS”: _________________

*Use SMART® Command Board to record hospital

availability and patient destinations.

NOTE:

1) Complete an After-Action Report (critique form) 2) Fax both this form and the After-Action Report the EMS Office of

the Resource Hospital IMMEDIATELY following the incident.

Your Name:

Contact Phone #:

REGION X MULTIPLE PATIENT MANAGEMENT PLAN 2/13/08 CLASS 1 CLASS 2 CLASS 3

Def

init

ion

Able to meet normal level of care

Unable to meet normal level of care

Note: Box Alarms may be activated

Overwhelmingly unable to meet normal

level of care

Note: May require EMS Divisions or

on-scene treatment areas

EMERGENT EVACUATION

OF A

HEALTHCARE FACILITY (PATIENTS REQUIRING MEDICAL CARE)

Init

ial

Co

mm

un

icat

ion

Contact closest hospital

State: “WE ARE ON THE SCENE OF A

CLASS 1

MULTIPLE PATIENT INCIDENT”

Contact Resource Hospital


CLASS 2




CLASS 3



State: “WE ARE ON THE SCENE OF AN

EMERGENT EVACUATION OF A

HEALTHCARE FACILITY”

Init

ial

Info

rmat

ion

• Event description

• Specific # patients

• Specific patient categories

• Closest appropriate hospitals


• Estimate # pts.

• Estimate patient acuities

(Use RED, YELLOW, GREEN)

• Closest Hospitals


• Estimate # pts.

• Estimate patient acuities

(Use RED, YELLOW, GREEN)

• Closest Hospitals


• Estimate # pts.

• Closest hospitals

• Possible alternative receiving

facilities

Pat

ien

t

Dis

bu

rsem

ent

• After conferring with closest hospital, transport

agreed upon # patients to that hospital

• Disburse no more than two patients to each

remaining hospital

• If it is determined that more than two patients

should be transported to a hospital, the closest

hospital will confirm with desired hospital(s)

prior to transport.

• Communicate remaining patients’ destinations

to closest hospital

Resource Hospital coordinates

transportation destination of patients

• Resource Hospital coordinates

transportation destination of patients

• POD Hospital may be activated for

assistance with communication and

additional resources

• Resource Hospital works in conjunction

with field command and administration of

affected facility to determine where

patients will be transported

• POD Hospital may be activated for

assistance with communication and

additional resources

Tri

age

Tag

s

Triage tags not used

Triage tags MUST be used



Tri

age

Met

hod

Use rapid assessment to

identify patient category

START Triage

START Triage

• Within facility use REVERSE TRIAGE

• Prior to transport use START TRIAGE

Am

bu

lan

ce t

o

Ho

spit

al

Co

mm

un

icat

ion

Every transporting ambulance contacts their

receiving hospital with abbreviated report

State:

“WE ARE TRANSPORTING FROM A


NO CONTACT BETWEEN TRANSPORTING AMBULANCE

AND RECEIVING HOSPITAL

NO CONTACT BETWEEN TRANSPORTING AMBULANCE

AND RECEIVING HOSPITAL

NO CONTACT BETWEEN TRANSPORTING AMBULANCE /

PATIENT TRANSPORTATION

VEHICLE AND

RECEIVING FACILITIES

Pt

Car

e

Rep

ort

s

Complete patient care reports as usual

Complete patient care reports as usual

No patient care reports

(Triage Tags serve as written report)

No patient care reports

(Triage Tags serve as written report)

REGION X: CLASS 1 ACTIVATION

CLASS 1 D

efin

itio

n

Able to meet normal

level of care

Init

ial

Co

mm

un

icat

ion

Contact closest hospital

State: “WE ARE ON THE

SCENE OF A

CLASS 1 MULTIPLE PATIENT

INCIDENT”

Init

ial

Info

rmat

ion


• Specific # patients

• Specific patient categories

• Closest appropriate hospitals (*Closest hospital must take

at least two patients.)

Pat

ien

t D

isbu

rsem

ent

-After conferring with closest

hospital, transport agreed upon

# of patients to that hospital

(not less than two)

-Disburse no more than two

patients to each remaining

hospital.

-Communicate remaining

patients’ destinations to closest

hospital

Am

bu

lan

ce t

o H

osp

ital

Co

mm

unic

atio

n

Transporting ambulance

quickly contacts receiving

hospital with an abbreviated

report

State:

“WE ARE TRANSPORTING

FROM A MULTIPLE

PATIENT INCIDENT”

OT

HE

R

• Triage Tags not utilized

• Use rapid assessment to

identify patient category

• Complete patient care reports

TRAUMA • Traumatic Arrest, Isolated Burns >20%: Transport to closest Trauma Center

• NO AIRWAY: Transport to CLOSEST Emergency Department

MEDICAL

↓ ↓

CATEGORY I TYPE OF HOSPITAL CATEGORY I Unstable Vital Signs:

• Systolic BP ≤ 90 x 2 (Peds ≤ 80 x 2)

• Glasgow Coma Scale ≤ 10 or deteriorating mental status

• Respiratory Rate ‹ 10 or › 29

• Revised Trauma Score ‹ 11

Anatomy of Injury:

• Penetrating injuries to head, neck, torso or groin

• Combination trauma with burns ≥ 20%

• Two or more proximal long bone fractures

• Unstable pelvic

• Flail chest

• Limb paralysis and / or sensory deficits above the wrist or ankle

• Open and depressed skull fractures

• Amputation proximal to wrist or ankle

Transport to

highest

level

Trauma

Center(s)

within

25 minutes

Transport to

closest

Emergency

Department(s)

UNSTABLE

• Altered mental status

• Systolic BP < 100

mmHg

CATEGORY II TYPE OF HOSPITAL CATEGORY II Mechanism of Injury:

• Ejection from automobile

• Death in the same passenger compartment

• Motorcycle crash › 20 mph or with separation of rider from bike

• Rollover (unrestrained)

• Falls ≥ 20 feet (Peds falls ≥ 3X body length)

• Pedestrian thrown or run over

• Auto vs. pedestrian / bicyclist with › 5 mph impact

• Extrication › 20 minutes

• High speed MVC: Speed › 40 mph, intrusion ≥ 12”,

major deformity ≥ 20”

Co-Morbid Factors:

• Age ≤ 5 without car / booster seat

• Bleeding disorders or on anticoagulants

• Pregnancy ≥ 24 weeks

Transport to

closest Trauma

Center(s)

Transport

To

closest

Emergency

Department(s)

STABLE

• Patient alert

• Skin warm and dry

• Systolic BP >100

mmHg

CATEGORY III TYPE OF HOSPITAL CATEGORY IIIOther simple trauma Transport to closest hospital(s)

Other simple medical

1/23/08

Primary & JumpSTART Triage

Secondary Triage

REGION X

MULTIPLE PATIENT MANAGEMENT PLAN

AFTER-ACTION REPORT

Date of Incident: ________ Time of Incident: ________ Primary Fire/Rescue Agency: ___________________

Description of Incident: ______________________________________________________________________

Check One:

CLASS 1 �: Total # patients: ____ (Specific # Trauma: Cat I___ Cat II___ Cat III___ Medical: Cat I___ Cat II ___ Cat III ___) CLASS 2 � / CLASS 3 �: Total # patients: _____ (Specific #: Red _____ Yellow _____ Green _____ Deceased _____)

Please answer the following questions. Use the reverse side for additional comments (take note when faxing form).

Which hospital was first contacted by field personnel?______________________________________________

Mode of communication between field and hospital: Cell phone � Telemetry � MERCI � Other:_______

Any difficulties with initial communication? No � Yes:__________________________________________

Was it difficult to determine the ‘Class’ of the incident? No � Yes:________________________________

Any difficulties with triage? No � Yes:_______________________________________________________

Receiving Hospitals / # pts to each hospital: ______________________________________________________

Any difficulties with patient disbursement? No � Yes:___________________________________________

Any difficulties with ambulance to hospital communication (Class 1 only): No � Yes:_________________

Was the two-sided Multiple Patient Management Plan REFERENCE CARD used? Yes � No �

If yes, was it helpful? Yes � No � Comments: _________________________________________

Was a Region X Multiple Patient Management Plan LOG FORM used? Yes � No �

If yes, was it helpful? Yes � No � Comments: _________________________________________

Overall, how effective was Region X Multiple Patient Management Plan in successfully disbursing patients from the

scene to area-wide hospitals?

Very Effective � Effective � Ineffective � Very Ineffective �

The success of the plan depends on your detailed comments. Please provide us with any additional information that

may be helpful:

_________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________ Hospital Personnel – Submit this form and Emergency Department Log form to your hospital EMS Coordinator.

Field Personnel – Fax this form and Field Provider Log Form to the Resource Hospital EMS Office.

Name:

FD or Hosp:

Two autos have been involved in a head-on crash. Each auto

was traveling in excess of 60 mph. Three people have

been thrown from the wreckage and are unconscious.

Four others are trapped inside with various types of severe injuries.

What Class?

What Category trauma?

Which hospital do you contact?

What do you say?

How does this affect the transporting

ambulances?

The administrator at a private school calls 911 to report

that a strange odor in the building has caused several

students to collapse. Someone has pulled the fire

alarm to evacuate the building.

As you arrive, students are running towards you.

What Class?

What Category medical?


What do you say?


ambulances?

What Class?



What do you say?


ambulances?

Two patients were in this car.

One patient is in traumatic

arrest.

One patient is unresponsive

but

breathing.

What Class?



What do you say?


ambulances?

Four teenagers have stolen

this vehicle and hit the building

at a moderate rate of speed.

Upon your arrival,

all victims are sitting

on the curb with minor

injuries and in police custody.

What Class?

What Category medical?

Which hospital do you contact?What do you say?

How does this affect the transporting ambulances?

Five members of a family

were rescued from this home.

All five are exhibiting signs of

severe smoke inhalation.

What Class?


What do you say?


ambulances?

This accident involves

a total of five patients:

2 Category I Trauma Patients

3 Category II Trauma Patients

What Class?



ambulances?

This crash involves four vehicles.

Category I = 3 patients

Category II = 1Category III = 2

What Class?



ambulances?

A car traveling at 60 mph

has hit a group of sevenbicycle riders. The bikes were

traveling at a high rate of speed.

The victims include:

6 Category One Trauma Patients

1 Category Two Trauma Patient

Pre-Quiz

Review of Region X Multiple Patient Management Plan

From July 2009 CE Material Name_________________________________Date___________ 1. What is the definition of a Class 1 multiple patient incident? 2. List 1 vital sign criteria and at least 3 anatomical criteria for classifying the patient as a Category I trauma patient. Vital signs: Anatomical criteria: 3. What is the purpose of primary triage and when is it performed? Purpose: Performed: 4. During a Class 1 incident, which hospital does EMS contact? 5. During Class 2 or 3 incidents, which hospital does EMS contact? 6. For which class in the Multiple Patient Management Plan are triage tags used? Class 1: YES NO Class 2: YES NO Class 3: YES NO

7. When is the After Action Report used and why? 8. What is the first question asked of patients when starting to use primary triage? 9. When would JumpSTART triage be used? 10. Your patient goes from a yellow to a red in the treatment area. How do you fix the triage tag to show the change?

File: CE, EMS; CE Packets; Quizzes; 2009; July 2009 Pre-quiz

Documents

July 2009 CE Site code #107200E-1209 Region X Multiple ......• Flail chest • Limb paralysis and / or sensory deficits above the wrist or ankle • Open and depressed skull fractures