Mass Casualty Incidentstcemca.org/wp-content/uploads/2018/04/TCEMCA_MCI.pdf · 2001 Ameritech Haz-mat, 75 triaged, 28 transported 2001 MVA GR&GR, Lansing, 7 triaged, 6 transported

Tri-County Emergency Medical Control Authorityin partnership with

Comprehensive Emergency Management Associatespresent

MCI ProtocolMCI Protocoland techniques for theand techniques for the management ofmanagement of

Mass Casualty IncidentsMass Casualty Incidents

- Comprehensive Emergency Management Associates, LLC -

Part 1- Introduction



Welcome & IntroductionsWelcome & Introductions Why this course?Why this course?

New TCEMCA MCI ProtocolNew TCEMCA MCI Protocol

MCIMCI’’s are among the most challengings are among the most challengingof all incident types - we will shareof all incident types - we will sharelessons learned from recent incidents thatlessons learned from recent incidents thatcan greatly improve the command andcan greatly improve the command andmanagement of these events.management of these events.



What we will cover todayWhat we will cover today

Introductory materialIntroductory material

Key elements of the new protocolKey elements of the new protocol

Review of ICS and triage basicsReview of ICS and triage basics

New skills and equipmentNew skills and equipment

Tabletop scenariosTabletop scenarios



What types of incidents create MCIWhat types of incidents create MCI’’s?s?



Do we have MCIDo we have MCI’’s in Tri-County?s in Tri-County?1977 Skywalk Collapse, 10 triaged, 6 transported1987 Bus rollover, 30-50 triaged1989 Lansing high-rise fire, 40 triaged, 15 transported1999 CATA bus – truck MVA, 24 triaged 12 transported1999 601 N. Cedar, High Rise Fire , 75 triaged, 6 transported2001 Ameritech Haz-mat, 75 triaged, 28 transported2001 MVA GR&GR, Lansing, 7 triaged, 6 transported2001 MVA, Sheriff van-auto, 10 triaged, 6 transported2005 I-96 MVA, 200 cars, 70 semi’s



Do we have MCIDo we have MCI’’s in Tri-County?s in Tri-County?

Last five year Last five year’’s s ““near missesnear misses”” ……2002 Lansing, CATA bus-auto MVA2002 Potterville train derailment, 2200 evacuated2003 Owosso, School bus crashes into home2003 Lansing school bus - car2003 Haslett, 24 unit apartment building fire2004 Eaton Rapids, School bus-truck MVA2004 Lansing Center, gas leak, 2400 evacuated2005 Okemos, 24 unit apartment building fire2005 Lansing, Car strikes apt, gas rupture, explosion & fire 2006 Delta Twp., apartment fire displaces 42



Definition of Mass Casualty IncidentDefinition of Mass Casualty Incident

Any incident, which because of it physicalAny incident, which because of it physicalsize, the number and criticality of victims,size, the number and criticality of victims,or its complexity, is likely to overwhelmor its complexity, is likely to overwhelmthose local resources which would typicallythose local resources which would typicallybe available.be available.



Vocabulary - ways to think of MCIVocabulary - ways to think of MCI’’s s ……

Over vs. OngoingOver vs. Ongoing

Defined vs. UndefinedDefined vs. Undefined


Part 2 - New MCI Protocol



New TCEMCA ProtocolNew TCEMCA Protocol In effect December, 2006In effect December, 2006 NIMS/ICS compliantNIMS/ICS compliant Based on national standards and bestBased on national standards and best

practicespractices Protocol approved by the StateProtocol approved by the State



TThree MCI Goalshree MCI GoalsDo the greatest good for the greatestDo the greatest good for the greatest

numbernumberMake the best use of personnel,Make the best use of personnel,

equipment and resourcesequipment and resourcesDo Do NOTNOT relocate the disaster relocate the disaster



Key ElementsKey Elements



Key ElementsKey Elements 2 part process for declaring an MCI:2 part process for declaring an MCI:

1. Radio transmission from Command to1. Radio transmission from Command toCommunications Center stating Communications Center stating ““I amI amformally declaring this incident to be anformally declaring this incident to be anMCIMCI””

2. Communication to nearest hospital2. Communication to nearest hospitaldirecting them to assume the directing them to assume the ResourceResourceHospitalHospital role and responsibilities under role and responsibilities underTCEMCA MCI protocolTCEMCA MCI protocol



Key ElementsKey Elements Suspension of other protocols:Suspension of other protocols:

§§5 - In the event of a conflict, the MCI protocol5 - In the event of a conflict, the MCI protocolsupersedes all otherssupersedes all others

§§ 6 - All 6 - All ““Gray BoxGray Box”” orders may be performed orders may be performedw/o radio contact for life saving purposesw/o radio contact for life saving purposes

§§ 14 - Abbreviated record keeping may be used 14 - Abbreviated record keeping may be used



Key ElementsKey Elements Communications PlanCommunications Plan

OFTEN THE BIGGEST CHALLENGEOFTEN THE BIGGEST CHALLENGE

Plan should includePlan should include•• Multiple agencies/hardware systemsMultiple agencies/hardware systems•• Possible multiple 911 CentersPossible multiple 911 Centers

Plain LanguagePlain Language Command - response formatCommand - response format



Key ElementsKey Elements Initial Actions (5-SInitial Actions (5-S’’s)s)




Scene Safety AssessmentScene Safety Assessment•• Electrical hazardsElectrical hazards•• Flammable liquidsFlammable liquids•• Hazardous materialsHazardous materials•• Other life threatening hazardsOther life threatening hazards




Scene Size UpScene Size Up•• Type and/or cause of incidentType and/or cause of incident•• Approximate # of victimsApproximate # of victims•• Severity of injuriesSeverity of injuries•• Area involved (perimeter controlArea involved (perimeter control

and access issues)and access issues)




Send InformationSend Information•• Establish CommandEstablish Command•• Size up to dispatchSize up to dispatch•• Official declaration of MCIOfficial declaration of MCI•• Designate resource hospitalDesignate resource hospital

continued continued ……




Send InformationSend Information•• Request additional resourcesRequest additional resources

–– Additional EMS, Fire, Law EnforcementAdditional EMS, Fire, Law Enforcement–– Technical rescueTechnical rescue–– County MCI trailersCounty MCI trailers–– Medrun & ChempackMedrun & Chempack–– Emergency Operations Center (EOC)Emergency Operations Center (EOC)




Scene Set-upScene Set-up•• Establish staging area (1st)Establish staging area (1st)•• ID best ingress and egressID best ingress and egress•• Establish work areasEstablish work areas

–– Triage, Triage, Treatment, Treatment, Transport, Transport, MorgueMorgue




(Scene) Safety Assessment(Scene) Safety Assessment (Scene) Size-up(Scene) Size-up Send InformationSend Information (Scene) Set-up(Scene) Set-up STARTSTART



Key ElementsKey Elements START (JumpSTART)START (JumpSTART)

will cover later will cover later ……



Key ElementsKey Elements Key Officer Roles (forms for all)Key Officer Roles (forms for all)

SafetySafety SStagingtaging Medical SupervisorMedical Supervisor TriageTriage TreatmentTreatment TransportationTransportation Rescue/ExtricationRescue/Extrication



Key ElementsKey Elements Key Officer Roles (forms for all)Key Officer Roles (forms for all)

SafetySafety SStagingtaging Medical SupervisorMedical Supervisor TriageTriage TreatmentTreatment TransportationTransportation Rescue/ExtricationRescue/Extrication



Key ElementsKey Elements Key Officer RolesKey Officer Roles

Medical Supv.Medical Supv.




Medical SupervisorMedical Supervisor•• Oversee all medical care: Triage,Oversee all medical care: Triage,

Treatment and TransportTreatment and Transport•• Responsible for Responsible for ““big picturebig picture”” patient patient

flow through the system, maintainingflow through the system, maintainingsupplies, anticipating needs as incidentsupplies, anticipating needs as incidentevolvesevolves




Triage OfficerTriage Officer




Triage OfficerTriage Officer•• Coordinate Triage teamCoordinate Triage team•• Collect and total team infoCollect and total team info•• Coordinate Pt. movement to TreatmentCoordinate Pt. movement to Treatment•• Final sweep of sceneFinal sweep of scene




Treatment OfficerTreatment Officer




Treatment OfficerTreatment Officer•• Establish adequate (BIG) trtmt areaEstablish adequate (BIG) trtmt area•• Ensure adequate suppliesEnsure adequate supplies•• Update Transportation officer ofUpdate Transportation officer of

changing RED-YELLOW-GREENchanging RED-YELLOW-GREENnumbersnumbers




Transport OfficerTransport Officer




Transport OfficerTransport Officer



Key ElementsKey Elements Transportation OfficerTransportation Officer

ONLY communicator w/ hospitals ONLY communicator w/ hospitals(i(instructs medic units NOT to call)nstructs medic units NOT to call)

Responsible for patient tracking info Responsible for patient tracking info Responsible for assisting out of area Responsible for assisting out of area

units, directions, etc.units, directions, etc.



Key ElementsKey Elements AppendicesAppendices

A-1, START & JumpSTART algorithmsA-1, START & JumpSTART algorithms A-2, Laws and standardsA-2, Laws and standards A-3, Resource inventoriesA-3, Resource inventories A-4, Maps and directionsA-4, Maps and directions A-5, Forms and checklistsA-5, Forms and checklists


Part 3 - Review and Refresher



Incident CommandIncident Command



Review of Incident Command SystemReview of Incident Command System Establishing CommandEstablishing Command

Who takes Command?Who takes Command?



Review of Incident Command SystemReview of Incident Command System Passing of CommandPassing of Command



Review of Incident Command SystemReview of Incident Command System Responsibilities of CommandResponsibilities of Command

Scene SafetyScene Safety Size-upSize-up Communications PlanCommunications Plan Operations - Operations - Incident PlanIncident Plan

•• Strategy & TacticsStrategy & Tactics



Unified CommandUnified Command Assembled heads from all disciplinesAssembled heads from all disciplines

choose a single leader > Commandchoose a single leader > Command Scene assessmentScene assessment All disciplines bAll disciplines build the planuild the plan Communication PlanCommunication Plan Scene set-up / assign key officersScene set-up / assign key officers



Unified CommandUnified Command Span of ControlSpan of Control

3 to 7, 5 optimum3 to 7, 5 optimum



Unified CommandUnified Command Divisions - geographic assignmentsDivisions - geographic assignments

A A (address)(address)

BB DD

CC

44

33

11

22

RoofRoof



Unified CommandUnified Command Groups - tactical assignmentsGroups - tactical assignments

Medical GroupMedical Group Rescue GroupRescue Group Perimeter Control GroupPerimeter Control Group



Unified CommandUnified Command Simple Incident Simple Incident

Command

TransportTreatmentTriage

Staging



Unified CommandUnified Command Complex Incident Complex Incident

ExtricationGroup

Command

Transport

Treatment

Triage

Operations

SafetyPIO

RescueGroup/Branch

MedicalGroup/Branch

LawGroup/Branch

Division-A

SpillGroup

TrafficControl

PerimeterSecurity

Staging



TriageTriage



Triage CategoriesTriage Categories

URGENT / CRITICAL

DELAYED(may deteriorate)

MINOR(can wait long period)

DEAD orNOT SALVAGEABLE



Basic Triage Basic Triage DesignDesign

1Triage

2Triage

TransportRED’s 1stYELLOW’S 2ndGREEN’s Last

TreatmentArea

Morgue

TreatmentArea


Part 4 - New Skills and Equipment



START TriageSTART Triage

Simple Treatment and Rapid TransportSimple Treatment and Rapid Transport


Part 4 - New Skills and Equipment START Triage (RPM & 30-2-Can Do)START Triage (RPM & 30-2-Can Do)

Get up and walk

Respiration

Perfusion

Mentation

A 4-step Process …

Green Group

Black Group

Everyone else, Red or Yellow


Part 4 - New Skills and Equipment START Triage (30-2-Can Do)START Triage (30-2-Can Do)

Get up and walk

Respiration

Perfusion

Mentation

Open AirwayYesNo

NO YES

10-30

Not10 - 30

Radial Pulse or Cap Refill < 2 sec

NoYes

No Yes


Part 4 - New Skills and Equipment START Triage - Exercise ISTART Triage - Exercise I

Number sheet 1-10

“Get up and walk” have gone,these victims remain …

Code each patient Red, Yellow, or Black



#1Compound fracture, left femur

Respirations 24/minuteRadial pulse absent

Awake & alert

#2Sudden onset of chest pain with shortness of breath

Respirations 30/minuteCapillary refill under 2 seconds

Awake, oriented



#330% Second degree burns

Respirations absent/presentRadial pulse present

Unconscious

#4Facial injury


Awake, disoriented



#5Unable to move legs

Respirations 24/minuteRadial pulse present

Awake, alert

#6No apparent injuriesRespirations 20/min

Capillary refill under 2 secondsAwake, unable to follow commands



#7Sucking chest woundRespirations 36/min.Radial pulse present

Unconscious

#8Dislocated right shoulder

Respirations 20/min.Radial pulse present

Awake, oriented



#9No visible wounds

Respirations absent/absentRadial pulse absent

Unconscious

#10Massive head injury, gray matter showing

Respirations 6/min.Radial pulse absent

Unconscious



Review of your responses



#1Compound fracture, left femur

Respirations 24/minuteRadial pulse absent

Awake & alert

#2Sudden onset of chest pain with shortness of breath


Awake, oriented



#330% Second degree burns

Respirations absent/presentRadial pulse present

Unconscious

#4Facial injury


Awake, disoriented



#5Unable to move legs

Respirations 24/minuteRadial pulse present

Awake, alert

#6No apparent injuriesRespirations 20/min

Capillary refill under 2 secondsAwake, unable to follow commands



#7Sucking chest woundRespirations 36/min.Radial pulse present

Unconscious

#8Dislocated right shoulder

Respirations 20/min.Radial pulse present

Awake, oriented



#9No visible wounds

Respirations absent/absentRadial pulse absent

Unconscious

#10Massive head injury, gray matter showing

Respirations 6/min.Radial pulse absent

Unconscious


Part 4 - New Skills and Equipment JumpSTART Triage (age 8 and younger)JumpSTART Triage (age 8 and younger)

P inappropriate, posturingor unresponsive

Get up and walk

Respiration

Perfusion

AVPU

Open AirwayNo - 5 breaths

YesNo

NO YES15-45

Not15-45

Palpable Pulse

NoYes

AV or P ok

Alert - Eyes are open, talking spontaneously Verbal - Responds appropriately to verbal commands Pain - Responds to painful stimuli Unresponsive - Does not respond


Part 4 - New Skills and Equipment JumpSTART Triage - Exercise IIJumpSTART Triage - Exercise II

Number sheet 1-10

“Get up and walk” have gone,these victims remain …

Code each patient Red, Yellow, or Black



#15 y/o, compound fx, left femur

Respirations 60/minutePulse not palpable

V-no

#24 y/o, bruise on forehead, blood in ears and nose

Respirations 12/min.Pulse palpable

Unconscious, no pain response



#38 y/o, sucking chest wound


AVP-OK

#43 y/o, no visible wounds

Respirations absent/absentPulse not palpable

Unconscious



#57 y/o, compound femur fx


Awake & responsive

#68 y/o, massive head injury


Unconscious, not responsive to pain stimulus



#77 y/o, amputated left arm, bleeding controlled


AVP-OK

#88 y/o, 3rd degree burns both legs


AVP-unresponsive



#91 y/o, no visible injury

Respirations absent/presentPulse palpable

Unconscious, responsive to pain stimulus

#105 y/o, impaled object left chest


Disoriented, responsive to pain stimulus



Review of your responses



#15 y/o, compound fx, left femur

Respirations 60/minutePulse not palpable

V-no

#24 y/o, bruise on forehead, blood in ears and nose


Unconscious, no pain response



#38 y/o, sucking chest wound


AVP-OK

#43 y/o, no visible wounds

Respirations absent/absentPulse not palpable

Unconscious



#57 y/o, compound femur fx


Awake & responsive

#68 y/o, massive head injury


Unconscious, not responsive to pain stimulus



#77 y/o, amputated left arm, bleeding controlled


AVP-OK

#88 y/o, 3rd degree burns both legs


AVP-unresponsive



#91 y/o, no visible injury

Respirations absent/presentPulse palpable

Unconscious, responsive to pain stimulus

#105 y/o, impaled object left chest


Disoriented, responsive to pain stimulus



New Skills New Skills (Tips and Tricks)(Tips and Tricks)

This section based on lessons learnedThis section based on lessons learnedfrom studying major incidents aroundfrom studying major incidents aroundthe worldthe world



New Skills (tips and tricks)New Skills (tips and tricks)

Think Think BIGBIGRReviews of past incidents typically show theeviews of past incidents typically show thesize of areas chosen were not adequate forsize of areas chosen were not adequate forvictims, rescuers and equipment movement victims, rescuers and equipment movement ……



New Skills (tips and tricks)New Skills (tips and tricks) Save Save skilled peopleskilled people for for skilled jobsskilled jobs

Reviews of past incidents show that skilledReviews of past incidents show that skilledpeople were wasted by assignment to unskilledpeople were wasted by assignment to unskilledtasks tasks ……

* use Community Emergency Response Team* use Community Emergency Response Team(CERT) or bystanders who want to help(CERT) or bystanders who want to help



New Skills (tips and tricks)New Skills (tips and tricks) Establish Establish drive-through loadingdrive-through loading

Problem: Reviews of past incidents show thatProblem: Reviews of past incidents show thatpoorly planned traffic flow can greatly slowpoorly planned traffic flow can greatly slowmovement of patients from scene movement of patients from scene ……



New Skills (tips and tricks)New Skills (tips and tricks) Solution: Drive-through loadingSolution: Drive-through loading

Treatment

Transport

Triage




Treatment

Transport

Triage




Treatment

Transport

Triage



New Skills (tips and tricks)New Skills (tips and tricks) (when necessary) (when necessary) Back In - Drive OutBack In - Drive Out

Problem: Reviews of past incidents show thatProblem: Reviews of past incidents show that(when drive-through loading is not possible)(when drive-through loading is not possible)backing into the pt. loading area is much saferbacking into the pt. loading area is much saferand more efficient and more efficient ……



New Skills (tips and tricks)New Skills (tips and tricks) Solution: Back In - Drive OutSolution: Back In - Drive Out

Treatment

Triage

Transport




Treatment

Triage

Transport




Treatment

Triage

Transport




Treatment

Triage

Transport




Treatment

Triage

Transport




Treatment

Triage

Transport




Treatment

Triage

Transport



New Skills (tips and tricks)New Skills (tips and tricks) Establish an Establish an equipment cacheequipment cache

Problem: Problem: Reviews of past incidents show thatReviews of past incidents show thatEMS vehicles often left the scene with fullEMS vehicles often left the scene with fullinventories on board while supplies wereinventories on board while supplies wereneeded at the scene needed at the scene ……

Solution: Treatment Officer creates equipmentSolution: Treatment Officer creates equipmentcache at scene by dropping essential supplies.cache at scene by dropping essential supplies.



New Skills (tips and tricks)New Skills (tips and tricks) Rendezvous ptRendezvous pt for out-of-area resources for out-of-area resources

Problem: Problem: Reviews of past incidents show thatReviews of past incidents show thatdistant resources often were delayed or lostdistant resources often were delayed or lostfrom not knowing the local area from not knowing the local area ……

Solution: Transport Officer sets up rendezvousSolution: Transport Officer sets up rendezvouspoints at easily found intersections.points at easily found intersections.



New Skills (tips and tricks)New Skills (tips and tricks) Rendezvous pt for out-of-area resourcesRendezvous pt for out-of-area resources

X



New Skills (tips and tricks)New Skills (tips and tricks) Load Load multiple patients in EMS vehiclesmultiple patients in EMS vehicles

Problem: Reviews of past incidents show thatProblem: Reviews of past incidents show thatEMS crews often left with only one patientEMS crews often left with only one patientwhile more REDwhile more RED’’s awaited transport s awaited transport ……

Solution: When prudent, Transportation OfficerSolution: When prudent, Transportation Officerorders minimum loading of 2 victims.orders minimum loading of 2 victims.



New Skills (tips and tricks)New Skills (tips and tricks) Order Order EMS round-tripsEMS round-trips

Problem: Problem: Reviews of past incidents showReviews of past incidents showthat some EMS units returned to quartersthat some EMS units returned to quartersafter delivering first victim(s) after delivering first victim(s) ……

Solution: Transportation Officer ordersSolution: Transportation Officer ordersround-trips back to scene until all patients areround-trips back to scene until all patients aretransported.transported.



New EquipmentNew Equipment



New EquipmentNew Equipment Funded by D1RMRCFunded by D1RMRC

District 1 Regional Medical Response CoalitionDistrict 1 Regional Medical Response Coalition

For every transporting EMS unit in Tri-CountyFor every transporting EMS unit in Tri-County



New EquipmentNew Equipment VestsVests

Quick role identityQuick role identity

Those filling key rolesThose filling key rolesmust be recognized and findable must be recognized and findable ……



New EquipmentNew Equipment Flag SetsFlag Sets

Be seen over the crowdBe seen over the crowd

Reviews of past incidents have shown thatReviews of past incidents have shown thatcrowds and other visual obstructions madecrowds and other visual obstructions madefinding key areas difficult finding key areas difficult ……



New EquipmentNew Equipment Fanny Packs - for primary triageFanny Packs - for primary triage

Gloves & eye protection (agency)Gloves & eye protection (agency) Bandage shearsBandage shears AirwaysAirways Dressings & clingDressings & cling



New EquipmentNew Equipment Fanny Packs - for primary triageFanny Packs - for primary triage

NOTE - Triage treatment limited to:NOTE - Triage treatment limited to: Establishing airwayEstablishing airway Stop major bleedingStop major bleeding



New EquipmentNew Equipment Tape Dispenser - for primary triageTape Dispenser - for primary triage

Tie tape to patientTie tape to patient Tear off end for your pocketTear off end for your pocket (pocket tags give Black-Red-Yellow (pocket tags give Black-Red-Yellow

totals)totals)



New EquipmentNew Equipment Clipboards & FormsClipboards & Forms

* responsibility of each agency* responsibility of each agency



New EquipmentNew Equipment

Ideally for every first-response vehicleIdeally for every first-response vehicle


Part 5 - TTX Scenarios



RULES of PLAYRULES of PLAY Real conditionsReal conditions Accelerated timeAccelerated time Respond based on instructionsRespond based on instructions Instructors will do injectsInstructors will do injects



Scenario #1 Scenario #1 Key PointsKey Points

5 S5 S’’ss StagingStaging Rig placementRig placement Transport flowTransport flow



Initial Actions: 5-SInitial Actions: 5-S’’ss Scene Safety SweepScene Safety Sweep Scene Size-upScene Size-up Send InformationSend Information Scene Set-upScene Set-up STARTSTART



How did we do?How did we do? 5 S5 S’’ss StagingStaging Rig placementRig placement Transportation flowTransportation flow




Triage vs.Triage vs.Transport orderTransport order

SectoringSectoring Supply CacheSupply Cache

Skywalk Collapse






How did we do?How did we do? Triage vs. Transport orderTriage vs. Transport order SectoringSectoring Supply CacheSupply Cache




OngoingOngoingincident, largeincident, largeno. victimsno. victims

Supply cacheSupply cache Out of areaOut of area

resourcesresources






How did we do?How did we do? Ongoing incident, large numberOngoing incident, large number

of victimsof victims Supply cacheSupply cache Out of area resourcesOut of area resources

Unified Command Unified Command Initial Actions: 5-SInitial Actions: 5-S’’ss Communication Plan Communication Plan START & JumpSTARTSTART & JumpSTART Think BIG Think BIG

Be visible - wear vests Be visible - wear vests Drive-thru vehicle flow Drive-thru vehicle flow Establish supply cache Establish supply cache Order round trips Order round trips Rendezvous points Rendezvous points

Summary - some key points

Questions ?Questions ?


Please complete thePlease complete the

Course EvaluationCourse Evaluation

Tri-County Emergency Medical Control AuthorityDistrict 1 Regional Medical Response Coalition

Congratulations!Congratulations!andand

Thank YouThank You

Comprehensive Emergency Management Associates- CEMA -

Email: [email protected]: www.cema.biz

Documents

Mass Casualty Incidentstcemca.org/wp-content/uploads/2018/04/TCEMCA_MCI.pdf · 2001 Ameritech Haz-mat, 75 triaged, 28 transported 2001 MVA GR&GR, Lansing, 7 triaged, 6 transported