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Region XRegion XMultiple Patient Management Multiple Patient Management
PlanPlan
20082008
An accident has An accident has occurred. occurred.
Rescue crews arrive on Rescue crews arrive on the scene.the scene.
The patients may all require transportation to a The patients may all require transportation to a hospital, hospital,
but sometimes there are simply too many patients but sometimes there are simply too many patients
to be cared for at a single facility.to be cared for at a single facility.
The revised Region X Multiple Patient Management Plan offers clear guidelines for the transportation
of multiple patients.
Effective May 1, 2008
Region X
MULTIPLE PATIENT MANAGEMENT PLAN
Last Revised – April 2008(Formerly known as: Region X Multiple Victims and Mass Casualty
Plan)
The purpose of the plan is to safely move The purpose of the plan is to safely move patients from the field to the most appropriate patients from the field to the most appropriate
hospital in an efficient and cooperative manner.hospital in an efficient and cooperative manner.
A Brief Review A Brief Review of the Basicsof the Basics
There are overone million peopleliving in Region X.
REGION X
POD HOSPITAL
RESOURCE HOSPITAL
ASSOCIATE HOSPITAL
A pre-established communication system links allof the hospitals located within Illinois.
ILLINOIS DEPARTMENT OF PUBLIC HEALTH (IDPH)
MABAS
MABAS stands for Mutual Aid Box Alarm System.
Illinois is a national leader in pre-established agreements between
fire departments.
Many other states are followingtheir example.
Region X
Divisions I, III, and IVare located within
Region X
INCIDENT MANAGEMENT
SYSTEM ORGANIZATION
The The RevisedRevised Plan Plan
The revised plan is presented in an improved
format.CLASS 1CLASS 1 CLASS 2 CLASS 3CLASS 3 EMERGENT EVACUATIONEMERGENT EVACUATION
OF AOF A
HEALTHCARE FACILITYHEALTHCARE FACILITY
DefinitionDefinition
Initial Initial CommunicatioCommunicatio
nn
Initial Initial InformationInformation
Patient Patient DisbursementDisbursement
Triage TagsTriage Tags
Triage MethodTriage Method
Ambulance to Ambulance to Hospital Hospital
CommunicatioCommunicationn
Patient Care Patient Care ReportsReports
This Patient Management This Patient Management Plan is based on four Plan is based on four
different different classesclasses.. Class 1Class 1 Class 2Class 2 Class 3Class 3
DefinitionDefinitionAble to meet Able to meet
normal level of normal level of care. care.
Unable to Unable to meet normal meet normal level of care.level of care.
NOTE: Box Alarms NOTE: Box Alarms may be activatedmay be activated
OverwhelminglOverwhelmingly unable to y unable to
meet normal meet normal level of carelevel of care
NOTE: May require NOTE: May require EMS Sections or EMS Sections or
on-scene treatment on-scene treatment
areasareas
EMERGENTEMERGENTEVACUATIONEVACUATION
OF OF
HEALTHCAREHEALTHCARE
FACILITYFACILITY
Note that the line between the third and fourth columns
is darker
‘Business as Usual’
The specifics for each class are The specifics for each class are clearly identified in a table clearly identified in a table
format.format. 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
Com
mun
icat
ion
Contact closest hospital
State: “WE ARE ON THE SCENE OF A CLASS 1
MULTIPLE PATIENT INCIDENT”
Contact Resource Hospital
State: “WE ARE ON THE SCENE OF A CLASS 2
MULTIPLE PATIENT INCIDENT”
Contact Resource Hospital
State: “WE ARE ON THE SCENE OF A CLASS 3
MULTIPLE PATIENT INCIDENT”
Contact Resource Hospital
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
Event description Estimate # pts. Estimate patient acuities
(Use RED, YELLOW, GREEN) Closest Hospitals
Event description Estimate # pts. Estimate patient acuities
(Use RED, YELLOW, GREEN) Closest Hospitals
Event description Estimate # pts. Closest hospitals Possible alternative receiving
facilities
Pat
ient
D
isbu
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
T
ags
Triage tags not used
Triage tags MUST be used
Triage tags MUST be 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
bula
nce
to
Hos
pita
l C
omm
unic
atio
n Every transporting ambulance contacts their receiving hospital with abbreviated report
State:
“WE ARE TRANSPORTING FROM A MULTIPLE PATIENT INCIDENT”
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 C
are
Rep
orts
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)
Classifying an Incident
During a Class 1 Multiple Patient Incidentfield providers are able
to provide their‘normal level of care’.
A few areas make Class 1 unique.
Hospitals MAY NOTdivert ambulances
transporting from a multiple patient incident.
CLASS 1
In a Class 1 IncidentEMS providers
now contact theirCLOSEST HOSPITAL
CLASS 1
Def
initi
on
Able to meet normal level of care
Initi
al
Com
mun
icat
ion
Contact closest hospital
State: “WE ARE ON THE SCENE OF A CLASS 1
MULTIPLE PATIENT INCIDENT”
Initi
al
Info
rmat
ion
Event description Specific # patients Specific patient categories Closest appropriate hospitals
Patie
nt
Dis
burs
emen
t
After conferring with closest hospital, transport agreed upon # of patients to that hospital
Disburse no more than two patients to each remaining hospital
If it is determined that more than two patients desire transport to the same hospital the closest hospital will confirm with desired hospital(s) prior to transport.
Communicate remaining patients’ destinations to closest hospital
Tri
age
T
ags
Triage tags not used
Tri
age
Met
hod
Use rapid assessment to identify patient category
Am
bula
nce
to
Hos
pita
l C
omm
unic
atio
n Every transporting ambulance contacts their receiving hospital with abbreviated report
State:
“WE ARE TRANSPORTING FROM A MULTIPLE PATIENT INCIDENT”
Pt C
are
Rep
orts
Complete patient care reports as usual
‘Business as Usual’
IN REVIEWIN REVIEW::
Contacting the Contacting the closestclosest hospital during a Class 1 incident to hospital during a Class 1 incident to discuss patient disbursement is a new approach in Region X.discuss patient disbursement is a new approach in Region X.
In the past….In the past….
EMSEMS
Resource HospitalResource Hospital
Receiving HospitalsReceiving Hospitals
Resource HospitalResource Hospital
EMSEMS
Now….Now….
EMSEMS
ClosestClosest HospitalHospital
‘Business as Usual’
CLASS 1
1
2
3
REGION X: CLASS 1 ACTIVATION
CLASS 1
Def
init
ion
Able to meet normal
level of care
Init
ial
Com
mun
icat
ion
Contact closest hospital
State: “WE ARE ON THE SCENE OF A
CLASS 1 MULTIPLE PATIENT
INCIDENT”
Init
ial
Info
rmat
ion
Event description Specific # patients Specific patient categories Closest appropriate hospitals
Pat
ient
Dis
burs
emen
t
-After conferring with closest hospital, transport agreed upon # of patients to that hospital -Disburse no more than two patients to each remaining hospital. -If it is determined that more than two patients desire transport to the same hospital the closest hospital will confirm with the desired hospital(s) prior to transport. -Communicate remaining patients’ destinations to closest hospital
Am
bula
nce
to H
ospi
tal
Com
mun
icat
ion
Every transporting ambulance contacts their receiving hospital
with 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 III
Other simple trauma Transport to closest hospital(s)
Other simple medical
2/11/08
This is the most unique addition to the Region X plan.
‘Business as Usual’
Occasionally, situations may arise during a Class 1 incident when field personnel want to
take more than two patients to the same hospital.
Two patients in this carhave been classified
as Category I trauma patients.
Three patients in this carhave been classified as
Category III trauma patients. They are a mother and two
small children.
Two PatientsBoth Category I Trauma Patients
LEVEL TWOTRAUMA CENTER
LEVEL ONETRAUMA CENTER
8 min 15 min
What if…EMS is on the scene of a auto accident with two Category 1
trauma patients.
A Level Two is 8 minutes away.A Level One is 15 minutes away.
WHICH HOSPITAL SHOULDBE CONTACTED BY FIELD PERSONNEL?
CLASS 2
During a Class 2 Multiple Patient Incident,
field providers are UNABLE to meet their ‘normal level of care’.
In a Class 2 Incident,EMS providers contact their
RESOURCE HOSPITAL.
Because resources and information will likelybe limited, providersgive the hospital an estimated number of
patients and their levels of acuity.During a Class 2 Incident,
providers will communicateto their Resource Hospital using
traditional triage colorsof red, yellow and green
based on the START Triage Method.
CLASS 2
Def
init
ion
Unable to meet normal level of care
Note: Box Alarms may be activated
Init
ial
Co
mm
unic
atio
n
Contact Resource Hospital
State: “WE ARE ON THE SCENE OF A
CLASS 2 MULTIPLE PATIENT INCIDENT”
Initi
al
Info
rmat
ion
Event description Estimate # pts. Estimate patient acuities
(Use RED, YELLOW, GREEN) Closest Hospitals
Pat
ient
Dis
burs
emen
t
Resource Hospital coordinates
transportation destination of patients
Tri
age
Tag
s Triage tags MUST be used
Tri
age
Met
ho
d START Triage
Am
bula
nce
to
Ho
spit
al
Co
mm
unic
atio
n
NO CONTACT BETWEEN TRANSPORTING AMBULANCE
AND RECEIVING HOSPITAL
Pt
Car
e
Rep
ort
s Complete patient care reports as usual
It is important to compare the difference in It is important to compare the difference in communication between Class 1 and Classes 2 communication between Class 1 and Classes 2
or 3.or 3.
CLASS 1 CLASSES 2 and 3
FIELD COMMAND
RESOURCEHOSPITAL
POTENTIALRECEIVING HOSPITALS
RESOURCEHOSPITAL
FIELD COMMAND
CLOSEST HOSPITAL
‘Business as Usual’
SCENE COMMAND
Communication StructureClass 2 and Class 3
RESOURCE
CLASS 3
During a Class 3 Multiple Patient Incident
responders are OVERWHELMINGLYunable to meet the
‘normal level of care’. The POD Hospital may be activated
for assistancewith communication
Transporting ambulanceswill not have any
communication withreceiving hospitals.
NO PATIENTCARE REPORTS
CLASS 3
Def
initi
on
Overwhelmingly unable to meet normal level of care
Note: May require EMS Divisions or
on-scene treatment areas
Initi
al
Com
mun
icat
ion
Contact Resource Hospital
State: “WE ARE ON THE SCENE OF A CLASS 3
MULTIPLE PATIENT INCIDENT”
Initi
al
Info
rmat
ion
Event description Estimate # pts. Estimate patient acuities
(Use RED, YELLOW, GREEN) Closest Hospitals
Pat
ient
D
isbu
rsem
ent Resource Hospital coordinates
transportation destination of patients POD Hospital may be activated for
assistance with communication and additional resources
Tri
age
T
ags
Triage tags MUST be used
Tri
age
Met
hod
START Triage
Am
bula
nce
to
Hos
pita
l C
omm
unic
atio
n NO CONTACT BETWEEN
TRANSPORTING AMBULANCE AND RECEIVING HOSPITAL
Pt
Car
e R
epor
ts
No patient care reports (Triage Tags serve as written report)
A Class 3 incident could involve an A Class 3 incident could involve an enormousenormous number of patients. number of patients.
Outdoor Concert Amusement Park
Political Rally College Stadium
EMERGENT EVACUATIONOF
HEALTHCARE FACILITY
D
efin
itio
n
EMERGENT EVACUATION OF A
HEALTHCARE FACILITY (PATIENTS REQUIRING MEDICAL CARE)
Init
ial
Com
mun
icat
ion
Contact Resource Hospital
State: “WE ARE ON THE SCENE OF AN EMERGENT EVACUTATION OF
A HEALTHCARE FACILITY”
Init
ial
Info
rmat
ion
Event description Estimate # pts. Closest hospitals Possible alternative receiving
facilities
Pat
ient
D
isbu
rsem
ent
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
T
ags
Triage tags MUST be used
Tri
age
Met
hod
Within facility use REVERSE TRIAGE Prior to transport use START TRIAGE
Am
bula
nce
to
Hos
pita
l C
omm
unic
atio
n NO CONTACT BETWEEN
TRANSPORTING AMBULANCE / PATIENT TRANSPORTATION
VEHICLE AND RECEIVING FACILITIES
Pt C
are
Rep
orts
No patient care reports
(Triage Tags serve as written report)
It is important to includethe administration ofthe facility in making
some decisions.
Note the different types of triage.
Charity HospitalNew Orleans
WHAT IS REVERSE TRIAGE?
A small fire occurs in theelectrical room of a large
hospital. Only a few patients havebeen injured, but the hospital
needs to be evacuated.
Patients that are able to exit the building on their own are removed first.
Patients that require assistance in a wheelchair
are next.
Patients that are extremely ill and require intensive manpower to move are
moved last.
As the patients arrive at a collection area, the process is reversed.
The most critical patients are transported first.
The patients requiring a moderateamount of care are sent next.
Patients requiring minimal medicalcare leave the facility last.
Typical Scenario:‘EMERGENT EVACUATION OF A
HEALTHCARE FACILITY’
Hospitals
Community Center
Alternate Nursing Home
Patients injured in fire.
Ambulatory nursing homeresidents not affected by fire.
Bed-ridden nursing homeresidents not affected by fire.
A FIRE OCCURSIN ONE WING
OF A NURSING HOME
Region X Disaster Management Service Committee (DMSC)
MULTIPLE PATIENT INCIDENT AFTER ACTION REPORT
Policy: All hospitals and fire departments involved in the Region X Multiple Patient Plan are to
complete this report following any incident or scheduled multiple patient drill. Purpose: This form will be utilized for post-incident critiques by the Region X DMSC with the
intent of continually reviewing and improving the multiple patient plan as well as to enhance the education of fire/rescue, hospital and communication personnel.
PRE-HOSPITAL: (This section should be completed by pre-hospital personnel) Date of incident: __________________ Time:_____________ Class: 1 2 3 Type of incident: _________________________________________________________ Primary Fire/Rescue Agency: _______________________________________________ Total # of patients: __________ #Red:_____ #Yellow:_____#Green:_____#Black:_____ Life Safety Box Implemented? Yes No Number of ambulances: ______________ Multiple patient plan initiated? Yes No Multiple patient plan initiated? Yes No Resource Hospital involved? Yes No Name: ____________________________ List receiving hospitals:____________________________________________________ Comments:______________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ HOSPITAL: (This section should be completed by hospital personnel) Date of incident:_____________________________ Time:___________________ Type of incident: _________________________________________________________ How were you contacted?__________________________________________________ Multiple patient plan initiated: Yes No Internal disaster plan initiated? Yes No Resource Hospital involved? Yes No Hospital:___________________________ Number of patients received at your hospital? __ #Red:__#Yellow:__#Green:__#Black:_ Comments:______________________________________________________________ ________________________________________________________________________ _______________________________________________________________________ Report submitted by: Name________________________________ Agency______________________________ Address______________________________ ______________________________ Date_________________________________ Please send original to the EMS System Coordinator of your Resource Hospital.
Rev: 2/08
An After-Action Report should be generated following any activation of the
Region X Multiple Patient Plan.
A copy of this formis found in the
plan.
TRIAGETRIAGE
The State of Illinois has adopted the START The State of Illinois has adopted the START triage method in partnership with the SMART® triage method in partnership with the SMART®
Incident Command System as a state-wide Incident Command System as a state-wide standard.standard.
SMART® Tags to be used when
doing START Triage.
START TRIAGESTART TRIAGEPRIMARY TRIAGEPRIMARY TRIAGE
ADULTS
Pediatric Patients Under 32 kg
RED Light Sticks are found in each pack to visually
identify critical patients in a dark environmental
SECONDARY TRIAGESECONDARY TRIAGE
All ambulances in Illinois have All ambulances in Illinois have receivedreceived
a SMART® Triage Pack.a SMART® Triage Pack.
Components of the Triage Pack:
• Folding SMART® Triage Tags• Mini-light sticks to identify RED patients at night• DEAD tags• SMART® Tape (to prioritize injured or sick children up to 32 kg)• Triage prompt card (to prioritize adults)• Dynamic record of casualties already triaged• Pencil
SMART® equipment is also being SMART® equipment is also being given given
to hospitals, fire departments and to hospitals, fire departments and MABAS Divisions.MABAS Divisions.
Command BoardSMART®® MCI Bag
Includes:-Four SMART Triage Packs
-One SMART Command Board
The Region X Multiple Patient Plan The Region X Multiple Patient Plan includes other important includes other important
information.information. Summary of O’Hare Disaster PlanSummary of O’Hare Disaster Plan Summary of State Disaster PlanSummary of State Disaster Plan Summary of National Disaster PlanSummary of National Disaster Plan Training guidelinesTraining guidelines Guidelines for sending medical Guidelines for sending medical
personnel to the scene of a disasterpersonnel to the scene of a disaster Post-incident recovery services (CISM)Post-incident recovery services (CISM) After-action Report FormsAfter-action Report Forms Hospital / Field log forms (template)Hospital / Field log forms (template)
Putting the Plan to Putting the Plan to WorkWork
ScenariosScenarios
REGION X: CLASS 1 ACTIVATION CLASS 1
Def
init
ion
Able to meet normal
level of care
Init
ial
Com
mun
icat
ion
Contact closest hospital
State: “WE ARE ON THE SCENE OF A
CLASS 1 MULTIPLE PATIENT
INCIDENT”
Init
ial
Info
rmat
ion
Event description Specific # patients Specific patient categories Closest appropriate hospitals
Pat
ient
Dis
burs
emen
t
-After conferring with closest hospital, transport agreed upon # of patients to that hospital -Disburse no more than two patients to each remaining hospital. -If it is determined that more than two patients desire transport to the same hospital the closest hospital will confirm with the desired hospital(s) prior to transport. -Communicate remaining patients’ destinations to closest hospital
Am
bula
nce
to H
ospi
tal
Com
mun
icat
ion
Every transporting ambulance contacts their receiving hospital
with 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 III
Other simple trauma Transport to closest hospital(s)
Other simple medical
2/11/08
OR
‘Business as Usual’
Truck Driver:57 year old male
Complains of Chest Pain prior to accidentDenies trauma, able to ambulate
Pale, cool and diaphoretic Respirations = 32/min
Car #1 - Driver25 year old male
Ambulatory at the sceneAir bags deployed / seat belt worn
Complains of wrist pain with deformityCar #2 – Driver
84 year old maleUnresponsive, Respirations = 24/min
Bilateral femur fractures
Car #2 – Passenger82 year old female
Laceration to foreheadRespirations = 32/min
Deteriorating mental status
-What Class?-Which hospital do you call?-Where should the patients be transported? -Specifics
1
The owner of this house has calledto report that he returned home from work to find his family unresponsive
and his carbon monoxide alarm going off.
• Patient #1: 50 year old unresponsive female
• Patient #2: 20 year old unresponsive female
• Patient #3: 17 year old unresponsive male
• Patient #4: 16 year old unresponsive female
•Patient #5: 15 year old unresponsive male
-What Class?-Which hospital do you call?-Where should the patients be transported? -Specifics
2
10-12 patients
4 Red5 Yellow
1-3 Green
All adults – All trauma patients
-What Class?-Which hospital do you call?-Where should the patients be transported? -Specifics
3
This picture is a simulation.
Patient #2: 20 year old maleUnresponsive
Thrown from a vehicle
Patient #1: 24 year old maleAmbulatory at the scene
Driver of this carAppears stable
Patient #4: 18 year old femaleBack seat passenger - restrained
Unresponsive
Patient #3: 18 year old maleFront seat passenger – unrestrained
Unresponsive-What Class?-Which hospital do you call?-Where should the patients be transported? -Specifics 4
An earthquake has occurred in Illinois. This building is located in
Region X and contained over 100 people.
Many other buildings have been damaged.
-What Class?-Which hospital do you call?-Where should the patients be transported? -Specifics
The New Madrid Fault line runs throughIllinois. An 1811 earthquake involving this fault line was the most destructive in U.S.
history. The Mississippi River actuallyran backwards. Some researchers contend
that a ‘mega-quake’ of this faultis long overdue.
5
6
-What Class?-Which hospital do you call?-Where should the patients be transported? -Specifics
Patient #1: Driver 18 year old male
UnresponsiveStill restrained
Patient #2: Front Seat Passenger18 year old female
Crying in painOpen Skull Fracture
Patient #1: DriverFATAL INJURY
(in accordance with Region X guidelines)
No transport
Patient #3: Front Seat PassengerThrown from vehicle
Unresponsive
Patient #2: Back Seat PassengerStill restrained
Denies ComplaintsNo trauma noted
-What Class?-Which hospital do you call?-Where should the patients be transported? -Specifics
7
8
This is a small nursing home.Eight elderly people and two
caregivers live here.
It is 2:30 a.m.
The temperature is below zero.
-What Class?-Which hospital do you call?-Where should the patients be transported? -Specifics
QUESTIONS?
We welcome your questions:
Jill Ramaker, RN, EMT-PChairman – Region X DMSC
EMS Coordinator, Evanston Hospital 847-570-2166
