Multiple Casualty Incident Manual Treatment Dispatch Manager Northern Virginia Multiple Casualty Incident Manual Module-6 Treatment Unit Leader Treatment Area Manager(s) Treatment Dispatch Manager Welcome to the Northern Virginia EMS Multiple Casualty Incident Management Manual Training Series – Module 6 - Functions of the Treatment Unit Leader, Treatment Area Managers and the Treatment Dispatch Manager.

Treatment Dispatch Manager Medical Group Treatment Unit Leader Treatment Area Manager(s) & Treatment Dispatch Manager Within an established EMS Branch operating on an MCI Incident – The Treatment Unit Leader, the IMMEDIATE, DELAYED and MINOR Treatment Area Managers and the Treatment Dispatch Manager all serve within the MEDICAL GROUP.

You’ll recall that once primary TRIAGE of the patients has been completed, a sufficient number of porters are immediately assigned to effect delivery of patients into each of the designated patient TREATMENT AREAS. From there, SECONDARY TRIAGE is performed and patients are provided appropriate pre-hospital EMS treatment by ALS and BLS providers. Patient transport priorities are then assigned for patients and communicated to the TRANSPORTATION GROUP who will facilitate patient transport to definitive care at an appropriate hospital receiving facility.

Let’s first review the role and key responsibilities of the assigned TREATMENT UNIT LEADER…

Usually first arriving EMS Transport Unit until relieved Reports to Medical Group Supervisor and supervises Treatment Managers and Treatment Dispatch Manager Assumes responsibility for : Treatment Preparation for transport Coordination of patient treatment in treatment areas Directing movement of patients to loading locations The TREATMENT UNIT LEADER is usually the AIC of the first arriving EMS transport unit, and will report directly to the MEDICAL GROUP SUPERVISOR. The TREATMENT UNIT LEADER is responsible for patient treatment and preparation for transport from each of the designated TREATMENT AREAS.

The TREATMENT UNIT LEADER utilizes #2 Company Level Workboard to organize and track the progress of overall activity and completion of essential tasks within each of the designated patient TREATMENT AREAS.

Review common responsibilities Review Unit Leader responsibilities Locate large, suitable treatment area and report location to next higher level of supervision as well as to Triage and Transportation Unit Leaders Direct and supervise Treatment Dispatch, Immediate, Delayed, and Minor Treatment areas The TREATMENT UNIT LEADER must identify and announce a safe and suitable area appropriate to the number of patients being treated. Known or suspect incident hazards, the number of patients, landscape, ingress and egress, and ongoing incident mitigation efforts should all be considered when deciding on the most suitable location for each of the patient TREATMENT AREAS.

Establish communications and coordination with Patient Transport Group Coordinate movement of patients from triage area to treatment areas with Triage Unit Leader Establish communications and coordination with Patient Transport Group Ensure continual triage of patients, documentation and tagging of patients as needed throughout treatment areas Direct movement of patients to ambulance loading area (s) Give periodic status reports to appropriate supervisor The TREATMENT UNIT LEADER shall coordinate early and often with the TRIAGE UNIT LEADER to facilitate the safe and effective movement of patients into the TREATMENT AREA and to make an early, appropriate request for any additional patient care resources needed at the incident scene. The TREATMENT UNIT LEADER is also responsible for coordinating with the assigned TRANSPORTATION GROUP SUPERVISOR to successfully move treated patients out of the patient TREATMENT AREAS and on to awaiting transport units.

Obtain Company Level Officer Command board (#2). Establish position in ICS and identify visually with donning appropriate vest and verbally on radio. Obtain Company Level Officer Command board (#2). Identify and establish Treatment Areas. Designate treatment area managers. Assign ALS /BLS personnel to treatment area: Immediate – One ALS and one BLS provider for each red tag patient in the treatment area Delayed – One ALS provider for every three yellow tag patients and one BLS provider for every yellow patient in the treatment area Minor – One BLS provider for every three green patients in the treatment area The TREATMENT UNIT LEADER shall assign TREATMENT AREA MANAGERS for each of the IMMEDIATE, DELAYED and MINOR patient TREATMENT AREAS and shall assure that adequate and appropriate EMS staffing is requested and maintained, as listed, commensurate to the number of patients being treated within each of the TREATMENT AREAS at any given time.

Notify IC of location (s) and give status report Establish communications with Triage Unit Leader Request sufficient medical caches and supplies as necessary Assess and report need for additional resources such as hospital response teams, etc. Provide access for Medical Care Support Units Establish communications with Patient Transportation Group Supervisor - Consider delegating this task to Treatment Dispatch Manager Once the TREATMENT AREA has been established, the TREATMENT UNIT LEADER shall immediately announce the location of the TREATMENT AREA, and provide the IC with all appropriate Resource and Situation Status Reports for the TREATMENT AREA. Once a TREATMENT DISPATCH MANAGER is assigned; the TREATMENT UNIT LEADER may consider delegating coordination with TRANSPORTATION GROUP to that individual.

Maintain accountability and safety of all patients Ensure no patient leaves treatment area without attached COG Disaster Tag Maintain accountability and safety of all patients Assess mental and physical well being of personnel Terminate treatment area activities and reallocate assigned resources as directed The TREATMENT UNIT LEADER shall assure that a COG Disaster TRIAGE Tag is attached to every patient leaving the TREATMENT AREA… Though an ample supply of TRIAGE TAGS is maintained in each bin of patient care supplies on the Regional MEDICAL CARE SUPPORT UNITS; the TREATMENT UNIT LEADER may consider directing placement of a tag on each patient, as they are portered into the appropriate TREATMENT AREA through a designated and visibly marked patient entry point. Each treated patient must be accounted for. Also, the TREATMENT UNIT LEADER must remember that Emergency Responders are people too… The effective TREATMENT UNIT LEADER is ever mindful of the physical and mental well being of all patient care providers working under such critical and extreme circumstances and of the necessity to effectively rotate and rehabilitate assigned crews as required.  

The IMMEDIATE TREATMENT MANAGER reports directly to the TREATMENT UNIT LEADER and is responsible for the effective and appropriate pre-hospital treatment of patients suffering severe life-threatening injuries in an MCI. Immediate Treatment Manager reports to Treatment Unit Leader and is responsible for treatment and secondary triage of patients assigned to Immediate Treatment Area.

Review common responsibilities Request or establish Medical Teams as necessary Assign appropriate patient care personnel to treat patients received in Immediate Treatment Area Ensure treatment of patients triaged to Immediate Treatment Area Ensure patients are prioritized for transportation Coordinate transportation of patients with Treatment Dispatch Manager Notify Treatment Dispatch Manager of patient readiness and priority for transportation Ensure appropriate patient information is recorded Throughout this presentation; You’ll notice that the TREATMENT MANAGERS for each patient care area possess commonly shared objectives and task responsibilities.

Ensure Treatment area is set up to accept patients Establish position in ICS and identify visually with donning appropriate vest and verbally on radio Ensure Treatment area is set up to accept patients Use personnel to assess and treat patients Obtain patient information and fill out COG disaster tag properly Re-triage and relocate patient as necessary Prioritize patients to be transported Request resources as necessary Maintain communications with Treatment Unit Leader Considerations exclusive to each of these MANAGERS will center around the number patients being cared for, the immediate and ongoing resource needs of their individual treatment area and through each of them effectively coordinating with the TREATMENT DISPATCH MANAGER to effectively deliver each treated patient to the TRANSPORTATION GROUP for transport to an appropriate hospital facility.

The DELAYED TREATMENT MANAGER reports directly to the TREATMENT UNIT LEADER and is responsible for the effective and appropriate pre-hospital treatment of less severely injured, non-ambulating patients during an MCI.   Delayed Treatment Manager reports to Treatment Unit Leader and is responsible for treatment and secondary triage of patients assigned to Delayed Treatment Area

Review common responsibilities Request or establish Medical Teams as necessary Assign appropriate patient care personnel to care for patients received in Delayed Treatment Area Ensure treatment of patients triaged to Delayed Treatment Area Ensure patients are prioritized for transportation Coordinate transportation of patients with Treatment Dispatch Manager Notify Treatment Dispatch Manager of patient readiness and priority for transportation Ensure appropriate patient information is recorded It is very important for the DELAYED AND MINOR TREATMENT MANAGERS to remain cognizant that a trauma patient’s condition may rapidly deteriorate.  

Ensure treatment area is set up to accept patients Establish position in ICS and identify visually with donning appropriate vest and verbally on radio Ensure treatment area is set up to accept patients Utilize personnel to assess and treat patients Obtain patient information and fill out COG disaster tag properly Re-triage and relocate patient as necessary Prioritize patients to be transported Request resources as necessary Maintain communications with Treatment Unit Leader Such circumstances shall require immediate patient reassessment and relocation to a more appropriate TREATMENT AREA for a higher level of patient care.

The MINOR TREATMENT MANAGER reports directly to the TREATMENT UNIT LEADER. He or she is responsible for the effective and appropriate pre-hospital treatment of lesser injured and ambulatory patients (commonly referred to as WALKING WOUNDED) during an MCI.   Minor Treatment Manager reports to Treatment Unit Leader and is responsible for treatment and secondary triage of patients assigned to Delayed Treatment Area

Review common responsibilities Request or establish Medical Teams as necessary Assign appropriate patient care personnel to treat patients received in Minor Treatment Area Ensure treatment of patients triaged to Minor Treatment Area Ensure patients are prioritized for transportation Coordinate transportation of patients with Treatment Dispatch Manager Notify Treatment Dispatch Manager of patient readiness and priority for transportation Ensure appropriate patient information is recorded Again, do not take for granted that these patients shall remain in such good shape. The MINOR TREATMENT MANAGER must consider that conscious and oriented victims absent of debilitating or distracting injury may relate and react more acutely to the scope and magnitude of the immediate incident scene. As such, these patients shall require constant observation and protection from further physical or psychological harm. It is not uncommon for such patients, if left unattended, to wander back into… or run very fast from the immediate incident scene. Again… REMEMBER…we are accountable for all patients brought into the TREATMENT AREA.

Ensure Treatment area is set up to accept patients Establish position in ICS and identify visually with donning appropriate vest and verbally on radio Ensure Treatment area is set up to accept patients Use personnel to assess and treat patients Obtain patient information and fill out COG disaster tag properly Re-triage and relocate patient as necessary Prioritize patients to be transported Request resources as necessary Maintain communications with Treatment Unit Leader Though the MINOR TREATMENT area should be positioned to allow for effective transfer of these patients to appropriate transport units, consideration must be lent to establishing and maintaining this area at a greater distance from more critically injured patient care activities and most especially from any designated morgue area.

Each TREATMENT MANAGER shall log patients received and departing their respective TREATMENT AREA on TREATMENT AREA MANAGER WORKSHEETS; utilizing the appropriate peel off tab correspondent to each patient’s COG DISASTER TRIAGE TAG.

The TREATMENT DISPATCH MANAGER reports directly to the TREATMENT UNIT LEADER and is responsible for coordinating with the TRANSPORTATION GROUP to successfully affect transfer of treated patients from the TREATMENT AREA to awaiting transport units for delivery to an appropriate hospital facility during an MCI.   Treatment Dispatch Manager reports to Treatment Unit Leader and responsible for coordinating with Transportation Group to successfully affect transportation of treated patients to appropriate receiving facilities

Review common responsibilities Establish communications with Immediate, Delayed and Minor Treatment Managers Establish communications with Medical Communications Coordinator Verify patients are prioritized for transportation Advise Medical Communications Coordinator of patient readiness and priority for dispatch Coordinate transportation of patients with Medical Communications Coordinator Ensure appropriate patient tracking information is recorded Coordinate ambulance loading with Treatment Manager and ambulance crew personnel The TREATMENT DISPATCH MANAGER coordinates directly with each of the TREATMENT MANAGERS, the MEDICAL COMMUNICATIONS COORDINATOR and TRANSPORT LOADERS to effectively determine which unit shall take which patient to which hospital receiving facility.  

Receive information from Treatment Managers Establish position in ICS and identify visually with donning appropriate vest and verbally on radio Receive information from Treatment Managers Establish and maintain communications with Medical Communications Coordinator Coordinate with Treatment Area Managers and Medical Communications Coordinator to transport patients to appropriate medical facilities Indicate hospital destination on Transport Record of COG Disaster Tag Once this determination is made; the TREATMENT DISPATCH MANAGER shall document the HOSPITAL DESTINATION on the TRANSPORT RECORD of the COG DISASTER TRIAGE TAG for each patient ready to leave the TREATMENT AREA.

The TREATMENT DISPATCH MANAGER shall log each patient’s departure time, hospital destination treatment priority and the total departing patient count from each of the respective TREATMENT AREAS on the TREATMENT DISPATCH MANAGER WORKSHEETS; again, utilizing the appropriate peel off tab correspondent to each patient’s COG DISASTER TRIAGE TAG.  

The systematic approach to multiple patient care and MCI management, as described within this presentation and in accordance with the Northern Virginia Multiple Casualty Incident Manual; will greatly assist our responders in DOING THE GREATEST GOOD FOR THE GREATEST NUMBER OF VICTIMS… WITH THE MOST APPROPRIATE RESOURCES. Thank you for your time and attention to this presentation… Please, enjoy the rest of the series.