King County MCI Tasks & Tactics

Goals of the Revised Plan County wide plan that was not a lesson plan Reduce choke points and unnecessary actions Streamline efforts and utilize procedures that are used every day A plan that is scalable and flexible A plan that is utilized and followed by all zones in King County

Noticeable Changes Elimination of formal funnel points Elimination of treatment tags Changes to how patients are tracked Elimination of patient numbering County wide MCI designators Hospital Control is now Disaster Medical Control Center (DMCC)

Changes

Changes

What defines an MCI A mass casualty incident (MCI) is any incident in which emergency medical services personnel and equipment at the scene are overwhelmed by the number and severity of casualties at that incident

What you need to know to wear a vest Don the vest Understand the Incident Objective Know the vest that you are adjacent to Provide progress reports Manage and request resources

First Arriving Officer Unit signature The location, or corrected location Initial basic impression Cause, if known This is the window survey

Scene Size Up Brief scene impression including known hazards Level of PPE Estimated total number of patients Establish the command designator and command post location Initial company assignments Designate the transportation corridor Base and staging locations Decide complex or not This is after your boots have hit the ground

Transportation Corridor One of the most important initial tasks determined by the first in officer Must be clearly communicated early to next in companies If the first in officer cannot establish the transportation corridor then the next in unit should take that responsibility Turn the corridor over to law enforcement when applicable

Incident Commander Is responsible for directing and/or controlling resources by virtue of explicit legal, agency, or delegated authority The IC is responsible for all aspects of the response, including developing incident objectives and managing all incident operations

Incident Commander Incident Commander

Recon Will be incident driven Advanced scene size up Will perform a 360 of the event Should identify: Equipment needs Estimated number of patients Hazards Cause of the incident Any physical barriers that may divide the incident, or prevent ingress or egress This is for a bigger incident where this information could not be obtained by the first in officer

Recon Incident Commander Operations Recon

Medical Group Should be assumed by a senior ALS member Responsible for: Transport Treatment Triage Activation of the DMCC Green Patient Management It needs to be noted that the MGS may or may not fill the roll of some or all of these rolls depending on the event

Medical Group Incident Commander Operations Recon Medical Group

Triage Will report to Medical in smaller incidents and Rescue if the situation dictates Will triage patients based on King Counties “Sick/Not Sick” guideline Triage can be accomplished by a Triage Team, Extraction Team, or after safely leaving the area It is understood that triage is fluid and dynamic and can change frequently Emphasize that triage may not be a formal

Types of Triage ABC (per King County EMT protocol) RPM Sacco START Red / Not Red

Triage County model of Sick vs. Not Sick Allows rescuers to use the same triage mechanism that they use every day Sick = Red Not Sick = Yellow

Treatment Identifies appropriate treatment areas Populates the treatment area appropriately Supervising treatment of all pt’s Responsible for re-triaging pt’s as necessary Coordinating with Transport Prioritizing pt’s for transport Apply the tracking band if time allows Assigning a paramedic to retriage once the pt makes it into the tx area

Treatment for Larger Incidents Assign a Red Treatment Leader Assign a Yellow Treatment Leader Request resources from Medical Monitor and request medical supplies

Treatment Incident Commander Recon Operations Medical Group Treatment Red Unit Leader Yellow Unit Leader

Transportation Reports directly to Medical Group Communicates directly with the DMCC Ultimately responsible for patient tracking Works with law enforcement liaison to keep the transportation corridor clear Responsible for Ambulance Staging Works directly with Treatment to coordinate patient transport

Transportation for Larger Incidents Assign an Ambulance Staging Manager Assign an Ambulance Loading Manager Assign a DMCC coordinator Assign a patient tracking aide Request resources from Medical

Ambulance Staging Manager Best staffed by an Ambulance Supervisor Should be given a radio Needs to remain in contact with Ambulance Loading or Transport Supervisor

Ambulance Loading Manager Coordinates the loading of transport vehicles Should be close to the treatment area to minimize the distance of patient movement

DMCC Coordinator Only injury pattern that needs to be communicated is burns, OB trauma, and if applicable, pediatric patients Do not give individual patient status, let them know what is loaded in the back of the transporting unit

Tracking Ensures that all patients have a tracking band All transport capable vehicles in King County will have two packs of 25.

Tracking Will place a tracking sticker on a tracking board All MSO’s and Medic units will have tracking sheets

Tracking Instruct all transporting personnel to place a tracking sticker on the portion of the MIRF that will stay with the hospital

Transport Incident Commander Recon Operations Medical Group Treatment Transport Ambulance Staging Ambulance Loading DMCC Coordinator Tracking Aide

Green Patient Area Manager Incident driven, 1 green pt or multiple green pts Needs to be away from the working incident Needs to have someone with medical authority to re-evaluate pt’s as needed Coordinate to get pts to the hospital as needed Liaison with law enforcement Ensure patient tracking Who should this person be in contact with to ask for transportation to the hospital if needed?

Medical Org Chart Incident Commander Operations Recon Medical Group Treatment Transport

Rescue Reports directly to operations Should secure their own radio channel Is responsible for overseeing extraction, extrication, and triage in larger incidents Responsible for requesting and releasing resources as needed

Rescue Incident Commander Operations Recon Medical Group Rescue

Extraction Mobilization of pt’s to the treatment area Extraction teams may also be assigned to triage Extraction teams should manage pt care during movement

Extraction Incident Commander Recon Operations Rescue Medical Group

Extrication Responsible for the physical disentanglement of patients Utilizes physical rescue tools

Extrication Incident Commander Operations Recon Medical Group Rescue Extraction Extrication

Growing Incident Incident Command Finance Planning Logistics Operations Medical Treatment Yellow Unit Red Unit Transport Ambulance Staging Ambulance Loading DMCC Coordinator Tracking Aide Rescue Extraction Extrication Triage Hazard Mitigation Decon Haz Mat Fire Recon