King County MCI Plan 2011 Updates Batt Chief Marty La Fave Bellevue Fire Department

A Review of Mass Casualty Management Company Officer: First five minutes MCI Plan: New Changes Division of Labor: Groups and Units

Initial Size-up Phase 1 Look for SLUDGE Identify immediate hazards Consider access/egress options Observe base/staging options Estimate number of patients

More Size-up Phase 2 Estimate number of non-ambulatory patients Consider extrication/relocation issues Scene status: Static or Dynamic? Decide: Complex…not complex

No SLUDGE No Fire, stable scene Southbound lanes open Overpass intact Patients walking around 6-10 Reds Simple extrication Static scene

Commanding the radio Provide size-up Initiate command Initial assignments Safety & handline Triage Treatment Request “base” resources Request “transport” resources

Requesting Resources Basic MCI Activities Complex Activities Rescue/Extrication Treatment/Transport Ambulance staging Complex Activities Fire Hazard Material CBRNE Collapse

Maintain the Transportation Corridor!

Physical Actions of the First-in Crew Engine/Ladder Company Recon / Risk Assessment Mitigate immediate high risks Secure Transportation Corridor Begin Triage Direct movement of “Green” Walking wounded Implement Rescue Group Medic Units/MSO Decide: Patient or Scene mgmt Medical Group Treatment Unit Transport Unit

Revised 2011 MCI Plan: WHY? Reduce choke points Suspend unnecessary actions Improve division of labor Increase plan scalability for all events Simplify patient tracking Align plan with NIMS Concepts

MCI Changes at a glance Develop “Rescue Group” to move patients Eliminate formal funnel point Eliminate use of treatment tags Elimination of patient numbering (felt pen) NIMS Terms: Hospital Control is now Disaster Medical Control Center (DMCC)

Changes

Changes

The Previous MCI Plan COMMAND MEDICAL GROUP TRIAGE TREATMENT TRANSPORT

Typical MCI Org Chart 2011 COMMAND RESCUE GROUP EXTRACTION UNIT EXTRICATION UNIT MEDICAL GROUP TREATMENT UNIT TRANSPORT UNIT GREEN UNIT

Are you doing the job…or leading it?

Unit Leader/Group Supervisor Don the vest Understand Action Plan Determine supervisors role Develop organization Develop relationships Maintain accountability Provide progress reports

So, who does Triage? Rapid Field Triage -BLS Minimal Treatment Who Supervises Triage: Medical Group Rescue Group Secondary Triage – ALS

Current Triage Systems First Order Second Order START ABC Sick/Not Sick Jump START Triage Sieve (UK) Triage Sort (UK) SAVE (Secondary Assessment of Victim Endpoint) Those who will die anyway Those who will survive anyway Move only those who will have a condition change

Treatment Unit Locate suitable area Secure supplies Develop treatment teams Determine transport priorities

Treatment Unit Reasons for a Treatment Area Visual indicator for injured No transportation available Immediate life-saving treatment Move the reds, hold others Assure appropriate treatment Use Aid/Medic Units for supplies Prioritize patients for transport Use a “Treatment Dispatch Manager” Benchmarks: All reds transported All patients transported

Expanding the Treatment Unit Treatment Unit Leader Red Manager Yellow Manager Treatment Dispatch Manager

Transport Unit Assure DMCC activation Establish Ambulance Staging Confirm transporting resources are inbound Coordinate patient loading Track Destinations

Transportation Unit Apply patient trackers Communicate with DMCC Receive patient destination Manage documentation Benchmarks: All reds transported All patients transported

Tracking All transport capable vehicles in King County will have tracking bands Typically applied at the ambulance loading or DMCC activity area. Ensures that all patients have a tracking band

Tracking Retain one peel-off sticker on a tracking board All MSO’s and Medic Units will have tracking sheets Tracking sheets allow for sticker or Barcode tracking

Tracking Instruct all transporting personnel to place a tracking sticker on the portion of the MIRF that will stay with the hospital. The transporting agency will also retain one sticker

Expanding the Transport Unit Transport Unit Leader Ambulance Staging Manager Coordinator DMCC Ambulance Loading Manager Tracking Aide

Rescue Group/Unit Disentanglement Moves all patients to Treatment area Personnel Intensive May report to Medical or Operations May provide field triage

Expanding the Rescue Group Extrication Unit Extraction

Expanding the Medical Group Treatment Unit Transport Unit Green Patient Unit

Incident Command Operations Medical Treatment Yellow Unit Red Unit Dispatch Manager Transport Ambulance Staging Ambulance Loading DMCC Coordinator Tracking Aide Green Patients Rescue Extraction Extrication Hazard Mitigation Decon Haz Mat Fire Recon Safety PIO Liaison

Summary of Key Points for MCI Secure the transport corridor Keep transport units staged separately Medics focus on Medical/Treatment/Transport Early notification of DMCC Suppression focus on Rescue/Extraction Perform secondary triage before transport Separate loading from DMCC activities

Questions?