Region X Multiple Patient Management Plan 2008

An accident has occurred.

Rescue crews arrive on the scene.

The patients may all require transportation to a hospital, but sometimes there are simply too many patients 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 patients from the field to the most appropriate hospital in an efficient and cooperative manner.

A Brief Review of the Basics

There are over one million people living in Region X. REGION X

POD HOSPITAL RESOURCE HOSPITAL ASSOCIATE HOSPITAL A pre-established communication system links all of 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 following their example. Region X Divisions I, III, and IV are located within Region X

INCIDENT MANAGEMENT SYSTEM ORGANIZATION

The Revised Plan

The revised plan is presented in an improved format. CLASS 1 CLASS 2 CLASS 3 EMERGENT EVACUATION OF A HEALTHCARE FACILITY Definition Initial Communication Initial Information Patient Disbursement Triage Tags Triage Method Ambulance to Hospital Communication Patient Care Reports

This Patient Management Plan is based on four different classes. Class 1 Class 2 Class 3 Definition 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 Sections or on-scene treatment areas EMERGENT EVACUATION OFHEALTHCAREFACILITY Note that the line between the third and fourth columns is darker ‘Business as Usual’

The specifics for each class are clearly identified in a table format.

Classifying an Incident

During a Class 1 Multiple Patient Incident field providers are able to provide their ‘normal level of care’. A few areas make Class 1 unique. Hospitals MAY NOT divert ambulances transporting from a multiple patient incident. CLASS 1 In a Class 1 Incident EMS providers now contact their CLOSEST HOSPITAL ‘Business as Usual’

IN REVIEW: Contacting the closest hospital during a Class 1 incident to discuss patient disbursement is a new approach in Region X. In the past…. In the past….EMS Resource Hospital Receiving Hospitals Resource Hospital EMS Now…. Now….EMSClosest Hospital Hospital ‘Business as Usual’

CLASS 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 car have been classified as Category I trauma patients. Three patients in this car have been classified as Category III trauma patients. They are a mother and two small children.

Two Patients Both Category I Trauma Patients LEVEL TWO TRAUMA CENTER LEVEL ONE TRAUMA CENTER 8 min15 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 SHOULD BE 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 likely be limited, providers give the hospital an estimated number of patients and their levels of acuity. During a Class 2 Incident, providers will communicate to their Resource Hospital using traditional triage colors of red, yellow and green based on the START Triage Method.

It is important to compare the difference in communication between Class 1 and Classes 2 or 3. CLASS 1 CLASSES 2 and 3 FIELD COMMAND RESOURCE HOSPITAL POTENTIAL RECEIVING HOSPITALS RESOURCE HOSPITAL FIELD COMMAND CLOSEST HOSPITAL ‘Business as Usual’

SCENE COMMAND Communication Structure Class 2 and Class 3 RESOURCE

CLASS 3 During a Class 3 Multiple Patient Incident responders are OVERWHELMINGLY unable to meet the ‘normal level of care’. The POD Hospital may be activated for assistance with communication Transporting ambulances will not have any communication with receiving hospitals. NO PATIENT CARE REPORTS

A Class 3 incident could involve an enormous number of patients. Outdoor ConcertAmusement Park Political Rally College Stadium

EMERGENT EVACUATION OF HEALTHCARE FACILITY It is important to include the administration of the facility in making some decisions. Note the different types of triage. Charity Hospital New Orleans

WHAT IS REVERSE TRIAGE? A small fire occurs in the electrical room of a large hospital. Only a few patients have been 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 moderate amount of care are sent next. Patients requiring minimal medical care leave the facility last.

Typical Scenario: ‘EMERGENT EVACUATION OF A HEALTHCARE FACILITY’ Hospitals Community Center Alternate Nursing Home Patients injured in fire. Ambulatory nursing home residents not affected by fire. Bed-ridden nursing home residents not affected by fire. A FIRE OCCURS IN ONE WING OF A NURSING HOME

An After-Action Report should be generated following any activation of the Region X Multiple Patient Plan. A copy of this form is found in the plan.

TRIAGE

The State of Illinois has adopted the START triage method in partnership with the SMART® Incident Command System as a state-wide standard. SMART® Tags to be used when doing START Triage.

START TRIAGE ADULTS Pediatric Patients Under 32 kg RED Light Sticks are found in each pack to visually identify critical patients in a dark environmental

All ambulances in Illinois have received 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 given to hospitals, fire departments and MABAS Divisions. Command Board ® SMART® MCI Bag Includes: -Four SMART Triage Packs -One SMART Command Board

The Region X Multiple Patient Plan includes other important information. Summary of O’Hare Disaster Plan Summary of O’Hare Disaster Plan Summary of State Disaster Plan Summary of State Disaster Plan Summary of National Disaster Plan Summary of National Disaster Plan Training guidelines Training guidelines Guidelines for sending medical personnel to the scene of a disaster Guidelines for sending medical personnel to the scene of a disaster Post-incident recovery services (CISM) Post-incident recovery services (CISM) After-action Report Forms After-action Report Forms Hospital / Field log forms (template) Hospital / Field log forms (template)

Putting the Plan to Work Scenarios OR ‘Business as Usual’

Truck Driver: 57 year old male Complains of Chest Pain prior to accident Denies trauma, able to ambulate Pale, cool and diaphoretic Respirations = 32/min Car #1 - Driver 25 year old male Ambulatory at the scene Air bags deployed / seat belt worn Complains of wrist pain with deformity Car #2 – Driver 84 year old male Unresponsive, Respirations = 24/min Bilateral femur fractures Car #2 – Passenger 82 year old female Laceration to forehead Respirations = 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 called to 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 Red 5 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 male Unresponsive Thrown from a vehicle Patient #1: 24 year old male Ambulatory at the scene Driver of this car Appears stable Patient #4: 18 year old female Back seat passenger - restrained Unresponsive Patient #3: 18 year old male Front 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 through Illinois. An 1811 earthquake involving this fault line was the most destructive in U.S. history. The Mississippi River actually ran backwards. Some researchers contend that a ‘mega-quake’ of this fault is 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 Unresponsive Still restrained Patient #2: Front Seat Passenger 18 year old female Crying in pain Open Skull Fracture

Patient #1: Driver FATAL INJURY (in accordance with Region X guidelines) No transport Patient #3: Front Seat Passenger Thrown from vehicle Unresponsive Patient #2: Back Seat Passenger Still restrained Denies Complaints No 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-P Chairman – Region X DMSC EMS Coordinator, Evanston Hospital