MCI/ Multi patient Emergencies & Triage

Class Objectives Describe an MCIDescribe an MCI Develop and implement an initial action plan for the MCI sceneDevelop and implement an initial action plan for the MCI scene Describe & demonstrate proper size up of an MCI sceneDescribe & demonstrate proper size up of an MCI scene Describe the term STARTDescribe the term START

Class Objectives continued Describe & demonstrate proper triage techniques & isolation proceduresDescribe & demonstrate proper triage techniques & isolation procedures Demonstrate the use of prioritized tag colors for triage identificationDemonstrate the use of prioritized tag colors for triage identification Demonstrate the proper communications procedures with Medical ControlDemonstrate the proper communications procedures with Medical Control Apply MCI & START procedures to table top exercisesApply MCI & START procedures to table top exercises

MCI Definitions MCI is defined as a medical incident that initially overwhelms the ability of responders to initially provide normal levels of care to injured victims.

Initial MCI Procedures MCI MCI –A Transportation Unit Leader will be assigned and will communicate START color and accident mechanism to the DCH –DCH will direct EMS Transportation Unit Leader to appropriate destinations –EMS crews WILL NOT contact destination hospital with patient info while en route.

Initial MCI Procedures –The initial arriving unit will notify their dispatch center and the DCH of emergency type as well as a size-up of the incident –DCH will contact other area hospitals to notify them of the incident

Initial MCI Procedures –Once command is established the IC shall provide their DCH an update of conditions so they can jointly determine if an MCI should be declared –The DCH will notify other area hospitals –EMS crews WILL NOT contact destination hospital with patient info while en route.

Update of conditions to the MCH ICS Title or the Unit Number ICS Title or the Unit Number Notification that a possible Mass Casualty Incident exists. Notification that a possible Mass Casualty Incident exists. An estimated number of patients. An estimated number of patients. Complicating circumstances (i.e. hazmat, safety hazards, etc.) Complicating circumstances (i.e. hazmat, safety hazards, etc.)

Successful MCI management Paint a picture for incoming units Paint a picture for incoming units –Size up Communicate an action plan Communicate an action plan –By radio or on scene briefing –Using Incident priorities Make assignments Make assignments –ICS positions as needed –Patient care Carry out assignments to mitigate the incident Carry out assignments to mitigate the incident

Scene Size up How many vehicles involved? Or type of facility involved How many vehicles involved? Or type of facility involved Mechanism (head on, rollover, rear-end, T- bone, Explosion, derailment, etc.) Mechanism (head on, rollover, rear-end, T- bone, Explosion, derailment, etc.) Speed (if MVA- High, Medium, low) Speed (if MVA- High, Medium, low) Special Hazards - Chemicals, Explosion, Radiation, etc. Special Hazards - Chemicals, Explosion, Radiation, etc. Number of Patients if known Number of Patients if known Name & locate command Name & locate command

Scene Size up “E1711 is on the scene of a one car medium speed rollover- car is upright, 4 patients, E1711 is starting triage, this will be 240 command”

Developing an Action Plan Incident Priorities –Life safety –Incident Stabilization –Property conservation –Environmental issues

Developing an action plan Using the incident priorities how will we mitigate the incident? Using the incident priorities how will we mitigate the incident? MCI plan gives us a framework to operate from MCI plan gives us a framework to operate from

Initial on scene priorities Establish Command & a Command Post Establish Command & a Command Post ID hazards and control or eliminate them ID hazards and control or eliminate them Perform START Perform START Establish a treatment area & staging area Establish a treatment area & staging area Give an updated report on conditions to DCH Give an updated report on conditions to DCH Request additional resources through the fire coordinator or dispatch agency Request additional resources through the fire coordinator or dispatch agency Establish medical communication with medical control (Transportation Unit Leader) Establish medical communication with medical control (Transportation Unit Leader)

Secondary on scene priorities Establish a Staging Area for non-ambulance resources Establish a Staging Area for non-ambulance resources Establish an Ambulance Staging Area for ground ambulances Establish an Ambulance Staging Area for ground ambulances Establish an Ambulance Loading zone accessible to the treatment area Establish an Ambulance Loading zone accessible to the treatment area Establish a Helispot in a safe and appropriate area if needed Establish a Helispot in a safe and appropriate area if needed Assign resources to build an organization of sufficient size to deal with the situation Assign resources to build an organization of sufficient size to deal with the situation

Communication tools 1 st call while en route - HEAR radio 1 st call while en route - HEAR radio 2 nd call Size-up - Cell phone or HEAR. 2 nd call Size-up - Cell phone or HEAR.

START Simple Triage And Rapid Transport Developed in early 1980’s by Newport Beach Fire & Hoag Hospital Rapid Approach to triaging large numbers of casualties Easy to remember

START Initial patient assessment and treatment should take less than 30 seconds for each patient

START First Step- Clear the walking wounded using verbal instructions First Step- Clear the walking wounded using verbal instructions –Direct them to the treatment areas for detailed assessment and treatment –Tag these patients as MINOR Green Now check your RPM’s Now check your RPM’s

START RPM Respirations –None- Open the airway Still none?- Deceased Black Still none?- Deceased Black Restored?- Immediate Red Restored?- Immediate Red –Present? Above 30?- Immediate Red Above 30?- Immediate Red Below 30?- CHECK PERFUSION Below 30?- CHECK PERFUSION

START RPM Perfusion –Radial Pulse Absent or Cap refill >2 seconds Immediate Red –Radial pulse present or Cap refill <2 seconds CHECK MENTAL STATUS

START RPM Mental Status –Can not follow simple commands (Unconscious or altered LOC) Immediate Red –Can follow Simple commands Delayed Yellow

START If the patient is immediate- priority 1- Red upon initial assessment, attempt only to correct the airway blockage or uncontrolled bleeding before moving on to the next patient

START When things get hectic with multiple patients rev up your RPM’s –R - Respiration – 30 –P - Perfusion – 2 –M - Mental status – Can do

Start Triage Walking wounded Yes Respirations Over 30 Under 30 Perfusion Cap Refill Radial pulse absent Control Bleeding Immediate Under 2 sec. No Position Airway Over 2 sec. Mental Status Radial Pulse Present Follows simple instructions Cannot Follow simple instructions YesNo

START Remember in START triage there are only 3 treatment options during triage Remember in START triage there are only 3 treatment options during triage –Open the airway & insert an airway –Apply pressure to bleeding –Elevate an extremity

The START process permits a very few rescuers to rapidly triage a large number of patients without specialized training The START process permits a very few rescuers to rapidly triage a large number of patients without specialized training After START is completed, patients are moved to treatment areas where more detailed assessment and treatment are conducted After START is completed, patients are moved to treatment areas where more detailed assessment and treatment are conducted START

START Concept and Flow Chart Property of Newport Beach Fire and Marine From their START Simple Triage & Rapid Treatment- A race with time