1 ZONE 4 MASS CASUALTY TRAINING 1

To assure all crews within Central Zone understand the roles and responsibilities of operating in the framework of a MCI incident. 22

 FIRESCOPE  COUNTY SAN DIEGO  CENTRAL ZONE POLICY  ZONE TRAINING OFFICERS 33

 Review MCI vs MPI  Review ICS Positions and Responsibilities  Review DMS “New” Triage Tag  Review START Guidelines  Table Top Exercise  Debrief 44

MPI - Multi-Patient Incident  MPI is any number greater than one patient.  Agency has sufficient resources to handle  Patients often numbered in sequence  Most common system used each day 5

MCI – MASS CASUALTY INCIDENT  MCI is an incident with multiple patients which will overwhelm the resources of the responding agencies or the area hospitals.  This can and will differ from agency to agency depending upon the size and scope of their respective resources. 66

 Often confusion between the two modes.  The difference between MPI and MCI is “AGENCY” driven.  Resource driven  Different Radio Formats 77

Example  A six patient accident place in San Diego City may be determined by the IC to be a MPI.  While the same six patient incident in a rural setting would most likely be deemed a MCI due to lack of relative resources. 8

 Med Com must supply clear and concise report.  Requires a more comprehensive radio report than an MCI per policy S-140  PAMSCATE format (Pt. Number, Age, Mechanism, Sex, Chief Complaint, Abnormal Findings, Transporting Unit and ETA) 9

 Patient Triage Tag Number (Last 4 digits)  Patient Status (WW, Immediate, Delayed)  Transporting Unit  ETA 10

 Specialty patients, such as Burn or Pediatric should be communicated to the base in an effort to get those patients to the best location for those types of patients.  Med Com must be disciplined and avoid extraneous radio information. 11

 Size up (Scope of the incident)  Safety  Determine and order Resources  Establish Traffic Flow (early) for incident  Declare MCI (Annex D)  Make Assignments  Establish Staging  Clear Direction  ICS Vests (if possible) 12

 Goal of triage is to sort patients rapidly  Use START Guidelines  ID Walking Wounded  Begin with closest patient  Consider Recon to get better understanding of scope.  Tag patients  Relay number of patients in each category to Transportation and Med Com 13

 Provide extrication and patient movement to either Transport Area or Treatment Area  Consider using Triage Team after they have completed Triage assignment. 14

 Responsible for communication between incident and the CLOSEST BASE HOSPITAL  (not necessarily the trauma center unless they are closest)  Initial contact with hospital uses unit number  Additional contacts use ICS terminology IE: “Greenfield Med Com”  Must be able to relay scope and size of incident to hospital. 15

 The Med Com and the Transportation Unit leader or Group Supervisor should be co- located near the patient loading zone for effective communications.  Scribe is highly recommended 16

 Med Com can quickly get overwhelmed  Highly recommend a scribe  Scribe works as a buffer  Information should be funneled through scribe 17

 Med Com and Scribe should work side by side  Scribe fields information  Scribe maintains accurate records ( bed counts, Patient acuity, Unit ID with destinations 18

 Establish early  Ambulance Staging Manager reports to the Transportation Group Supervisor  Responsible for organizing the staging area, resource accountability, briefing units on the situational awareness and maintains unit documentation. 19

 Staging should organize the available supplies from waiting ambulances in the staging area  Load up one ambulance with supplies collected in staging and send to scene  When organizing the staging area, the staging manager should separate the transportation resources by patient care capabilities when possible 20

 The Staging Manager should monitor the number of units in staging and advise Operations or the IC when resources fall below minimum levels  The Staging Manager should also coordinate resource levels with the Transportation Unit Leader 21

 Assign early  This role requires leadership and organization skills to perform the critical tasks required for this position  ID best location (ingress/egress)  Communicates with Med Com 22

 Transportation Group supervisor use natural barriers, cones or banner tape to identify and create a funnel where patients move though.  Transportation Group supervisor should request a scribe early to assist with the documentation.  In a coordinated process the Transportation Group supervisor will request an ambulance from the ambulance staging manager 23

 Transportation Group supervisor will request a destination from Med Com and assign the patients to the transporting ambulance  The County’s Annex D policy requires that every receiving hospital will accept a minimum of 1 Immediate and 1 Delayed patient and every Trauma Center to accept a minimum of 2 Immediate patients 24

 An important but not always necessary position  Set up areas, (WW, Immediate, Delayed)  Assure Treatment Areas have sufficient supplies  Communicates with Triage, Med Com and Transport 25

26 --Patient Flow --Comm Flow

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 A simple approach  Where to START  One patient at a time  START Triage Algorithm  Patient scenarios 28

29 S imple T riage A nd R apid T reatment In the early 1980’s the START method was developed in California by Hoag hospital and Newport Beach Fire and Marine. It provided rescuers with an easy, simple step-by-step approach to assessing and treating a large number of patients with varying degrees of injuries.

30 S imple T riage A nd R apid T reatment The Initial assessment and treatment of each patient is accomplished within 30 seconds. Initial treatment is limited to correcting immediate life-threatening conditions (i.e. opening an airway and controlling severe bleeding)

31 S imple T riage A nd R apid T reatment The Triage Tag A Tag is placed on each patient once they have been assessed. The tag displays the patient’s current status and advises those providing treatment with one of the four possible treatment priorities: Minor Delayed Immediate Deceased

32 S imple T riage A nd R apid T reatment The Triage Tag Each tab is distinctly color-coded allowing fast patient priority identification from a distance DECEASED IMMEDIATE DELAYED MINOR

33 S imple T riage A nd R apid T reatment Triage Tags are designed with tear-off tabs. There is two tabs per category. One tag gets torn off by Triage Team and one tab is left with the patient.

34 Start where you stand - begin the triage process with the patient closest to you. Solicit the help of bystanders and/or uninjured victims. They can be utilized to control bleeding, help maintain an open airway or hold c-spine traction. Do not spend too much time on any one patient. Move quickly from one patient to the next. Assess each patient’s RPM s R espirations P erfusion M ental Status

35 Upon your arrival, first make sure the scene is safe. Then begin by directing the walking wounded away from the immediate scene to a pre-determined evaluation and treatment area. Tag them as MINOR (GREEN)

36 R PM ASSESS RESPIRATIONS If the patient is not breathing then Open the Airway If the patient is still not breathing then tag them as DECEASED (BLACK) Move on to the next patient...

37 R PM ASSESS RESPIRATIONS If breathing is present then Assess the Rate If the rate is greater than >30 then tag them as IMMEDIATE (RED) Move on to the next patient… If the rate is less than <30 then assess PERFUSION

38 R P M ASSESS PERFUSION If a radial pulse is absent (or) the capillary refill is greater than > 2 seconds then tag them as IMMEDIATE (RED) Move on to the next patient… If a radial pulse is present (or) the capillary refill is less than < 2 seconds then assess MENTAL STATUS

39 RP M ASSESS MENTAL STATUS If the patient cannot follow simple commands (or) has an altered mental status (or) is unconscious then tag them as IMMEDIATE (RED) Move on to the next patient… If patient is able to follow simple commands then tag them as DELAYED (YELLOW) Move on to the next patient…

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41 S imple T riage A nd R apid T reatment This patient states he cannot move or feel his legs His respirations are 24 He has a radial pulse of 100 He is awake are oriented How would you triage this patient?

42 S imple T riage A nd R apid T reatment This patient states he cannot move or feel his legs His respirations are 24 He has a radial pulse of 100 He is awake are oriented DELAYED (YELLOW)

43 S imple T riage A nd R apid T reatment This patient has a blood soaked shirt on His respirations are 36 His capillary refill is less than 2 seconds He is awake are oriented How would you triage this patient?

44 S imple T riage A nd R apid T reatment This patient has a blood soaked shirt on His respirations are 36 His capillary refill is less than 2 seconds He is awake are oriented IMMEDIATE (RED)

45 S imple T riage A nd R apid T reatment This patient has some minor abrasions on his forehead His respirations are 16 His capillary refill is less than 2 seconds He is very slow in recalling his name and whereabouts How would you triage this patient?

46 S imple T riage A nd R apid T reatment This patient has some minor abrasions on his forehead His respirations are 16 His capillary refill is less than 2 seconds He is very slow in recalling his name and whereabouts IMMEDIATE (RED)

47 S imple T riage A nd R apid T reatment This patient appears to have no injuries Her respirations are 20 Her capillary refill is less than 2 seconds She is unconscious How would you triage this patient?

48 S imple T riage A nd R apid T reatment This patient appears to have no injuries Her respirations are 20 Her capillary refill is less than 2 seconds She is unconscious IMMEDIATE (RED)

49 S imple T riage A nd R apid T reatment This patient is lying quietly on the floor He is not breathing His capillary refill is more than 2 seconds He is unconscious What is the first thing you would do?

50 S imple T riage A nd R apid T reatment This patient is lying quietly on the floor He is not breathing His capillary refill is more than 2 seconds He is unconscious REPOSITION THE AIRWAY!

51 S imple T riage A nd R apid T reatment He gurgles a couple of times as you attempt to open his airway but does not resume breathing on his own His capillary refill is still more than 2 seconds He is still unconscious How would you triage this patient?

52 S imple T riage A nd R apid T reatment He gurgles a couple of times as you attempt to open his airway but does not resume breathing on his own His capillary refill is still more than 2 seconds He is still unconscious DECEASED (BLACK)

 DVD 8 MINUTES in length 53

 First Tuesday of the month, start date not yet set  Why?: Most field mis-classify patients as “acute” or “delayed” and aren’t comfortable or familiar with triage tags  To make Pre-Hospital and Hospital personnel more familiar with triage tags and terminology  Will report patient tag number and provide a triage report on every call (including medical calls) 54

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 Exercise our understanding of a MCI scene management  Exercise our communication skills as it relate to MCI.  Review large scale MCI ICS management. 56

 Engage as a role player.  Communicate as you would in a real incident.  Obtain a ICS Vest  Track patients 57

 IC  Determines other positions  Facilitator  Dispatcher  Companies 58

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 1830 hours  Wednesday July 14 th  El Cajon Car Show  Report Auto v. Ped 61

 Was objectives met?  Were communications and orders clear?  Were proper lines of communications used?  Were sufficient resources ordered?  Was START guidelines used?  Was patient transport effective?  Was patient tracking done? 62

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