1. NOVA MCI Manual Changes

2. WHAT’S NEW in EMS MCI Manual? Incident Priorities Quick Reference Guide Transport Prioritize movement Task Force and MCI Alarm Changes Mutual Aid Resources Guide EMS Branch Positions Transportation Group Supervisor Air/Ground Coordinator Patient Transportation Recorder

3. WHAT’S NEW in EMS MCI Manual? Patient Accountability Patient Intake Point (PIP) Patient Exit Point (PEP) Patient Tracking Devices Quick Review Staging Staging Area Manager Changes in Work-boards

4. Incident Priorities

5. What are your Incident Priorities? What do you have??? Triage Transport What are your resources ? Needed resources? Where to assign personnel? Location of staging and who is running it?

6. Quick Reference Guide that is MCI Specific:

7. UNIT MCI PRIORITIES (Assigned to EMS – SEE NOTES) 1 ST E 1 ST Suppression Unit - Triage Unit Leader - Initiate & Complete Primary Patient Triage 2 ND E 2 ND Suppression Unit - Treatment Unit Leader- Establish & Set-up Patient Treatment Area(s) Establish & announce “P.I.P” 3 RD E 3 RD Suppression Unit - Assume Air/Ground Coordinator Reinforce Transport Loading area 4 TH E 4th Suppression Unit Report to Triage Unit Leader 1 ST T 5 TH Suppression Unit - Report to Treatment Unit Leader 2 ND T 6 th Suppression Unit Report to Staging or Establish same, if not already done. 1 ST R All other Unit(s) Report to Staging 1 ST EMS 1 st EMS Transport unit - Establish Transport Group & Transport Recorder. Establish & announce “P.E.P.” 1 ST EMS SUP.1 ST EMS SUPVR. – Establish EMS Branch (then Med. Grp. Sup. once relieved) 1 ST BC1 ST BC - Assume EMS Branch Director 2 ND BC 2 nd EMS SUP.2 nd EMS SUPVR. – Assume Transport Group Supervisor 3 rd EMS SUP.3 rd EMS SUPVR. Assume Treatment Unit Leader

8. TRANSPORT, TRANSPORT, TRANSPORT 1 st EMS transport unit shows up Sets up Transport Other EMS transport unit(s) load and go Move – Move – Move those RED patients LIFE BEFORE PROPERTY

9. Prioritize Movement Prioritize movement of most critically injured patients (Red Tags) from scene, to appropriate, definitive care as rapidly and efficiently as possible.

10. Taskforce and MCI Alarm Changes

11. EMS Taskforce and MCI Alarm Changes EMS TASKFORCE (Dispatched Units) MCI ALARM (Dispatched Units) 5 EMS Transport Units 1 Battalion Chief 2 EMS Supervisors 2 Suppression Units Air Transport Units (Upon request) 10 Suppression Units 10 EMS Transport Units (Min. 5 ALS) 3 EMS Supervisors 1 Battalion Chief 1 Mobile Communications Unit 1 Green Transport Bus 1 Medical Care Support Unit (MCSU) 1 Medical Ambulance Bus (MAB) Air Transportation Units (Upon Request)

12. AGENCYUNIT DESIGNATION UNIT LOCATION LEVEL UASI FUNDED Washington, D.C. MCU 1 MCU 2 MCSU 3 MAB 1 MAB 2 MAB 3 Eng. Co. 24 Eng. Co. 33 Eng. Co. 24 Eng. Co. 33 III II III YES NO YES NO YES Maryland Frederick County MCSU 928 MCSU Sta. 28 - Point of Rocks II I NO Montgomery County MCSU 722 MCSU 726 MAB 726 MAB 722 Sta. 22 – Germantown Sta. 26 - Bethesda Sta. 26 – Bethesda Sta. 22 - Germantown III YES Prince Georges County MCSU 855 MCSU 841 MAB 830 Sta. 55 – Bunker Hill Sta. 41 – Calverton Sta. 30 – Landover Hills III II YES NO YES Virginia Metro Wash. Airports Authority MCSU-302 MCSU-301 Sta. 302 - Dulles Sta. 301 - Reagan III NO AlexandriaMSU 202Sta. 202 – 213 E. Windsor Ave.III NO Arlington MC 100 MAB 100 Sta. 2 – 4805 Wilson Blvd. IIIYES Fairfax County MCSU 415 MCSU 429 MCSU 435 MAB 427 Sta. 15 - Chantilly Sta. 29 - Tysons Corner Sta. 35 - Pohick Sta. 27 - Springfield II III NO YES Loudoun County MC 699 MC 615 MC 614 MAB 623 Loudoun Training Sta. 15 - Sterling Rescue Sta. 14 – Purcellville Sta. 23 – Ashburn (Moorefield) II III NO YES Manassas CityMCU 501Manassas CityII NO Prince William County MCS 508 MCS 520 Sta. 8 – Yorkshire Sta. 20 - Dale City II NO Stafford County MCSU-12 MAB-12 Sta. 12, Berea IIINO MCSU’s in National Capital Region * MCSU 301 and 302 are Level III x2 Both units can handle 200 patents Level I 25 Patients Level II 50 Patients Level III 100 Patients * *

13. EMS Branch Positions

14. Transportation Group Supervisor First arriving transport unit establishes Transportation Group. AIC/OIC - Transportation Group Supervisor. Once relieved by 2nd arriving EMS Supervisor (assigned to EMS Branch), then becomes Medical Communications Coordinator (MCC). Unit operator shall assume and maintain role of Air/Ground Ambulance Coordinator To include role of Patient Transport Recorder until relieved

15. Transportation Group Supervisor Responsibilities: Confirm initial (& follow up) Communication with RHCC Request dedicated radio channel for Transportation group Determine total patient count & transportation needs Ensure best access & egress for patient loading area Ensure patient information & destination recorded for all patients prior to departure from scene Identify & establish patient transport corridors Establish contact with: Staging area Treatment Unit Leader Assign Patient Loaders Coordinate air & ground transportation of all patients Monitor operations with Group; make requests to EMS Branch Director. Maintain log of activity Demobilize Transportation Reconcile all records through: Medical Communication Coordinator Air/Ground Coordinator(s) RHCC

17. Air/Ground Ambulance Coordinator Establish position, announce location, & don appropriate vest. Maintain communications with Transportation Group Supervisor Establish loading area for ground or air ambulances Designate points & paths of entry and exit for all transport units Supervise Transportation Recorder. Ensure all patients leaving scene have COG disaster tag Request additional transportation resources through Staging Area Manager Request additional patient transfer resources as needed Provide needed receiving facility directions to ground transport units Effectively manage all transport resources within assigned area Obtain Air/Ground Ambulance Coordinator Worksheet & Transport Recorder Worksheet, ensuring all appropriate documentation is completed Reconcile all patient transport records through the Transportation Group Supervisor Each Air/Ground Ambulance Coordinator reports to Transportation Group Supervisor and manages their respective areas.

19. Patient Transportation Recorder Responsibilities: Establish position, announce location, and don appropriate vest Alert Air/Ground Ambulance Coordinator of any patient within loading area who does not have a COG disaster tag, or whose tag does not have assigned receiving facility destination. Request instructions from Air/Ground Ambulance Coordinator Obtain Patient Transport Recorder Worksheet Maintain records of all patients departing scene Maintain appropriate incident documentation relevant to patients transported from scene, including: COG disaster tag and unique identifying number (UIN). Ensure disaster tag is attached to each patient & scanned with PTD, if available Record transporting unit number Record destination receiving facility Record total number of patients (per unit) Triage status, age, sex, chief complaint of patient when transported off scene Patient Transportation Recorder MUST be assigned to each established patient loading area. (i.e., multiple LZ/ground ambulance transportation corridors)

20. Patient Transportation Recorder

23. Patient Accountability

24. In a rapidly evolving incident, critical Red Tag patients may bypass Treatment Area and should be taken directly to transport.

25. This can be done by: Placing COG disaster tag on patient Scan tag with Patient Tracking Device (PTD) if available Scan TRANSPORT RECORD sticker with PTD if available and update information that patient was transported and where. Complete as much of front side of tag as possible Emphasis on PATIENT INFORMATION section at top and TRANSPORT RECORD at bottom of tag Remove large TRANSPORT RECORD sticker from bottom of disaster tag Place it on Transport Recorder Worksheet for appropriate destination receiving facility

26. PIP and PEP Formalizes two naturally occurring patient transit points to require higher degree of victim accountability. Patient Intake Point (PIP): Physical location(s) prior to entering Treatment areas through which all patients are funneled and where Disaster Tag is applied When possible, tag shall be scanned into Patient Tracking System Patient Exit Point (PEP): Physical location through which patient exits scene via transport unit (air or ground) in which transport stub is collected (by Transport Recorder) from disaster tag and affixed to Transport Record If available, departure shall be scanned into Patient Tracking System

31. Patient Tracking Device

32. Patient Tracking Website

35. 2-1-1 Virginia Virginia Hospital Alerting and Status System (VHASS) was established by Virginia Hospital and Health Care Association and Virginia Department of Health. All hospitals across Commonwealth and Office of the Medical Examiner (OME) participate in system. Available for use during MCI where large number of patients need to be cared for initially onsite and then transported to hospital. Hospitals and OME enter MCI patient information into system through www.vhha- mci.org.

36. Staging

37. Definitions: Staging: Staging Area: Location where units awaiting tasking are assigned. Usually located within short travel distance but far enough away to not interfere with ongoing operations. Location near incident where incident personnel and equipment are assigned on three-minute available status.

38. Staging Area Manager Normally established by driver of 1 st due Engine on 2nd Alarm Staging Area Manager reports to Incident Commander (IC) Roles and responsibilities may greatly expand during MCI Critical that Incident Staging be established early in incident Assigned sufficient resources to support this function i.e., an entire suppression unit crew

39. Staging Area Manager Responsibilities: Establish position, announce location, and don appropriate vest Utilize Check-in Sheets as reference for anticipating resource needs Establish staging area layout Ensure adequate transportation resources available within Staging Area ingress and egress controlled for patient transport vehicles (staffed and unstaffed) Respond to requests for resource assignments Maintain log of activity as required Establish & maintain communication with Air/Ground Ambulance Coordinator(s) Facilitate movement of transport units from Staging Area to appropriate transportation loading areas Ensure transporting units leaving Staging Area switch to assigned Transportation Channel Demobilize Staging Area in accordance with Incident Demobilization Plan

40. Review: Incident Priorities Quick Reference Guide Transport Prioritize movement Task Force and MCI Alarm Changes Mutual Aid Resources Guide EMS Branch Positions Transportation Group Supervisor Air/Ground Coordinator Patient Transportation Recorder Patient Accountability Patient Intake Point (PIP) Patient Exit Point (PEP) Patient Tracking Devices Staging Staging Area Manager Changes in Work-boards

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