1. Mass Casualty Incident Triage Course

2. This course is provided to you by:
Alabama Fire College
Workplace Safety Training Program

3. Instructor

4. Course Terminal Objectives
Define Mass Casualty Incident (MCI)
Define Incident Management System (IMS)
Function in an assigned roles under the IMS for EMS
Use the “START” triage system
Perform Chemical & Trauma triage
Identify the EMS resources needed for MCI response
Identify the procedures and equipment requirements of mass decontamination
Review the course terminal objectives and introduce the training materials that are being provided to the trainees. Take a few minutes to review the First Responders Field Guide to Hazmat and Terrorism Emergency Response. This can best be accomplished with reference to the Quick Reference Guide (Section 1) of the Field Guide. Explain that the Field Guide is useful in all aspects of MCI response, from basic hazard recognition to MCI Triage (which will be covered in detail in module 5).
Have trainees review the MCI/Triage resource listing (provided in course packet) and explain that every resource used in the course is included in the list. Explain also that additional recommended references are included on the list and show sample copies to the class.

5. Warning ! Graphic Videos
After viewing each of the three following video clips, ask the class to identify the key characteristics and hazards of each incident. List comments on flip chart pages at the end of each video clip, and post each sheet on the classroom wall using 3M Post-it easel flip chart paper or masking tape. Through this, you will begin working toward defining MCIs.
The trainees should identify factors such as the following as common denominators of MCIs:
Hostile Environment
Hazards to responders
Chaos & Confusion & Noise
Poor Communications
Accountability
Leadership & ICS critical
Multiple traumatic injuries
Efficient triage & treatment critical
Critical Incident Stress

6. Mass Casualty Incident Triage Course
Video Clip
Beach Invasion Saving Pvt. Ryan 12 minutes

7. Video time approximately 13 minutes.

8. April 19, 1995
Note that the Oklahoma City bombing was proof terrorism can happen in any city.

9. Mass Casualty Incident Triage Course
Video Clip
Guide discussion, list class responses on flip chart pages, and post the pages as for the previous video clip.
Oklahoma City Bombing
:09 Minutes

10. Video time approximately 09 minutes.

11. Mass Casualty Incident Triage Course
Video Clip
I-65 MCI
30 Seconds

12. Guide discussion, list class responses on flip chart pages, and post the pages as for the previous video clip.
Emphasize the similarities of all three events regardless of their size or the cause.

13. Point out that the triage tag used in the military is the same type of tag used in civilian triage.

14. Military vs. Civilian Triage
Priority is to get as many soldiers back into action as possible.
Priority is to maximize survival of the greatest number of victims.
Point out that although the tags are the same the triage priorities differ in the military as opposed to civilian applications.

15. Mass Casualty Incident Defined
U.S. Department of Transportation
Any event resulting from man-made or natural causes resulting in illness and/or injuries that exceed EMS capabilities of a hospital, locality, jurisdiction and/or region.
Use the next several slides to discuss the different mass casualty definitions. In doing so, refer to the information posted on the flip chart pages generated through class discussion based on the previous video clips.

16. Mass Casualty Incident Defined
Arizona State System
Multi-casualty (<25 patients)
Mass-casualty ( patients)
EMS disaster (>100 patients)
A given event that is defined as a Multi Casualty Incident by a large EMS agency may be considered a Mass Casualty Incident in a practical by a smaller agency based on the strain on available resources.

17. Mass Casualty Incident Defined
Definitions vary from one community to another
Can be described as an incident that reduces the effectiveness of the traditional EMS response because of:
number of patients,
special hazards, or
difficult rescue
This is the generally accepted definition of an MCI.

18. MCI based on numbers
An example of local MCI in a small jurisdiction (Opelika, Alabama).

19. Repeated MCI
An example of a second MCI occurring in the same jurisdiction (Opelika, Alabama) on a holiday weekend.

20. Special planning requirements
Single Incident
1 Dead
8 injured
Four water-related fatalities resulted from several accidents during recreational activities near Birmingham, Alabama over a single weekend. Notice the date on the article - the events occurred on July 4th weekend. One of the incidents resulted in 1 fatality and 8 serious injuries. Lead the class in discussion on the special rescue requirements needed to mitigate such an incident. Emphasize the need to be prepared at all times.

21. MCI-Like Event Based on Special Rescue: Crane Rescue Incident
The background to this incident:
An EMS incident occurred involving a tower crane operator that had a heart attack atop the crane on an outside 18-inch catwalk. This incident forced rescuers to operate beyond their normal range of service delivery. They had to rely on external resources of the construction company equipment and employees. After the rescuers climbed to the top of the crane, they found signs of life in the victim. At the request of the rescuers, the construction company brought another crane to assist in lowering the patient to the ground. Lesson learned: a mass casualty-like event can sometimes result from the extenuating circumstances of the incident – even if only one patient is involved.

22. Mass Casualty Incident Types
Low Impact Incident
Manageable by local
emergency personnel
High Impact Incident
Stresses local EMS, Fire, and
Police resources
Disaster, Terrorism Incident
Overwhelms regional emergency
response resources
Note that examples of all 3 types of incidents were presented in the previous video clips and news photos.

23. Ohio State University Disaster Research Center “Delivery of Emergency Medical Services in Disasters”
In 1977 OSU conducted a study of mass casualty incidents. The title of this study was “Delivery of Emergency Medical Services in Disasters”. The study included field work done in 44 communities located in 17 states, Washington DC and the Virgin Islands. The research covered localities from small towns to metropolitan areas and included communities with a wide range of EMS development, from those with very rudimentary capabilities to those with complex and well established systems. Observations based on the study are listed on the next slide.

24. Results of the OSU Disaster Research Center Disaster Study
An MCI can happen at any time and in any community, large or small.
A major transportation-related disaster can occur in almost any community.
Any town with hotels, schools, churches, shopping centers, apartment buildings, or auditoriums can have a building-related MCI.
A hazmat disaster can occur wherever hazmats are manufacturer, used, stored, or transported.
If an MCI occurs, the highest probability is that 40 to 80 serious injuries will result. To preplan for a lesser number is to invite failure.
Observations based on the OSU disaster study were:
An MCI can happen at anytime of the day or night, at any season of the year, in any part of the country, and in communities both large and small.
If a community transports children to school in buses; if there is a highway or railroad running through a town; if there are commuters to and from town; if a town is on the banks of a river; if it is located under or near a flight path, then there is a chance of a major transportation-related disaster.
If a town has buildings where large groups of people gather-hotels, schools, churches, shopping centers, apartment buildings, auditoriums, etc.-then there is a chance of a building-related MCI.
If any businesses in an area make up, use or store hazardous materials, or if hazardous materials are ever transported near or through a town, then there is a chance of a hazardous materials related disaster.
If an MCI does occur, there is the highest probability of having from 40 to 80 seriously injured people to treat. To preplan for any lesser number is to invite failure
Note that these observations apply equally to small farming communities and major metropolitan areas.
It is foolish to suppose, for any reason, that a Mass Casualty Incident “can’t happen here.” It can! The only questions are, ‘When will it happen?’ and ‘Will you be prepared?’
Key Point: Every community should have a response plan and properly trained personnel ready to respond when an MCI becomes a reality!

25. University of Delaware Disaster Research Center Study of 29 MCIs
In 1983, the University of Delaware Disaster Research Center studied 29 disasters and found many common problems associated with MCI management. The results are listed on the two following slides.

26. University of Delaware Disaster Research Center
Top 10 common problems of MCI Management
Poor Triage
Inadequate notification of hospitals/agencies
Lack of primary stabilization of all patients
Failure to establish treatment area/sector & quickly move patients to this area
Transport of stable patients before unstable patients
If you carefully read this list (1-10), you’ll note that almost all of the items are in some way related to communications skills and capabilities. MCI planners therefore must examined their agencies’ communication systems and methods to determine if they need improvement , or perhaps a complete redesign.
(Continued next slide)

27. University of Delaware Disaster Research Center
Top 10 common problems of MCI Management (con’t)
6. Improper distribution of patients to medical facilities
7. Improper use of field personnel
8. Lack of recognizable EMS field command
9. Delivery of inappropriate & overly time-consuming care
10. Lack of proper preplans & lack of adequate training of all personnel
With regard to communication issues, success or failure of an MCI rescue operation depends on several elements:
Designating personnel to identify the MCI and initiate action
Radio frequency assignments
Portable MCI equipment
Interagency, interpersonal, and interstate communications must be evaluated
Good organizational face-to-face communication with all potential responders in an MCI.

28. Mass Casualty Incident Triage Course
Video Clip
To reinforce the importance of good communication, this video clip serves as an excellent demonstration of poor communications and its causes.
Communications

29. Video length approximately 05 minutes.

30. Communication Channels
Command
Operations
Transportation
Logistics
These communication channels should be used when possible.

31. MCI Preparedness Three “P’s” Participation Planning Practice
In order to be prepared for an MCI, regardless of the cause, an agency must develop a strategy. One method that is widely accepted is the 3-P approach, as covered in the four slides that follow.

32. Participation Most important step
Involve All agencies (police, fire, ems, private, haz-mat, rescue, gov’t)
Emphasize the critical need locally for all agencies to participate.

33. Planning Avoid the “can’t plan for it” attitude!
General planning is the easiest of the P’s
Develop MCI plans using IMS as a blueprint
Perform both a local hazard assessment and a capability assessment
Select 10 most common hazards for practice
Base your planning on an “All Hazards” approach.

34. Practice Drills should be realistic Include all agencies
Don’t rely on hospital-based drills to meet MCI requirements
Perform a comprehensive critique
Identify “lessons learned”
The key to success of the plan is (1) commitment to practicing the plan and (2) revising the plan based on lessons learned.

35. Practice (con’t) Drill Tabletop Functional Full Scale
It is very important to begin the practice phase at the correct level of the preparedness state. Practice must be carried out after plans are developed, but before an actual incident occurs.

36. A Lesson To Be Learned….. In 1995 a nuclear, biological and chemical
exercise was held in NYC. It was determined that
the first 150 emergency responders to arrive at
the scene were “killed” because they were not
adequately trained for this type of emergency
DON’T BECOME A CANARY!
Key Point: Don’t be like the miners canary in hazard detection.

37. MCI Resources www.fire-ems.com
Note: Point out the MCI Triage Resources List included in the course folder. Describe and discuss key resources from the list using the remaining slides. This slide shows free literature to assist in being prepared, with the web site listed for easy ordering.

38. MCI Resources www.homelandresponse.org
Free literature to assist in being prepared. Web site is listed for easy ordering.

39. MCI Resources
Excellent resource but is not free.

40. MCI Resources
Excellent resource but is not free.

41. MCI Resources
Excellent resource but is not free.

42. MCI Resources
Suggested resources: The job aid can be purchased for a nominal fee or downloaded in electronic format for free. The other two resources are included in the course materials provided to trainees.

43. Metropolitan Medical Response System Trailer (MMRS)
This local mass casualty resource trailer was provided through the Metropolitan Medical Response System (MMRS) and is capable of providing a compliment of EMS equipment and triage supplies for up to 125 victims.

44. MCI Resources Vests Barrier Tape
Identification vests and scene control barrier tape are critical resources for MCI management.

45. S.T.A.R.T MCI Resources Simple Triage and Rapid Treatment
The START kit contains airway adjuncts, triage tags, and other items needed for triage using the START system. It can be purchased through EMS vendors for approximately $80.00

46. Triage Tags
This is the ”All Risk” or “All Hazards” tag that is included in the trainee packet for the course. We will cover the use of the tags in module 5.

47. MCI Resources Triage Ribbon
A triage ribbon kit may also be purchased from EMS vendors and used as an alternative to tags for patient triage. We will cover the use of the ribbon in module 5.

48. MCI Resources
5 Person Trauma Kit

49. Other Triage Resources
Triage Tarps
Triage Flags
Command Tactical Charts
EMS Supplies and Equipment
Accountability Systems
Command Section Flags
Do a show and tell session using the items on display around the classroom as demonstration items.

50. Questions ?