1. Multiple Casualty Incidents (MCI)
S-SV EMS MICN Course
Module 7
Multiple Casualty Incidents (MCI)
S-SV EMS Agency MICN Training (Updated )

2. California OES Mutual Aid Regions
California is divided into 6 OES mutual aid regions
OES Region IV includes Nevada & Placer Counties
OES Region III includes Butte, Colusa, Shasta, Siskiyou, Sutter, Tehama and Yuba Counties
S-SV EMS Agency MICN Training (Updated )

3. S-SV EMS Agency MICN Training (Updated 05-2016)
Regional MCI Plans
Region IV MCI Plan
Developed/implemented in 1997 (outdated)
Region III MCI Plan
Region IV MCI Plan used as a template
Updated to reflect current technology/procedures
Developed/implemented in 2013, updated in 2015
Manual 1 – Field Operations
Manual 2 – Control Facility (CF) Operations
S-SV EMS Agency MICN Training (Updated )

4. Control Facility (CF) Definition
Entity responsible for coordination & dispersal of patients during Multi Casualty Incidents (MCIs)
Hospital, dispatch center, or local warning center
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5. CF Purpose & Responsibilities
Single point of contact for the field Medical Communications Coordinator (MCC)/patient dispersal during an MCI
Supports other Operational Areas (OAs) involved in patient dispersal (CF to CF)
S-SV EMS Agency MICN Training (Updated )

6. S-SV EMS Designated CFs
OES Region IV:
Sierra Nevada Memorial Hospital
Western Slope of Nevada County
Sutter Roseville Medical Center
Western Slope of Placer County
Tahoe Forest Hospital
Tahoe Basin & Eastern Slope of Nevada & Placer Counties
REMSA dispatch may act as a backup CF in this area upon request from Tahoe Forest Hospital
S-SV EMS Agency MICN Training (Updated )

7. S-SV EMS Designated CFs
OES Region III:
Enloe Medical Center
Butte & Colusa Counties (Glenn & Plumas Counties)
Mercy Medical Center Redding
Shasta, Siskiyou & Tehama Counties (Modoc & Trinity Counties)
Rideout Regional Medical Center
Sutter & Yuba Counties
S-SV EMS Agency MICN Training (Updated )

8. CF Personnel Positions
CF Supervisor:
Provides hospital CF program oversight and direction
Responsible for training of CF staff
Schedules and runs drills/exercises
Liaison with administration/other facilities
Evaluates/keeps records of MCIs
Attends/helps organize critiques
S-SV EMS Agency MICN Training (Updated )

9. CF Personnel Positions
Patient Dispersal Officer:
Activated/assigned during MCI
Assumes patient dispersal decisions
Communicates directly with field Medical Communications Coordinator (MCC)
Provides destination to other EMS units during an MCI
S-SV EMS Agency MICN Training (Updated )

10. CF Personnel Positions
Facility Status Officer:
Activated/assigned during MCI
Provides patient destination notification and other relevant incident information to receiving facilities
Role may be assumed/maintained by the Patient Dispersal Officer depending on the incident
S-SV EMS Agency MICN Training (Updated )

11. Receiving Facility Positions
Receiving Facility Officer:
Determines/reports patient treatment capabilities
Communicates with the CF as needed
Advises facility staff of pertinent incident information and number/type of patients they are receiving
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12. S-SV EMS Agency MICN Training (Updated 05-2016)
MCI Communications
Med Net radios
VHF/800 MHz radios
Amateur Radio (ham radio)
EMResource
Blast phone/landline
Cellular telephone
S-SV EMS Agency MICN Training (Updated )

13. S-SV EMS Agency MICN Training (Updated 05-2016)
MCI Types
Trauma
Physical injuries and/or burns (traffic collision, plane crash, earthquake, explosion, mass shootings, etc.)
Hazmat
Release of toxic materials, radioactive matter, or radioactive energy from a radiation emission device
Medical
Non-trauma, non-hazmat incidents (biological or clandestine radiological incidents, environmental, medical resource depletion, medical evacuations, etc.)
S-SV EMS Agency MICN Training (Updated )

14. S-SV EMS Agency MICN Training (Updated 05-2016)
MCI Activation
MCI Criteria (any of the following)
5 or more IMMEDIATE (Red)/DELAYED (Yellow) patients
10 or more MINOR (Green) patients
Prehospital and/or hospital provider discretion
S-SV EMS Agency MICN Training (Updated )

15. S-SV EMS Agency MICN Training (Updated 05-2016)
MCI Activation
The CF may be activated by any of the following entities:
EMS dispatch center
Field EMS personnel (responding or at scene)
Neighboring CFs for incidents exceeding their capacity to disburse patients within their area
Medical Health Operational Area Coordinator (MHOAC)
S-SV EMS Agency MICN Training (Updated )

16. MCI Pre-Alert by EMS Responders
The CF should obtain the following information from dispatch/field personnel when possible:
Incident location
Incident type
Trauma
Hazmat
Medical
Possible number of patients
S-SV EMS Agency MICN Training (Updated )

17. S-SV EMS Agency MICN Training (Updated 05-2016)
Initial CF Response
When notified of a possible or confirmed MCI, the CF should:
Assign appropriate staff to manage the incident
Create an MCI Event in EMResource
Identify the incident location on facility maps and determine the receiving facilities within 30 minutes travel time
Maintain communications with the field Medical Communications Coordinator (MCC)
S-SV EMS Agency MICN Training (Updated )

18. S-SV EMS Agency MICN Training (Updated 05-2016)
Initial CF Response
The following information should be provided by field personnel upon MCI confirmation:
Incident location (if unclear – CF staff must clarify)
Incident name
Type of incident
Approximate number of patients
Type of transport resources available (ground/air ambulances, buses)
Estimated time triage is expected to be completed
S-SV EMS Agency MICN Training (Updated )

19. EMResource MCI Event Creation
Select ‘Event’ Tab
Select ‘Event Management’
S-SV EMS Agency MICN Training (Updated )

20. EMResource MCI Event Creation
Select ‘Create’ for the event location (OA)
S-SV EMS Agency MICN Training (Updated )

21. EMResource MCI Event Creation
Enter the appropriate event information
S-SV EMS Agency MICN Training (Updated )

22. EMResource MCI Event Creation
Utilize EMResource tools to lookup event location if necessary
S-SV EMS Agency MICN Training (Updated )

23. EMResource MCI Event Creation
Select the appropriate receiving facilities you want to poll
Select ‘Save’ to initiate the Event
S-SV EMS Agency MICN Training (Updated )

24. EMResource MCI Event Creation
Return to the ‘View’ screen and select your event on the colored bar to monitor receiving facility reporting capability status
S-SV EMS Agency MICN Training (Updated )

25. EMResource MCI Event Creation
Receiving facility capacities are updated as reported & totaled at the bottom of the screen
S-SV EMS Agency MICN Training (Updated )

26. Receiving Facility Response
Receiving facilities notified of a MCI (polled) are required to determine and report their patient receiving capabilities on EMResource
S-SV EMS Agency MICN Training (Updated )

27. Receiving Facility Response
Receiving capabilities are based on available patient teams and beds:
Immediate Patient Team (1 patient per team)
1 ED Bed
ED physician
Surgeon (if Trauma MCI)
2 nurses
S-SV EMS Agency MICN Training (Updated )

28. Receiving Facility Response
Delayed Patient Team (2 patients per team)
2 ED Beds
ED physician
2 nurses
Patients in spinal immobilization or unaccompanied minors are minimally triaged as Delayed regardless of condition
Minor Patient Team (10 patients per team)
1 nurse
Minor patients can often be directed to ED waiting room for re-triage or possible alternate treatment areas
S-SV EMS Agency MICN Training (Updated )

29. Receiving Facility Response
The receiving facility documents their capabilities on the Receiving Facility Capacity Worksheet and enters their patient capacity in EMResource within 5 minutes
S-SV EMS Agency MICN Training (Updated )

30. Receiving Facility Response
The receiving capabilities screen, accompanied by an audible alert, will automatically show on the EMResource screen for each hospital polled
S-SV EMS Agency MICN Training (Updated )

31. Receiving Facility Response
Enter the appropriate capabilities for your facility, or leave default value at “0” if correct
Enter surgeon information if applicable
Select ‘Save’ to submit your capabilities
S-SV EMS Agency MICN Training (Updated )

32. Receiving Facility Response
If the screen does not automatically show, or you need to update your capabilities at any time, the following process may be utilized:
Select the applicable event on the colored bar
S-SV EMS Agency MICN Training (Updated )

33. Receiving Facility Response
Select the ‘keys’ icon for your facility
S-SV EMS Agency MICN Training (Updated )

34. Receiving Facility Response
Select each category to expand and enter your capabilities
S-SV EMS Agency MICN Training (Updated )

35. S-SV EMS Agency MICN Training (Updated 05-2016)
Field Operations
S.T.A.R.T. triage is utilized by prehospital personnel on any declared MCI
Approved triage tags are applied to each patient prior to transport
S-SV EMS Agency MICN Training (Updated )

36. S-SV EMS Agency MICN Training (Updated 05-2016)
Field Operations
The Medical Communications Coordinator (MCC) communicates directly with the CF
The MCC may also assume/maintain the Medical Group Supervisor and/or Patient Transport Unit Leader role depending on the incident
S-SV EMS Agency MICN Training (Updated )

37. S-SV EMS Agency MICN Training (Updated 05-2016)
Field Operations
When the MCI is in progress:
All EMS patient communication should be routed through the CF (even for non-MCI patients)
Individual EMS units should not provide patient reports to receiving facilities unless they do not interfere with MCI operations/communications
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38. S-SV EMS Agency MICN Training (Updated 05-2016)
Patient Destinations
Additional information relayed to the CF by MCC:
Total number of patients by triage category
Immediate (classified as ‘Head’, ‘Chest’, or ‘Abdomen’ if applicable)
Delayed
Minor
Special patient circumstances (pediatric/pregnancy/families) should also be reported
Number and category of patients ready for transport
Number and type of transport resources available
S-SV EMS Agency MICN Training (Updated )

39. S-SV EMS Agency MICN Training (Updated 05-2016)
Patient Destinations
When patients are ready for transport, the MCC contacts the CF to obtain patient destination and mode of transport
S-SV EMS Agency MICN Training (Updated )

40. S-SV EMS Agency MICN Training (Updated 05-2016)
Patient Destinations
When notified by the MCC that patient triage is complete, the CF documents patient information on the Patient Destination Worksheet
S-SV EMS Agency MICN Training (Updated )

41. S-SV EMS Agency MICN Training (Updated 05-2016)
Patient Destinations
The CF assigns destinations using the following Patient Destination Guidelines:
Immediate Patients
Send to Immediate Teams at facilities within 30 minutes transport time, whenever possible
Send Immediate trauma patients to designated trauma centers (following S-SV EMS policies/protocols)
Send other specialty patients (burns, pregnancy, pediatric trauma, etc.) to designated specialty receiving centers (following S-SV EMS policies/protocols)
S-SV EMS Agency MICN Training (Updated )

42. S-SV EMS Agency MICN Training (Updated 05-2016)
Patient Destinations
Delayed Patients
Send to Delayed or Immediate Teams within 60 minutes transport time from the incident whenever possible
Minor Patients
Transport of minor patients can be delayed
Send to Minor or Delayed Teams within 30 minutes transport time from the incident whenever possible
If there are a large number of minor patients to distribute, local receiving facilities should consider opening a temporary minor treatment area at their facility to triage and treat these patients
Transporting minor patient by bus is permitted
S-SV EMS Agency MICN Training (Updated )

43. S-SV EMS Agency MICN Training (Updated 05-2016)
Patient Destinations
Austere Care
If there are more patients within any triage category than available teams to accept those patients, consider:
Requesting local receiving facilities to increase patient capacity
Sending more patients to local teams than standard guidelines
Sending patients beyond the standard transport time radius
S-SV EMS Agency MICN Training (Updated )

44. S-SV EMS Agency MICN Training (Updated 05-2016)
Patient Destinations
CF directs where to transport each patient in coordination with the MCC
CF must be advised by the MCC when each unit departs the scene and their ETA to the receiving facility
CF notifies receiving facility of transport unit ID/ETA and pertinent patient information
S-SV EMS Agency MICN Training (Updated )

45. Receiving Facility Patient Transport Notification
The CF notifies the receiving facility of incoming patients utilizing any of the following methods:
Telephone
Radio
EMResource Incoming Patient Notification (IPN) Form
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46. S-SV EMS Agency MICN Training (Updated 05-2016)
EMResource IPN Form
Select ‘Add Incoming Patient Notification’ under the ‘Form’ tab, or the Ambulance quick link icon at the top of the page
S-SV EMS Agency MICN Training (Updated )

47. S-SV EMS Agency MICN Training (Updated 05-2016)
EMResource IPN Form
Complete the appropriate patient information
Select the receiving hospital from the drop down box
Select “Save” to notify the receiving hospital
S-SV EMS Agency MICN Training (Updated )

48. S-SV EMS Agency MICN Training (Updated 05-2016)
EMResource IPN Form
System will display a confirmation box that the IPN form has been sent to the receiving hosp.
S-SV EMS Agency MICN Training (Updated )

49. S-SV EMS Agency MICN Training (Updated 05-2016)
EMResource IPN Form
Receiving hospital will receive a visual/audible alert
The form can be reviewed (opens in another browser window), or printed if desired
S-SV EMS Agency MICN Training (Updated )

50. ‘Review’ Browser Window
EMResource IPN Form
‘Review’ Browser Window
‘Print’ Version
S-SV EMS Agency MICN Training (Updated )

51. S-SV EMS Agency MICN Training (Updated 05-2016)
EMResource IPN Form
To review a list of all your IPN forms sent/received within the last 24 hours, select ‘Incoming Patient Notifications’ under the ‘Form’ tab
S-SV EMS Agency MICN Training (Updated )

52. S-SV EMS Agency MICN Training (Updated 05-2016)
Patient Tracking
A Prehospital Patient Tracking Worksheet is utilized by field personnel on any MCI:
All patients are logged prior to EMS transport
Completed worksheets are submitted to the S-SV EMS Agency as soon as possible
S-SV EMS Agency MICN Training (Updated )

53. S-SV EMS Agency MICN Training (Updated 05-2016)
Patient Tracking
The patients assigned triage tag number should be entered into the patient’s hospital chart
S-SV EMS Agency MICN Training (Updated )

54. S-SV EMS Agency MICN Training (Updated 05-2016)
Updating the MCI Event
The CF should update event information as appropriate:
MCI is cancelled
New pertinent event information is received
Updated patient counts
Need to expand the receiving facility capabilities polling request to additional hospitals
When all patients have been transported
S-SV EMS Agency MICN Training (Updated )

55. S-SV EMS Agency MICN Training (Updated 05-2016)
Updating the MCI Event
Select the ‘Event’ tab
Select the ‘Edit’ link in the ‘Action’ column next to your event
S-SV EMS Agency MICN Training (Updated )

56. S-SV EMS Agency MICN Training (Updated 05-2016)
Updating the MCI Event
Enter the appropriate updates in the ‘Title’ and/or ‘Information boxes
Select any additional receiving facilities you wish to poll
Select ‘Save’ at either the top or bottom of the screen
S-SV EMS Agency MICN Training (Updated )

57. S-SV EMS Agency MICN Training (Updated 05-2016)
Ending the MCI Event
The event should be ended when all patients are transported
Select the ‘Event’ tab
Select the ‘End’ link in the ‘Action’ column next to your event
S-SV EMS Agency MICN Training (Updated )

58. MCI Critique & AAR Process
S-SV EMS conducts an AAR of all MCIs to recognize areas that went well and identify opportunities for improvement, education, and/or policy/plan revisions
CF, receiving facility and prehospital providers are required to complete and submit the appropriate MCI critique form within seven (7) days of the event
S-SV EMS Agency MICN Training (Updated )

59. S-SV EMS Agency MICN Training (Updated 05-2016)
MHOAC Program
The Medical Health Operational Area Coordinator (MHOAC) Program is based on the functional activities described in Health and Safety Code §
Within each OA (county), the Health and Safety Code authorizes the county health officer and local emergency medical services administrator to jointly act as the MHOAC or appoint another individual to fulfill the responsibilities
S-SV EMS Agency MICN Training (Updated )

60. S-SV EMS Agency MICN Training (Updated 05-2016)
MHOAC Program
The MHOAC Program is notified by the CF in the following circumstances:
Incidents involving hospital evacuation
Incidents requiring implementation of altered levels of care in the field, hospitals, or system-wide
Inability of the Control Facility to conduct patient distribution activities among local receiving facilities
Other unusual events
S-SV EMS Agency MICN Training (Updated )

61. S-SV EMS Agency MICN Training (Updated 05-2016)
MHOAC Program
The MHOAC Program can be contacted through the public safety dispatch center by requesting the MHOAC or Public Health Duty Officer
The S-SV EMS Duty Officer can be contacted utilizing the contact procedures provided
S-SV EMS Agency MICN Training (Updated )

62. Special Circumstances
Crisis Standard of Care
A level of medical care delivered to individuals under conditions of duress, such as a disaster, or when medical resources are insufficient for demand of emergency care
S-SV EMS has developed policies to allow for altering the EMS system under the direction of the S-SV EMS Medical Director in consultation with the applicable county health officer(s)
S-SV EMS Agency MICN Training (Updated )

63. Special Circumstances
Crisis Standard of Care
CFs may be requested to perform the following functions in these extreme instances (under specific direction of the S-SV EMS Medical Director and county health officer):
Direct EMS patients to alternate destinations (alternate care sites, field treatment sites, etc.)
Direct field personnel not to transport certain types of patients and/or refer certain types of patients to non- emergency numbers to arrange transportation
S-SV EMS Agency MICN Training (Updated )