1. MASS CASUALTY INCIDENTS
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

2. MCI RESPONSE Potential Danger
Major and catastrophic incidents are a potential in any community. With the great variety of natural and man-made disasters that face us everyday, something major can happen almost anywhere.
Whether it is a natural disaster or terrorist incident there can be significant impact on the community
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

3. MCI RESPONSE
Familiarization with Target Hazards
Site that have great potential for significant loss of life or monetary loss:
Public assembly facilities
Hospitals
Nursing homes
Theaters
Industrial sites using hazardous materials
Railroads
Highways
Schools
Malls
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

4. MCI Response Prepare Train in ICS / UICS Train in mock disasters
Understand your responsibilities
Understand the vocabulary
Train in mock disasters
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

5. MCI Response
Primary concern must be to save as many lived as possible and protect responders
Response
First unit establishes command and sizes-up the scene
The IC determines need for additional resources
Triage
Treatment
Transport
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

6. MCI Response Establish Command
Senior member of first arriving unit becomes IC
Will remain in charge until relieved by a higher authority
Unified Command should be considered early in the event.
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August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

7. MCI Response Scene Organization Ensure an effective response
Secure the area (limit access)
Determine scene safety (is decon required)
Assign personnel
Establish staging and T-3 areas
Establish communications
Determine ingress and egress (flow of traffic)
Maintain records
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

8. MCI Response Potential for Terrorism
The IC must be cognizant of the possibility the MCI was deliberate
Preserve evidence
Watch for secondary devices
PIO releases only necessary information
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

9. MCI Response Decontamination PPE may be needed if the scene includes:
Nuclear
Biological
Chemical
Determined by HazMat Team
Victims must be deconed prior to T-3
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

10. T-3 Triage Treatment Transport MCI Response August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

11. Triage
The concept of triage is simply a method of quickly identifying victims who have immediately life-threatening injuries
AND who have the best chance of surviving so that when additional rescuers arrive on scene, they are directed first to those patients. 
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

12. START (Simple Triage and Rapid Treatment)
Developed by Hoag Hospital and the Newport Beach Fire Department (Newport Beach, CA)
Relies on making a rapid assessment (taking less than a minute) of every patient
Determining which of four categories patients should be in
Visibly identifying the categories for rescuers who will treat the patients
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

13. MCI Response Triage Victims are divided in the following categories:
Immediate (RED)
Life-threatening
Delayed (YELLOW)
Serious but not life-threatening
Minor (GREEN)
Walking wounded
Deceased (BLACK)
Includes non-salvageable
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

14. MCI Response START Triage Simple Triage and Rapid Treatment
Designed to assess a large number of victims objectively, efficiently and rapidly
Can be used by personnel with limited training
30 – 60 seconds per victim
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

15. MCI Response Evaluating Patients
START, ambulatory patients are automatically triaged for delayed care
30-2 can do
Non-ambulatory evaluated:
Respiration
Perfusion
Mental status
R.P.M
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August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

16. EMS & Trauma Systems Section Office of Public Health Preparedness
Slide hidden by DE – BF: Might be inclined to keep this or have a separate lecture on START.
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

17. Visibly identifying the categories for rescuers who will treat the victims…
The Triage Tag or Colored Strip
Color Coded
Person doing initial START triage does NOT fill out the tag, only tears off the color strip
Should write time and initial the tag
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August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

18. MCI Response Medical Treatment During Triage
Only life-threatening problems are corrected
Opening the airway
Attempt to control exsanguation
Resuscitation is not attempted
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August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

19. MCI Response Triage Categories START RED – Immediate YELLOW – Delayed
RPM outside of desired values
YELLOW – Delayed
RPM within desired values
Significant injuries
GREEN – Minor
Ambulatory, able to move with instruction from EMS
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

20. MCI Response Target Values Respiration Capillary refill
Between 10 & 30 per minute
Capillary refill
Less than 2 seconds or radial pulse present
Victim can do what you ask
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August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

21. MCI Response Assess Respiration If between 10-30 go to perfusion
If <10 or >30 tag red and move to next patient
If not breathing, open airway and remove obstructions if visible
If victims starts breathing, follow #1 or #2 above
If patient is still not breathing, prioritize BLACK
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August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

22. R=Respiration First check for breathing (estimate rate) Yes Rate
< 30
>30
Red Tag
Check Perfusion
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

23. Breathing Continued… Not Breathing Reposition/Open Airway
Still Not Breathing
Breathing Resumes
Black Tag-Dead
Red Tag-Immediate
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August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

24. MCI Response Assess Perfusion
If radial pulse is present or capillary refill is less than 2 seconds go to MENTAL STATUS assessment
If no radial pulse or capillary refill greater than 2 seconds, prioritize RED
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August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

25. P = Perfusion Check a radial pulse Yes Check Capillary Refill
Not Present
Red Tag & Move to
Next patient
Note: May have the victim or a less injured victim put pressure on any bleeding and elevate feet
< 2 Seconds
> 2 Seconds
Move to Mental Status
Slide hidden
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

26. MCI Response Assess Mental Status
Assess the victim’s ability to follow simple commands
Alert to person, place and time
If victim does not follow command, is unconscious or disoriented, prioritize RED
If victim follow commands and is oriented, prioritize GREEN or YELLOW
Slide hidden
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

27. M = Mental Status Check Mental Status Follows Simple Commands Yes No
Yellow Tag-Delayed &
Move to next victim
Red Tag-Immediate &
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August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

28. EMS & Trauma Systems Section Office of Public Health Preparedness
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

29. Black – deceased Red – immediate Yellow – delayed
Green – minor
This tag shows the patient's category as "Immediate."
                          
Slide hidden
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

30. Respirations No Position Airway Deceased Immediate Yes < 30/m
No Respirations
Deceased
Immediate
Yes
< 30/m
> 30/m
Perfusion
Radial Pulse Absent OR
Control Bleeding If Nec.
Radial Pulse Present
Capillary Refill
> 2 Sec.
Mental Status
Follows Simple Instr.
Delayed
Cant Follow Simple Instr.
< 2 Sec.
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

31. MCI Response Treatment
Patients are re-evaluated using more in-depth assessment
Secondary triage
Separate treatment areas; Red, Yellow, Green
Definitive/stabilizing emergency care
ABC’s
Wound care
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

32. MCI Response Transport Transported by triage determination
Red go first
Green patients made be transported by alternative means (Bus)
Accompanied by medical personnel
Transportation Officer designates facility
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

33. MCI Response CISM Pre-incident education Defusing Debriefing
Information on symptoms of stress and methods to deal with stress
Defusing
Brief group sessions to vent thoughts and feeling
Immediately following incident
Debriefing
Longer more structured group sessions
Typically 24 – 72 hours following incident
Slide hidden
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

34. MCI Response Long-Term Operations EMS among last to leave
Stand by during search
Maintain rehab care
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

35. MCI Response Reports and Records
IC must assemble all reports and records
Resources requested and received and where assigned
Incoming and outgoing ambulances (times)
Triage log
Staging log
Patient destination log
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

36. REGIONAL MEDICAL COORDINATION CENTER (MCC)
MCC Responsibilities
Provide initial and update alerts via appropriate communication resources
Provide frequent updates to on-scene EMS ICS Directors/Supervisors/Leaders regarding hospital casualty care capacity
May assist with relay casualty transport information to receiving facilities
May assist with relay urgent and routine communications to appropriate entities
May assist in coordination and distribution of resources
Other appropriate tasks as necessary for an effective regional medical response
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

37. SCENE MANAGEMENT
EMS personnel should accomplish the following actions upon arrival.
Survey the scene
If Incident Command has not been established the senior EMS personnel shall assume the role of IC. The IC shall assume to role of all other elements of the ICS until she/he as assigned other personnel to their roles.
Advise dispatch who has assumed command and who has EMS Branch Director/Group Supervisor and their exact location.
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

38. SCENE MANAGEMENT
EMS personnel should accomplish the following actions upon arrival. (cont.)
Organize the scene and ensure an effective response including:
Securing the area and limiting access to nonessential personnel
Determining whether the incident scene is safe to enter and whether decontamination is required
Assigning personnel to the necessary tasks and roles
Establishing staging, triage, treatment, and transportation areas
Establishing communication between areas
Establishing traffic pattern that provided for the smooth flow of patients and vehicles
Ensure that appropriate record-keeping takes place
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

39. SCENE MANAGEMENT
EMS personnel should accomplish the following actions upon arrival. (cont.)
Call for additional resources
EMS personnel
Any specialized equipment
MEDDRUN
CHEMPACK
Regional Medical Coordination Center (MCC)
Other available resources
Inform the “Coordinating Resource” of nature and scope of incident
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness

40. EMS & Trauma Systems Section Office of Public Health Preparedness
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August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness