1. Incident Command and Multiple-Casualty Incidents

2. You Are the Emergency Medical Responder
Lesson 45: Incident Command and Multiple-Casualty Incidents
You Are the Emergency Medical Responder
A school bus carrying 30 students is involved in a collision and is severely damaged near the front of the bus. The students are scared and some are injured. People are starting to crowd around the area, and the local fire department already is on scene. You arrive as an EMR on scene.

3. Incident Management Systems
National Incident Management System (NIMS)
Systematic, proactive approach to guide organizations responding to incidents
Provides a template for the management of incidents
National Response Framework (NRF)
Guide to how an all-hazards response is conducted
Incident Command System (ICS)
Organizes who is responsible for overall direction

4. Incident Command System
Management system originally developed to help manage fighting forest fires
All-hazards management system
Incident commander—
Establishes incident objectives
Scene safety, identify the MCI, patients
Manages resources
Fire, ambulances, HZMAT
Supervises use of resources

5. Common Roles in the ICS Triage officer Treatment officer
Initial triage of patients
Treatment officer
Sets up area/medical care
Transportation officer
Transport vehicles
Staging officer
Distributes resources
Safety officer
Maintains scene safety

6. Multiple-Casualty Incidents
Motor-vehicle crashes
Transportation accidents
Flood
Fire
Explosion
Structure collapse
Train derailment
Airliner crash
HAZMAT incidents
Earthquake
Tornado
Hurricane

7. Triage French for separate, sift or select
The process for identifying which patients require urgent care in a multiple-casualty incident
Triage officer performs triage on all patients
Primary and secondary triage
Each patient is tagged and identified by a tag/tape
Green, yellow, red, and black

8. Types of Triage Primary
Used on scene to rapidly categorize the condition of the patients, including the number and location of the patients and what transportation is needed
Secondary
Often performed after patients are moved to the treatment area or before entering the treatment area

9. The START System Simple Triage And Rapid Treatment
START is a triage system used only in situation in which your assessment and care-giving skills are modified
The system requires you to assess and base you treatment level on three factors
Breathing
Radial pulse (Circulation)
Level of consciousness
The emergency care steps taken prior to a MCI do not always work in this type of situation. A person who is not breathing because the tongue is blocking the airway could die while you manage a laceration on the leg. This processing of identifying victims may leave you feeling like you are heartless, but it is a necessity of the job.
START is a simple system that requires you to check on three items:
Breathing, circulation, and LOC
Based on these variables you will classify a victim as immediate, delayed, or dead/unsalvageable

10. Triage Categories Ambulatory (walking wounded): Green
Immediate care: Red
Delayed care: Yellow
Deceased/non-salvageable/expectant: Black
Hold: White

14. Other Methods for Triage
SALT Mass Casualty Triage
Priority 1: Still/obvious life threat
Priority 2: Waving/purposeful movement
Priority 3: Walking
JumpSTART
Used with children
Not for use with infants younger than 12 months

15. Activity
You are assisting with triage at the scene of a multi-vehicle collision involving several automobiles and a tractor trailer. One of the patients, a 35-year-old woman, is alert and responsive with a small cut on her forehead and forearm and is complaining of a headache. An 8-year-old child has a fractured leg with the bone protruding through the skin with significant bleeding. A third victim, a 65-year-old male is not breathing, even after attempting to open and clear his airway.

16. Stress at a Multiple-Casualty Incident
Patient
More then just visible injuries
Cognitive, emotional, physical and behavioral
Children and elderly with increased risk for severe stress reactions
EMRs and the need for debriefing
Adequate rest/down time
Talking with colleagues about their experience

17. You Are the Emergency Medical Responder
A number of students from the bus are yelling at you to help them, and one of the firefighters asks you to come over and check the coach, whose pain in his abdomen and chest seems to be getting worse.