1. EMS Support and Operations
Chapter 19

2. Objectives By the end of this lesson, you will be able to:
list the phases of an out-of-hospital call.
describe an incident command system and its components
define a multiple casualty incident.
discuss the role of the first responder in the multiple‑casualty situation.
summarize the components of basic triage.
triage a patient based on the nature and extent of the injuries and/or illness.

3. Phases of an EMS Response
Nine Phases
Preparation for a care
Dispatch
En-route to scene
Arrival at the scene
Transferring victim to ambulance
En-route to receiving facility
Arrival at the facility
En-route to the station
Post run

4. EMS Support and Operations
Multiple Casualty Incidents (MCI)
Situation involving two or more victims
Incident Command System (ICS)
Management system used for a variety of emergencies
Advantages
Common terms with an integrated communication system
One “boss”
One unified command structure with well established manageable divisions

5. EMS Support and Operations
Leadership Positions
Incident Commander
Responsible for managing & directing response
Operations Section Chief
Responsible for developing a plan that works
Planning Section Chief
Responsible for keeping incident commander updated on the status of the incident
Logistics Section Chief
Responsible for establishing communication, coordinating crowd control efforts and evaluating scene if necessary, getting additional resources (personnel, equipment & supplies)

6. EMS Support and Operations
Triage
French meaning “to sort”
Process of sorting multiple victims according to the severity of the injury or illness
START System
Simple Triage And Rapid Transportation
Rules
Greatest Good for the Greatest Number
Preservation of life over preservation of limb

7. START System Requires you to check only three things
Breathing
Circulation (including bleeding)
Level of Consciousness
Allows you to classify victims into 4 levels
Priority One (Red Tag)
Immediate care required
Life-threatening Injuries or Illness
Priority Two (Yellow Tag)
Urgent Care Required
Can delay care up to one hour

8. START System To make these decisions take the following steps
Priority Three (Green Tag)
Delayed Care (“walking wounded”)
Care can be delayed up to three hours
Priority Four ( Black or Gray Tag)
Dead / nonsalvageable
To make these decisions take the following steps
Refer to page 439, figure 19-6

9. START System Step One Step Two Begin where you stand
First responders clear the area of all victims with only minor injuries
Step Two
Check Breathing
If not breathing. Open the airway & recheck the breathing
If not breathing (dead/nonsalvageable)

10. START System If breathing after you open the airway
Red Tag
If victim is breathing when you begin check respiratory rate
30 bpm or more - red tag
less than 30 bpm - evaluate further

11. START System Step Three Check Circulation
Radial Pulse (Brachial in infants)
If no pulse, classify as black tag (unless ample help is available)
If weak or irregular pulse, check for and treat severe bleeding, classify as red tag
If pulse present, move on to next step

12. START System Step Four Check level of consciousness using AVPU
Alert - Yellow or green tag depending on injury or illness
Any level of consciousness other than alert should be classified as needing immediate care (red tag)

13. Priorities Priority One (Red Tag)
Airway and respiratory difficulties or respiratory arrest
Spinal injuries with respiratory problems
Cardiac Arrest (if enough help available)
Severe hemorrhage
Open chest or abdominal injuries
Major or complicated burns (including lightning strikes)
Tension pneumothorax or pericardial tamponade

14. Priorities Priority One (Red Tag) Severe or impending shock
Poisoning, diabetes with complications, pregnancy
Hypo or hyperthermia

15. Priorities Priority Two (Yellow Tag) Burns without complications
Spinal injury (without respiratory problems)
Major, open or multiple fractures (without major bleeding)
Eye injuries
Stable abdominal wounds
Seizures

16. Priorities Priority Three (Green Tag) Simple Fractures
Sprains / Strains
Minor / Moderate lacerations & abrasions (no significant blood loss)
Minor soft tissue injuries
Minor burns

17. Priorities Priority Four (Black or Gray Tag)
Patients are dead or have such severe injuries that they have little chance for survival.
If limited resources these patients must be ignored in order to treat “salvageable” patients