1. Mass Casualty Incident
MCI Lecture
May 20, 2005
Mass Casualty Incident
Annex
INTRODUCTION
This plan is comprised of two sections. The first section gives general guidance in plan format. The second section is attachments that should be used as checklists in the field. The second section should be laminated and put in triage bags ready for use.
The plan utilizes ICS to manage the incident, with the incident commander in charge and assigning positions.

2. MCI Lecture
May 20, 2005
See Page 6-10
PURPOSE OF THE ANNEX
Provide direction for managing emergency medical care during Mass Casualty Incidents (MCI) in Lewis County
SCOPE
This plan applies to all Fire Services/Emergency Medical Services (EMS) response entities and provides guidance and direction to supporting entities that are assisting during a mass casualty incident
PURPOSE
The purpose of this plan is to provide guidance for optimal emergency medical care during Mass Casualty Incidents (MCI) in Lewis County.
SCOPE
This plan applies to all Fire Services/Emergency Medical Services (EMS) response entities and provides guidance and direction to supporting entities that are assisting during a mass casualty incident.
POLICY STATEMENT
The primary objective of Fire Services and Emergency Medical Services (EMS) in a Mass Casualty Incident (MCI) is to ensure that basic and advanced life support services are organized and coordinated to provide prompt, adequate and continuous emergency care to victims.
AUTHORITY TO DECLARE
Any EMS, Fire Service, Law Enforcement or other qualified individuals en route to or on the scene of the emergency are authorized to declare the Level of MCI and request activation of the Emergency Operations Center (EOC) if necessary.

3. MCI Lecture
May 20, 2005
See Page 6-12
Mass Casualty Incident: Any medically oriented incident that overwhelms the initial EMS response
·  Level I - MCI: Exceeds capabilities of initial responding agencies involving 10 or less patients
·  Level II - MCI: Greater than 10 victims but less than 30. May require out of county resources and multiple medical facilities
·  Level III - MCI: Medical Disaster with more than 30 victims. May require out of county resources and multiple medical facilities
Mass Casualty Incident: Any medically oriented incident that overwhelms the initial EMS response. MCI is categorized into three levels:
- Level I - MCI: Medically oriented incident that exceed the capabilities of the initial responding agencies involving 10 or less patients.
- Level II - MCI: Medically oriented incident involving greater than 10 victims but less than 30.
-- Possible activation of the Emergency Operations Center.
-- May need out of county resources and multiple medical facilities.
- Level III - MCI: Medical Disaster involving more than 30 victims.
-- EOC personnel will be notified.
-- May require out of county assistance.
Emergency Operations Center (EOC)/Emergency Coordination Center (ECC): The EOC supports incident management by coordinating information and resources. The ECC is a higher-level support system that may be activated to assist city EOCs with incident management coordination when they are activated. The Lewis County EOC and ECC will usually be collocated at Lewis County Emergency Management and work together to enhance coordination efforts.

4. Suggested Operating Procedures for Responding EMS Units to MCI
MCI Lecture
May 20, 2005
See Page 6-25
Suggested Operating Procedures
for Responding EMS Units to MCI
Keep radio communications to a minimum
Dispatch will advise of staging area location
Respond directly to the Staging Area
Do not abandon your unit unless approved by command 
Dispatch will advise of operations frequency after signing en route
Instructions given on scene by radio should be repeated back to assure the message is received accurately
PROCEDURE 100 – EMS RESPONSE (Page 6-12)
Action By: Action:
911 Communications - Initial dispatch and incident command communications shall be conducted on Fire Frequency Dispatch will only record en route and available times. Record all other times. Dispatch shall advise of staging area location (if it has been determined).
Incident Commander - Assigns the event to one of the following operations frequencies:
  REDNET
2. Hear
911 Communications - Advise EMS responders to switch to the operations frequency after signing en route.
EMS Responders - Respond directly to the Staging Area unless directed to go to the scene. Do not abandon your unit unless approved by command. Check in with the staging officer in person. Advise them if you have specialized capabilities such as extrication equipment, ALS capable, etc.
SUGGESTED OPERATING PROCEDURES FOR RESPONDING EMS
EMS units responding to an MCI should follow the SOP on page 6-24.
Response procedures
Frequencies listed and phone numbers

5. MCI Lecture
May 20, 2005
See Page 6-25
EMS Response
First arriving unit - determine Incident Commander who will complete IC Help Sheet
Additional responders proceed to the Staging Area unless directed to the scene
TASK 100 – EMS RESPONSE
The first responding unit will establish the Incident Commander, who will accomplish the Incident Commander Help Sheet.
Additional responders will proceed directly to the Staging Area unless directed to go to the scene. Check in with the Staging Officer.

6. Incident Commander Establishes command and command post
MCI Lecture
May 20, 2005
See Page 6-26
Incident Commander
Establishes command and command post
Identifies operations frequencies
Gets additional assistance if needed
Establishes staging area
Determines level of MCI
Assigns staff positions
INCIDENT COMMANDER
The Incident Commander shall be responsible for the management of operations at the scene of the incident. The most qualified responder/officer from the first arriving unit shall establish this position.
TASK INCIDENT COMMANDER
1. Immediately accomplish a size-up of the scene to include the following:
a. Description of the scene.
b. Determine initial actions.
c. Identify dispatch and operations frequencies to be used. Operations frequency will be either: REDNET or HEAR
d. Establish command and Incident Command Post.
e. Determine location of staging area.
f. Identify safety concerns.
g. Determine need for additional resources.
h. Name the incident ________________________
2. Provide the above size-up information to the 911 dispatch center.
3. Don “Incident Commander” vest, assign the following staff positions and distribute position checklists as the incident requires:
a. Medical Officer
b. Triage Officer
c. Treatment Officer
d. Transport Officer
e. Staging Officer
4. Notify medical facility of situation:
a. Type of incident.
b. Estimated patient count.
c. Special considerations (Hazardous Material).
5. Determine level of incident.
6. Request status updates from all officers every 10 minutes (use 10-minute benchmark to track time, if applicable).
Consider other needs: mass transportation, morgue, chaplains, rehabilitation, debriefings (after incident).
Deal with victim and responder accountability.
Appoint Public Information Officer to act as media liaison.

7. Medical Officer Directs all medical operations
MCI Lecture
May 20, 2005
See Page 6-28
Medical Officer
Directs all medical operations
Responsible for accountability tracking of the medical group officers:
Triage Officer
Treatment Officer
Transport Officer
 Staging Officer
Ensures placement of Medical Supply area and Medical Command Post if needed
Obtains patient count from Triage Officer
C. POLICY MEDICAL OFFICER
Incident Commander will assign the position of Medical Officer.
The medical officer shall be responsible for directing all medical operations and takes direction from the Incident Commander or Operations Officer. The medical officer shall be responsible for accountability tracking of the following medical group officers:
  Triage Officer
  Treatment Officer
  Transport Officer
Staging Officer
TASK 300 – MEDICAL OFFICER
1. If delegated by the IC, immediately provide a size up to the dispatch center with the following information:
a. Describe the scene.
b. Advise of safety concerns.
c. Location of the command post.
d. Name the incident _____________________________
e. Describe initial actions.
f.  Request additional resources.
g. Location of staging area.
h. On scene operations frequency.
2. Don “Medical Officer” vest.
3. If delegated by Incident Commander, relay the following information to the medical facility:
a.Type of incident.
b. Estimated patient count.
c. Special considerations (Hazardous Material).
4. Ensure placement of:
a. Medical Command Post (if needed)
b. Medical Supply Area(s)
Obtain patient count from Triage Officer. Relay to medical facility and Incident Commander.
Determine the need for additional resources and request them through the IC.

8. Triage Officer Responsible for:
MCI Lecture
May 20, 2005
See Page 6-29
Triage Officer
Responsible for:  
Development of tagging and backboard teams  
Establishing triage funnel(s)  
Triaging patients at funnel(s)  
Accountability tracking of personnel assigned to Triage Group
D. POLICY 400 – TRIAGE OFFICER
Incident Commander will assign the position of Triage Officer.
The Triage Officer shall take direction from the Medical Officer and be responsible for:
· Developing tagging and backboard teams.
· Establishing triage funnel(s).
· Triaging patients at funnel(s).
· Accountability tracking of personnel assigned to the triage group.
TASK 400 – TRIAGE OFFICER
1. Don “Triage Officer” vest.
2. Issue (10) triage tags to each tagger.
3. Report patient count to Medical Officer.
4. Establish and staff triage funnel.
5. Direct backboard teams to/through funnel and into treatment areas.
6. Match torn tag stubs with Transport Officer.

9. Triage System Help Sheet
MCI Lecture
May 20, 2005
Triage System Help Sheet
See Page 6-30
TAGGING:
Distribute triage tags
Place triage tags on victims
TRIAGE:
Set up and mark the triage area (funnel)  
Use walking wounded and non-injured to assist
Triage the victims at the funnel  
TREAT:
Set up treatment areas near triage funnel
Take patients to the treatment area
Treatment Officer coordinate patient evacuation
1.       TAGGING:
a. Ensure taggers have a packet of 10 triage tags.
b. Place triage tag on the right wrist or uninjured arm of all victims. If victim is deceased, tear the triage tag to black. Do not decide the level of triage now.
c. When tagging, the following may be accomplished:
- Open the airway for each patient not breathing
- Give two breaths only if you think there was an airway obstruction from neck position. Do not start CPR.
- Apply constricting band or instruct victim or onlookers in direct pressure bleeding control techniques.
2.       TRIAGE:
a. Taggers return to triage for assignment and to count remaining tags to determine the number of tags used. This will determine the number of potential patients to be treated and transported.
b. Set up the triage area (funnel) where it will be easiest to move patients through to treatment areas.
c. Mark the area (survey tape is suggested).
d. Move the walking wounded that are not helping with victims to a separate area.
Assign an EMT to reassess the victims while waiting for transportation.
e. Assign crews to transport victims via backboard to the triage funnel. Do not try to find the most serious patients first. This will only slow things down. Do not move those obviously dead.
f. Triage the victims at the funnel. Tear the tag levels off until the appropriate level remains. Keep the torn section for accountability. 
3.       TREAT:
Set up treatment areas near triage funnel. Mark them with survey tape.
- Red: Immediate
- Yellow: Delayed
- Green: Minor
Take patients to the treatment area that matches their tag color.
The treatment officer will coordinate the evacuation of the patients with the transport officer.

10. Triage System Philosophy
MCI Lecture
May 20, 2005
Page 6-19
Triage System Philosophy
An organized approach for sorting, treating and transporting patients in a mass casualty situation
Real patient care occurs in the treatment area
Treating patients where they lay slows the system
With overwhelming number of victims, even care in the treatment areas will be less than normal  
Use the walking wounded and non-injured to assist with patient care
MCI Bags:
Keep MCI bags current and in all response vehicles
Use recommended contents list on page 6-19 to standardize all kits throughout the county
The goal of this system is to provide an organized approach for sorting, treating and transporting patients in a mass casualty situation. You are trying to save the greatest number of savable patients possible. Remember this is not your normal call; otherwise you would not be using this triage system.
Unlike what you would normally do, real patient care does not occur until you get the patient into a treatment area. Treating patients where they lay will only slow the system down for other patients. When dealing with overwhelming numbers of victims, even the care in the treatment areas will be less than what would normally be done on a smaller incident.
Use the walking wounded and non-injured to assist with patient care. The system encourages the use of responders with little formal medical training. The system should work well with a very limited number of medically trained responders.
MCI bags should be widely distributed in response agency vehicles to expedite activation of the system. Using the recommend contents list will help standardize all bags.

11. Treatment Officer Develops and supervises treatment areas
MCI Lecture
May 20, 2005
See Page 6-31
Treatment Officer
  Develops and supervises treatment areas 
  Coordinates patient loading with Transport Officer  
  Tracks personnel assigned to Treatment Group
  Maintains treatment area medical supply
  Uses Log Sheet on page 6-31 for tracking
Incident Commander will assign the position of Treatment Officer.
The treatment officer shall take direction from the medical officer and be responsible for:
· Supervising treatment areas.
· Coordinating patient loading with transport officer.
· Accountability tracking of the treatment group.
TASK TREATMENT OFFICER
Don “Treatment Officer” vest.
Obtain briefing from Medical Officer.
Develop treatment teams from available BLS/ALS and other personnel.
Develop treatment areas:
· Red: Immediate
· Yellow: Delayed
· Green: Minor
5. Supervises patient care within immediate and delayed care areas. May delegate responsibility for minor area.
6. Work with Transport Officer to coordinate patient loading and transport.
7. Maintain treatment area medical supply, working through Medical Officer for resupply.

12. Transport Officer Supervises patient loading activities
MCI Lecture
May 20, 2005
See Page 6-33
Transport Officer
Obtains patient destinations from Medical Facility
Supervises patient loading activities
Tracks personnel assigned to Transport Group
Uses Log Sheet on page 6-33 for tracking
Incident Commander will assign the position of Transport Officer.
The Transport Officer shall take direction from the Medical Officer and communicate directly with medical facility (Providence Centralia and/or Morton General)
The transport officer shall be responsible for:
· Obtaining patient destinations from medical facility. If patients are diverted due to nature of their injuries, notify the Transport Officer.
· Supervising patient loading activities.
· Accountability tracking of personnel assigned to transport group.   
TASK TRANSPORT OFFICER
1. Don “Transport Officer” vest.
2. Obtains briefing from Medical Officer.
3. Develops patient loading zones, coordinates entrance and degress routes with Medical Officer and Staging Officer.
4. Requests transport units move into loading zone directly from Staging Officer.
5. Directs loading of transport vehicles.
6. Completes transport unit log. Obtain destination from medical facility. Relay to Transport Unit.
7. Collect tag stubs. Match with Triage Officer. Report findings to the Medical Officer.

13. Staging Officer Develops and manages three-part staging area
MCI Lecture
May 20, 2005
See Page 6-35
Staging Officer
Develops and manages three-part staging area
·  Part One: Transport Units
·  Part Two: Consists of single resources, i.e. extrication crews should stay together
·  Part Three: Consists of all other equipment
Uses Log Sheet on page 6-35 for tracking
Arriving units report to the Staging Officer who assembles all resources in one area.
Staging Officer takes direction from the Medical Officer and is responsible for managing a three-part staging area.
TASK STAGING OFFICER
Don “Staging Officer” vest.
Obtains briefing from Medical Officer.
Directs Transport Units to loading area as requested by the Transport Officer.
4. Develops three-part staging area. If possible, staging should be within eyesight of the transport zone.
a. Part One: Consists of patient Transport Units. Transport Unit personnel will be advised to stay with their unit. 
b. Part Two: Consists of single resources, i.e. extrication crews should stay together.
c. Part Three: Consists of all other equipment. If needed, medical equipment should be taken to medical supply areas located near treatment areas. Extra personnel shall remain in staging until requested by the command.
5. Notify the Medical Officer when transport vehicle numbers fall below the number set by the Medical Officer.

14. MCI Scene Scene Staging Area Medical Supply Loading Zone
MCI Lecture
May 20, 2005
MCI Scene
Staging Area
This is an example of an MCI setup.
There are many different ways to set up, but it should provide good flow to get from the scene to the loading zone.
Medical Supply
Loading Zone
Treatment Area
Triage Area
Incident Command
Morgue Area
Scene

15. Summary
Expect chaos
Establish positions quickly to disseminate tasks and responsibilities
Use checklists to guide actions
Do the best you can for the most you can
Prepare ahead of time:
Training and practice
Keep Triage bags current and available