1. The following Module, Module 2, will introduce you to the Multiple Casualty Incident Manual.
The Manual

2. Regional standardization Compliance
Virginia Mass Casualty Incident Manual
National Incident Management System (NIMS)
Reference
Not just for Mass Casualty Incidents
As you proceed through the presentation, you will get a brief overview of what the manual does and doesn’t do.
The manual offers standardization throughout the region, so no matter what NOVA region jurisdiction you are operating in, everyone is on the same page when it comes to terminology and procedures. For example, when asking for an EMS taskforce in any jurisdiction, you will get the same complement.
The Manual is also NIMS compliant.
The manual is to be used on any incident with multiple patients. It shouldn’t be stored on a shelf and brought out only on those large Mass Casualty Incidents.

3. We will now review some of the specific components of the manual

4. Establish effective NIMS compliant MCI plan for Nova region
Establish MCI response packages
based on casualty numbers with predetermined assignments and central resource control point
Do the greatest good for the greatest number
Effectively use personnel, equipment and resources
Avoid relocating incident
When the NOVA Mass Casualty Committee met and was given the assignment of designing a Multiple Patient Incident Manual, we had specific goals we wished to accomplish for the manual:
The manual had to be NIMS compliant.
We wanted to established a response package component that would supply enough units to effectively manage an incident with multiple patients.
Ultimately, as with any Multiple Patient Incident, we wanted to give the tools to do the greatest good for the greatest number.
We wanted to give the tools to effectively manage personnel.
We wanted to ensure that there were enough personnel to stabilize and manage the incident on scene vs. relocating the disaster to the hospital.

5. First arriving unit initiates five S’s
First arriving suppression unit recons situation and establishes command
As per NOVA Command Officer Operations Manual
First arriving unit initiates five S’s
Note: First arriving unit may not be a suppression unit
The manual is to be used as a guideline and in no way meant to restrict an incident commander if they need to change their tactics and strategies.
The first arriving units are to perform recon, which coincides with the NOVA Command Officer Operations Manual
In aligning with that manual, the first arriving unit will initiate the five S’s.
Remember that the first arriving unit may not be a suppression unit.

6. Safety Size-Up Send First arriving unit’s priority is scene safety
Declare MCI and stage incoming units until scene is secure
Mitigate IDLH if appropriate and warn incoming units of hazards
Size-Up
Ascertain type of incident
Determine approximate number of patients
Determine severity and type of injuries or illness
Determine best scene access
Send
Give situation report to communications
Request appropriate MCI resources (EMS Task Force vs. MCI Alarm)
Request additional resources as needed
Assure closest hospital is notified for potential surge
Activate RHCC/MedComm if appropriate
We will now review the five S’s:
1st S – Safety: The first arriving unit is responsible for identifying any hazards and ensure scene safety, voice the type of incident (a Mass Casualty Incident or Multiple Patient Incident).
2nd S – Size-up: Confirm your type of incident, approximate number of patients, severity and type of injuries (i.e. burns, blast trauma, chem./bio), and determine best scene access.
3rd S – Send info: Provide your SitRep, request appropriate MCI response, activate RHCC (aka MedComm) and then notify the closest hospital for the possibility of surge and self transport.

7. START/Jump START Triage
Set Up
Establish & maintain command until relieved
Establish staging area
Establish casualty collection point
Set up scene access and egress
Set up perimeter using fire line tape or other means
START/Jump START Triage
Initiate triage, once hazard mitigation is addressed
Triage Unit Leader responsibilities goes to first arriving suppression company not assigned to hazard mitigation
Follow START/Jump START Algorithm & treat life threatening injuries
Maintain patient contact time of 60 seconds or less
Move ambulatory Green Patients to defined Casualty Collection Point
Transition personnel to Porter Units after completion of triage
4th S – Set-up: Establish and maintain command until relieved. Identify a staging area for incoming units, a casualty collection point (especially for the walking wounded that flock to you upon your arrival), scene access and egress, and also a perimeter using fire line tape or any other means necessary. (This is often a good job for police officers if they are already on scene.)
5th S – START/JumpSTART: Once hazard mitigation has been addressed, begin triage. Assume or identify someone to become Triage Unit leader (and use the Triage Unit Leader board which is located on every front line piece in the NOVA region). Maintain the rule of no more than 60 seconds per patient. Have ambulatory patients (green tags) relocate to the designated Casualty Collection Point until a formal treatment area can be set up.

8. EMS Taskforce Incident
Low impact
Handled by conventional response characteristics
Patients are assigned directly to EMS units
Establishment of Treatment and Transportation area not required
Multiple Casualty Alarm Incident
High impact
Reduces effectiveness of traditional fire/EMS response
Increased number of patients often with special hazards or difficult rescue
Require development of all or part of EMS Branch
Usually, Multiple Casualty Incidents are identified as one of the following:
EMS Task Force Incident: The EMS Task Force Incident is usually:
Low impact.
Can be managed with normal response packages.
Patients are assigned directly to incoming transport units.
Establishment of a formal treatment area and transportation area are usually not required.
Multiple Casualty Alarm Incident: The Multiple Casualty Alarm Incident is usually:
High impact.
Reduces the effectiveness of traditional Fire/EMS response.
Increased number of patients, often with special hazards or difficult rescue.
Often requires development of all or part of the EMS Branch

9. EMS Taskforce (up to 10 patients maximum)
Number of available transport units matches number of victims
Transport unit loading area and Casualty Collection Point established to maintain incident organization
Treatment and Transportation area not required
MCI Alarm (more than 10 patients)
Dispatch one MCI Alarm per 25 patients
There are two response packages:
EMS Taskforce:
Usually will manage 10 patients (dependent upon the severity of injuries).
A transport loading area should be identified as well as a casualty collection point.
A formal transportation area should not be required.
MCI Alarm:
Usually utilized when you have more than 10 patients.
Each MCI Alarm will usually handle 25 patients depending upon the severity of injuries.

10. EMS TASKFORCE MCI ALARM
Dispatched units:
5 EMS Transport Units (All must be ALS)
2 EMS Supervisors
2 Suppression Units
Air Transport Units (Upon request)
EMS Taskforce Assignments
5 EMS Transport Units
Air Transport Units (Upon Request)
MCI ALARM
Dispatched Units:
10 Suppression Units
10 EMS Transport Units (Min. 5 ALS)
3 EMS Supervisors
1 Battalion Chief
1 Green Transport Bus
Air Transportation Units (upon request)
1 Medical Care Support Unit (MCSU)
1 Medical Ambulance Bus (MAB)
Patient Treatment/Transport
1st due
Medical group supervisor
2nd due
Medical communications coordinator
The following sheet shows the specific response packages. Review the sheet to see what you will receive when you request an EMS Task Force or an MCI Alarm. A few things to keep in mind:
The response packages are not set in stone. You may call an “audible” to add or delete units as necessary.
For example: The EMS task force will provide you with 5 transport units, all must be ALS units. Upon your size-up, you realize you need only 2 ALS units. So, when you request your resources, you may say “Send me an EMS task force, however, only two of the units need to be ALS.” You may also add or delete units as necessary.
If you are requesting an MCI alarm and you realize you may need two to effectively manage the number of patients, it is better to ask for the full component instead of asking for 1 MCI Alarm and then later asking for one additional MCI Alarm.
Also, notice that any air transport units must be requested and are not automatic.
1st due Triage Unit Leader
2nd due Porters/Loaders
Reports to IC

11. What the manual doesn’t do:
It doesn’t tell you how to manage your incident. Rather, it gives you the tools to effectively manage it.
It doesn’t tell you how to mitigate your hazards. That is why we have the other NOVA Manuals.

12. This concludes Module 2: an introduction to The Multiple Casualty Incident Manual.