Multiple Casualty Incidents (MCI)

Multiple Casualty Incidents (MCI)
S-SV EMS MICN Course Module 7 Multiple Casualty Incidents (MCI) S-SV EMS Agency MICN Training (Updated )

California OES Mutual Aid Regions
California is divided into 6 OES mutual aid regions OES Region III includes Butte, Colusa, Glenn Shasta, Siskiyou, Sutter, Tehama and Yuba Counties OES Region IV includes Nevada & Placer Counties S-SV EMS Agency MICN Training (Updated )

S-SV EMS Agency MICN Training (Updated 12-2018)
Regional MCI Plan Region III MCI Plan Utilized by all S-SV EMS Counties (OAs), including Nevada and Placer Regularly updated to reflect current technology and MCI procedures Manual 1 – ‘Field Operations’ Manual 2 – ‘Control Facility (CF) Operations’ S-SV EMS Agency MICN Training (Updated )

Control Facility (CF) Definition
Entity responsible for coordination & dispersal of patients during Multi Casualty Incidents (MCIs) Can be a hospital, dispatch center, or local warning center S-SV EMS Agency MICN Training (Updated )

CF Purpose & Responsibilities
Single point of contact for the field Medical Communications Coordinator (MCC) to assist/direct patient dispersal during an MCI S-SV EMS Agency MICN Training (Updated )

S-SV EMS Designated CFs
OES Region III: Enloe Medical Center Butte, Colusa and Glenn Counties Mercy Medical Center Redding Shasta, Siskiyou & Tehama Counties Rideout Regional Medical Center Sutter & Yuba Counties S-SV EMS Agency MICN Training (Updated )

S-SV EMS Designated CFs
OES Region IV: Sutter Roseville Medical Center Western Slope of Nevada & Placer Counties Tahoe Forest Hospital Tahoe Basin & Eastern Slope of Nevada & Placer Counties REMSA dispatch may act as a backup CF in this area upon request from Tahoe Forest Hospital S-SV EMS Agency MICN Training (Updated )

CF Personnel Positions
CF Supervisor: Provides hospital CF program oversight and direction Responsible for training of CF staff Schedules and runs drills/exercises Liaison with administration/other facilities Evaluates/keeps records of MCIs Organizes/attends MCI reviews/critiques S-SV EMS Agency MICN Training (Updated )

Patient Dispersal Officer: Assigned during an MCI Assumes patient dispersal decisions Communicates directly with field Medical Communications Coordinator (MCC) S-SV EMS Agency MICN Training (Updated )

Facility Status Officer: Assigned during an MCI Provides patient destination notification and other relevant incident information to receiving facilities Role may be assumed/maintained by the Patient Dispersal Officer depending on size of the incident S-SV EMS Agency MICN Training (Updated )

Receiving Facility Positions
Receiving Facility Officer: Determines/reports patient treatment capabilities Communicates with the CF as needed Advises facility staff of pertinent incident information and number/type of patients they are receiving S-SV EMS Agency MICN Training (Updated )

MCI Communications Med Net radios VHF/800 MHz radios Amateur Radio (ham radio) EMResource Blast phone/landline Cellular telephone S-SV EMS Agency MICN Training (Updated )

MCI Types Trauma Physical injuries and/or burns (traffic collision, plane crash, earthquake, explosion, mass shootings, etc.) Hazmat Release of toxic materials, radioactive matter, or radioactive energy from a radiation emission device Medical Non-trauma, non-hazmat incidents (biological or clandestine radiological incidents, environmental, medical resource depletion, medical evacuations, etc.) S-SV EMS Agency MICN Training (Updated )

MCI Activation MCI Criteria (any of the following) 5 or more IMMEDIATE/DELAYED patients 10 or more MINOR patients Prehospital and/or hospital provider discretion S-SV EMS Agency MICN Training (Updated )

MCI Activation The CF may be activated by any of the following entities: EMS dispatch center Field EMS personnel (responding or at scene) Neighboring CFs for incidents exceeding their capacity to disburse patients within their area Medical Health Operational Area Coordinator (MHOAC) S-SV EMS Agency MICN Training (Updated )

MCI Pre-Alert by EMS Responders
The CF should obtain the following information from the activating entity when possible: Incident location Incident type Trauma Hazmat Medical Possible number of patients S-SV EMS Agency MICN Training (Updated )

Initial CF Response When notified of a possible or confirmed MCI, the CF should: Assign appropriate staff to manage the incident Create an MCI Event in EMResource (including polling appropriate surrounding hospitals) Maintain communications with the field Medical Communications Coordinator (MCC) Communication should be clear, concise and include only information necessary for appropriate patient dispersal S-SV EMS Agency MICN Training (Updated )

Initial CF Response The following information should be provided by field personnel upon MCI confirmation: Incident location (if unclear – CF staff must clarify) Incident name Type of incident Approximate number of patients Type of transport resources available (ground/air ambulances, buses, etc.) Estimated time triage is expected to be completed S-SV EMS Agency MICN Training (Updated )

EMResource MCI Event Creation
Select ‘Event’ Tab Select ‘Event Management’ *Note: There are additional procedures for creating an MCI event to also poll Sacramento County Hospitals which are not included in these instructions S-SV EMS Agency MICN Training (Updated )

Select ‘Create’ for the event location (OA) S-SV EMS Agency MICN Training (Updated )

Enter the appropriate event information S-SV EMS Agency MICN Training (Updated )

Utilize EMResource tools to lookup event location if necessary S-SV EMS Agency MICN Training (Updated )

Select the appropriate receiving facilities you want to poll Select ‘Save’ to initiate the Event S-SV EMS Agency MICN Training (Updated )

Return to the ‘View’ screen and select your event on the colored bar to monitor receiving facility reported capability status S-SV EMS Agency MICN Training (Updated )

Receiving facility capabilities are updated as reported & totaled at the bottom of the screen S-SV EMS Agency MICN Training (Updated )

Receiving Facility Response
Receiving facilities notified of a MCI are required report their patient receiving capabilities on EMResource within 5 minutes of notification S-SV EMS Agency MICN Training (Updated )

Receiving capabilities are based on available patient teams and beds: IMMEDIATE Patient Team (1 patient per team) 1 ED Bed ED physician Surgeon (if Trauma MCI) 2 nurses S-SV EMS Agency MICN Training (Updated )

DELAYED Patient Team (2 patients per team) 2 ED Beds ED physician 2 nurses MINOR Patient Team (10 patients per team) 1 nurse Minor patients can often be directed to ED waiting room for re-triage or possible alternate treatment areas S-SV EMS Agency MICN Training (Updated )

The receiving capabilities screen, accompanied by an audible alert, will automatically show on the EMResource screen for each hospital polled S-SV EMS Agency MICN Training (Updated )

Enter the appropriate capabilities for your facility, or leave default value at “0” if correct Enter surgeon information if applicable Select ‘Save’ to submit your capabilities S-SV EMS Agency MICN Training (Updated )

If the screen does not automatically show, or you need to update your capabilities at any time, the following process may be utilized: Select the applicable event on the colored bar S-SV EMS Agency MICN Training (Updated )

Select the ‘keys’ icon for your facility S-SV EMS Agency MICN Training (Updated )

Select each category to expand and enter your capabilities S-SV EMS Agency MICN Training (Updated )

Field Operations S.T.A.R.T. triage is utilized by prehospital personnel on any declared MCI Approved triage tags are applied to each patient prior to transport S-SV EMS Agency MICN Training (Updated )

Field Operations Special patient triage circumstances Pts placed in spinal motion restriction or unaccompanied children must be triaged as a DELAYED or higher Pts with a tourniquet or hemostatic dressing applied must be triaged as an IMMEDIATE S-SV EMS Agency MICN Training (Updated )

Field Operations The Medical Communications Coordinator (MCC) communicates directly with the CF The MCC may also assume/maintain the Medical Group Supervisor and/or Patient Transport Unit Leader role depending on the incident S-SV EMS Agency MICN Training (Updated )

Field Operations When the MCI is in progress: All EMS patient communication should be routed through the CF (even for non-MCI patients) Individual EMS units should not provide patient reports to receiving facilities unless they do not interfere with MCI operations/communications S-SV EMS Agency MICN Training (Updated )

Patient Destinations Additional information relayed to the CF by MCC: Total number of patients by triage category IMMEDIATE (classified as ‘Head’, ‘Chest’, or ‘Abdomen’ if applicable) DELAYED MINOR Special pt. circumstances (pediatric, pregnancy, families, etc.) Routine pt. information (vital signs, assessment, specific injury types not indicated above) is not necessary for pt. distribution and should not be requested by the CF S-SV EMS Agency MICN Training (Updated )

Patient Destinations When patients are ready for transport, the MCC contacts the CF to obtain/confirm patient destination and mode of transport S-SV EMS Agency MICN Training (Updated )

Patient Destinations When notified by the MCC that patient triage is complete, the CF documents patient information on the Patient Destination Worksheet S-SV EMS Agency MICN Training (Updated )

Patient Destinations The CF assigns destinations using the following Patient Destination Guidelines: Send trauma patients who meet trauma triage criteria to designated trauma centers when possible Send other specialty patients (burns, pregnancy, pediatric trauma, etc.) to designated specialty receiving centers when possible Transport of MINOR patients by bus is permitted S-SV EMS Agency MICN Training (Updated )

Patient Destinations Austere Care If there are more patients within any triage category than available teams to accept those patients, consider: Requesting local receiving facilities to increase patient capacity Sending patients to further receiving facilities S-SV EMS Agency MICN Training (Updated )

Patient Destinations CF directs where to transport each patient in coordination/consultation with the MCC CF is advised by the MCC when each unit leaves the scene and their ETA to the receiving facility CF notifies receiving facilities of patients being transported to their facility S-SV EMS Agency MICN Training (Updated )

Patient Tracking A Prehospital Patient Tracking Worksheet is utilized by field personnel on any MCI: All patients are logged prior to EMS transport Completed worksheets are submitted to S-SV EMS S-SV EMS Agency MICN Training (Updated )

Patient Tracking The patients assigned triage tag number should be entered into the patient’s hospital chart S-SV EMS Agency MICN Training (Updated )

Updating the MCI Event The CF should update event information as appropriate: MCI is cancelled New pertinent event information is received Updated patient counts Need to expand the receiving facility capabilities polling request to additional hospitals When all patients have been transported S-SV EMS Agency MICN Training (Updated )

Updating the MCI Event Select the ‘Event’ tab Select the ‘Edit’ link in the ‘Action’ column next to your event S-SV EMS Agency MICN Training (Updated )

Updating the MCI Event Enter the appropriate updates in the ‘Title’ and/or ‘Information boxes Select any additional receiving facilities you wish to poll Select ‘Save’ at either the top or bottom of the screen S-SV EMS Agency MICN Training (Updated )

Ending the MCI Event The event should be ended when all patients are transported Select the ‘Event’ tab Select the ‘End’ link in the ‘Action’ column next to your event S-SV EMS Agency MICN Training (Updated )

MCI Critique & AAR Process
S-SV EMS conducts an AAR of all MCIs to recognize areas that went well and identify opportunities for improvement, education, and/or policy/plan revisions CF, receiving facility and prehospital providers are required to complete and submit an MCI review form within seven (7) days of the event S-SV EMS Agency MICN Training (Updated )

MHOAC Program The Medical Health Operational Area Coordinator (MHOAC) Program is based on the functional activities described in Health and Safety Code § Within each OA (County), the Health and Safety Code authorizes the County Health Officer and Local Emergency Medical Services Agency (LEMSA) administrator to jointly act as the MHOAC or appoint another individual S-SV EMS Agency MICN Training (Updated )

MHOAC Program The MHOAC Program is notified by the CF in the following circumstances: Incidents involving hospital evacuation Incidents requiring implementation of altered levels of care in the field, hospitals, or system-wide Inability of the Control Facility to conduct patient distribution activities among local receiving facilities Other unusual events S-SV EMS Agency MICN Training (Updated )

MHOAC Program The MHOAC Program can be contacted through the public safety dispatch center by requesting the MHOAC or Public Health Duty Officer The S-SV EMS Duty Officer can be contacted utilizing the contact procedures provided S-SV EMS Agency MICN Training (Updated )

Special Circumstances
Crisis Standard of Care A level of medical care delivered to individuals under conditions of duress, such as a disaster, or when medical resources are insufficient for demand of emergency care S-SV EMS has developed policies to allow for altering the EMS system under the direction of the S-SV EMS Medical Director in consultation with the applicable County Health Officer S-SV EMS Agency MICN Training (Updated )

Special Circumstances
Crisis Standard of Care CFs may be requested to perform the following functions in these extreme instances (under specific direction of the S-SV EMS Medical Director and County Health Officer): Direct EMS patients to alternate destinations (alternate care sites, field treatment sites, etc.) Direct field personnel not to transport certain types of patients and/or refer certain types of patients to non- emergency numbers to arrange transportation S-SV EMS Agency MICN Training (Updated )

Multiple Casualty Incidents (MCI)

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