1. Incident Command and Multiple-Casualty Incidents
Unit 49
Incident Command and
Multiple-Casualty Incidents

2. Overview Multiple patient encounters
National incident management systems
Multiple-casualty incidents
EMS operations sector

3. Introduction
Multiple-casualty incidents require management of multiple patients, emergency responders, response vehicles, elements of environment, and incident itself
Understanding fundamentals of incident command and multi-casualty incident will help EMT competently treat patients

4. Multiple Patient Encounters
Patient care approach for a hundred patients is the same as for one patient
A leader is needed to direct activities of others on arrival and throughout call
First: determine priority of patient
Next: treat patient
Finally: notify communications center and hospital of patient transport

5. National Incident Management Systems
Events of September 11, 2001: highlighted need for developing national standards for incident operations
National Incident Management System (NIMS): established management criteria for all responders
Goal of NIMS: ensure interoperability between various groups and agencies

6. Components of NIMS Command and management Preparedness
Incident command system (ICS)
Multiagency coordination system
Public information system
Preparedness
Planning, training, exercises, personnel qualifications, standards, equipment, etc.

7. Components of NIMS (cont’d.)
Resource management
Standardized requirements for resources
Communication and info management
Effective interoperable communications
Supporting technologies
Data, display, records, tracking systems
Ongoing management and maintenance
Strategic oversight and direction

8. Multiple-Casualty Incidents
Event overextending EMS resources
Incident command system
Standardized command structure
Small incident: only one incident commander (IC) needed
Large incidents: several ICs share joint command at centralized location
Leadership rotates according to incident needs

9. Incident Command System (cont’d.)
Chain of command: hierarchical reporting system
Command personnel
Safety officer (SO): responsible for safety of all personnel
Public information officer: meets with media and reports state of affairs at incident

10. Figure 49.2 The Incident Management System provides for both command and control

11. Role of the EMT in Incident Management
EMTs should be familiar with their roles during an incident
Objective of EMT:
Understand when to activate incident management system (IMS)
How to participate in IMS as a provider

12. EMS Operations Sector Five tasks in a disaster:
Take control or command of situation
Assemble resources and personnel
Locate and sort patients according to severity of injuries
Render needed medical care according to severity
Transport patients

13. EMS Director
Responsible for EMS operations and interfacing with other emergency services commanders
Must establish command post and make a declaration (problem present and resources needed)
Tactical command sheets: instructions for how to proceed with specific incident

15. EMS Director (cont’d.) Transfer of command
Whenever another person assumes EMS command, he will need briefing
EMS commander must provide most up-to-date info about current state of affairs
Tactical command sheets and status boards reviewed

17. Staging Officer
Staging area: off-scene location where personnel and vehicles assemble and await assignment
Staging officer: manages staging area, assembling and assigning equipment and personnel
Equipment staging
Equipment manager maintains supplies

19. Triage Officer
Patient survival depends on effective utilization of limited resources
Triage: distribution of patients into treatment classifications according to injury severity
Triage officer: oversees triage process

21. Triage Systems
Evacuation triages determine which patients require immediate removal
Following evacuation, color-coded system signifies treatment priority
Red: immediate medical care required
Yellow: medical help can be delayed
Green: minor injuries
Black: dead or dying

22. Triage Systems (cont’d.)
START triage system
Simple triage and rapid treatment
JumpSTART pediatric triage
Specific assessment techniques for infants and children to differentiate from adults
Triage tags
Allows for quick identification of patient condition and prevents duplication of effort

23. Figure 49.8 START stands for Simple Triage And Rapid Treatment

24. Treatment Officer Field hospital Morgue
Temporary on-site treatment facility
Managed by treatment officer
Morgue
Area set aside for deceased patients, overseen by morticians or funeral directors

25. Transportation Officer
Responsible for overall movement of patients from scene to hospital
Maintains communications with hospitals
Tracks patients’ whereabouts
Most patients will require ambulance from staging area
For minor injuries, buses may be used

26. Conclusion Major incident need not be disaster for EMT
EMTs need to ensure personal safety while delegating tasks
Standard approach to major incident much the same as standard approach to any patient, only on much greater scale