1. EMS COMMAND What we imagine is order is merely the prevailing form of chaos. Kerry Thornley, Principia Discordia, 5th edition

2. PROCEDURE  At all medical incidents where Command has been established, the Incident Commander will implement the necessary components of the EMS Command structure to ensure firefighter and public safety.  Additionally, he/she will effectively mitigate the incident while maintaining strict accountability for all patients and their personal belongings.

3. EMS COMMAND IMPLEMENTATION  Implement EMS Command early.  Develop the system in a logical order.  Provide tactical objectives to subordinate positions when you assign them.  Determine if your incident requires the expanded EMS ICS structure to manage it.  Think about geography (Scene set-up).  Use visual indicators to assist responders and the public.

4. TERMINOLOGY  Mass-Casualty Incident – Any incident with multiple patients that will significantly impact local resources including area hospitals.  1 st Alarm Medical – Through our established Automatic Aid Agreement, a 1 st Alarm Medical will result in the response of 2 Engines, 2 Rescues, and 1 Command Officer. (No such thing as a 2 nd Alarm Medical)  EM’s System – The Medical Communications Officer will activate the EM’s system through Summit Regional. This system will indicate the availability and status of all regional facilities. (Flagstaff, Phoenix, Tucson, etc….)

5. ROLES AND RESPONSIBILITIES

6. COMMAND  Command :  Establishes an effective command structure.  Manages Communications.  Utilize EMS Command tools to assist in this process.  EMS Tactical Worksheet  Command Checklist

7. MEDICAL  Medical :  Reports to Command.  Organizes incoming resources to mitigate large EMS incidents.  Medical Branch Director Checklist

8. TRIAGE  Triage :  Reports to Medical/Command.  Recon incident area.  Is responsible for sorting and prioritizing all casualties.  Triage Unit Leader Checklist

9. EXAMPLE: “Medical, Triage Team 1 triaged 15 patients, 7- Immediate, 7-Delayed, and 1-Dead or Dying” Triage Team Medical Branch Incident Command Triage Team, reports findings up the Chain of Command

10. TREATMENT  Treatment :  Reports to Medical/Command  Responsible for prioritizing casualties and treating the injured.  Treatment Unit Leader Checklist

11. TREATMENT OFFICER SUPERVISES TREATMENT AREA. REPORTS TO MEDICAL / COMMAND TEAM SETS UP TREATMENT AREA UTILIZE VISUAL CUES TO DESIGNATE THE AREAS Minor Treat Area Delayed Treat Area Immediate Treat Area Treatment Entry Point

12. Treatment Teams are responsible for re-evaluating and stabilizing patients brought by each assigned “litter bearers.” TREATMENT OFFICER / TEAMS

13. TRANSPORTATION  Transportation  Organizes and coordinates the transportation of all casualties.  Transportation Unit Leader Checklist  Transportation Record

14. TRANSPORTATION OFFICER Remains around the designated treatment area and works with the Treatment Officer on transport priorities. Assigns patients to transport units. Removes last tag and puts it into the “Hospital Can” Reports to Medical / Command.

15. RESCUE  Rescue/Extrication:  Reports to Medical/Command  Removes trapped victims and provides for their movement to triage/treatment area(s) (whichever is most appropriate.)  Rescue Group Checklist

16. MEDS COMM  Medical Communications (MEDS COMM)  Reports to Medical/Command  Maintains communications with area hospitals (EMSCOM) and dispatch to facilitate transportation of victims to the appropriate facilities.  MEDS COMM Checklist

17. MEDICAL COMMUNICATIONS  Medical Communications Officer maintains communication with area hospitals via EMSCOM.  Receiving hospitals availability in terms of #’s of Immediate/Delayed/Minor pt’s they can take.  Report to receiving facilities the pt. triage level, transport unit #, and ETA.  If requested by Medical Branch, implement the EM’s system.

18. MEDICAL STAGING  Medical Staging :  Reports to Transportation/Medical  Establishes, organizes and maintains an area for incoming medical resources.  Medical Staging Checklist

19. MORGUE  Morgue:  Report to Medical/Command.  Collect, protect, and identify deceased victims.  Morgue Manager Checklist

20. MORGUE MANAGER  Mission-Collect, Protect, and Identify bodies  Establish morgue area  Utilize Law Enforcement/Coroner for assistance  Use litter bearers for moving of dead Morgue

21. MEDICAL SUPPLY  Not included in the EMS Command Kits.  Treatment Officer assigns team to rob equipment off of every truck.  Or, have trucks bring all equipment to treatment area prior to being assigned to a task.  As the MCI develops, other actions may need to be taken to facilitate equipment. (Department Stock).

22. EXAMPLE  The following is an example of a typical MCI and the associated command structure.

23. The ICS Structure IC Triage Group Triage Teams Litter bearers Treatment Group Immediate Manager Delayed Manager Minor Manager Medical Supply Transportation Group Medical Staging Ground Ambulance Manager Air Ambulance Manager Rescue Group Extrication Teams MEDS COMMorgue

24. The ICS Structure IC Medical Branch Triage Group Triage Teams Litter bearers Treatment Group Immediate Manager Delayed Manager Minor Manager Medical Supply Transportation Group Medical Staging Ground Ambulance Manager Air Ambulance Manager Rescue Group Extrication Teams MEDS COMMorgue Hazmat BranchFire Branch DivisionsGroups PIOSafety

25. The ICS Structure IC Operations Medical Branch Triage Group Triage Teams Litter bearers Treatment Group Immediate Manager Delayed Manager Minor Manager Medical Supply Transportation Group Medical Staging Ground Ambulance Manager Air Ambulance Manager Rescue Group Extrication Teams MEDS COMMorgue Hazmat BranchFire Branch DivisionsGroups PlanningLogisticsAdmin/Finance PIOSafety

26. Minor Treat Delayed Treat Immediate Treat Treatment Entry Point Medical Staging Triage Area