1. King County MCI Plan 2011 Updates
Batt Chief Marty La Fave
Bellevue Fire Department

2. A Review of Mass Casualty Management
Company Officer: First five minutes
MCI Plan: New Changes
Division of Labor: Groups and Units

4. Initial Size-up Phase 1 Look for SLUDGE Identify immediate hazards
Consider access/egress options
Observe base/staging options
Estimate number of patients

5. More Size-up Phase 2 Estimate number of non-ambulatory patients
Consider extrication/relocation issues
Scene status: Static or Dynamic?
Decide: Complex…not complex

6. No SLUDGE
No Fire, stable scene
Southbound lanes open
Overpass intact
Patients walking around
6-10 Reds
Simple extrication
Static scene

7. Commanding the radio Provide size-up Initiate command
Initial assignments
Safety & handline
Triage
Treatment
Request “base” resources
Request “transport” resources

8. Requesting Resources Basic MCI Activities Complex Activities
Rescue/Extrication
Treatment/Transport
Ambulance staging
Complex Activities
Fire
Hazard Material
CBRNE
Collapse

9. Maintain the Transportation Corridor!

10. Physical Actions of the First-in Crew
Engine/Ladder Company
Recon / Risk Assessment
Mitigate immediate high risks
Secure Transportation Corridor
Begin Triage
Direct movement of “Green” Walking wounded
Implement Rescue Group
Medic Units/MSO Decide: Patient or Scene mgmt
Medical Group
Treatment Unit
Transport Unit

11. Revised 2011 MCI Plan: WHY? Reduce choke points
Suspend unnecessary actions
Improve division of labor
Increase plan scalability for all events
Simplify patient tracking
Align plan with NIMS Concepts

12. MCI Changes at a glance Develop “Rescue Group” to move patients
Eliminate formal funnel point
Eliminate use of treatment tags
Elimination of patient numbering (felt pen)
NIMS Terms: Hospital Control is now Disaster Medical Control Center (DMCC)

13. Changes

14. Changes

15. The Previous MCI Plan
COMMAND
MEDICAL GROUP
TRIAGE
TREATMENT
TRANSPORT

16. Typical MCI Org Chart 2011 COMMAND RESCUE GROUP EXTRACTION UNIT
EXTRICATION UNIT
MEDICAL GROUP
TREATMENT UNIT
TRANSPORT UNIT
GREEN
UNIT

17. Are you doing the job…or leading it?

18. Unit Leader/Group Supervisor
Don the vest
Understand Action Plan
Determine supervisors role
Develop organization
Develop relationships
Maintain accountability
Provide progress reports

19. So, who does Triage? Rapid Field Triage -BLS Minimal Treatment
Who Supervises Triage:
Medical Group
Rescue Group
Secondary Triage – ALS

20. Current Triage Systems
First Order
Second Order
START
ABC
Sick/Not Sick
Jump START
Triage Sieve (UK)
Triage Sort (UK)
SAVE (Secondary Assessment of Victim Endpoint)
Those who will die anyway
Those who will survive anyway
Move only those who will have a condition change

21. Treatment Unit Locate suitable area Secure supplies
Develop treatment teams
Determine transport priorities

22. Treatment Unit Reasons for a Treatment Area
Visual indicator for injured
No transportation available
Immediate life-saving treatment
Move the reds, hold others
Assure appropriate treatment
Use Aid/Medic Units for supplies
Prioritize patients for transport
Use a “Treatment Dispatch Manager”
Benchmarks:
All reds transported
All patients transported

24. Expanding the Treatment Unit
Treatment Unit Leader
Red Manager
Yellow Manager
Treatment Dispatch Manager

25. Transport Unit Assure DMCC activation Establish Ambulance Staging
Confirm transporting resources are inbound
Coordinate patient loading
Track Destinations

26. Transportation Unit Apply patient trackers Communicate with DMCC
Receive patient destination
Manage documentation
Benchmarks:
All reds transported
All patients transported

28. Tracking
All transport capable vehicles in King County will have tracking bands
Typically applied at the ambulance loading or DMCC activity area.
Ensures that all patients have a tracking band

29. Tracking Retain one peel-off sticker on a tracking board
All MSO’s and Medic Units will have tracking sheets
Tracking sheets allow for sticker or Barcode tracking

30. Tracking
Instruct all transporting personnel to place a tracking sticker on the portion of the MIRF that will stay with the hospital.
The transporting agency will also retain one sticker

31. Expanding the Transport Unit
Transport Unit Leader
Ambulance Staging Manager
Coordinator
DMCC
Ambulance Loading Manager
Tracking Aide

33. Rescue Group/Unit Disentanglement Moves all patients to Treatment area
Personnel Intensive
May report to Medical or Operations
May provide field triage

34. Expanding the Rescue Group
Extrication
Unit
Extraction

35. Expanding the Medical Group
Treatment Unit
Transport Unit
Green Patient Unit

36. Incident Command
Operations
Medical
Treatment
Yellow Unit
Red Unit
Dispatch Manager
Transport
Ambulance Staging
Ambulance
Loading
DMCC
Coordinator
Tracking Aide
Green Patients
Rescue
Extraction
Extrication
Hazard Mitigation
Decon
Haz Mat
Fire
Recon
Safety
PIO
Liaison

37. Summary of Key Points for MCI
Secure the transport corridor
Keep transport units staged separately
Medics focus on Medical/Treatment/Transport
Early notification of DMCC
Suppression focus on Rescue/Extraction
Perform secondary triage before transport
Separate loading from DMCC activities

38. Questions?