1. JUNE, 2012 Zone One MCI Training June, 2012

2. Training Objectives Focused at the Company Officer Level Review of initial MCI scene size-up Overview of general MCI concepts Summary of new King County MCI Plan changes

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  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 (funnel) points Minimize unnecessary actions Improve division of labor Increase plan scalability for all events Simplify patient tracking Utilize NIMS terminology

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

13. 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. 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 Current Triage Systems

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 tracking bands 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 Medical Incident Report:  Hospital form  Agency form  EPCR agencies need to enter number in laptop

31. Expanding the Transport Unit Transport Unit Leader Ambulance Staging Manager DMCC Coordinator 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 Rescue Group Extrication Unit Extraction Unit

35. Expanding the Medical Group 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 ExtractionExtrication 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?