1. Prepared by B. Carr Module 2/5 Defining and Implementing TEMS OPS: MCI and Casualty Collection Points Concepts in Tactical EMS

2. Review of Module #1 and Overview of Module #2 Tactical EMS is an emergency posture designed for response to dynamic threats. TEMS involves coordination between F/EMS and Law Enforcement units. JH F/EMS SOP 17.6.1 addresses response to a range of threats and implementation of TEMS methodologies.

3. Review of Module #1 and Overview of Module #2 Module #2: Assumes familiarity with SOP 17.6.1 and understanding of where and when responders will implement TEMS standards Reviews MCI environments and obstacles to care Provides guidance for MCI operations Introduces operational procedures for casualty collection points

4. Mass Casualty Incidents (MASCAL) Also known as “Multi-Casualty Incidents” A mass casualty event overwhelms immediately available medical capabilities to include personnel, supplies, and/or equipment. Demands rapid transition from routine to contingency medical operations Effective TRIAGE is the guiding principle for establishing order during a confused situation

5. START REVIEW

6. TRIAGE PRINCIPLES Triage is a constant and dynamic process as casualties move within and through the system of care. F/EMS's ultimate goal is organizing casualties to determine necessary treatments and to complete rapid transport to definitive medical care. Effective triage requires establishing areas for sorting, treating, and holding casualties

7. Jackson Hole Fire/EMS's Mass Casualty Guidelines Division 20 Review policy HEREHERE

8. Casualty Collection Points (CCP) Differ from standard triage collection areas due to nature of incident Forward operating area secured—but not cleared—from ongoing risk Require additional PPE mandated by incident type (e.g. ballistic armor and helmet; chemical protective clothing)

9. Casualty Collection Points (CCP) GUIDELINES Involve Planning and Execution phase s. ALWAYS consider— Location Security Transport (MEDEVAC) ambulance and air Equipment supply and consolidation

10. BASICS OF CASUALTY COLLECTION POINT STRATEGY (PLANNING PHASE #1/2) Consider location of CCP based on pre-planning and surveillance of soft targets. schools, shopping centers, grocery stores, etc. COVER/CONCEALMENT “reasonably” close to hot zone operations anticipate need to manage “choke points” Plan for patient exchange areas ambulance exchange points (AXP), helicopter landing zones (HLZ)

11. BASICS OF CASUALTY COLLECTION POINT STRATEGY (PLANNING PHASE, #2/2) Have command and control in place BEFORE committing to location ICS roles Security established for CCP and (possibly) HLZ/AXP CCP Unit leader and operators determined Communications plan Formulate plan for evacuation from hot zone Will their be “aid and litter” teams to assist in patient extraction from point of injury? What are alternate plans?

12. CASUALTY COLLECTION POINT TACTICS (EXECUTION PHASE) Establish and secure casualty collection point (CCP). Plan early for security maintenance even after threat is neutralized Gather and distribute casualty collection point equipment. PPE, medical, extraction, and tagging supplies Consider establishing locations for dedicated supplies Airway, IV, etc.

13. CASUALTY COLLECTION POINT TACTICS (EXECUTION PHASE) Secure accountability for F/EMS and LE personnel. “Unity of Command” in place confirm contact-superior’s call name/number and communications plan Request MEDEVAC link-up point and communication. Plan for resupply and need to expand if/when casualty load increases. Assign area for “black” patients/victims.

14. SUGGESTED TRAINING ACTIVITIES Review “soft targets” in area of response Jackson and Wilson Schools Albertsons, Smiths, St. Johns (re)Familiarize crews with Casualty Collection Point Kits MS 82, 35, 78, 76 Review included CCP templates Modify/adapt to demands

15. REVIEW and NEXT TIME Purpose of MCI protocols and CCP are: provide resilience in response provide for rapid extraction and sorting provide life saving interventions shorten time for victims and officers from point of injury to initial care streamline transport to definitive care

16. NEXT TIME Module 3 will introduce and review: Ballistic Protection, Medical Supplies, Chemical Protective Clothing Additional resources: FEMA Guide for Active Shooters and MCI (link) FEMA Guide for Active Shooters and MCI Included Casualty Collection Point Templates adapted for civilian TECC from U.S. SOCOM Tactical Emergency Medical Protocols