1. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Incident Command and Triage Chapter 4

2. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 4.1 Define incident command system. 4.2 Describe the primary responsibilities of each of the five functional areas of the incident command system. 4.3 Describe and demonstrate how to use the “ID-ME” triage system. 4.4 Describe and demonstrate how to use the START system of triage.

3. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Topics National Incident Management System (NIMS) Incident Command System (ICS) ICS and the OEC Technician Triage Chapter Summary

4. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY NIMS National Incident Management System Framework for managing, emergencies or situations involving multiple jurisdictions Benefits ◦ Rescuers from different agencies work effectively together at an incident continued

5. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY NIMS National Incident Management System Managerial Benefits ◦ Formal chain of command ◦ Management by objectives ◦ Span of control ◦ Personal accountability ◦ Integrated communication ◦ Resource management continued

6. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY NIMS National Incident Management System Activities consist of four major components: ◦ Command and Management ◦ Preparedness ◦ Resource Management ◦ Communications and Information Management continued

7. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY NIMS National Incident Management System

8. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Presentation You are dispatched to respond to “skier that has fallen from a lift and may be hurt.” As you ski over to their location, the scene before you is pure chaos. All down the lift line, people are clinging to lift chairs, some have fallen by as much as 40 feet from the lift. Bystanders appear to be rendering aid.

9. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Presentation Copyright Mike Halloran

10. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY ICS Incident Command System Method for managing an incident: ◦ 5 functional areas within the ICS structure Incident Command (IC) Operations Section Planning Section Logistics Section Finance / Administration Section continued

11. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY ICS Incident Command System 1.Incident Command (IC) ◦ First to be established at any incident ◦ Managed by incident commander Assume command of the incident Establish an Incident Command Post Provide overall incident management Determine incident objectives & strategy Determine / develop the organizational structure needed to manage the incident ◦ If needed – command staff formed continued

12. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY ICS Incident Command System continued

13. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY ICS Incident Command System 2.Operations Section ◦ Next section to be established at any incident ◦ Managed by Operations Section Chief Participate in planning process (Create the Incident Action Plan, IAP) Reduce immediate hazard(s) continued

14. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY ICS Incident Command System 2.Operations Section ◦ Managed by Operations Section Chief Save lives and property Establish situational control Restore the scene to a state of normalcy ◦ Branches may be created continued

15. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY ICS Incident Command System Copyright Mike Halloran continued

16. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY ICS Incident Command System 3.Planning Section ◦ Managed by Planning Chief ◦ Collects, assesses, distributes, and uses incident-related data ◦ Coordinates the preparation of the IAP and other incident documents continued

17. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY ICS Incident Command System Copyright Studio 404 continued

18. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY ICS Incident Command System 4.Logistics Section ◦ Managed by Logistics Chief ◦ Provides support for all the functional areas continued

19. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY ICS Incident Command System 4.Logistics Section ◦ Ensuring that all incident facilities meet specified needs Secure Out of public view Able to grow in size as needed Accessible to incident personnel ◦ Service / Support Branch units activated continued

20. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY ICS Incident Command System Copyright Studio 404 continued

21. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY ICS Incident Command System 5.Finance / Administration Section ◦ Managed by Finance Chief ◦ Support Management activities Provide financial management Accountability Administrative services ◦ Units may be activated ◦ (Time, Procurement, Compensation / Claims, Cost)

22. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY ICS and the OEC Technician Roles that an OEC Technician may be assigned: ◦ Incident Commander Command of the incident (notify dispatch) Establish command post ◦ Operations Chief Oversee all rescue and patient treatment activities Establish medical branch continued

23. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY ICS and the OEC Technician Roles that an OEC Technician may be assigned: ◦ Medical Branch Director Manage medical branch Expand the branch into groups if needed (Triage, Treatment, Transportation) continued

24. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY ICS and the OEC Technician Copyright Mike Halloran continued

25. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY ICS and the OEC Technician Triage ◦ Managed by Triage Group Officer Prioritize patients for treatment Provide minimal care Move patients to treatment area Identify, collect, and sort patients ◦ Triage funnel Maintaining a written record continued

26. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY ICS and the OEC Technician Copyright Mike Halloran continued

27. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY ICS and the OEC Technician Treatment ◦ Managed by Treatment Group Officer ◦ On scene care to triage patients ◦ Hospital capacity status report ◦ Maintaining a written record continued

28. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY ICS and the OEC Technician Transportation ◦ Managed by Transportation Group Officer Identify transport needs Coordinate transport needs Track patients Provide updates to EMS branch director ◦ Oversee movement of patients from the incident to medical facilities ◦ Maintain a written record continued

29. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY ICS and the OEC Technician continued Copyright Edward McNamara

30. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Update You contact patrol dispatch and identify yourself as the Incident Commander. A patroller calls and says “about 30 patients are on the ground and 120 trapped on the lifts.” You begin to formulate your Incident Action Plan. The Patrol Director enters the CP and assumes the role of IC. You give a verbal report and status of your actions. The transfer of incident command to the Patrol Director is announced to notify everyone of the change. You are designated as the Operations Chief and directed to lead the rescue effort. continued

31. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Update Once on scene, a patroller says the lift has collapsed and that “there are patients all the way down to the bottom!” At that point, a person approaches you and identifies himself as a doctor. He tells you that he is one of several emergency physicians who have come to help.

32. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY continued Triage Process of prioritizing patients for treatment and transportation based on clinical signs and symptoms: ◦ Multiple casualty incident (MCI) Involving two or more patients Number of patients exceeds resources Rescuers quickly assess each victim Rapidly identify specific resources needed Triage implemented- emergency care system overwhelmed

33. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Triage Categorization System “ID-ME” ◦ IImmediate (Red) Person will die unless immediate medical treatment Complication with airway, breathing, or circulation ◦ D Delayed (Yellow) Needs medical attention or will rapidly deteriorate Complication with airway, breathing, or circulation continued

34. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Triage continued Copyright Edward McNamara

35. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY continued Triage Categorization System “ID-ME” ◦ M Minimal (Green) Minor injuries that can go untreated for hours “Walking wounded” ◦ E Expectant (Black) Little if any chance of survival Already dead or will die regardless of treatment ◦ Triage tags

36. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY continued Triage Copyright Mike Halloran

37. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY continued Triage

38. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY continued Triage Triage Methods ◦ START Simple Triage & Rapid Treatment Less serious injured separated from seriously injured RPM (“30-2-CAN Do”) ◦ SALT (Sort, Assess, Life Saving Triage) ◦ MASS (Move, Assess, Sort, Send) ◦ CIT (Continuous Integrated Triage)

39. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Triage

40. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Disposition You soon have several patrollers and ski resort staff members on scene. You assign a director to each. Primary triage reveals the following patient information: 11 Immediate (Red) 18 Delayed (Yellow) 21 Minimal (Green) 0 Expectant (Black) continued

41. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Disposition As more resources arrive, they are assigned to one of the two branches. This incident took more than 4 hours; Operations section evacuated 220 people from the lift and treated or transported more than 100 patients, including 50 who had fallen from the lift.

42. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary All rescue organizations and personnel are federally mandated to use the incident command system. Every incident must have an Incident Commander continued

43. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary There are five ICS functional areas: 1.Incident Command 2.Operations 3.Planning 4.Logistics 5.Finance/Administration continued

44. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary The four triage categories can be remembered using the acronym ID- ME (Immediate, Delayed, Minimal, Expectant). Triage is a dynamic process that may need to be performed more than once. Use START triage.