1. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Division 5 Special Considerations & Operations

2. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 48, Operations Part 2 Medical Incident Management

3. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Topics Origin of the Incident Command System Command at a Mass-Casualty Incident Divisions of Command Command System Support The START System

4. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Multiple-Casualty Incident An incident that generates large numbers of patients Makes traditional EMS response ineffective Also called a “mass-casualty incident” (MCI)

5. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ On February 26, 1993, the incident command system was used in response to the bombing of the World Trade Center in New York.

6. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Incident Management System A national system used for the management of multiple-casualty incidents Involves assumption of command and the designation and coordination of elements such as triage, treatment, transport, and staging

7. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ The scene of the April 19, 1995, bombing of the Alfred P. Murrah Federal Building in Oklahoma City

8. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Crews with various kinds of protective gear attempting to locate and extricate victims from the debris.

9. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ A Uniform, Flexible System (C-FLOP) C—Command F—Finance/administration L—Logistics O—Operations P—Planning

10. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Command at Mass-Casualty Incidents

11. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Incident Commander (IC) A single person is responsible for ALL incident activities. Chain of command—delegation of authority. All nondelegated functions are left to command. Coordinates all scene activities. Also called Incident Manager (IM) or Officer in Charge (OIC).

12. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ The first on-scene unit must assume command and direct all rescue efforts at a mass-casualty incident (MCI).

13. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Singular vs. Unified Command Singular command –One person coordinates the incident. –Most useful in smaller, single- jurisdictional incidents. Unified command –Managers from different jurisdictions share command. Fire, EMS, law enforcement

14. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Successful handling of any MCI involves coordination of key personnel—whether it be two or twenty people.

15. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Establishing Command First arriving unit establishes command. Assign command early in an incident. Establish a command post.

16. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ It is better to call too many resources than too few.

17. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Incident Priorities Life safety Incident stabilization Property conservation

18. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Identifying a Staging Area Primary Staging –As close to the scene as possible –Quick, easy access to the scene –Good access and exit areas Secondary –Different direction than primary staging –Provides a contingency plan if conditions change

19. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Communications Communication forms the cornerstone of the Incident Management System.

20. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Resource Utilization The primary role of an incident commander is the strategic deployment of all necessary resources at an incident.

21. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Using command vests at a mass-casualty incident makes it easier to identify personnel. The incident manager or commander directs the response and coordinates resources.

22. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ An EMS incident tactical worksheet from the town of Colonie, New York

23. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Transfer of Command Command is transferred face-to-face, with current incident commander conducting a short but complete briefing on the incident status.

24. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Termination of Command Resources are reassigned or released as an incident progresses.

25. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Support of Incident Command Safety Liaison Public information (PIO) Mental health support Finance/ administration Logistics Operations Planning

26. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Safety Officer Monitors risk management activities and corrects hazardous conditions –Observes all personnel for inappropriate behavior –Provides a safe work environment at all times

27. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Liaison Officer Functions as contact person for outside agencies and representatives –Coordinates with county EOC –Communicates with any outside agency representatives

28. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Public Information Officer (PIO) Provides information to the news media as directed by the IC –Establishes media area –Prepares media briefings and releases –Coordinates tours of incident area

29. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Mental Health Support Rotates personnel to facilitate rest Evaluates for signs and symptoms of stress

30. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Finance/Administration Coordinates financial and administrative activities Time assessment Authorizes procurement Cost analysis

31. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Logistics Supports incident operations Coordinates procurement and distribution of all medical resources

32. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Operations Patient tracking Employs all directives Carries out tactical objectives Maintains plan of action

33. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Planning Coordinates planning activities for future incident operational needs Monitors situation status Supervises personnel allocation Coordinates resources

34. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Basic elements of the incident management system

35. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Examples of branches that may operate in a major incident

36. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ EMS Branch Functions Triage Treatment Transport

37. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Triage Sorting of patients based upon the severity of their injuries Primary triage Secondary triage

38. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Organization for a small- to medium- sized incident

39. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Operation of the START system, the most widely used triage system

40. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ The START System Simple Triage and Rapid Transport Based on –Ability to walk –Respiratory effort –Pulses/perfusions –Neurological/mental status

41. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ START Direct the “walking wounded” to a primary treatment site for further evaluation and treatment if necessary. Walking wounded should be tagged as “minor” patients.

42. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ After the Walking Wounded… Assess RPMs –Respirations –Perfusion –Mental Status

43. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Respirations None – Open the airway –Still none – Deceased –Present – Immediate Present –Rate >30 – Immediate –Rate <30 – Check perfusion

44. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Perfusion Radial pulse absent or delayed capillary refill – Immediate Radial pulse present or normal capillary refill time – Check mental status

45. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Mental Status Cannot follow simple commands – Immediate Can follow simple commands – Delayed

46. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Triage Tags Alert care providers to patient priority Prevent re-triage of the same patient Serve as a tracking system

47. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ The METTAG

48. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Treatment Red treatment unit Yellow treatment unit Green treatment unit Supervision of treatment units

49. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Treatment sector at an incident (MCI)

50. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Other Areas On-scene physicians Staging Transport Extrication/Rescue Rehabilitation

51. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ A hazardous materials team may be involved in the extrication and rescue phases of some mass-casualty incidents.

52. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Communications EMS communications officer Alternative means of communications

53. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Disaster Management Mitigation Planning Response Recovery

54. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Things can and do go wrong at MCIs and disasters. Anticipate problems in advance.

55. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Drill often, utilizing the actual resources and equipment available to the service on a regular basis.

56. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Disaster Mental Health Services Psychological first aid to meet providers’ emotional needs Screening of rescuers and victims for abnormal signs and symptoms of traumatic stress

57. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Sample command structure for an MCI at a rest home

58. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Never say, “It will never happen here.”

59. Bledsoe et al., Essentials of Paramedic Care : Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Summary Origin of the Incident Command System Command at a Mass-Casualty Incident Divisions of Command Command System Support The START System