San Luis Obispo County MCI Plan - SLO EMSA · PDF file · 2017-03-23San Luis Obispo County MCI Plan ... • Provides an after -action form to be completed by the IC for every MCI

San Luis Obispo County MCI Plan

Basic Training for MICN

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Many thanks to Joe Piedalue and Diane Burkey for their hard work in developing this training program

How To Use This Training Tool

Have on hand: Copy of SLO County MCI Plan http://sloemsa.org/files/210_MCI.pdf Copy of MCI Matrix http://sloemsa.org/files/210_Attachement_A_MCI_Matrix.pdf

Triage tags Review this MCI PowerPoint while referencing the MCI Plan Watch triage tag video using link at the end of this PowerPoint

(from DMS) You MUST complete the quiz and submit it to your agency

training officer/coordinator/MICN Liaison

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http://sloemsa.org/files/210_MCI.pdf

http://sloemsa.org/files/210_Attachement_A_MCI_Matrix.pdf

Plan Development Health and Safety Code

This plan was reviewed and revised in 2016 The California Health and Safety Code, Division 2.5, Chapter

4—Local Administration provides authorities for the development and implementation of this plan by the San Luis Obispo County Emergency Medical Services Agency The authorities include sections 1791.204, 1791.250,

1797.103, and 1797.252

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MCI Plan

Revisions Include: • Consistent with FIRESCOPE MCI model (Chapter 15, Multi-

Casualty). • Sets minimum ICS training requirements. • Specifies procedure to declare MCI at Level I or II. • Includes pre-designated receiving facilities. • Includes MedCom polling.

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MCI Plan (cont.)

• Requires use of START/JumpSTART triage. • Requires treatment area(s) • Provides an after-action form to be completed by the IC for

every MCI. • Requires the consideration of an after-action meeting for

every MCI.

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Objectives Upon completion of this course participants will be

able to: • Define a Mass Casualty Incident (MCI).

• Please remember that not all MCIs are trauma! • Identify initial priorities related to a MCI response. • Identify communication methods specified in the MCI Plan. • Identify roles and responsibilities of the MCI responders as

specified in the MCI Plan. • Identify priorities related to triage, treatment and

transport.

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What is a MCI? • A suddenly occurring event that has the potential to

overwhelm any part of the EMS system and/or the number of patients is greater than can be handled by the usual initial response.

• All casualties originate from the same scene (vs. widespread such as earthquake or flood).

• The number of patients is known or can be closely estimated and is limited in scope.

• Operational management is maintained at the scene. • Requires use of triage tags for both MCI Levels (I and II)

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Daily Emergency vs MCI

Provide the best care for each individual patient.

Singular, focused care

Do the greatest good for the greatest number of

people.

Maximize Survival

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Single Patient Mass Casualty Incidents

In a perfect world! This is how we train…

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In the real world! Rescuers are constantly adjusting and adapting to changing conditions

What Goes Wrong?

Scene size-up

Lack of information

Communication

Knowledge of roles and responsibilities

Triage

Lack of adequate resources

and staff

Utilization of resources

Patient tracking

Lack of information

Communication Training gap Patients prioritized to

inappropriate facilities

Lack of adequate resources and staff

Patient tracking Unanticipated surge

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MCI Philosophies • Slow down to be efficient.

• Taking a little extra time to get things right the first time is efficient!

• Communicate often and succinctly. • Communicate when necessary, but as little as needed.

• Only fulfill your role(s) until completed or reassigned. • Please do not move from role to role unless you are reassigned.

• Reassess, reassess and reassess! • Right patient to the right facility.

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Declaration • Declare the MCI early and appropriately based on the number

of potential patients: 3 – 10 patients is a Level I 11 or more patients is a Level II

• The first agency with knowledge of the number of potential patients shall declare the MCI a Level I or Level II MCI.

• An official declaration of a Level I or Level II MCI shall be communicated with the Dispatch Authority Having Jurisdiction (AHJ) and transmitted by the AHJ dispatch to all other responding units and responding unit dispatch centers.

• The first arriving unit shall do a scene size-up.

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Incident Command System (ICS)

• All incidents, regardless of the size and complexity will at least have an Incident Commander – who is responsible for the scene management

• Developed in Southern California in the early 1970s (FIRESCOPE)

• Standardizes Command & control, communication, and coordination of resources

• Expands and contracts depending on the size/needs of the incident

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Basic MCI Command Structure

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Incident Commander

Medical Group Supervisor

Triage Unit Leader

Triage Personnel

Patient Transportation

Group Supervisor

MEDCOMM

San Luis Obispo County MCI Levels • Level I:

• 3-10 patients OR • A suddenly occurring event that has the

potential to overwhelm any part of the EMS system and/or the number of patients is greater than can be handled by the usual initial response.

• The system may have adequate resources to respond and transport the patients.

• Duration is normally less than 1 hour. • Examples are:

• Vehicle accident and active shooter

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http://www.policeone.com/mass-casualty/

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INCIDENT COMMAND

Single Resource

Single Resource

Ambulance Coordinator

Medical Communications

Coordinator

Multi-Casualty Initial Response Organization

Minor Treatment

Immediate Treatment

Delayed Treatment

Considerations: • Assume command

• Scene survey, size-up, order additional resources

• Assess scene hazards including need for decontamination

• Declare MCI and establish common radio frequency

• Begin START/JumpSTART triage

• Establish Immediate, Delayed and Minor Treatment Areas

• Establish MedCom (ALS experience ideal)

• Establish Ambulance Coordinator

Triage Unit

San Luis Obispo County MCI Levels • Level II:

• > 11 patients • Regional medical mutual aid system

will be activated; • Adequate number of ambulances

are not likely to be available; • Receiving hospitals may be

overwhelmed; • Duration = greater than one hour. • Examples:

• Bus crash, train accident and explosive device

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INCIDENT COMMAND

Liaison Officer

Safety Officer

OPERATIONS Section

Single Resource

Single Resource



Coordinator

Staging Area(s) Resource Unit

Morgue Manager

Patient Transportation Unit Leader

Medical Group Supervisor Medical Supply Coordinator Helispot Manager

Treatment Unit Leader

Multi-Casualty Multi-Group Response

Organization

Responder Rehabilitation

Minor Treatment

Immediate Treatment

Delayed Treatment

Medical Group Response: All positions within the Medical Group are now filled. The Air Operations Branch is shown to illustrate the communication between the Patient Transportation Unit and the Air Operations Branch in determining transportation to distant facilities and types of aircraft. Rescue Group may be established to free entrapped victims. Fire/Hazard Control Group may be established to control any fire or hazardous condition.

Triage Unit Leader

Considerations: • May consult with the MHOAC for additional

hospital and ambulance resources such as Ambulance Strike Teams.

Patient Loading Coordinator

Fire Suppression Group Supervisor

Rescue Group Supervisor

Single Resource

Single Resource

Single Resource

Single Resource

Role of the MICN in a MCI Receive the MCI information from the field related to the incident and patient count

It is OK to request certain information related to patient triage/demographics.

Designate a single MICN to answer the radio and coordinate the communication when possible

Activate a MCI in ReddiNet, if not already done by field personnel, based on the information provided

Assess current situation in your own emergency department and prepare polling of bed availability by MedCom Determine priorities related to patient care (surgical, CT, x-ray, other ambulance traffic, etc.) Activate plans and notify internal staff/managers as required Complete patient tracking information in ReddiNet

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Declaring a MCI • First report may come from dispatch, or from the first

arriving unit. If known, dispatch can inform all responding personnel of a “possible” MCI, the location and the potential number of patients. Based on the potential number of patients, the appropriate Level, I or II, shall be transmitted to all responding agencies.

• The first arriving unit shall perform and report a scene size-up.

• First arriving unit on scene from the AHJ will declare a MCI to AHJ dispatch, notifying them of the assigned command and tactical channels.

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Communications/Notifications • Communications shall be established via command,

tactical and medical frequencies. • Relay the assigned command and tactical frequencies to

all involved agencies (including ambulances). • Relay pertinent information to responding units

(including ambulances). • The AHJ dispatch operates as the lead dispatch for the

incident. • Upon knowledge of the MCI, MedCom shall alert all SLO

County hospitals and Marian Medical Center of the level of the MCI, potential number of patients and the location.

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Communications/Notifications (Continued)

• When requested by the IC or the Transportation Unit Leader, MedCom shall poll the appropriate receiving hospitals by radio, ReddiNet and/or other means to determine the number and triage category of patients that each hospital can take by number of red, yellow and green tags.

• MedCom shall communicate the numbers and colors back to the IC/Transportation Unit Leader.

• MedCom will activate the Medical Health Operational Area Coordinator (MHOAC) on Level II MCIs. 26

Incident Commander

• The First Responder vested with Incident Command shall:

• Assume Command. • Do a scene size-up and estimate number of patients,

regardless if this has been done previously by another agency.

• Officially activate the MCI plan by notifying dispatch of the MCI and appropriate Level (I-II).

• Use assigned command, tactical and medical channels; request additional channels as needed.

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Incident Commander (Continued)

• The First Responder vested with Incident Command shall:

• Assign initial ICS positions. • Ensure distribution of triage tags, vests, position

checklists, and forms. • Designate staging areas for equipment and personnel

that are away from ingress and egress pathways for response operations.

• Determine and order additional resources including fire apparatus, ambulances and air resources.

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IC Transportation Resource Ordering • Ground and Air Transport:

• All ground and air transport resources will be ordered by the IC.

• All ground and air transport resources will be dispatched by

MedCom.

The estimated required ground ambulances for a MCI is equal to:

NUMBER OF IMMEDIATE PATIENTS + PLUS ONE(1) DIVIDED BY TWO (2)

• Air Units = Consider early polling, activation and integration into the transportation plan!

• All out of county ground transportation resources will be coordinated by the MHOAC.

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Roles and Assignments • First units on scene:

• Report to the IC for assignments, vests, forms. • Additional responding units may be directed to a staging area for

assignment. • Potential MCI Assignments Include:

• Medical Group Supervisor • Triage Unit Leader • Treatment Unit Leader • Patient Transport Unit Leader

• It is recommended that this role be fulfilled by the first arriving transport paramedic.

• Medical Communications Coordinator • Ambulance Coordinator

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Medical Group Supervisor

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INCIDENT COMMAND

Liaison Officer

Safety Officer

OPERATIONS Section

Single Resource

Single Resource



Coordinator


Morgue Manager





Organization


Minor Treatment

Immediate Treatment

Delayed Treatment


Triage Unit Leader






Single Resource

Single Resource

Single Resource

Single Resource

Medical Group Supervisor (Typically ALS FD, but could be ambulance or BLS)

• Gets briefing from IC • Establishes a Medical Group • Designates his/her unit leaders and treatment areas • Determines the amount and type of resources still needed • Establishes communication and coordination with

Transportation Unit Leader • Maintain Activity Log (ICS Form 214)

* Reference Job Action Sheet for full job details.

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Triage Unit Leader

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Triage Unit Leader

INCIDENT COMMAND

Liaison Officer

Safety Officer

OPERATIONS Section

Single Resource

Single Resource



Coordinator


Morgue Manager





Organization


Minor Treatment

Immediate Treatment

Delayed Treatment







Single Resource

Single Resource

Single Resource

Single Resource

Triage Unit Leader • Reports to the Medical Group Supervisor • Assumes responsibility for:

• providing triage management (not direct triage). • movement of patients from triage area to treatment or

morgue areas. • Ensures adequate patient decontamination. • Establishes the number of involved versus the number of

injured. • Tracks number and categories of victims using the

(must be used in Level II MCI)next slide.

• Receives and maintains all Category Receipts. *Reference Job Action Sheet for full job details.

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Triage

• Triage tags will be used on all declared MCIs! • In Level II

• Triage tags may be used in lieu of a Patient Care Report (PCR).

• Any care provided will be documented on the triage tag. • Triage tags stay with the patient and become part of the

hospital medical record. • Use START triage for adult patients. • Use JumpSTART triage for pediatric patients. • Re-triage for trauma criteria in the treatment area

*See next two slides for START and JumpSTART algorithms.

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View additional JumpSTART presentation at conclusion of training.

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Triage Tags Benefits Problems

• Marks who has been triaged

• Identifies patients who are contaminated

• Identifies patients who have been decontaminated

• How many auto injectors have been used

• Reminds responders of criteria for RPM

• Acts as a tracking tool for patient destination

• Requires ball point pen • Somewhat waterproof • Difficult to tear • Only documentation

during a Level 2 MCI • Very limited room for

documentation of care provided

Presenter

Presentation Notes

Disaster Medical Solutions Addresses hazards, including CBRNE, and contamination Addresses patient tracking issues

Timeline of the Triage Tag • Triage tag is placed around patient’s neck.

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Timeline of the Triage Tag • Triage tag is placed around patient’s

neck. • If appropriate, remove the

Contaminated Evidence strip from the bottom of the tag.

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• Remove unused Category Receipts to denote patient condition level. Retain removed receipts for collection by Triage Unit Leader.

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• Upon arrival at appropriate Treatment Area, Treatment Unit staff removes one of the Category Receipts from the tag.

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• Upon arrival at appropriate Treatment Area, Treatment Unit staff removes one of the Category Receipts from the tag.

• Category Receipt is stored in the Triage Tag Receipt Holder.

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Timeline of the Triage Tag • Treatment Unit staff records patient

vitals, treatment, and other information on the Triage Tag.

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• Personal Property Receipt is removed and placed with patient’s personal belongings.

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• Personal Property Receipt is removed and placed with patients personal belongings.

• Patient Loading staff remove Transportation Receipt when loading patient into transport unit.

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• Complete required information and fill in the proper Category Circle.

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• Complete required information and fill in the proper Category Circle.

• Place Transportation Receipt into the Transportation Receipt Holder and notify hospital.

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Timeline of the Triage Tag • Transporting unit removes Ambulance

Receipt for their records. Patient’s Triage Tag Number is entered into ePCR.

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Timeline of the Triage Tag • Transporting Unit removes Ambulance

Receipt for their records. Patients Triage Tag Number is entered into ePCR.

• Upon arrival at the Hospital, Triage Tag number and patient demographics are entered into the ReddiNet MCI system.

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Timeline of the Triage Tag • Transporting Unit removes

Ambulance Receipt for their records. Patients Triage Tag Number is entered into ePCR.

• Upon arrival at Hospital, Triage Tag number and Patient Demographics are entered into the ReddiNet MCI system.

• Category Receipts, Transport Receipts, and ReddiNet system are compared to ensure an accurate accounting for all patients.

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Treatment Unit Leader • Reassesses patients for appropriate triage level and re-

categorize if indicated • Re-assess for trauma triage criteria if indicated • Establishes treatment areas

• Red – immediate • Yellow – delayed • Green – walking wounded

• Coordinates with Patient Loading Coordinator and Transportations Unit Leader for transport to hospitals

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Triage Unit Leader

INCIDENT COMMAND

Liaison Officer

Safety Officer

OPERATIONS Section

Single Resource

Single Resource



Coordinator


Morgue Manager





Organization


Minor Treatment

Immediate Treatment

Delayed Treatment







Single Resource

Single Resource

Single Resource

Single Resource

Patient Transportation Unit Leader (Typically the first arriving transport paramedic or Field

Supervisor)

• Reports to the Medical Group Supervisor • Designates ambulance staging area away from ingress and

egress pathways for ground/air resources. • Establishes communication with Ambulance Coordinator. • Coordinates the establishment of the Landing Zone (LZ)

with Medical Group Supervisor and Helispot Manager.

*Reference Job Action Sheet for full job details.

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Patient Transportation Unit Leader (Typically the first arriving transport paramedic or Field

Supervisor)

• Coordinates requests for additional ground ambulance resources with the IC.

• Coordinates requests for air ambulance resources with the IC.

• Assures hospital communications via medical frequency or other coordinating facility/agency with pertinent incident information.

(next slide) with all triage tag transportation receipts following patient departures from scene.


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Destination • Patients should be transported to the most appropriate facility

based upon their injury or illness, with consideration to those needing care at a Trauma Center.

• Notification to the intended receiving hospital(s) should be attempted whenever possible. Communication is imperative in all situations!

• Regardless of a receiving hospital’s initial capacity, the appropriate distribution of patients is imperative to ensure that one facility is not overloaded!

• Morgue: Deceased patients should be tagged as black and left in place unless they hamper extrication efforts for viable patients. 60

Trauma Triage Destination Integration

• Level I MCI:

• Level II MCI:

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Destination Decision Algorithm

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Hospital Red Tag/ Immediate

Yellow Tag/ Delayed

Green Tag/ Minor

Arroyo Grande 1 1 2 or more

French 1 2 2 or more

Sierra Vista - TC 4 3 10

Twin Cities 3 4 12

Marian - TC 3 6 12

Destination Decision

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• Receiving facilities are polled by MedCom to determine the number of patients for each triage tag color that they are capable of receiving. Polling should be done early to eliminate time delays associated with waiting for patient destination.

• All communication regarding the number of each triage

tag color that the hospital is capable of receiving must be communicated as a number and color.

• Distribution goal is to get the right patient to the right hospital while not overwhelming any single hospital resources.

Medical Communications Unit Leader

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Triage Unit Leader

INCIDENT COMMAND

Liaison Officer

Safety Officer

OPERATIONS Section

Single Resource

Single Resource



Coordinator


Morgue Manager





Organization


Minor Treatment

Immediate Treatment

Delayed Treatment







Single Resource

Single Resource

Single Resource

Single Resource

Medical Communications Unit Leader

• Reports to the Patient Transportation Leader • Confirms that hospitals have been notified and

that MedCom has initiated a MCI poll. • Maintains current status of hospital/medical

facility availability including designated Trauma Centers

• Identifies availability of out-of-area Trauma Center/Non-Trauma Center services as needed to accommodate all patients.

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Medical Communications Unit Leader Continued

• Receives patient information: • Number of Red, Yellow, Green, from Treatment Unit

Leader or Treatment Manager. • Determines which hospitals can receive the patients. • Coordinates methods of transportation with Transportation

Unit Leader. • Tracks patients and informs hospitals of incoming patients. • Maintains

.(next slide)


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Transportation

• On smaller incidents, patient transportation may be coordinated by the Treatment Unit Leader and MedCom.

• On larger incidents, additional positions may be assigned:

• Patient Loading Coordinator • Ambulance Coordinator


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MCI Response Organization • The IC manages initial response resources as well as

the command and general staff requirements. • The first arriving ambulance shall interface with

the IC and expect to be assigned Transportation Unit Leader.

• Additional resources, including ambulances, are ordered and cancelled by the IC, not the first arriving ambulance. Other arriving medical resources, at the discretion of the IC, may assigned Triage and Treatment Unit Leaders and triage/treatment area personnel. 70

Incident Termination • At the conclusion of the incident the IC shall terminate

the MCI activation via declaration by radio to the AHJ dispatch center.

• The AHJ dispatch center shall communicate that the MCI is terminated to all other dispatch centers with resources at, or responding to the incident.

• MedCom shall notify all hospitals that the MCI has been terminated. • This notification denotes the termination of the MCI,

but patients may still be in transport to the hospital(s).

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Post Incident Review

• After Action checklist to be completed by IC after every MCI.

• Checklist submitted to EMS Agency by IC within 24 hours of the event.

• Operational debrief of incident response will be facilitated by the agency vested with IC responsibility and will include all agencies involved.

• After Action Report may be prepared by the AHJ in consultation with EMS Agency.

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Key Declaration Points • Declare MCI early. • Declare appropriate MCI Level (I or II). If Level II,

MedCom will activate the MHOAC. • Do a scene size-up. • Assign command and tactical frequencies and have the

AHJ dispatch relay this information to all responding resources, including ambulances.

• Set up the ICS/FIRESCOPE structure early.

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Key Scene Communication Points

• Utilize assigned command, tactical and medical channels. • Ensure proper use of the chain of command at all levels. • MedCom communication must be established.

Remember to communicate often, but

succinctly!

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Key Triage/Treatment/Transportation Points

• Use Initial START/JumpSTART triage efficiently. • Entrapped patients are not always red tags!

• Always use triage tags on a declared MCI! • Always designate a treatment area! • Deceased patients should be tagged as black and left in place unless

they hamper extrication efforts for viable patients. • Seriously consider staging resources, particularly transportation

resources, to ensure that patients are not inadvertently loaded into the wrong transportation resource.

• Always remember that the rest of the county needs to function while the MCI is ongoing. Please use the ambulance formula when determining transportation resource needs.

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Key Triage/Treatment/Transportation Points (continued)

• Consider early polling, activation and integration of air transportation resources into the transportation plan.

• Patients should be transported to the most appropriate hospital, with an emphasis on patients requiring a Trauma Center.

• Consider distributing patients to out-of-county hospitals, always emphasizing those needing care at a Trauma Center.

• Reassess often! • Utilize the Hospital Initial Capacity algorithm as a guideline for

transportation destinations until polling information becomes available.

• Regardless of a hospital’s capacity at the time of the MCI, always distribute patients to the most appropriate facility and as evenly as possible. Do not overwhelm one facility!

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Key Hospital Communications

• MedCom to notify all hospitals of the MCI as early as possible. • When requested by the IC/Transportation Unit Leader, MedCom to

poll hospitals regarding their capabilities. Only transmit/receive polling information as a number and color!

• All hospital communication should be done preferably by a single individual.

• All patient communications shall include the triage tag number and color.

• Make every effort to “step” trauma patients and notify the receiving trauma center of what step the patient is.

• The hospitals must be notified that the MCI has concluded.

Remember to communicate often, but succinctly!

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• Watch the DMS triage tag video. • Take the quiz and present it to your Training Coordinator.

Your training is not complete! In order to receive full credit for this course you must still complete the

following steps.

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Link to Video if embedded video does not work: https://www.youtube.com/watch?v=-SPGJCOqlSo

https://www.youtube.com/watch?v=-SPGJCOqlSo

Documents

San Luis Obispo County MCI Plan - SLO EMSA · PDF file · 2017-03-23San Luis Obispo County MCI Plan ... • Provides an after -action form to be completed by the IC for every MCI