EMERGENCY MEDICAL SERVICE
MULTI-CASUALTY INCIDENT (MCI) PLAN
I.PURPOSE
The purpose of this plan is to provide guidelines in the implementation of a pre-planned, coordinated response to a major emergency medical situation, whether it be man-made (localized) or as a result of a natural disaster (widespread). ______EMS employees will follow an incident command system at all times while operating under this plan.
A multi casualty incident will be declared based upon the numbers and categories of patients, the estimated time to transport patients to the hospital (given factors such as distance, entrapment, etc.) and the need for field medical care beyond the capabilities of EMS paramedics. On line medical control will be consulted for the declaration of an MCI.
This is an internal plan dealing only with emergency medical services and is intended to be a supplement to existing local plans. Although other agencies have been mentioned herein such as the medical society, police and fire, etc. , there was no intention to dictate those agencies' responsibilities during a disaster. However, for this plan to be effective, certain areas of responsibility had to be defined. Transportation will primarily be provided by ground ambulances where maximum patient care can be delivered. If this is not feasible due to the disaster site, helicopter and rough terrain vehicles will be utilized when available. Frequent drills and communication between the various emergency services will help insure a high level of readiness throughout the county, thus assuring the best possible chance of survival for the largest number of victims.
It is also important that post-drill and post-disaster critiques be held as soon as possible after each incident. This should help provide a mechanism for plan evaluation. It is necessary, therefore, that this plan always be considered to be in a "rough draft" stage - subject to revision.
IIDEFINITIONS
Signal 9 - MCI: This disaster situation represents some number of seriously injured or ill casualties which cannot be handled in the "normal" course of operations. It may be of small scale, short duration with a number of entrapped critically injured or ill patients requiring intensive advanced medical or surgical care, or a very large number of minor to moderate severity patients that require extensive duration field triage and treatment. an MCI could also be declared for a wide scale, long duration incident, as would be expected with many natural disasters.
Air Traffic Control: Authority responsible for controlling emergency air units. (Especially necessary in darkness. Hopefully this will be possible from the airport. If not, a military air command post may be necessary and/or will be handled by the EPD Air Operations Officer.)
Command Post (CP): Suitable site selected early in the operations where all ranking officials of participating agencies will gather to exercise command. Officials should remain in this area until problem is concluded.
Control Point: Police-secured point through which all emergency vehicle traffic, equipment and personnel will pass in and out.
Medical Control: Designated hospital emergency department from which the Ambulance Coordinator will be advised as to which area hospital will be receiving victims and in what order. Responsible for initiating and updating bed availability counts at area hospitals.
EOC (EmergencyOperationsCenter): Designated facility set up with several outside lines and enough space for additional communications equipment and operational personnel. Normally, this center will only be staffed and put into operation for wide-scale disasters such as a hurricane, earthquake, etc. Furthermore, the EOC should be self-supporting with cooking and sleeping facilities for support operations that may last several days to weeks.
Landing Zone (Hospital) (LZ): Area at hospital designated for landing helicopters for patient drop-off. May be pre-planned, paved pad set aside for this purpose or, in case of an emergency, a parking lot or field free of overhead obstacles can be used. (Selected area of parking lot may be designated ahead of time and painted with a large red "H".)
Loading Zone: Victims pickup point located adjacent to field treatment area. Should be situated in such a way as to eliminate the necessity for backing up ambulances. This will require circular traffic loop.
Treatment Areas: Incident area where patients are taken for field treatment and secondary triage, prior to transportation. Size of area will be dependant on number of patients and accessibility to forward site and transportation sectors. Area must be located such that it is safe from physical or chemical hazards, yet easily accessible from the forward (incident) site and to the Transportation Sector. This is the area Triage Team physicians report to following Tasking Sector check in. CCEMS paramedics will be assigned to each category of treatment area as needs require and resources allow. Equipment and supply drop from incoming ambulances will be done adjacent to treatment area.
Temporary Morgue: Designated site for placement of DOAs. A simple roped-off area may suffice or in severe incident, several parked unmarked refrigerated trucks may be needed. Medical examiner will be responsible for this function supported by police for security and FBI for victim identification.
III.MASS CASUALTY INCIDENT (MCI) CRITICAL TASKS
The Following positions have been identified as essential to the efficient management of an MCI. They will be manned by Senior EMS personnel and will be easily identified by high-visibility vests, helmets, or other devices. To facilitate effective coordination of manpower and resources, all personnel should be aware of these positions and their functions.
The EMS Group Commander: Also referred to as EMS Command. Responsible for the entire EMS operation at the MCI. He works closely with the other Group Coordinators (police, fire, and rescue representatives) at the Command Post. EMS Command is responsible for assumption of all sector appointments in the EMS Group not delegated directly.
Rescue Group Commander: Responsible for the coordination of all Search and Rescue (SAR) Operations. Coordinates with the FSO and Scene Commander in allocating manpower and resources to SAR operations.
EMS Group Safety Officer: Responsible for the safety of all personnel assigned to the EMS Group. Assesses tasks assigned to the EMS Group, reviews required Site Specific Health and Safety Plans or Entry Permits as indicated. Approves all personal protective equipment (PPE) required at the incident. EMS safety has the authority to stop any EMS Group mission in progress if a condition found to be immediately dangerous to life and health (IDLH) exists. Such suspension of mission will be immediately reported to EMS Command.
Forward Site Officer: The EMS Group Commander's representative at the forward incident site. Oversees the extrication and movement of patients to treatment area according to triage categories. Coordinates with the EMS Group Commander at the CP regarding SAR operations. Triage is done in the forward site utilizing survey tape for patient category & identification. In most cases, only emergent (RED), non urgent (GREEN) and deceased (BLACK) triage will be done in forward site. Treatment in the forward site will be limited to only immediate life/limb sustaining intervention.
Treatment/Triage Paramedic: The Senior Paramedic in each Treatment category. Works closely with the Treatment/Triage physician in providing the ALS and final triage of patients in preparation for transport. As additional Paramedics are assigned tot he treatment area, they should report to the Treatment/Triage Paramedic. Will wear a colored ribbon or other identification for the category assigned. When utilized, MCI Triage Tags will be filled out in the Treatment Sector.
Ambulance Coordinator (3):
a.Ambulance Coordinator - Acts as the communication link
between the Loading Zone and the Medical Control hospital. Tracks and relays patient data to the Receiving hospital and the Medical Control hospital as appropriate. Information is recorded on large Patient Evacuation Board along with depart from scene and arrive hospital times. Ambulance Coordinator will record on the Victim Evacuation Record the following:
Unit Number transporting
Number of victims on board
Victim count by destination (Hospital ERs)
Victims categorized 1 - 4
Victim's name when available
b.Loading Supervisor - Responsible for overall operations at
the Loading Zone. Works closely with the Triage physician. CP determines distribution of patients to hospitals and relays it and other information to the driver.
c.Assistant Ambulance Coordinator - He serves as a comm-
unication link between the CP, Ambulance Coordinator, and
the Loading Zone. Maintains victim Evacuation Record. He
instructs the MICU driver regarding destination, route, etc.
Oversees loading and assists with patient record tracking.
Tasking Coordinator: Responsible for assigning arriving personnel to specific tasks and recording EMS Group personnel on scene. Works closely with the Scene Commander and the other Group coordinators in assigning manpower to those areas. All arriving personnel should report on to him/her. Location for reporting will be determined by EMS Command.
Staging Officer: The Staging Officer (SO) insures the orderly staging and movement of transport units and other EMS Group resources at the Control Point and Loading Zone. All drivers should receive directions from the SO before preceding past the Control Point. Staging Officer may also be responsible for movement of equipment and supplies from incoming ambulances to equipment/supply drop adjacent to treatment area.
Messenger: Assigned to the Command Post. Should be knowledgeable of all MCI operations. Responsible for the efficient delivering of messages between the CP and Group Coordinators.
Primary Dispatcher: Dispatcher handling radio communications.
Backup Dispatcher: Dispatcher(s) responsible for monitoring radio and answering phones, keeping logs, etc.
Logistics - Supply Officer: Responsible for equipment and supply delivery to scene, acquisition of necessary equipment and supplies throughout all phases of incident, restock of equipment and supplies following incident termination. Responsible for coordination of stocked disaster trailer, equipment/supplies in normal usage stock, resources available from local suppliers, etc.
IV.NOTIFICATION PROCEDURES
A.Implementation of Signal 9 (MCI)
Upon receipt of disaster alert (possible Signal 9), the duty dispatcher
will (See Attachment A):
1.Dispatch medic unit(s), duty shift supervisor, Director,
Assistant Director and rescue units directly to the scene.
(Number of initial response units will depend on "verification
of call and will be determined by senior dispatcher on duty
and duty supervisor.) After arrival on scene of first EMS
medic unit, the senior officer will call approximate number of live, seriously ill or injured casualties and consult with on line medical control (108, 112, CMH) for activation of the
SIGNAL 9 PLAN. The senior EMS officer will initiate
designation of site areas for treatment, triage, loading, etc.
The senior EMS official on scene will assume EMS Command until properly relieved by an EMS officer of
equal or higher rank.
2.Dispatcher will automatically:
a.Notify ______(Medical Control
Hospital). Advise them of the situation and ask them
to activate Medical Control for bed count status and
to stand by for communication from the field for
possible activation of the Triage Team.
b.At the request of EMS Medical Control, will assist
with activation of the ______
Triage Team.
c.Alert ______City Police Department or
CountySheriff's Office that it may become necessary
to provide a police cruiser(s) to pick up TRIAGE
TEAM at designated hospital and transport team to
the scene. (Ambulance or staff car(s) may also be
available for this.)
3.Following notification of Medical Control, the dispatcher will
initiate ______EMS Personnel Notification
Plan. Under this plan, the following will be alerted:
a.Director
b.Assistant Director
c.Medical Director
Assistant Medical Director
d.Training Officer
e.Remaining shift supervisors
f.Supply Supervisor
g.Maintenance Supervisor
h.Dispatch Supervisor
i.EMS Safety Officer
j.Project Officer
k.EPD Director
l.Sheriffs Office (PAWN if warranted)
m.Jurisdictional Fire Department
n.Rescue Squad
o.ALERT Mutual Aid Teams if appropriate as deter-
mined by EMS Command through Command Post.
p.Off-duty dispatchers/field personnel as needs are ant-
icipated, as determined by EMS Director or designee.
B.Following implementation of Signal 9, after all first responder units
have been dispatched, the backup dispatcher will:
1. Break out disaster Victim Evacuation Record (Table 1) and
maintain by monitoring radio communications between
Medical Control and Command Post. Relay broadcasts as
necessary, keeping telephone lines (hotlines) open.
"Information Seeking" calls from media or citizens, etc. will be referred to EMS HQ office staff when available or calls
will be politely terminated.
2.Maintain a separate time card on each responding unit insuring that each card receives the same call number.
3.Maintain dispatch log sheets and other records as usual.
4.Assist in triage of incoming calls.
V.FIRST ON-SCENE
A.The first Medic Unit On-Scene will:
1.Verify Signal 9 with live victim count and call back informa-
tion to dispatcher.
2.Establish EMS Group Command. As resources allow, set
up appropriate EMS Sectors (treatment, loading, staging,
tasking, etc.) Appoint EMS Group Safety Officer. Senior
EMS official on scene will maintain EMS Command until
properly relieved.
3.Begin Triage, patient tagging with survey tape, and admin-
istration of emergency care when possible. In an MCI field treatment situation, the only procedures done are those that are immediately life saving (eg. airway opening and external hemorrhage control). In some instances the first unit in may become a "decoy", luring the walking-wounded and bystanders away from the critical areas, allowing a second unit to perform these functions.
NOTE: First unit will not immediately attempt to transport any patients. It will remain on-scene as a mobile intensive care unit serving as part of EMS Group. The crew will begin TRIAGE using the four-point category system below: For quick identification, colored ribbons will be placed on all patients based upon triage criteria. Senior Crew Chiefs must insure that a roll of each color is available on unit at all times. Only one emergency vehicle at CP will have on roof beacon. Others will be off to help reduce confusion. CP Area will be designated with a Green Emergency Light.
As available, medic crews will be assigned to assist the Emergency Mental Health Services (EMHS) Team with the initial establishment of an area set aside for injured victims who will be delayed (Category 3) who are experiencing severe emotional problems as soon as practical. These patients should be apart from those other Category 3 victims already tagged and sorted. EMHS Team leaders will keep the on-scene command post and the Triage area aware of any special requirements.
B.Subsequent Medic Units or supervisors will assume EMS Command
roles delegated specific sector assignments previously described; as appropriate.
NOTE: These sectors will have to be coordinated with the first arriving ranking police and fire officials. It is suggested that in the early onset of the Signal 9, a Control Point be established to control access of equipment and personnel. Staging should be located away from the immediate scene to make room for vital functions. All arriving EMS personnel need to check in with EMS Command or EMS Tasking Officer for duty assignment.
C.The First Supervisor On-Scene will:
1.Assume EMS Command after situation report from senior EMS Official on scene. Continue sector assignments as
necessary. Appoint EMS Group Safety Officer as
appropriate.
2.Establish a communications net using portable radio or mobile unit. See Table 1 and 2.
a.The Talk Groups to be used are as follows:
b.Standard radio codes will be used only on Primary
dispatch channel. Plain English will be used on remaining channels. When possible, standard radio
procedure should be observed on all channels.
c.The senior dispatcher at CommunicationsCenter will
insure that units responding to routine calls (outside
of disaster situation) will utilize hospital communications.
d.Departing ambulances will be instructed to turn unit
to hospital channel after advising dispatcher they have left the scene. Once on the hospital channel they may give receiving hospital general information about patients, but only if it is requested. If additional patient information is requested it will be given as questions are raised. The normal communications format between paramedic and hospital will not be used as it is imperative to keep all radio traffic to bare essentials, especially during the initial phases of the plan.
D.Subsequent Supervisors arriving on scene will report to Command
Post for assignment by Assistant Director, or in his absence, by the
senior EMS Supervisor on the scene.