1. Emergency Medical Response Incident Command and Multiple-Casualty Incidents

2. Emergency Medical Response You Are the Emergency Medical Responder A school bus carrying 30 students is involved in a collision and is severely damaged near the front of the bus. The students are scared and some are injured. People are starting to crowd around the area, and the local fire department already is on scene. You arrive as an EMR on scene. Lesson 45: Incident Command and Multiple-Casualty Incidents

3. Emergency Medical Response Incident Management Systems  National Incident Management System (NIMS)  Systematic, proactive approach to guide organizations responding to incidents  Provides a template for the management of incidents  National Response Framework (NRF)  Guide to how an all-hazards response is conducted  Incident Command System (ICS)  Organizes who is responsible for overall direction

4. Emergency Medical Response Incident Command System  Management system originally developed to help manage fighting forest fires  All-hazards management system  Incident commander—  Establishes incident objectives  Scene safety, identify the MCI, patients  Manages resources  Fire, ambulances, HZMAT  Supervises use of resources

5. Emergency Medical Response Common Roles in the ICS  Triage officer  Initial triage of patients  Treatment officer  Sets up area/medical care  Transportation officer  Transport vehicles  Staging officer  Distributes resources  Safety officer  Maintains scene safety

6. Emergency Medical Response Multiple-Casualty Incidents  Motor-vehicle crashes  Transportation accidents  Flood  Fire  Explosion  Structure collapse  Train derailment  Airliner crash  HAZMAT incidents  Earthquake  Tornado  Hurricane

7. Emergency Medical Response Triage  French for separate, sift or select  The process for identifying which patients require urgent care in a multiple-casualty incident  Triage officer performs triage on all patients  Primary and secondary triage  Each patient is tagged and identified by a tag/tape  Green, yellow, red, and black

8. Emergency Medical Response Types of Triage  Primary  Used on scene to rapidly categorize the condition of the patients, including the number and location of the patients and what transportation is needed  Secondary  Often performed after patients are moved to the treatment area or before entering the treatment area

9. Emergency Medical Response The START System  Simple  Triage  And  Rapid  Treatment  START is a triage system used only in situation in which your assessment and care-giving skills are modified  The system requires you to assess and base you treatment level on three factors  Breathing  Radial pulse (Circulation)  Level of consciousness

10. Emergency Medical Response Triage Categories  Ambulatory (walking wounded): Green  Immediate care: Red  Delayed care: Yellow  Deceased/non- salvageable/expectant: Black  Hold: White

14. Emergency Medical Response Other Methods for Triage  SALT Mass Casualty Triage  Priority 1: Still/obvious life threat  Priority 2: Waving/purposeful movement  Priority 3: Walking  JumpSTART  Used with children  Not for use with infants younger than 12 months

15. Emergency Medical Response Activity You are assisting with triage at the scene of a multi- vehicle collision involving several automobiles and a tractor trailer. One of the patients, a 35-year-old woman, is alert and responsive with a small cut on her forehead and forearm and is complaining of a headache. An 8-year-old child has a fractured leg with the bone protruding through the skin with significant bleeding. A third victim, a 65-year-old male is not breathing, even after attempting to open and clear his airway.

16. Emergency Medical Response Stress at a Multiple-Casualty Incident  Patient  More then just visible injuries  Cognitive, emotional, physical and behavioral  Children and elderly with increased risk for severe stress reactions  EMRs and the need for debriefing  Adequate rest/down time  Talking with colleagues about their experience

17. Emergency Medical Response You Are the Emergency Medical Responder A number of students from the bus are yelling at you to help them, and one of the firefighters asks you to come over and check the coach, whose pain in his abdomen and chest seems to be getting worse.