1. MASS CASUALTY INCIDENT(MCI) and INCIDENT COMMAND SYSTEM (ICS)

2. Mass Casualty Incidents A mass casualty incident (MCI) is any incident that injures enough people to overwhelm the resources usually available in a particular system or area. A mass casualty incident (MCI) is any incident that injures enough people to overwhelm the resources usually available in a particular system or area. It places great demands on resources including equipment, personnel, and facilities It places great demands on resources including equipment, personnel, and facilities

3. Mass-Casualty Incidents Incidents where resources are stretched to their limits Incidents where resources are stretched to their limits May occur with an incident having more than one patient May occur with an incident having more than one patient Ask yourself how many patients can you and your team treat and transport? Ask yourself how many patients can you and your team treat and transport? Call for back up. Call for back up.

4. Types of MCI: Natural Disasters Extreme heat or cold Extreme heat or cold Fires Fires Floods Floods Earthquakes Earthquakes Topical Storms / hurricanes Topical Storms / hurricanes Tornadoes Tornadoes Epidemics Epidemics

5. Types of MCI: Technical Hazards Building collapse Building collapse Hazardous material incidents Hazardous material incidents Fires & explosions Fires & explosions Transportation accidents Transportation accidents Major industrial accidents Major industrial accidents

6. Types of MCI: Civil & Political Disorder Demonstrations Demonstrations Strikes Strikes Riots Riots Mass shootings Mass shootings Hostage taking Hostage taking Terrorism Terrorism

7. CONFUSION THE FACE OF EVERY DISASTER IS

8. Immediately Establish COMMAND

9. Incident Command System ICS is used to help control, direct, and coordinate resources. ICS is used to help control, direct, and coordinate resources. It ensures clear lines of responsibility and authority. It ensures clear lines of responsibility and authority. Incident commander has overall responsibility for the scene. Incident commander has overall responsibility for the scene. Safety officer is designated to circulate among responders. Safety officer is designated to circulate among responders.

10. INCIDENT COMMAND SYSTEM INCIDENT COMMANDER MEDICAL TRIAGE OFFICER TREATMENT OFFICER TRANSPORTATION OFFICER RESCUE EVAC

11. Structure of an Incident Command System Expanded

12. FLOW OF OPERATION 1. TRIAGE 2. EVAC 3. TREATMENT SITE 4. TRANSPORT 5. MEDICAL FACILITY MCI

13. Incident Command System Provides an orderly means of communications & information gathering for decision making Provides an orderly means of communications & information gathering for decision making

14. Makes interactions with other agencies easier through a well defined organizational structural Makes interactions with other agencies easier through a well defined organizational structural Incident Command System

15. Triage Priorities Patients should be color coded early. Patients should be color coded early. Patients tagged red should be assessed in the treatment area. Patients tagged red should be assessed in the treatment area. If patients are entrapped, extrication is required. If patients are entrapped, extrication is required. Establish a triage area for patients. Establish a triage area for patients.

16. Triage – is a French term that originated in the WWI battlefields and was applied to the process of sorting out casualties who could be returned to the front by concentrating the limited medical resources available to their ailment. Today, triage has come to mean the process by which all injured individuals are sorted and classified according to the type and urgency of their condition. Triage at Impact Zone

17. VICTIM CLASSIFICATION AT IMPACT ZONE Class I (critical – Immediate) Red Tag Class II (severe – delayed) Yellow Tag Class III (minor – non-urgent) Green Tag Class IV (dead/dying) Black Tag

18. TRIAGE AT IMPACT ZONE (S.T.A.R.T. – Check: RPM) I. Instruct all victims who are able to ambulate to move to safe area – these are the “walking wounded”, tag them green. II. For the remaining victims, check RPM : Respiration, Perfusion, Mental Status.

19. TRIAGE AT IMPACT ZONE (S.T.A.R.T. – Remember: RPM) R ESPIRATION NO POSITION AIRWAY BREATHING? NO DECEASED YES >30/MINUTE IMMEDIATE YES <30/MINUTE ASSESS PERFUSION

20. TRIAGE AT IMPACT ZONE (S.T.A.R.T. – Remember: RPM) P ERFUSION CAPILLARY REFILL >2 SECONDS OR NO RADIAL PULSE CONTROL BLEEDING IMMEDIATE CAPILLARY REFILL <2 SECONDS OR W/ RADIAL PULSE ASSESS MENTAL STATUS

21. TRIAGE AT IMPACT ZONE (S.T.A.R.T. – Remember: RPM) M ENTAL STATUS FAILS TO FOLLOW SIMPLE COMMANDS IMMEDIATE FOLLOWS SIMPLE COMMANDS DELAYED NOTE:Once a patient reaches a triage level indicator in the algorithm, (i.e. IMMEDIATE TAG box), triage should stop and the patient should be tagged accordingly.

22. Triage Decision Flowchart Assess & Position Airway/Check Breathing No Reposition Airway No Dead Yes If Breathing, Check the Rate <30 bpm Check Perfusion >30 bpm Marked ‘I” Treat for Shock PERFUSIONMENTAL STATUS RESPIRATION

23. Factors Influencing Incident Management Magnitude Magnitude Resources Resources

24. Factors Influencing Incident Management Magnitude - size of the event Magnitude - size of the event number of patients involved number of patients involved area area

25. Factors Influencing Incident Management Resources Resources response & support personnel response & support personnel equipment & vehicles equipment & vehicles facilities facilities

26. Goals of MCI Management Greatest good Greatest good Resource Management Resource Management Don’t move the disaster Don’t move the disaster

27. -Search -Rescue -Triage -First Aid Disaster AreaTransportationHospitalization BASIC RESCUE CHAIN

28. in practice… Disaster AreaTransportationHospitalization

29. more realistically… “Multi Bottle Neck” Chain Field Transport A&ED (Surgery, IC) Hospitalization Immediate Care Pre-HospitalHospital Access Resources Location Resources Space Resources Space Resources Space Resources BASIC RESCUE CHAIN

30. MEDICAL RESCUE CHAIN Search Rescue Triage Stabilization Regulation Evacuation Triage Definitive Care Disaster Area Advanced Medical Post TransportHospitalization realistically…