MULTI- CASUALTY INCIDENTS GLENDALE FIRE DEPARTMENT ANNUAL TRAINING MARIANNE NEWBY

COURSE OBJECTIVES Review overall ICS for MCI Back to basics Some new things from DHS Lessons learned from past incidents Multiple jurisdictions Separate triage / treatment / transportation areas MCI Task Force Reference: FOG Manual: ICS 420-1

ROLE OF THE FIRST-IN UNIT On scene size up: What do I have ? What do I need ? What am I doing ? Who is in command ? Assign crew to triage

Incident Commander Triage Unit Engine Immediate Treatment Medical Communications Coordinator INITIAL RESPONSE

Incident Commander Triage Unit Single Resource Treatment Unit Immediate Treatment Delayed Treatment Minor Treatment Patient Transport Unit Medical Communications Coordinator Ambulance Coordinator Safety Officer

RADIO FREQUENCIES REQUIRED Tactical channel Command channel Direct channel- Ask for an additional tactical channel Communication triangle Treatment dispatch manager Medical communications coordinator Ground ambulance coordinator

INITIAL RESPONSE Prioritize your needs and assign resources: First priority Incident Commander (officer) Triage personnel Second priority Triage Unit Leader (officer) next priority Med Com Treatment Unit Leader (officer) next priority Transportation Group Supervisor ( officer)

REINFORCED RESPONSE Priorities (continued) Next priority Medical Supply Coordinator Treatment Dispatch Manager ( PM or Captain) Treatment Area Managers ( PM’s) Medical Group Supervisor (Chief or Captain that was previous IC)

INCIDENT COMMANDER Who becomes I.C.? First in company officer First in battalion chief The incident commander remains in charge until relieved

TRIAGE UNIT LEADER Responsibilities Develop organization large enough to handle assignment Implement triage process Coordinate movement of patients from triage to treatment areas Maintain security of triage area Establish morgue

TRIAGE PERSONNEL Supervised by triage unit leader Triage and tag injured patients Direct movement of patients to proper treatment area Provide appropriate medical treatment to patients prior to movement as incident indicates

TRIAGE PROCESS FIRST Verbalize Reassurance and ask: “Whoever can walk please do so now. Help has arrived” Direct them to a specific location. (By asking this you’ve immediately triaged a group of MINOR patients)

NEXT…. Move from Patient to Patient Beginning with the person closest to you (to perform a < 1-minute triage) Is the person Breathing? (they’re either breathing or Not) Yes? How Fast? No? Re-position Airway

R= RESPIRATIONS Airway Repositioned Spontaneous Breathing This Person is IMMEDIATE Still Apneic This Person is DECEASED Move on to Other Victims

P= PERFUSION You have a BREATHING patient With respirations UNDER 30 / min Is the Radial Pulse PRESENT? AND CAP REFILL < 2 SEC Now Eval MENTAL STATUS Is the Radial Pulse ABSENT? Control Bleeding Now This Patient is IMMEDIATE OR is CAP REFILL > 2 SEC

M= MENTAL STATUS Your Patient is Breathing, Has a Pulse Cap refill is < 2 sec What is their MENTAL STATUS? Can’t Follow SIMPLE COMMANDS? This Patient is IMMEDIATE! Follows SIMPLE COMMANDS! This patient is DELAYED!

TRIAGE

TREATMENT UNIT LEADER Responsibilities Manage all activities within area Develop organization large enough to handle assignment Plan layout Coordinate patient transportation needs Assign H.E.R.T. Teams as needed Provide guidance to subordinates Immediate, delayed, minor area managers

TRANSPORT PRIORITY GUIDELINES

PATIENT TRANSPORTATION GROUP SUPERVISOR (1 OF 3) Responsibilities: This may be same as ground ambulance coordinator depending on size of incident ( officer) Establish the following positions: Ground ambulance coordinator Staging officer Recorder Only priority that splits the crew Establish ambulance staging area Request additional ambulances as needed

PATIENT TRANSPORTATION GROUP SUPERVISOR (2 OF 3) Responsibilities (continued): Establish a loading zone Control all ambulance loading activities and movement Establish communications with ground ambulance coordinator and medical communication coordinator

PATIENT TRANSPORTATION GROUP SUPERVISOR (3 OF 3) Direct the transportation of patients as indicated by medical Group supervisior Assure all patient information and destinations are recorded

GROUND AMBULANCE COORDINATOR  Responsibilities: ◦ Establish ambulance staging area ◦ Determine route of travel ◦ Communicate with med. Comm. And treatment dispatch manager ◦ Maintain records as required

PRIVATE AMBULANCE RESOURCES Some terms you need to know: Exclusive Operating Area (EOA) Private ambulance companies contracting with DHS to provide emergency patient transport within seven established areas Where this transport is not provided by the jurisdictional 911 provider Fire Operational Area Coordinator (FOAC) LA County Fire Department

STAGING OFFICER Establish appropriate staging area for resources Maintain communications with I.C. Or operations section chief Maintain records as required Request additional resources if appropriate

RECORDER Responsibilities Document all patient information and destination Complete multi- casualty recorder worksheet (pt. Info)

CHIEF OFFICER ARRIVAL Face to face briefing Transfer of command Establish command post Name incident (if not established) Former incident commander becomes medical group supervisor or remains with IC through the remainder of incident.

MED COM Establish communication with MAC via the Hear Radio This should be a medic from the initial response. First in Medic should contact MAC.

MED COM Size-up Advise of working multi-casualty incident Location of incident State “ this is not a drill ” Approximate number of patients Request Hospital availability Standing orders ( 806) HERT teams if necessary 1:1 staffing May break contact with MAC and recontact Large incidents may require additional personnel for recording

COMMUNICATION TRIANGLE Used to streamline patient movement only Separate frequency Key players: Medical communication coordinator Treatment dispatch manager Ground ambulance coordinator Back to ICS Chart Back to MedCom

MEDICAL SUPPLY COORDINATOR Acquire, distribute and maintain medical equipment Request additional supplies if required (medical cache) Distribute supplies to treatment and triage Maintain documentation

TREATMENT DISPATCH MANAGER Establish communications with: Immediate, delayed and minor area managers Medical communications coordinator Ground ambulance coordinator Verify patient priority Coordinate transportation of patients to loading zone

AREA TREATMENT MANAGERS Immediate, delayed and minor Request medical teams as necessary Treatment of patients in areas Prioritize transportation Notify treatment dispatch manager of patient readiness

Managing Large Scale Incidents

Deputy Med Comm. (Division A) Deputy Med Comm. (Division B) Deputy Med Comm. (Division C) Deputy Med Comm. (Division D) Treatment Unit Leader (1 Officer) Treatment Dispatch Manager (1 Officer) Immediate Treatment Manager (1 EMT/Officer) Delayed Treatment Manager (1 EMT/Officer) Minor Treatment Manager (1 EMT/Officer) Imm. Tx Area (2 PM, 1 Company) Delayed Tx Area (2 PM, 1 Company) Minor Tx Area (2 PM, 1 Company) Treatment Unit Leader (1 Officer) Treatment Dispatch Manager (1 Officer) Immediate Treatment Manager (1 EMT/Officer) Delayed Treatment Manager (1 EMT/Officer) Minor Treatment Manager (1 EMT/Officer) Imm. Tx Area (2 PM, 1 Company) Delayed Tx Area (2 PM, 1 Company) Minor Tx Area (2 PM, 1 Company) Treatment Unit Leader (1 Officer) Treatment Dispatch Manager (1 Officer) Immediate Treatment Manager (1 EMT/Officer) Delayed Treatment Manager (1 EMT/Officer) Minor Treatment Manager (1 EMT/Officer) Imm. Tx Area (2 PM, 1 Company) Delayed Tx Area (2 PM, 1 Company) Minor Tx Area (2 PM, 1 Company) Treatment Unit Leader (1 Officer) Treatment Dispatch Manager (1 Officer) Immediate Treatment Manager (1 EMT/Officer) Delayed Treatment Manager (1 EMT/Officer) Minor Treatment Manager (1 EMT/Officer) Imm. Tx Area (2 PM, 1 Company) Delayed Tx Area (2 PM, 1 Company) Minor Tx Area (2 PM, 1 Company) Medical Comm. Coordinator (1 Officer - Former I.C.)

Deputy Med Comm. (Division B) Deputy Med Comm. (Division A) Deputy Med Comm. (Division C) Deputy Med Comm. (Division D) Treatment Unit Leader (1 Officer) Treatment Dispatch Manager (1 Officer) Immediate Treatment Manager (1 EMT/Officer) Delayed Treatment Manager (1 EMT/Officer) Minor Treatment Manager (1 EMT/Officer) Imm. Tx Area (2 PM, 1 Company) Delayed Tx Area (2 PM, 1 Company) Minor Tx Area (2 PM, 1 Company) Treatment Unit Leader (1 Officer) Treatment Dispatch Manager (1 Officer) Immediate Treatment Manager (1 EMT/Officer) Delayed Treatment Manager (1 EMT/Officer) Minor Treatment Manager (1 EMT/Officer) Imm. Tx Area (2 PM, 1 Company) Delayed Tx Area (2 PM, 1 Company) Minor Tx Area (2 PM, 1 Company) Treatment Unit Leader (1 Officer) Treatment Dispatch Manager (1 Officer) Immediate Treatment Manager (1 EMT/Officer) Delayed Treatment Manager (1 EMT/Officer) Minor Treatment Manager (1 EMT/Officer) Imm. Tx Area (2 PM, 1 Company) Delayed Tx Area (2 PM, 1 Company) Minor Tx Area (2 PM, 1 Company) Treatment Unit Leader (1 Officer) Treatment Dispatch Manager (1 Officer) Immediate Treatment Manager (1 EMT/Officer) Delayed Treatment Manager (1 EMT/Officer) Minor Treatment Manager (1 EMT/Officer) Imm. Tx Area (2 PM, 1 Company) Delayed Tx Area (2 PM, 1 Company) Minor Tx Area (2 PM, 1 Company)