Virginia MASS Casualty Incident Management Lieutenant Jeff Lawson Roanoke County Fire & Rescue Department

Course Objectives Complete initial response actions to MCI Triage using START Use correct triage ribbons Accurate casualty count Complete Virginia Triage Tag

The Problem Geographic Location Population Centers Transportation Routes Unique Hazards

There is potential for an incident With large numbers of patients that overwhelms any EMS system

MASS CASULTY INCIDENT Overwhelms resources available in a system or area Places great demand on resources: Personnel, Equipment, & Hospital Facilities

MCI TYPES -TECHNINCAL HAZARDS Building Collapse High Rise Incidents Major Industrial Accidents Transportation Accidents Hazardous Materials Incidents

MCI TYPES - CIVIL/POLITICAL Civil disobedience Criminal or terrorist incidents Military attack on the United States

Incident Management System Allows effective control, direction, coordination of response resources Communications and information gathering Improved interaction with other agencies

Influencing Factors Magnitude of the event Available resources

Magnitude How big is the incident –N–Number of patients –a–area –b–boundaries: open or closed

Resources Response and support personnel Apparatus Facilities (Hospital’s, Temporary Shelters, & etc.

Categories of MCI’s Expanded Medical Incident Major Medical Incident Disaster Catastrophe

Expanded Medical Incident Produces multiple casualties - a multiple vehicle accident Pre-hospital resources adequate Hospital capacity adequate

Major Medical Incident Produces a large number of casualties - the World Trade Center bombing Multi-jurisdictional and regional EMS response Regional allocation of patients to hospitals

Disaster Mass casualties - a major earthquake Overwhelms local, multi- jurisdiction, and regional mutual aid Assistance from State, interstate, or Federal resources.

Catastrophe Overwhelm local, multi- jurisdictional, regional, State resources Interstate and Federal resources needed - as in Hurricane Andrew Local resources are concentrating on their own survival

Goals of MCI Management Greatest good for greatest number Scarce resource management Don’t relocate the disaster

Do the Greatest Good Make the best possible use of available resources Salvage the most patients possible Heroic resuscitation not appropriate Concentrate on those we can save!

Resource Management Call for needed resources early! Be prepared for delays Use command –to coordinate with other hospitals –to coordinate transportation decisions

Don’t Relocate the Disaster Transport patients to facilities based on: –P–Predetermined plan –a–ability of facility to receive types and numbers of patients –D–Don’t move the incident to the hospital

5S - Safety Assessment Fire Electrical Hazard Flammable Liquids HAZ-MAT Other Life Threats and Hazards to Rescuers

5S -Scene Safety Type of incident Approximate number of patients Severity of injuries Area involved and access

5S - Send Information Contact dispatch with survey information Request resources and mutual aid Notify command hospital RMH)

First EMS Provider Establishes Medical Group Directs triage of all patients Assigns resources as available to get key functions running

5S - Set Up Medical Group Supervision Triage Treatment Medical Communication Transportation Extrication Staging Medical Supply

Transportation Decisions Patient prioritization Destination facilities Transportation resources

START Simple Triage and Rapid Treatment

Triage From French word “to sort” Separates patients needing rapid care Reduces urgent burden on capabilities Provides rational casualty distribution

Triage Problems Reliance on specific diagnosis to put patients in categories Too slow a process

START does these things

Ideal Triage System Simple No Advanced Skills No Specific Diagnosis Easy to do Rapid and simple life-saving intervention Easy to teach and learn

Triage Ribbon Concept Red –IMMEDIATE (highest priority) –respiration, perfusion, mental status, severe burns

Yellow –DELAYED (second priority) –burns,major or multiple bone or back injuries Triage Ribbon Concept

Green –M–Minor (third priority) –M–Minor painful, swollen deformities, minor soft tissue injuries

Black –D–DEAD (lowest priority) –D–Deceased or non-salvageable

Start First Steps Begin where you stand Move all who can walk –away from the site –use GREEN ribbons

Start - First Steps Move in orderly pattern through patients Assess using START and put ribbons on

Start - First Steps Keep a count of casualties Give only minimal treatment –open the airway –stop gross bleeding

Start - First Steps Keep moving

Respiration Assessment Not Breathing? Open Airway! –Still not breathing - BLACK (DEAD) –Starts to breath - RED (immediate)

Respiration Assessment Breathing >30 breaths per minute - RED <30 breaths per minute - Next Step Maintain airway any way you can

Perfusion Assessment Radial pulse absent?RED (immediate) Radial pulse present - NEXT STEP Stop any gross hemorrhage

Mental Status Assessment Ask patient to do something simple Does not follow command - RED Able to follow command - YELLOW

Treatment Functions Purpose –Identify specific injury –Categorize patients and give care –Prioritize for transport

Treatment Functions Start depends on three simple observations –Respiration –Perfusion –Mental Status

Treatment Functions Reassessment and tagging –on way to treatment or (in small incidents) at the site –in treatment area –in ambulance

Treatment Functions MCI’s will require two triage stages Reassessment in treatment is secondary triage –more subjective –based on specific condition and experience

Secondary Triage RED (Immediate) –L–Life threatening injury –H–High probability of survival –c–can be stabilized –r–risk of asphyxiation or shock present or imminent

YELLOW (Delayed) –Potentially life threatening injury –Severely debilitating injury –Can stand a delay in treatment and transport

Secondary Triage GREEN (Minor) –Non life threatening injuries –Minimal care with minimal risk

Secondary Triage BLACK (Deceased or non- salvageable –Unresponsive with no circulation –Deceased at the site en route to treatment in treatment

Summary MCI’s can overwhelm you - go for the goals: –greatest good for greatest number –scarce resource management –don’t relocate the problem

Summary Fist responders take first steps - the 5-S’s: –Safety –Survey –Send –Set-up –START

Summary START sorts large number of patients Treatment phase requires secondary triage as in-depth assessment Triage Tag IMS expands to meet the needs of response