MASS CASUALTY INCIDENTS August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

MCI RESPONSE Potential Danger Major and catastrophic incidents are a potential in any community. With the great variety of natural and man-made disasters that face us everyday, something major can happen almost anywhere. Whether it is a natural disaster or terrorist incident there can be significant impact on the community August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

MCI RESPONSE Familiarization with Target Hazards Site that have great potential for significant loss of life or monetary loss: Public assembly facilities Hospitals Nursing homes Theaters Industrial sites using hazardous materials Railroads Highways Schools Malls August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

MCI Response Prepare Train in ICS / UICS Train in mock disasters Understand your responsibilities Understand the vocabulary Train in mock disasters August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

MCI Response Primary concern must be to save as many lived as possible and protect responders Response First unit establishes command and sizes-up the scene The IC determines need for additional resources Triage Treatment Transport August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

MCI Response Establish Command Senior member of first arriving unit becomes IC Will remain in charge until relieved by a higher authority Unified Command should be considered early in the event. Slide hidden August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

MCI Response Scene Organization Ensure an effective response Secure the area (limit access) Determine scene safety (is decon required) Assign personnel Establish staging and T-3 areas Establish communications Determine ingress and egress (flow of traffic) Maintain records August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

MCI Response Potential for Terrorism The IC must be cognizant of the possibility the MCI was deliberate Preserve evidence Watch for secondary devices PIO releases only necessary information August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

MCI Response Decontamination PPE may be needed if the scene includes: Nuclear Biological Chemical Determined by HazMat Team Victims must be deconed prior to T-3 August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

T-3 Triage Treatment Transport MCI Response August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

Triage The concept of triage is simply a method of quickly identifying victims who have immediately life-threatening injuries AND who have the best chance of surviving so that when additional rescuers arrive on scene, they are directed first to those patients.  August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

START (Simple Triage and Rapid Treatment) Developed by Hoag Hospital and the Newport Beach Fire Department (Newport Beach, CA) Relies on making a rapid assessment (taking less than a minute) of every patient Determining which of four categories patients should be in Visibly identifying the categories for rescuers who will treat the patients August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

MCI Response Triage Victims are divided in the following categories: Immediate (RED) Life-threatening Delayed (YELLOW) Serious but not life-threatening Minor (GREEN) Walking wounded Deceased (BLACK) Includes non-salvageable August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

MCI Response START Triage Simple Triage and Rapid Treatment Designed to assess a large number of victims objectively, efficiently and rapidly Can be used by personnel with limited training 30 – 60 seconds per victim August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

MCI Response Evaluating Patients START, ambulatory patients are automatically triaged for delayed care 30-2 can do Non-ambulatory evaluated: Respiration Perfusion Mental status R.P.M Slide hidden August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

EMS & Trauma Systems Section Office of Public Health Preparedness Slide hidden by DE – BF: Might be inclined to keep this or have a separate lecture on START. August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

Visibly identifying the categories for rescuers who will treat the victims… The Triage Tag or Colored Strip Color Coded Person doing initial START triage does NOT fill out the tag, only tears off the color strip Should write time and initial the tag Slide hidden August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

MCI Response Medical Treatment During Triage Only life-threatening problems are corrected Opening the airway Attempt to control exsanguation Resuscitation is not attempted Slide hidden August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

MCI Response Triage Categories START RED – Immediate YELLOW – Delayed RPM outside of desired values YELLOW – Delayed RPM within desired values Significant injuries GREEN – Minor Ambulatory, able to move with instruction from EMS August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

MCI Response Target Values Respiration Capillary refill Between 10 & 30 per minute Capillary refill Less than 2 seconds or radial pulse present Victim can do what you ask Slide hidden August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

MCI Response Assess Respiration If between 10-30 go to perfusion If <10 or >30 tag red and move to next patient If not breathing, open airway and remove obstructions if visible If victims starts breathing, follow #1 or #2 above If patient is still not breathing, prioritize BLACK Slide hidden August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

R=Respiration First check for breathing (estimate rate) Yes Rate < 30 >30 Red Tag Check Perfusion August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

Breathing Continued… Not Breathing Reposition/Open Airway Still Not Breathing Breathing Resumes Black Tag-Dead Red Tag-Immediate Slide hidden August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

MCI Response Assess Perfusion If radial pulse is present or capillary refill is less than 2 seconds go to MENTAL STATUS assessment If no radial pulse or capillary refill greater than 2 seconds, prioritize RED Slide hidden August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

P = Perfusion Check a radial pulse Yes Check Capillary Refill Not Present Red Tag & Move to Next patient Note: May have the victim or a less injured victim put pressure on any bleeding and elevate feet < 2 Seconds > 2 Seconds Move to Mental Status Slide hidden August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

MCI Response Assess Mental Status Assess the victim’s ability to follow simple commands Alert to person, place and time If victim does not follow command, is unconscious or disoriented, prioritize RED If victim follow commands and is oriented, prioritize GREEN or YELLOW Slide hidden August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

M = Mental Status Check Mental Status Follows Simple Commands Yes No Yellow Tag-Delayed & Move to next victim Red Tag-Immediate & Slide hidden August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

EMS & Trauma Systems Section Office of Public Health Preparedness August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

Black – deceased Red – immediate Yellow – delayed Green – minor   This tag shows the patient's category as "Immediate."                            Slide hidden August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

Respirations No Position Airway Deceased Immediate Yes < 30/m No Respirations Deceased Immediate Yes < 30/m > 30/m Perfusion Radial Pulse Absent OR Control Bleeding If Nec. Radial Pulse Present Capillary Refill > 2 Sec. Mental Status Follows Simple Instr. Delayed Cant Follow Simple Instr. < 2 Sec. August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

MCI Response Treatment Patients are re-evaluated using more in-depth assessment Secondary triage Separate treatment areas; Red, Yellow, Green Definitive/stabilizing emergency care ABC’s Wound care August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

MCI Response Transport Transported by triage determination Red go first Green patients made be transported by alternative means (Bus) Accompanied by medical personnel Transportation Officer designates facility August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

MCI Response CISM Pre-incident education Defusing Debriefing Information on symptoms of stress and methods to deal with stress Defusing Brief group sessions to vent thoughts and feeling Immediately following incident Debriefing Longer more structured group sessions Typically 24 – 72 hours following incident Slide hidden August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

MCI Response Long-Term Operations EMS among last to leave Stand by during search Maintain rehab care August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

MCI Response Reports and Records IC must assemble all reports and records Resources requested and received and where assigned Incoming and outgoing ambulances (times) Triage log Staging log Patient destination log August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

REGIONAL MEDICAL COORDINATION CENTER (MCC) MCC Responsibilities Provide initial and update alerts via appropriate communication resources Provide frequent updates to on-scene EMS ICS Directors/Supervisors/Leaders regarding hospital casualty care capacity May assist with relay casualty transport information to receiving facilities May assist with relay urgent and routine communications to appropriate entities May assist in coordination and distribution of resources Other appropriate tasks as necessary for an effective regional medical response August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

SCENE MANAGEMENT EMS personnel should accomplish the following actions upon arrival. Survey the scene If Incident Command has not been established the senior EMS personnel shall assume the role of IC. The IC shall assume to role of all other elements of the ICS until she/he as assigned other personnel to their roles. Advise dispatch who has assumed command and who has EMS Branch Director/Group Supervisor and their exact location. August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

SCENE MANAGEMENT EMS personnel should accomplish the following actions upon arrival. (cont.) Organize the scene and ensure an effective response including: Securing the area and limiting access to nonessential personnel Determining whether the incident scene is safe to enter and whether decontamination is required Assigning personnel to the necessary tasks and roles Establishing staging, triage, treatment, and transportation areas Establishing communication between areas Establishing traffic pattern that provided for the smooth flow of patients and vehicles Ensure that appropriate record-keeping takes place August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

SCENE MANAGEMENT EMS personnel should accomplish the following actions upon arrival. (cont.) Call for additional resources EMS personnel Any specialized equipment MEDDRUN CHEMPACK Regional Medical Coordination Center (MCC) Other available resources Inform the “Coordinating Resource” of nature and scope of incident August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness

EMS & Trauma Systems Section Office of Public Health Preparedness Slide hidden August 2005 EMS & Trauma Systems Section Office of Public Health Preparedness