JUNE, 2012 Zone One MCI Training July, 2012

Revised 2011 MCI Plan: WHY? Reduce choke (funnel) points Minimize unnecessary actions Improve division of labor Increase plan scalability for all events Simplify patient tracking Utilize NIMS terminology

Training Objectives Discuss Updates and Changes of the Plan Review of initial MCI scene size-up Overview of general MCI concepts Demonstrate each element of the MCI process on the drill ground Review equipment on MCI-99

MCI Changes at a glance Develop “Rescue Group” to package and move patients Eliminate formal funnel point Eliminate use of treatment tags Eliminate patient numbering (felt pen) Utilize NIMS Terms: Hospital Control is now Disaster Medical Control Center (DMCC)

WMD Incidents

Initial Size-up Phase 1 Look for SLUDGE Identify immediate hazards Consider access/egress options to secure a transportation corridor. Observe base/staging options Estimate number of patients

Maintain the Transportation Corridor!

More Size-up Phase 2 Estimate number of non-ambulatory patients Consider extrication/relocation issues Scene status: Static or Dynamic? Decide: Complex…not complex

Requesting Resources Basic MCI Activities  Rescue/Extrication  Treatment/Transport  Ambulance staging Complex Activities  Fire  Hazard Material  CBRNE  Collapse

No SLUDGE No Fire, stable scene Southbound lanes open Overpass intact Patients walking around 6-10 Reds Simple extrication Static scene

Commanding the radio Provide size-up Initiate command Initial assignments  Safety & hoseline  Triage  Treatment Request “base” resources Request “transport” resources

Physical Actions of the First-in Crew Engine/Ladder Company  Recon / Risk Assessment  Mitigate immediate high risks  Secure Transportation Corridor  Begin Triage  Direct movement of “Green” Walking wounded  Implement Rescue Group Medic Units/MSO Decide: Patient or Scene mgmt  Medical Group  Treatment Unit  Transport Unit

Changes

The Previous MCI Plan COMMAND MEDICAL GROUP TRIAGE TREATMENT TRANSPORT

Typical MCI Org Chart 2012 COMMAND RESCUE GROUP EXTRACTION UNIT EXTRICATION UNIT MEDICAL GROUP TREATMENT UNIT TRANSPORT UNIT GREEN UNIT

Are you doing the job…or leading it?

Unit Leader/Group Supervisor Don the vest Understand Action Plan Determine supervisors role Develop organization Develop relationships Maintain accountability Provide progress reports

So, who does Triage? Rapid Field Triage -BLS Minimal Treatment Who Supervises Triage:  Medical Group (small)  Rescue Group (Large) Secondary Triage – ALS

Treatment Unit Locate suitable area Secure supplies Develop treatment teams Determine transport priorities

Treatment Unit Reasons for a Treatment Area  Visual indicator for injured  No transportation available  Immediate life-saving treatment  Move the reds, hold others Assure appropriate treatment Use Aid/Medic Units for supplies Prioritize patients for transport  Use a “Treatment Dispatch Manager” Benchmarks:  All reds transported  All patients transported

Expanding the Treatment Unit Treatment Unit Leader Red Manager Yellow Manager Treatment Dispatch Manager

King County MCI Resource Vehicles Units that are specifically designed to manage at least 35 MCI patients with medical equipment, backboards, and oxygen supplies. There are regionally located: MCI-99North King County MCI-9Eastside MCI-51 and 81 South King County MCI-1 City of Seattle MCI-777Port of Seattle

Transport Unit Assure DMCC activation Establish Ambulance Staging Confirm transporting resources are inbound Coordinate patient loading Track Destinations

Transportation Unit Apply tracking bands Communicate with DMCC Receive patient destination Manage documentation Benchmarks:  All reds transported  All patients transported

Tracking All transport capable vehicles in King County will have tracking bands Typically applied at the ambulance loading or DMCC activity area. Ensures that all patients have a tracking band

Tracking Retain one peel-off sticker on a tracking board All MSO’s and Medic Units will have tracking sheets Tracking sheets allow for sticker or Barcode tracking

Tracking Instruct all transporting personnel to place a tracking sticker on the Medical Incident Report:  Hospital form  Agency form  EPCR agencies need to enter number in laptop

Expanding the Transport Unit Transport Unit Leader Ambulance Staging Manager DMCC Coordinator Ambulance Loading Manager Tracking Aide

Rescue Group/Unit Disentanglement Moves all patients to Treatment area Personnel Intensive May report to Medical or Operations May provide field triage

Expanding the Rescue Group Rescue Group Extrication Unit Extraction Unit

Summary of Key Points for MCI Secure the transport corridor !! Keep transport units staged separately Medics focus on Medical/Treatment/Transport Early notification of DMCC Suppression focus on Rescue/Extraction Perform secondary triage before transport Separate loading from DMCC activities

Questions?