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Incident Command at a Mass Casualty Incident

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Presentation on theme: "Incident Command at a Mass Casualty Incident"— Presentation transcript:

1 Incident Command at a Mass Casualty Incident
Chris Goliver, M.D. Chief Resident St. Vincent’s Mercy Medical Center

2 Incident Command System
Designed for all kinds of emergencies Applicable from single jurisdiction to multiagency incidents Applicable to both small day to day operations as well as very large and complex incidents

3 Design Requirements Structure must be able to adapt to any type of emergency Must be applicable to users of diverse backgrounds Should be readily adaptable Must be able to expand Must be able to avoid CHAOS

4 CHAOS C - Chief H - Has A - Arrived O - On S - Scene

5 ICS Terminology Apparatus Command Command Post Communications Center
Sector Staging Area

6 ICS Operations Common Terminology - All communications should be in plain English (NO Codes) Modular Organization Manageable Span of Control - In general from 3 to 7 Unified Command Structure

7 Command Post Location from which all operations are directed
Should only be one command post All appropriate authorities should be at the command post

8 Staging Area Established for temporary location of equipment and personnel Status Conditions - Assigned, Available, and Out of Service

9 Major Incident An event for which available resources are insufficient to manage the number of casualties Consider in cases which require more than two ambulances, hazardous materials or specialized equipment

10 Preparing for a Major Incident
Phase 1 - The Preplan Phase 2 - Scene Management Phase 3 - Post Disaster Follow-up

11 FEMA Incident Command System
Federal law requires the use of ICS for hazardous materials incidents Ideal to use the ICS as standard operating procedure on all incidents

12 ICS Organization Built around five major components Command Planning
Operations Logistics Finance / Administration

13 Command Function Command should belong to one person who can coordinate a variety of emergency activities Command should be established immediately The Incident Commander must be clearly identified

14 Types of Command Singular Command - One individual is responsible for the entire operation Unified Command - Specialized organizations are identified and personnel unify to compliment command

15 Example of Unified Command
Incidents that affect more than one jurisdiction Incidents involving multiple agencies within a jurisdiction

16 ICS Organization The Incident Commander will base decisions to expand the ICS Organization based on three major incident priorities: Life Safety Incident Stability Property Conservation

17 Planning Section Provides past, present, and future information about the incident and the status of resources

18 Operations Section Directs and Coordinates all emergency scene operations Ensures safety of all operational personnel Operations Section Chief is in charge of the actual scene

19 Logistics Section Supports the logistical needs of the incident
Primary function is to provide gear and support to the incident responders

20 Finance/Administration Section
Seldom used on small scale incidents Accounts for costs and accounting of personnel

21 Establishing Command Generally the first arriving unit starts the Incident Command System Unification of EMS command with fire and police may become necessary

22 Scene Assessment First unit on scene should make a quick and rapid assessment of the situation: Type of incident, Number of patients, Additional resources needed Scene assessment must be continually updated

23 Obtaining Resources Should have a written Standard Operating Procedure already in place for requesting additional resources Use of staging to ensure timely response of resources

24 Task Force Any combination of resources put together for a specific assignment

25 Strike Team Set number of resources of the same kind and type
Examples: Ambulances, Engine companies

26 Extrication Sector Responsible for managing entrapped patients at the scene Patient care activities should only include assessment and treatment of life threatening injuries

27 Treatment Sector As patients are delivered they are categorized according to their medical needs Provides advanced care and stabilization until the patients are transported to a medical facility

28 Rehabilitation Sector
Usually set up in a location outside the operational area Monitors personnel and ensures proper rest and hydration Works with logistics to ensure proper hydration, nutrition and supplies

29 On-Scene Physicians Medical Direction for EMS personnel
Use at treatment area to make secondary triage decisions Emergency Surgery to facilitate extrication

30 Disposition of the Deceased
Assisting in the establishment of an appropriate and secure area for a morgue Working with the medical examiner, law enforcement and other appropriate agencies to coordinate disposition

31 Transportation Sector
Communicates with the receiving hospitals, ambulances and aeromedical services Must work closely with the treatment sector to determine appropriate destinations for the injured

32 Staging Sector Required for large incidents to prevent vehicle congestion and delays All emergency vehicles should report to staging for further direction

33 Support Sector Coordinates the gathering and distribution of equipment and supplies for all other sectors May be responsible for obtaining medical supplies, rescue equipment, etc.

34 Sector Identification
Radio communications use operation titles instead of personal or unit names For example EMS sector to Command

35 Radio Communications Preplanning includes identifying a radio frequency to be used in a major incident All responding units should have multi-channel radios Separate frequencies for EMS, Fire, Police, Etc.

36 Radio Communications Sector Officers should have radios that allow direct communication with Command Radio traffic MUST be in clear, concise and plain English Avoid use of radio codes and signals

37 Principles of Triage A method used to categorize patients for priorities of treatment Assessment of patient severity is based on: Abnormal vital signs, Obvious anatomic injury, Concurrent disease factors that might affect prognosis

38 Primary vs. Secondary Triage
Triage is a CONTINUOUS process

39 Primary Triage Used to rapidly categorize patient condition for treatment Label patient with triage labels, tags or tape Focus on speed to sort patients quickly No care other than immediate lifesaving interventions

40 Secondary Triage Used at Treatment area
Patients are triaged and labeled according to their present physiological status

41 START Triage Simple Triage And Rapid Treatment. Uses a 60 second assessment Focuses on the patient’s: Ability to Walk Respiratory Effort Pulses / Perfusion Neurological Status

42 30 - 2 - Can Do Respiratory Rate >30 or <10
Capillary Refill < 2 seconds or Positive Carotid with Negative Radial Pulses Altered Mental Status or Inability to Follow Commands

43 START Triage Assessment used to classify victims as: Urgent Delayed
Dead or Dying Critical

44 START Triage Allows rescuers to quickly identify victims at greatest risk of early death Advise other rescuers of the patient’s need for stabilization by tagging the patient with color coded disaster tags

45 START Triage Repositioning the airway and controlling severe hemorrhage are the only initial treatment efforts in the primary triage

46 Triage Labeling Many Variations of tags, tape and labels are available
Immediate - Red - Priority 1 Delayed - Yellow - Priority 2 Hold - Green - Priority 3 Deceased - Black - Priority 4

47 Purpose of Tagging Identify the priority of the patient
All tags and labels should be easy to use, rapidly identify patient priority, allow for easy tracking, allow room for documentation and prevent patient from being re-triaged

48 Tracking System A destination log that integrates the triage tagging system must be maintained by the transportation officer Triage log must contain: Patient ID, Transporting unit, Patient priority, and Hospital destination

49 Transportation of Patients
Method of transportation determined by triage priority and situation Air ambulances are usually reserved for critical patients Buses should be considered for transporting large number of priority 3 patients

50 Critical Incident Stress Management
A potential hazard for rescue personnel Should be part of the post disaster SOP Monitor personnel for signs of stress Develop pre-designated resources

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