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Seattle / King County Multiple Casualty Incident Plan
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Introduction History Significant Changes Organization
Key responsibilities HISTORY: County wide plan that was not a lesson plan Reduce choke points and unnecessary actions Streamline efforts and utilize procedures that are used every day A plan that is scalable and flexible A plan that is utilized and followed by all Zones in King County DEFINITION- perhaps give our current definition, but stress that others work too?
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Significant updates NIMS / ICS compliant
Emphasis on a transportation corridor Roles & responsibilities vs “seat-assignments “ Who wears a vest and what this means Triage Criteria Patient Tracking Green patient area Point out that these are merely highlights of some of the significant changes Give detailed presentation of “Vest responsibilities” Don the vest Understand the Incident Objective Know the vest that you are adjacent to Provide progress reports Manage and request resources We will address Triage and Tracking and Green patient management later
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Significant updates Triage may be assigned to Rescue
Elimination of formal funnel points Elimination of patient numbering Elimination of the treatment tag Hospital Control is now DMCC
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Key Roles and responsibilities
First-in unit Incident Command Recon Rescue Triage Extraction Extrication Medical Group Treatment Red Area Yellow Area Transportation Ambulance Staging Ambulance Loading DMCC Tracking Aid Green Patient area We will touch on each of these, but our primary focus will be on the responsibilities associated with Medical Group
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MCI with Competing Interests
Suppression HazMat SWAT/AB/BDU CBRNE Uses up personnel What is “AB?”
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Dispatch Zone Controlled Need some help here
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Arrival/Size up Jurisdiction dependant: Transportation Corridor
Short report Estimate of total patient count Early Recon Transportation Corridor Early notification of DMCC
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Organizational Chart (simplified)
Incident Command Medical Treatment Transport Green Pt Rescue Hazard Mitigation Safety PIO Liaison Yellow – Command Blue – Operations White – EMS (Paramedics)
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Organizational Chart (Expanded)
Incident Command Medical Treatment Yellow Unit Red Unit Dispatch Manager Transport Ambulance Staging Ambulance Loading DMCC Mgr Tracking Aid Green Pt Rescue Extraction Extrication Hazard Mitigation Decon Haz Mat Fire Safety PIO Liaison
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Organizational Chart (Detailed)
Incident Command Finance Planning Logistics Operations Medical Treatment Yellow Unit Red Unit Dispatch Manager Transport Ambulance Staging Ambulance Loading DMCC Mgr Tracking Aid Green Patients Rescue Extraction Extrication Hazard Mitigation Decon Haz Mat Fire Recon Safety PIO Liaison
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Unit Leader / Supervisor
Don the vest Understand Action Plan Determine supervisors role Develop organization Develop relationships Maintain accountability Provide progress reports Manage and request resources
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Rescue Group Initial triage Extraction Extrication May add ALS
Flagging Triage zones Extraction Extrication May add ALS The Triage by “extractors” piece should probably be covered here, as well as triage zones in a large scale incident
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Medical Group Ensure activation of DMCC
Verify Transportation Corridor / ambulance staging Assign/Assume key positions: Treatment area Transportation Green Patient area Communications / talk group Adequate resources and personnel Focus of DMCC is to achieve universal method for activation and use With a confirmed MCI, early notification to DMCC is important- On-scene? En-route? Before you leave the barn? Resources- be sure the IC adequately staffs the Treatment and Transport areas with BLS crews
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Green Patient Area May be managed by BLS company
Address obvious needs: Containment Shelter Re-triage Liaison with Law Enforcement Documentation Note that this is addressed here to emphasize the importance of dealing with the Green Patients
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Transportation is the priority
Treatment Transportation is the priority Location Team Leaders (Red area, Yellow area) Appropriate level of treatment Resources Personnel Equipment Re-triage Level of Treatment- discuss Plan A2, ventilator issues, etc.
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Transportation Verify transportation corridor Location: Resources
Proximity to treatment area Ambulance loading area- consider exhaust, hazards, etc. DMCC coordinator and tracking aid- remote location Resources Backboards Tracking bands Transportation units Establish DMCC communication Should probably discuss multiple Treatment / Transportation sites. What is the point about Status of Transportation units?
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Transportation Assign key positions: Ambulance Staging
Ambulance loading DMCC coordinator Tracking Aid Ambulance Staging May be private ambulance company supervisor Ambulance Loading DMCC Coordinator DMCC coordinator and Tracking Aid should be located at a remote location from the loading point Do not give individual patient status, only what is loaded in the back of the transporting unit No numbers or Tracking information is relayed to DMCC The only injury pattern that needs to be communicated is Burns, OB Trauma and pediatric patents Tracking Aid
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“Sick or Not Sick” Triage
Discuss how alternative triage criteria can be integrated EMT students will still be taught a triage method (ABC, etc) Emphasis the dynamic nature of Triage
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Patient Tracking and Documentation
The Gold Standard will be a fully completed MIRF (Form 20B) for every patient We may at some time consider an abbreviated method of documentation (Green patients?) When a MIRF / 20B is impractical, the tracking band system will be implemented Pt tracking Bands Tracking Sheets (write in rain paper) Tracking Boards Expanded Hospital bar code (Scanner at future date) Concept of Pt Tracking – bracelet with unique identifier – set for use with manual or electronic tracking Pt tracking does not lead the process Pt tracking does not delay treatment nor transport Identifies origin of patient Repatriation of families Tied into Hospital/Public Health tracking system Utilized by all transport (public & private) to follow through on system Somebody’s job is to answer patient destination at some point in time – not necessarily Fire All transport capable vehicles in King County will have two packs of 25 bands
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Patient Tracking and Documentation
All transporting personnel will be instructed to place a tracking sticker on the portion of the MIRF that will stay with the hospital. Explain how this provides for “backwards accountability”
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Questions / Comments
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Assignments Josh – Lead In / Welcome / Introduction Aaron - Intro through arrival/size-up (1 – 8) Marty - Org charts through Vest wearers (9 – 12) Josh - Rescue Group through Transportation (13 – 18) John - Triage through Tracking (19 – 21) All – Questions (22)
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