Multi-Casualty

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Multi-Casualty
Incident Plan
2007 Training
FIRE-EMS TRAINING Contra Costa County EMS
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Tim W. HennessyMCI Plan

• Tim W. Hennessy
• Communications Supervisor
• Contra Costa County
• Sheriffs Communication
• 1975-2007
• This MCI Plan
• is dedicated to Tim.
• His expertise and commitment in developing this
  plan was invaluable.

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History

• 1979 First MCI Committee organized to develop
  plan following Yuba City bus crash in Martinez
• 1983 Board of Supervisors approved the first MCI
  Plan
• Several revisions to the basic plan since 1983

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Current MCI Working Group

• Appointed in 2005 to conduct a ground-up rewrite
  of the MCI Plan
• Multidisciplinary
• Fire
• Emergency Ambulance Zone Provider (public and
  private)
• Law Enforcement
• Hospitals
• Public Safety Communications
• EMS Agency staff

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Why Rewrite the Plan?

• Improve the usefulness of the document for first
  responders
• Compare the Plan to the Countys current risk
  profile
• Compare the Plan to the Countys current public
  safety and EMS resources

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Why Rewrite the Plan?

• Attempt to resolve weaknesses in the Plan
  experienced during previous incidents
• Incident command and control
• Communication flow
• Resource ordering and tracking
• Ensure compliance with NIMS

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MCI Plan Objectives
Objective 1 Establish a common organization,
management, and communications structure for the
coordination of emergency response to a
multi-casualty incident.
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MCI Plan Objectives
Objective 2 Establish methods of triage and
transportation that will provide the best medical
outcome possible for the greatest number of
casualties.
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MCI Plan Objectives
Objective 3 Establish pre-defined
responsibilities of all entities with key roles
in achieving successful implementation of the
plan.
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MCI Plan Objectives
Objective 4 The Plan will be drilled regularly,
and reviewed annually and following significant
activations of the Plan as directed by the EMS
Director.
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Key Concepts

• Use of Incident Command System
• Expansion and contraction of structure is dynamic
  and incident-driven
• Use of single point ordering for resource
  requests
• Emphasis on exchanging information

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Key Concepts

• Importance of Unified Command
• The Rule of 2 and 4

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MCI Tiers

• Plan consolidates Expanded Medical Emergencies,
  Medical Advisory Alerts and MCIs into a single
  MCI Plan with 4 activation tiers
• Use of tiered MCI Plan reinforces the scalability
  of the Plan

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MCI Tiers

• Use of Tiers modeled after Community Warning
  System Levels
• Consistent with best practices

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Tier Zero

• Notification of incident with potential to
  escalate to a higher tier (Medical Advisory
  Alert)
• CWS Level II and III Incidents
• Report of Active Shooter incident
• Attempted emergency landing of passenger aircraft

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Tier One

• 6-10 patients with scene contained, number of
  patients not expected to rise
• Multi-vehicle collision
• Multiple gunshot victims at contained scene and
  no ongoing active shooter

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Tier Two

• 10 50 patients or less than 10 patients with
  substantial chance of increase in number of
  patients
• Transportation resource ordering switches to
  EMSOACC
• Petrochemical incident
• Passenger train derailment
• Active shooter with uncontained scene

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Tier Three

• More than 50 patients or reasonable expectations
  of large number of casualties
• Actual or suspected WMD incident
• Significant explosion in populated area
• Emergency evacuation of hospital or SNF

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Plan Components

• Responsibilities matrix/checklists
• Communications flowchart
• Communications overview
• ICS position checklists
• ICS communications forms 205 and 217A

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Responsibilities Matrix

• Review pertinent matrices
• Pp 7 - 16

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MCI Checklists

• Common Responsibilities
• Back of each checklist
• Get Assignment
• Check In
• Get Briefed
• Get work materials
• Undertake mission safely
• Organize and brief subordinates
• Assure comms
• Use clear text
• Complete forms
• Demobilize as required/practical

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Unit Leader Responsibilities

• Back of each checklist
• Participate in planning as required
• Get accurate SitStat/ReSTat of assigned units
• Confirm arrival time of resources
• Assign duties to subordinates as required
• Develop accountability, safety and security
• Supervise demobilization
• Provide logistics with re-supply needs
• Maintain unit log

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Packaging of MCI Plan

• Standard Packaging
• Hand out bundles
• You are the checklist until you delegate it
• Morgue Manager-Law enforcement
• Certs/Quals determine who does whatnot rank or
  position

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Personnel Options

• Branch Director
• Chief Officer(Fire)/Lieutenant/Captain (Law)
• EMS/Pt Transport Group Supervisors
• Captain (Fire)/Sergeant (Law)/Supervisor(EMS)
• Triage/Treatment/Transport Unit Leaders
• Captain(Fire)/Sergeant(Law)/Supervisor(EMS)

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Transportation Group Supervisor/Unit Leader

• Only one per incident
• If a Single EMS Group Supervisor
• Reports to the EMS group supervisor
• If multiple EMS Group Supervisors
• Reports to the EMS Branch Director/Ops
• Single Staging area for ground transport units
• Single Helispot for air transport units

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Transportation Highlights

• 2/4 Concept
• Continue to disperse casualties as much as
  possible
• Use farther hospitals first
• Especially if potential exists for walk ins
• Hospital polling whenever possible but certainly
  after 2/4 has been maximized
• Coordinate with EMSOACC as much as possible

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Transportation Highlights (cont)

• Emergency Ambulance Zone Providers still
  responsible for normal coverage too
• If limited ambulances, minors can be transported
  by other means
• Tier 2 3 suspend ambulance to hospital comms
• PCRs
• Whenever possible PCRs shall be completed
• Tier 3 Branch( or designee) can suspend standard
  PCR protocol and replace with triage tag info
• Triage tags are minimum level of documentation

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Predetermined Staging Areas

• East/Central/West
• Rallying point in case of loss of communications

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Example of Tier 1 Scenario

• MVA with 7 patients in 3 vehicles
• Single Medical Group
• Transportation reports to Med Grp Sup
• Triage patients and treat where they were found
• Do not send all patients to same hospital
• Can use close hospital due to lack of probability
  of self transporting patients to closest facility

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Example of Tier 2 Scenario

• Shooting incidents with 21 patients
• Single Medical Group
• Transportation reports to Med Grp Sup
• Triage patients where they are found
• Litter bearers move patients to specific
  treatment areas
• Patients re-triaged in treatment areas and
  assigned priority for transport
• Avoid close proximity hospitals if possible due
  to potential private transport arrivals

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Example of Tier 3 Scenario

• Large structural collapse with multiple victims
  trapped over a widespread area
• Multiple Medical Groups (probably by Division)
  report to Medical Branch
• Transportation reports to Medical Branch
• Still just one transportation staging area
• Triage patients where they are found
• Litter bearers move patients where they are found
• Patients re-triaged in Treatment areas and
  assigned priority
• Maximize 2/4 concept as needed

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Triage Considerations

• START Triage system
• BLS personnel perfect for this
• Utilize teams whenever possible
• Good mission for an Engine Company
• Minimal Treatment
• Do not re-triage at scene
• Can re-triage in Treatment Areas

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Triage Considerations (cont)

• Patients can be upgraded or downgraded
• New tag if not written on
• Fold old tag and give new one if started writing
  patient info on it
• ?Who providers litter bearers
• PT TX Unit Leader
• DOAs stay where found unless need for movement
  necessitates taking them to a morgue location
• Patients may not be moved to a Tx Area
• MVAs with limited number of victims

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START and Tag Review

• .PDF