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Mass casualty incident, start triage, jumpstart triage, and selective immmobiliation

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Title: Mass casualty incident, start triage, jumpstart triage, and selective immmobiliation Author: Elizabeth Peaslee Last modified by: Teresa Ehrhardt – PowerPoint PPT presentation

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Title: Mass casualty incident, start triage, jumpstart triage, and selective immmobiliation

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Date of CE presentation June/ July, 2016
Topic Mass Casualty and Triage
Behavioral Objectives
Upon successful completion of this module, the
EMS provider will be able to
Describe the components of the Nations Incident
Management System (NIMS).
Describe the purpose and function of triage,
treatment, and transportation sectors.
Review the Region X Multiple Patient Plan.
Review the documentation process related to a
variety of levels of disaster response.
Describe and demonstrate how to use SMART Triage
Tags.
Compare the START and JumpSTART triage processes.
Review the 2015 Selective immobilization
protocol.
Review correct procedure to size and apply
c-collar.
Actively participate in mass casualty scenarios
Bibliography
https//emilms.fema.gov/IS200b/ICS0101100text.htm
Region X Multiple Patient Management Plan,
Amended March 1, 2013
Region X SOPs, IDPH Approved, April 10, 2014
Hopkins, Sharon, Multiple Patient PowerPoint
June/July 2015
http//www.jumpstarttriage.com/uploads/MCI_Primary
_and_Secondary_Triage_exercise.doc

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Mass casualty incident, start triage, jumpstart
triage, and selective immmobiliation

By Elizabeth Peaslee, rn

4
objectives

Describe the components of the Nations Incident
Management System (NIMS).
Describe the purpose and function of triage,
treatment, and transportation sectors.
Review the Region X Multiple Patient Plan.
Review the documentation process related to a
variety of levels of disaster response.
Describe and demonstrate how to use SMART Triage
Tags.
Compare the START and JumpSTART triage processes.
Review the 2015 Selective immobilization
protocol.
Review correct procedure to size and apply
c-collar.
Actively participate in mass casualty scenarios.

5
National incident management system (nims)

A systematic, proactive approach to guide
departments and agencies at all levels of
government, nongovernmental organizations, and
the private sector to work together seamlessly
and manage incidents involving all threats and
hazards-regardless of cause, size, location, or
complexity-in order to reduce loss of life,
property, and harm to the environment.
www.fema.gov

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Why nims?

A plan that is applicable for all potential
incidents
Improves the communication and working
relationships between all public and private
agencies involved
Provides a common standard so that all reporting
agencies know what to expect and procedures they
will follow

7
Nims components

Preparedness
Communication and Information Management
Resource Management
Command and Management
Ongoing Management and Maintenance

8
preparedness

Necessary for effective incident and emergency
management
Continuous cycle of planning, organizing,
training, equipping, exercising, evaluating, and
taking corrective action to maintain readiness

9
Communications and information management

Provides a standard overview of incident
Makes sure all agencies involved have the same
understanding and knowledge of the incidents
status
Keeps all agencies up-to-date with on-going
operations

10
Resource management

Know the resources available and what is needed
Coordinates resources to provide timely response
Will continue to evaluate throughout incident to
order and deploy resources as necessary
Inventories all resources at end to account for
resources used

11
Command and management

Facilitates effective and efficient incident
management and coordination
Comprised of
Incident Command System (ICS)
Standardized on-scene emergency management tool
to assist with use of facilities, equipment,
personnel, procedures and communication.
Multiagency Coordination System (MACS)
Common support system for prioritization of
resources, allocation of communication systems,
and information coordination
Public Information
Manages public information

12
Ongoing management and maintenance

Homeland security is required to routinely
coordinate with agencies involved with NIMS to
ensure the most effective plan is in place
Also coordinate with Technology Directorate to
update and develop programs to assist with
efficient large scale incidents

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triage

One of the first functions that must be done at
any incident
To sort patients based on severity of injuries
Do the most good for the most patients with the
least amount of resources
Drives subsequent operations

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Treatment sector

Set up of area needs planning
Requires availability of medical equipment
Color zones with universal colors to separate
patients
Patients are separated into categories
Prioritization based on patient needs and acuity
Initiate treatment and continued on-going
assessment
Be organized moving patients in and out to
transport sector

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Transport sector

Transport officer has to coordinate with staging
and treatment officer for patient movement from
scene
One pathway for ambulances to move through scene
Communicate essentials from scene to receiving
hospital
Remove SMART transport tag when patient leaving
scene, as a way to track patients

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Multiple patient plan

Each ambulance should have guidelines in the
ambulance
First responding unit will be acting commander,
until relieved and will activate plan
Plan is to be activated as soon as possible to
allocate all necessary resources
Endorsed by MABAS Divisions, medical directors
and Disaster Management Services Committee of
Region X
Approved by Region X Trauma/EMS Advisory
Committee and IDPH

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purpose

Enables Fire/EMS agencies and region X hospitals
to respond effectively and efficiently to
multiple patient incidents.
Not to tax the resources of any single
pre-hospital provider or healthcare facility
Assign specific responsibilities to EMS and
hospitals
Promotes orderly disbursement of patients
Uniforms operational guidelines
Links communication between all responding
Fire/EMS, receiving hospitals and resource
hospital
Establishes responsibility of EMS responders
Gives guidelines for emergency evacuation of a
healthcare facility

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Plan breakdown

Business as usual
Less than 3 ambulances
Small Scale
3-6 ambulances
Medium Scale
6-10 ambulances
Large Scale
Greater than 10 ambulances

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business as usual

Less than 3 ambulances
Managed with routine resources
Command and general staff usually not activated
No written Incident Action Plan (IAP) required
Often done within one hour

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Small scale incident

3-6 ambulances
Requires more than routine resources
Command and General Staff only if required
One operational period in control phase
No written Incident Action Plan required

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Ems/fire responsibility

Contact closest appropriate hospital (if on
bypass, ER doctor will determine to divert or
accept patients)
Report description, number of patient, general
patient descriptions, and closest appropriate
hospitals
Incident command will assign other hospital
destination if closest cannot take all patents.
No more than 2 patients to each remaining
hospital.
If more than 2 needed, ECRN at closest hospital
will seek approval
All ambulances are to contact receiving hospital
with patient care report
Complete After-Action report and submit it to EMS
office at resource hospital within 48 hours.

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Medium Scale

6-10 ambulances
Exist when capabilities exceed the typical
initial emergency response
Some or all of the Command and General Staff
positions will be activated, as well as Group
Supervisors or Unit Leaders
May extend into multiple operational periods
A written Incident Action Plan may be required

23
Large Scale

Greater than 10 ambulances
Extends beyond the capabilities of local control
Most or all Command and General Staff positions
are filled
Multiple operational periods
Written Incident Action Plan may be required for
each operational period

24
Ems responsibilities(medium/large)

Contact resource hospital IMMEDIATLEY
Utilize the Field Provider Log Form for
assistance with communication
Report events, estimated number of patients,
patient acuities, closest hospitals
Provide resource hospital with call back number
After resource hospital relays capabilities,
record information, assign patient and
destination to ambulances
Hospitals on bypass must receive patients during
plan
Maintain contact with Resource Hospital until
scene is cleared (report ambulance number,
acuities of patients and destinations
Complete After-Action Report and turn into EMS
office of Resource Hospital within 48 hours

25
SMART triage tag

Standard for Region X triage
Specific triage tags that show only one color at
a time
May refold to reflect another color with changes
in patient status

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Components of triage pack

Folding SMART triage tags
Mini light sticks to identify RED patients at
night
Dead tags
START triage prompt cards
JumpSTART triage prompt cards
Dynamic record of casualities already triaged
Pencil

27
Triage stages

Primary (first)
Sort patients into groups based on vital signs
and level of consciousness
Secondary
Prioritize treatment and transport based on
anatomical and physiologic criteria

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primary

Obtain triage pack
PPE
Request all ambulatory victims to move to a safe
area (GREEN or priority 3)
Approach remaining patients and use START triage
for adults and Jump START triage for pediatrics
Remove SMART tag from plastic sleeve and replace
with proper color showing
Attach elastic band to victimss upper extremity

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Primary cont

If dark, use mini-light stick in addition to RED
triage tag to designate most serious victims
Life support interventions limited to opening
the airway and hemmorrage control
After finished with initial triage, patients are
moved to designated color-coded areas

30
Secondary triage

In the collection area patients will be
reassessed using GCS, respiration rate and
systolic BP
Determine treatment and transport priorities
May also now change original priority code,
refold original tag
Prior to transport, remove transport strip from
tag and tag is kept by transport officer

31
C-collar

Partner maintains manual immobilization
Assess necessity
Appropriately size (measure from shoulder to
horizontal line drawn from jaw)
Place chin groove under patient chin
Bring collar behind patient neck and secure into
place without movement of cervical area

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START/jumpstart triage

Separates sickest patients
Ask all patients who can walk to go to designated
GREEN area
Begin to triage those patients left at the sceen
Use SMART triage tags
Once a color is designated, move on to next
patient
Limit life support interventions
Adult
Attempt to open airway and provide hemorrhage
control
Pediatric
Repostion airway, deliver 5 rescue breaths

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Table Top Triage Instructions

SET UP
Place each patient in accident area.
Set up color coded triage areas to receive
patients.
Team leader will direct
Assign 2 people to be first on scene, these
people will triage the accident scene and direct
movement of patients to designated area.
The rest will be working the triage area.
TO START
Team leader will inform players of scene.
Two families caravanning in minivans swerve to
avoid an oncoming car. One van rolls, the other
slams into an overpass embankment. The weather is
warm but roads are slick from recent rain.
First on Scene
Will go through accident victims in numerical
order
Place the victims to designated areas on table
Team Leader
After initial triage is done, team leader will
check for right placement by looking to second
card in the stack.
Triaged Sector
The rest of the team in the triage sector will
work together for second assessments on the
patients.
Flip to the next card to know what your patient
is presenting with.
Now discuss possible treatment options (the
following card will give suggestions)
Now give second triage color, change if
necessary, and list priority