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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


1
(No Transcript)
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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

3
Mass casualty incident, start triage, jumpstart
triage, and selective immmobiliation
  • By Elizabeth Peaslee, rn

4
objectives
  1. Describe the components of the Nations Incident
    Management System (NIMS).
  2. Describe the purpose and function of triage,
    treatment, and transportation sectors.
  3. Review the Region X Multiple Patient Plan.
  4. Review the documentation process related to a
    variety of levels of disaster response.
  5. Describe and demonstrate how to use SMART Triage
    Tags.
  6. Compare the START and JumpSTART triage processes.
  7. Review the 2015 Selective immobilization
    protocol.
  8. Review correct procedure to size and apply
    c-collar.
  9. 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

6
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

13
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

14
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

15
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

16
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

17
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

18
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

19
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

20
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

21
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.

22
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

26
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

28
primary
  1. Obtain triage pack
  2. PPE
  3. Request all ambulatory victims to move to a safe
    area (GREEN or priority 3)
  4. Approach remaining patients and use START triage
    for adults and Jump START triage for pediatrics
  5. Remove SMART tag from plastic sleeve and replace
    with proper color showing
  6. Attach elastic band to victimss upper extremity

29
Primary cont
  1. If dark, use mini-light stick in addition to RED
    triage tag to designate most serious victims
  2. Life support interventions limited to opening
    the airway and hemmorrage control
  3. After finished with initial triage, patients are
    moved to designated color-coded areas

30
Secondary triage
  1. In the collection area patients will be
    reassessed using GCS, respiration rate and
    systolic BP
  2. Determine treatment and transport priorities
  3. May also now change original priority code,
    refold original tag
  4. Prior to transport, remove transport strip from
    tag and tag is kept by transport officer

31
C-collar
  1. Partner maintains manual immobilization
  2. Assess necessity
  3. Appropriately size (measure from shoulder to
    horizontal line drawn from jaw)
  4. Place chin groove under patient chin
  5. Bring collar behind patient neck and secure into
    place without movement of cervical area

32
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

33
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
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