Summit County Mass Casualty Incident Plan

1. Summit CountyMass Casualty Incident Plan

2. Summary of Changes • Terminology is NIMS compliant. • Term hospital has been expanded to include free standing emergency facilities. • LVI language has been removed. • Directions to facilities removed. • “Police” is now law enforcement.

3. Summary of changes • Law enforcement duties have been expanded. • CISM for patients, families, as well as responders will be coordinated by the ADM and American Red Cross. • Allied health personnel removed. • “Akron Safety Communications” is replaced with SC Sheriff’s Communications.

4. Summary of changes • “Red Cross” replaced with American Red Cross of Summit and Portage Counties. • ARC will provide patient tracking. • Number of triage tags reduced from 100 to 25 per med unit; triage tape added. • No decon tape as the triage tags will indicate.

5. Summary of changes • Triage tags attached to wrist or ankles and not on clothing. • Communications to emergency care units routed through the EMS Transport Unit Leader. • Law enforcement will now assign a liaison to the FBI and coordinate “in custody” patients with EMS if applicable.

6. Summary of changes • Section now included for explanations of acronyms. • Sample ICS organization chart now included. • Summit County Mass Casualty Trailer Activation Policy now included. • Glossary of terms now included. • Section of ready to use ICS forms now included.

7. Mass Casualty Incident (MCI) • Incident where the number of victims exceeds the number of rescuers and resources that can be immediately triaged, treated and transported. or • 25 or more victims.

8. Command Structure • Incident Commander (MCI) • Ranking fire or rescue officer at the scene • EMS Branch Director or Group Supervisor • In charge of all EMS related actives • EMS Triage Group Supervisor/Unit Leader • In charge of all triage, tagging, & movement into the EMS Treatment Area. • Reports to EMS Branch Director or Group Supervisor • EMS Treatment Group Supervisor/Unit Leader • In charge of all activities including treatment & retriage within the EMS Treatment Area. • Reports to EMS Branch Director or Group Supervisor

9. Command Structure • EMS Transport Group Supervisor/Unit Leader • In charge of all patient movement from the EMS Transportation Unit to the receiving emergency care facilities. Communications with the coordinating hospital. • Reports to EMS Branch Director or Group Supervisor • Is advised by the Coordinating Hospital where victims are to be transported • EMS Transport Group Supervisor Aid (if needed) • Assists the EMS Transport Group Supervisor in duties as assigned. • Reports to EMS Transport Group Supervisor

10. Command Structure • Safety Officer • Recommends and develops measures for assuring personnel safety; to assess or anticipate hazards and unsafe situations.

11. Command Structure • Ambulance Staging Manager (if needed) • Maintains inventory control over ambulance staging. • Reports to EMS Transport Group Supervisor • Mass Decontamination Unit Leader • In charge of all mass decontamination operations onsite. • Staging Area Manager • In charge of all off-site equipment & manpower. • Maintains inventory control over staging area and available resources. • Reports to Incident Commander

12. Joint Information Center • This is a fixed facility for dissemination of public information. • All agencies involved in the MCI are represented in the JIC.

13. Emergency Operations Center • A fixed facility, away from the scene where involved agencies’ representatives, elected officials and support agencies make command decisions. This will usually be activated when multiple agencies are involved. • There is never more than one EOC.

14. Direction & Control Areas • Command Post • Fixed, clearly marked, on-scene location where Incident Commander makes command decisions and coordinates all scene operations. • A command post shall be used for each incident scene. • Identified by green flashing light • Cold Zone • Perimeter separating bystanders & traffic from the incident. • Warm Zone • Separates the Incident Area from the Support Area. • Accessible to only active working personnel. • For safety, media not permitted without an escort. • Hot Zone • Restricted area, usually meaning some type of protective measure is needed for entry. Not always activated during an MCI. • In a Hazardous Materials incident, decontamination may be required for all persons and equipment leaving the hot zone.

15. Direction & Control Areas • EMS Transport Unit • Located within the inner perimeter where patients are moved for retriage, treatment & prioritization of transport. • Divided in to rows with colored flags or markers. • Red, Yellow & Green • Retagging can take place

16. Special Situations • Burns • Four or less victims (adult/children) transported to Akron Children's Hospital Burn Unit. • With five or more victims, the four most critical will be transported to Burn Unit, the remainder rotated to each receiving hospital. • Coordinating hospital notifies Burn Unit of total number of burn victims & locations of victims. • Medical Director of the Burn Unit will decide on any patients to be transshipped or further care instructions.

17. Special Situations • Children • Twenty-five or more victims are rotated to all hospitals. The more seriously injured will be transported to Children’s. DOA’s All DOA’s are left in place until released by the Medical Examiner.

18. Special Situations • Physician requested at the scene • EMS Medical Advisor for the community may choose to respond. • If an additional physician is needed, the EMS Branch Director or Group Supervisor should request the EMS Transport Group Supervisor to notify the coordinating hospital of the specific indications/situation which requires a physician on the scene. • A returning EMS unit or law enforcement officer may assist in the relay of the physician to the scene. • Send needed equipment with the physician.

19. Incident Operations • First unit on the scene will give a survival scan, estimate number of victims & types of injuries . • In an obvious MCI, the first unit will advise the local dispatch who will call Summit County Sheriff’s Communications Center. It should be clearly stated this is a MASS CASUALTY INCIDENT. • All operations will be in plain English. NO radio codes will be used. • Consider activating mass casualty trailer and whether chempaks should be brought to the scene.

20. DOA’S • All DOA’s are left at the scene until released by the Medical Examiner. DOA’s should not be moved unless: • Access is needed to aid other victims When a DOA is moved-try not to Disturb any evidence, keep the victim as close to their original place (position) as possible. • On their MCI tag, make notations/diagrams.

21. ACTIVATING MCI • Once your communications center has been instructed by the senior officer to activate the MCI the following will occur: • Notify Summit County Sheriff’s Communications Center. Speak with a supervisor ONLY & advise: • Location/staging of the incident • Estimate of amount of victims & type of injuries All further communications will be to the dispatcher on the dispatch frequency (MERC) and to the coordinating hospital by cellular phone.

22. Summit County Sheriff’s Communications Center • Contacts Summit County Emergency Management Agency, American Red Cross, Summit County Medical Examiner.

23. Response Duties & Responsibilities Coordinating Hospital • Is the medical control for the involved community. • Receives initial calls. • Maintains constant Communication with the EMS Transportation Group Supervisor or Unit Leader ONLY, at the scene via cellular telephone, MERC Fire 5 or landline telephone. • Advises the EMS Transport Group Supervisor which hospital patients are to be transported to. • Notifies all county hospitals on HITS hotline of the situation & updates them periodically. • Coordinates with other counties’ Coordinating Hospital the distribution of the victims when out of county hospitals are involved in the MCI Event.

24. Response Duties & Responsibilities Receiving Hospitals • Area hospitals will be notified by Coordinating Hospital. The Receiving Hospital will discuss any special concerns with the Coordinating Hospital via the HITS phone. • Receiving Hospitals will work with American Red Cross on victim processing and notifications. • Activate their in house disaster plans • Mental health support for patients and families may be provided by receiving facility staff.

25. Response Duties & Responsibilities • Fire Departments • All fire suppression and rescue activities. • May also handle EMS depending on local procedure. • Emergency Medical Services • All EMS activities relating to triage, patient care & transport. • Law Enforcement • All activities regarding scene security. • Work with other emergency personnel to establish cold, warm & hot zones, crowd control, investigation, security for temporary morgue etc.

26. Response Duties & Responsibilities • Medical Examiner • Responsibility for the deceased individuals. • American Red Cross • Collection of patient names & destinations from receiving hospitals/emergency care facilities. • Receipt of health & welfare inquiries from public. • Establishment of shelter & feeding facilities for displaced families.

27. Response Duties & Responsibilities • Summit County Emergency Management Agency • Assistance to the Incident Commander by locating special resources at the local, state & federal level. • Coordination of special volunteer resources. • Establish Emergency Operations Center when requested by the Incident Commander. • Notify Akron Regional Hospital Association.

28. Response Duties & Responsibilities • Amateur Radio • Summit County Amateur Radio personnel will be used as the primary backup to normal two-way and telephone communications systems. • May be used as the primary link for relaying patient info between hospitals & American Red Cross.

29. Medical Response/Patient Care • First EMS unit estimates number of casualties and type of incident. • Incident Commander designates a Command Post & an EMS Branch Director or Group Supervisor. • EMS Group Supervisor designates the EMS Triage Unit Leader, EMS Treatment Unit Leader & EMS Transport Unit Leader.

30. Triage Tags & Equipment • Each community EMS unit in Summit County will be equipped with a package of 25 Summit County Triage Tags. • Triage tape system will be located on each EMS unit for rapid assessment. • Triage tags must be completed on all patients. • Additional equipment • Vest for each unit leader. • Colored flags or markers for patient areas.

31. Triage Tags & Equipment • Red Tag • Most urgent, 1st priority • Patients with life-threatening injury that have a high probability of survival if given immediate care and rapidly transported. • Yellow Tag • Urgent, 2nd priority • Victims with injuries that may become life-threatening if not treated.

32. Triage Tags & Equipment • Green Tag • Non-urgent, 3rd priority • Patients with localized injuries that need treatment but do not have an immediate systemic implication. • Black Tag • DOA, 4th priority • Patients who are obviously dead or in cardio-pulmonary arrest. • Patients whose injuries are so grave that they have little chance of survival regardless of care.

33. Special Situations • If the initial responding EMS unit is not capable of transmitting on cellular phone the safety services radios will be used (MERC). • Amateur radio will be considered for additional backup. • Should the HITS fail, backup would be identical to above (MERC). • The ARC and the Barberton RC will be the lead agencies to handle RC responsibilities.

34. Questions??