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Unit 49. Incident Command and Multiple-Casualty Incidents. Overview. Multiple patient encounters National incident management systems Multiple-casualty incidents EMS operations sector. Introduction.
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Unit 49 Incident Command and Multiple-Casualty Incidents
Overview • Multiple patient encounters • National incident management systems • Multiple-casualty incidents • EMS operations sector
Introduction • Multiple-casualty incidents require management of multiple patients, emergency responders, response vehicles, elements of environment, and incident itself • Understanding fundamentals of incident command and multi-casualty incident will help EMT competently treat patients
Multiple Patient Encounters • Patient care approach for a hundred patients is the same as for one patient • A leader is needed to direct activities of others on arrival and throughout call • First: determine priority of patient • Next: treat patient • Finally: notify communications center and hospital of patient transport
National IncidentManagement Systems • Events of September 11, 2001: highlighted need for developing national standards for incident operations • National Incident Management System (NIMS): established management criteria for all responders • Goal of NIMS: ensure interoperability between various groups and agencies
Components of NIMS • Command and management • Incident command system (ICS) • Multiagency coordination system • Public information system • Preparedness • Planning, training, exercises, personnel qualifications, standards, equipment, etc.
Components of NIMS (cont’d.) • Resource management • Standardized requirements for resources • Communication and info management • Effective interoperable communications • Supporting technologies • Data, display, records, tracking systems • Ongoing management and maintenance • Strategic oversight and direction
Multiple-Casualty Incidents • Event overextending EMS resources • Incident command system • Standardized command structure • Small incident: only one incident commander (IC) needed • Large incidents: several ICs share joint command at centralized location • Leadership rotates according to incident needs
Incident Command System (cont’d.) • Chain of command: hierarchical reporting system • Command personnel • Safety officer (SO): responsible for safety of all personnel • Public information officer: meets with media and reports state of affairs at incident
Figure 49.2 The Incident Management System provides for both command and control
Role of the EMT in Incident Management • EMTs should be familiar with their roles during an incident • Objective of EMT: • Understand when to activate incident management system (IMS) • How to participate in IMS as a provider
EMS Operations Sector • Five tasks in a disaster: • Take control or command of situation • Assemble resources and personnel • Locate and sort patients according to severity of injuries • Render needed medical care according to severity • Transport patients
EMS Director • Responsible for EMS operations and interfacing with other emergency services commanders • Must establish command post and make a declaration (problem present and resources needed) • Tactical command sheets: instructions for how to proceed with specific incident
EMS Director (cont’d.) • Transfer of command • Whenever another person assumes EMS command, he will need briefing • EMS commander must provide most up-to-date info about current state of affairs • Tactical command sheets and status boards reviewed
Staging Officer • Staging area: off-scene location where personnel and vehicles assemble and await assignment • Staging officer: manages staging area, assembling and assigning equipment and personnel • Equipment staging • Equipment manager maintains supplies
Triage Officer • Patient survival depends on effective utilization of limited resources • Triage: distribution of patients into treatment classifications according to injury severity • Triage officer: oversees triage process
Triage Systems • Evacuation triages determine which patients require immediate removal • Following evacuation, color-coded system signifies treatment priority • Red: immediate medical care required • Yellow: medical help can be delayed • Green: minor injuries • Black: dead or dying
TriageSystems (cont’d.) • START triage system • Simple triage and rapid treatment • JumpSTART pediatric triage • Specific assessment techniques for infants and children to differentiate from adults • Triage tags • Allows for quick identification of patient condition and prevents duplication of effort
Figure 49.8 START stands for Simple Triage And Rapid Treatment
Treatment Officer • Field hospital • Temporary on-site treatment facility • Managed by treatment officer • Morgue • Area set aside for deceased patients, overseen by morticians or funeral directors
Transportation Officer • Responsible for overall movement of patients from scene to hospital • Maintains communications with hospitals • Tracks patients’ whereabouts • Most patients will require ambulance from staging area • For minor injuries, buses may be used
Conclusion • Major incident need not be disaster for EMT • EMTs need to ensure personal safety while delegating tasks • Standard approach to major incident much the same as standard approach to any patient, only on much greater scale