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Chapter 47 Medical Incident Command

Chapter 47 Medical Incident Command. Disasters and Mass Casualty Incidents (MCIs). Most challenging situations Overwhelming Large number of patients Lack of specialized equipment and/or adequate help.

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Chapter 47 Medical Incident Command

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  1. Chapter 47 Medical Incident Command

  2. Disasters and Mass Casualty Incidents (MCIs) • Most challenging situations • Overwhelming • Large number of patients • Lack of specialized equipment and/oradequate help Courtesy of Petty Officer 2nd Class Kyle Niemi/US Coast Guard. Photo courtesy of US Army.

  3. Systematic Approach • Incident command system (ICS) • Provides a structured and orderly span of control to respond to and recover from an incident minimizing freelancing and duplication of efforts • National incident management system (NIMS) • Created to promote efficient coordination

  4. Disasters • Critical infrastructure • Electrical power grid • Communication system • Fuel for vehicles • Water • Sewage removal • Food • Hospitals • Transportation systems

  5. Disaster Management • Planners • Preparedness • Planning • Training • Response • After-action review

  6. Mass-Casualty Incidents • The number of patients exceeds the resources available. Courtesy Michael Rieger/FEMA

  7. Open Incident • Number of casualties to locate • Triage or treat in multiple locations. • Ongoing situation that produces more patients • School shootings • Tornadoes • Hazardous materials release • Rising floodwaters

  8. Closed Incident • Situation that is not expected to produce more patients • Triaged and treated as they are removed • May suddenly become an open incident

  9. You have been dispatched to a motor vehicle collision. • You find no other EMS or fire agencies on scene. • A tour bus is down an embankment off of the interstate highway. • One victim is waving for help; a bystander says there appear to be 30 or so victims. • What are your initial actions? • Is this a closed or an open incident?

  10. The Incident Command System • Terminology • Modular organization structure • Span of control • Organizational division • Emergency operations center

  11. ICS Roles and Responsibilities (1 of 4) • Command • Incident commander • Unified command system • Single command system • Transfer of command • Finance • Finance section chief • Document all expenditures

  12. ICS Roles and Responsibilities (2 of 4) • Logistics • Logistics section chief • Communications equipment • Facilities • Food and water • Fuel • Lighting • Medical equipment and supplies

  13. ICS Roles and Responsibilities (3 of 4)

  14. ICS Roles and Responsibilities (4 of 4) • Operations • Operations section • Manages tactical operations • Supervises rescuers • Planning • Planning section • Solves problems • Obtains and analyzes data • Predicts what or who is needed

  15. Command Staff (1 of 4) • Safety officer • Monitors the scene for hazards • Environmental health and hazardous materials specialist • Authority to stop an emergency operation

  16. Command Staff (2 of 4) • Public information officer (PIO) • Provides the public and media with information • Positioned well away from incident command post • Must keep the media safe • Disseminates messages aimed at helping a situation, preventing panic, and/or providing evacuation directions

  17. Command Staff (3 of 4) • Joint information center (JIC) • Works in cooperation with PIOs from other agencies

  18. Command Staff (4 of 4) • Liaison officer (LNO) • Relays information and concerns among command, the general staff, and other agencies

  19. (continued) • As you approach the bus, you see multiple victims inside. • You smell diesel fuel around the bus. • The crash has blocked all access doors. • What agencies do you anticipate needing? • You encounter a patient who is ejected and lying on the ground. What do you do?

  20. The NIMS • President implemented in March 2004 • Provides a consistent nationwide template • Prepare for, prevent, respond to, and recover from domestic incidents • Underlying principles • Flexibility • Standardization • Interoperability

  21. Major Components of NIMS • Command and management • Preparedness • Resource management • Communications and information management • Supporting technologies • Ongoing management and maintenance

  22. EMS Response Within the ICS • Preparedness • Decision making and basic planning before an incident occurs • Each EMS agency • Written disaster plans • Disaster supplies • Mutual aid agreements with surrounding organizations • Assistance program for the families of EMS responders

  23. Scene Size-up • Unsafe scene • Three basic questions • What do I have? • What do I need to do? • What resources do I need?

  24. Establishing Command • Notify other responders. • Request necessary resources. • Command system ensures resources are coordinated.

  25. Communications • Often the key problem at an MCI or disaster • Problems should be worked out before a disaster happens. • Plain English should be used. • Avoid use of signals and codes.

  26. (continued) • The division fire chief arrives and you assume the role of triage. • You find an entry point and enter the bus. • You find a older male who is breathing 20 times/minute and has a regular, strong pulse, but cannot remember his name. • What color do you assign the older male?

  27. Medical Incident Command • Medical group leader • Supervises primary roles of the medical group • Triage • Treatment • Transport of the injured • Ensures EMS units are working within the ICS

  28. Triage Unit • Triage officer • Counting and prioritizing patients • Ensures initial assessment and transportation to appropriate treatment group • Don’t begin treatment until all patients are triaged.

  29. Treatment Officer • Locates and sets up treatment area • Tier for each priority of patient • Secondary triage • Communicates with medical branch leader

  30. Transportation Officer (1 of 2) • Coordinates transportation and distribution • Coordination with incident command • Communicates with area hospitals • Determines where to transport patients • MCI typically disrupts region’s trauma system.

  31. Transportation Officer (2 of 2) • Documents and tracks • Number of vehicles transporting • Patients transported • Facility destination of each vehicle and patient

  32. Staging Officer • Area established away from the scene • Stages equipment and responders • Tracks unit arrivals • Sends out vehicles as needed

  33. Physicians on Scene • Ability to make difficult triage decisions • Secondary triage • On-scene medical direction

  34. Rehabilitation Officer • Establishes a rehabilitation section • Area providing protection for responders from the elements and the situation • Located away from exhaust fumes and crowds (especially the media) and out of view of the scene • Monitors for signs of stress • Defuses and debriefs team

  35. Extrication and Special Rescue • Extrication officer (rescue officer) • Determines the type of equipment and resources needed for the situation • Victims may need to be extricated or rescued before triage and treatment.

  36. Morgue Officer (1 of 2) • Dead patients • Coordinates removal of bodies and body parts • Leave victims in the location found until removal plan determined. • Location of victims may help in identification. • Crime scene considerations

  37. Morgue Officer (2 of 2) • If morgue area necessary • Out of view of the living patients and other responders • Secure from the public

  38. (continued) • Another patient is pulseless and apneic. • A third has difficulty breathing and a flail chest, respirations 32 breaths/min. • A pregnant female is saying she is delivering, and has no immediate injuries. • What color do you triage the pulseless patient? • What color do you assign the flail chest? • What color do you give the pregnant female?

  39. Triage (1 of 2) • “To sort”

  40. Triage (2 of 2) • Primary triage • Secondary triage • Report • Total number of patients • Number of patients in each category • Recommendations for extrication and movement • Resources needed

  41. Triage Categories • Four common triage categories (IDME) • Immediate (red tag) • Delayed (yellow tag) • Minimal (green tag) • Expectant (black tag)

  42. Triage Tags • Assist in tracking patients and keeping an accurate record • Weatherproof and easily read • Color-coded • Symbols and colors • Tag will become part of the patient’s medical record.

  43. START Triage (1 of 2) • Simple triage and rapid treatment • Assessment of • Ability to walk • Respiratory status • Hemodynamic status • Neurologic status

  44. START Triage (2 of 2) • Steps • Call out. • Assess the respiratory status and open airway. • Check for a radial pulse. • Determine ability to follow simple commands.

  45. JumpSTART Triage for Pediatric Patients • Pediatric patients • Children younger than 8 or less than 100 pounds • Respiratory status assessment • Hemodynamic status • Neurologic status

  46. Triage Special Considerations • Hysterical and disruptive patients • A sick or injured rescuer • Hazardous materials and weapons of mass destruction

  47. Transportation of Patients • Immediate (red) or delayed (yellow) • In extreme situations, “walking wounded” are transported by bus.

  48. Critical Incident Stress Management • Responders may become overwhelmed. • Stress management should be available but not imposed.

  49. After-Action Reviews • All agencies involved • Discourage finger pointing.

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