PRINCIPLES OF MEDICAL SUPPORT IN CASE OF MULTIPLE CASUALTY INCIDENT

1. PRINCIPLES OF MEDICAL SUPPORT IN CASE OF MULTIPLE CASUALTY INCIDENT

2. MASS CASUALTY INCIDENT PLAN • Objective, scope, jurisdiction and command • Plan outline: alert and activation criteria • Advisory alert: initiation and termination • Activation: when, who, how? • ICS organization - General duty statements

4. INCIDENT COMMANDER LIASON P.I.O. SAFETY PLANS OPERATIONS LOGISTICS STAGING MEDICALSUPPORT UNIT MEDICAL GROUP TRANSPORTATION GROUP FIRE GROUP LAW GROUP AIR OPS MEDICAL SUPPLY AMBULANCE STAGING RESCUE PERIMETER ENFORCEMENT TRIAGE HOSPITAL COORDINATION EXTRICATION INTERNAL ENFORCEMENT TREATMENT AIR AMBULANCE SUPRESSION MORGUE

5. ICS Organization: • Incident Commander • Liaison Officer • Public Information Officer • Safety Officer • Operations Section Chief – Staging Manager • Plans Section Chief • Logistics Section Chief – Medical Support Unit Leader

6. ICS – Group Supervisors • Medical • Transportation • Fire • Law and Civilian Defense • Air Operations

7. ICS – Unit Leaders • Medical supply, Triage, Treatment, Morgue • Ambulance Staging, Hospital Coordination, Air Ambulance • Rescue, Extrication, Suppression • Perimeter and Internal Enforcement

8. Implementing the MCI Plan First Unit on the Scene: • Assess and check for unusual hazards • Advise County Communication of the situation • Establish a preliminary Command Post and Incident Commander • Initiate triage • Request mutual aid through County Communication

9. Criteria and Procedures • The requesting agency has committed all of its available resources and determines additional resources are needed to ensure quality pre-hospital patient care • Incident Commander requests for assistance: the nature and location of emergency, the number of personnel and type of specialized or equipment needed, the location where assisting units should report.

10. SCENE OPERATIONS • COMMAND POST • STAGING • TRIAGE • TREATMENT • TRANSPORTATION • SPECIAL SCENE CONSIDERATIONS

11. COMMAND POST • Established by Incident Commander • Ease of access and visibility, no conflict with emergency operations, safety of staff • Identified in conspicuous manner • The location from which all operations are directed

12. STAGING • General Staging Area: location of all arriving resources • Ambulance Staging Area: established by the Transportation Group Supervisor closer to the incident scene so that move-up for loading can be signaled by visually or by radio • Medical Supplies coordinate delivery of incoming medical supplies with the Medical Group Supervisor

13. TRIAGE • Triage Unit: START (immediate, delayed, minor, deceased), principles and procedures • Tags • Movement of casualties from the scene into the Treatment Area • If the MCI location is potentially hazardous victims will be moved to a safe location prior to triage and tagging

14. START TRIAGESimple Triage and Rapid Treatment

15. TREATMENT • Objective • Safety of the pre-hospital care provider • Treatment areas: IMMEDIATE, DELAYED, MINOR • Hazardous materials exposure • Emotionally disturbed victims

16. TRANSPORTATION • Patient loading • Casualty distribution • Special scene consideration (hazardous materials contamination)

17. Forces and Resources • Communications: county, EMS, military, special, cell phones, etc. • Fire service (extrication and rescue) • Civilian Defense • Law enforcement • Emergency medical services agency • Hospitals: civilian, military • Red Cross • Helicopters – Air Operation Procedures

18. Communication • Purpose, radio identification • Implement MCI Plan, alert and activation • Assignment of receiving hospitals to patient transport vehicles • Communications at the scene • Other communication pathways: EMS system, fire, police, military, special.

19. Fire Service, Law Enforcement, Civilian Defense • Responsibility • Procedures: - take initiative: action, alert, activation - establish Command Post - provide a communication link - scene security/extrication and rescue - traffic control - investigation, preserving the crime scene

20. Emergency Medical Services • EMS Chief Duty Officer notify the EMS Director of MCI activation • Respond as necessary to the Command Post as EMS representative • Initiate medical mutual aid requests • Implement operational contingencies to support MCI • Coordinate for procurement and allocation of critical public and private medical and other resources

21. Hospital Instructions • Provide the number of Immediate/Delayed/Minor patients they are capable of receiving • Make preparation for the activation of their internal disaster plan • Prepare casualty information for RED CROSS: patient’s name, address if possible, triage tag number

22. Red Cross • Field coordinator • Mass Care (feeding, shelter/evacuation centers) • Family Services • Disaster Health Services • Casualty information

23. Helicopters procedures • Helicopter utilization • Communications: air to ground, air to air • Landing zone and night operation specifications • Working around an aircraft

24. Parametersthat define the medical performance • Functioning of the coordinating structures • Continuous medical supply • Total autonomy for at least 24 hours • Number of hospitals implied in the actions • Time for medical response • Communication (pre-hospital, hospital, local authorities, families) • Safety and appropriate transportation lesson learned after such experience (?)

25. Medical response OVEREVALUATINGthe situation may generate a chaotic response, wasting resources UNDEREVALUATING the situation may lead to the inefficiency of the response

26. Conclusions: • First responders must be prepared and trained • Collaborate with other forces involved in implementation of Incident Commander System • Ensure central control, provide for inter-agency coordination and provide that no one individual becomes overloaded with specific assignments or details • Save the greatest number of lives