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Medical Incident Command

Medical Incident Command

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Medical Incident Command

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  1. Medical Incident Command

  2. OpeningCase Medical Incident Command

  3. School Bus Crash • 32 children were on board this bus, on the way to school, when the brakes on the bus failed at 35 mph • The driver went off the road, rolled once, and then struck a tree

  4. You are the first crew on the scene of this school bus crash. What should you do first? • Wait for police and fire to clear you into the scene • Establish a patient count • Ask walking wounded children to gather in a triage area • Call for additional resources

  5. You are the first crew on the scene of this school bus crash. What should you do first? • Wait for police and fire to clear you into the scene • Establish a patient count • Ask walking wounded children to gather in a triage area • Call for additional resources

  6. Triage is the prioritization of patient care based on what? • Severity of illness, prognosis, and resources • Severity of injury, available resources, and time • Airway, breathing, and circulatory status • Resources available and critical injuries

  7. Triage is the prioritization of patient care based on what? • Severity of illness, prognosis, and resources • Severity of injury, available resources, and time • Airway, breathing, and circulatory status • Resources available and critical injuries

  8. EMT Review • Take a minute to write down what principles you learned in EMT-Basic class about how to handle a mass casualty incident. • Do these principles still hold true as a paramedic?

  9. Introduction

  10. Introduction • Every incident must be managed by implementing an incident command system

  11. Small MCIs occur every day; larger catastrophes are rarer ICS and NIMS are scalable Katrina

  12. History of Incident Management Systems

  13. History of Incident Management Systems • Began in the early 1970s • Two systems initially developed • The National Interagency Incident Command System (NIICS) • The Fire Ground Command (FGC)

  14. The National Incident Management System • Department of Homeland Security • National Incident Management System • Responsibility • Incident command system • Emergency operations centers

  15. Overview of Incident Command Systems

  16. No matter how small or large, every incident must have • First responders • An incident commander • A triage officer • A unified command post

  17. No matter how small or large, every incident must have • First responders • An incident commander • A triage officer • A unified command post

  18. Overview of Incident Command Systems • Starts when the first unit communicates a scene size-up • Position staffed at every incident • Incident action plan • Types of incidents designed for ICS

  19. ICS Key Concepts and Principles • Chain of command • Unity of command • Unified command

  20. Incident Command Facilities • Incident command post (ICP) • Staging areas • Bases • Camps • Helibases and helispots • Emergency operations centers

  21. The Incident Action Plan • Plan containing the general objectives that reflect the overall strategy • The only type of incident that must have a written IAP is a hazmat incident

  22. The Incident Commander • Three responsibilities of the IC • Unified command

  23. Command Staff • The number of people a supervisor can effectively manage • Three common positions

  24. Command Staff

  25. General Staff • Four functions of large scale incidents • Operations • Planning • Logistics • Finance/administration • General staff • Chief

  26. General Staff

  27. General Staff • Operations section • Responsible for the management of tactical operations • EMS is a portion of operations • Planning section • Develops the incident action plan (IAP) • Documents incident and plans for demobilization

  28. General Staff • Logistics section • Responsible for the acquisition and coordination of required support resources • Logistics section medical unit • Mental health and stress monitoring

  29. General Staff • Finance/administration section • Responsibilities • Potential length of responsibilities

  30. General Staff • Modular resource components • Types of modular organization • Branches • Divisions/groups • Units • Strike teams/task forces

  31. General Staff

  32. General Staff

  33. General Staff

  34. Examples

  35. Examples

  36. Examples

  37. Examples

  38. Examples

  39. Guiding Concepts of NIMS

  40. Guiding Concepts of NIMS • Development of disaster plans • The need for drills

  41. Concept #1 There is a clear chain of command and unity of command • The essential nature of a clear command structure • Area command • Emergency operations center

  42. Concept #2 Command is established early and includes an incident size-up • First unit: • Establishes command • Ensures safety • Uses resources efficiently • Passing command • Recommended or not?

  43. Concept #3 There is an incident action plan emphasizing a management by objective approach • Process of creating an IAP

  44. Concept #4 Transfer of command • Necessary to transfer to someone higher in command? • Advising staff of command changes • Tactical worksheet

  45. Concept #5 Each supervisor has a manageable span of control • Commander and number of subordinates • When to make more functional units

  46. Concept #6 All agencies use common terminology • Use of common language during all portions of the incident command

  47. Concept #7 All emergency service agencies will use the NIMS-designated position titles • Use of NIMS-designated titles • Use of vests and helmets

  48. Examples

  49. Concept #8 Communications between participating agencies are integrated • Every service should have the ability to communicate with responding units

  50. Examples