MASS CASUALTY MASS CASUALTY INCIDENT(MCI) INCIDENT(MCI)

and and INCIDENT COMMAND INCIDENT COMMAND

SYSTEM (ICS)SYSTEM (ICS)

Mass Casualty Mass Casualty IncidentsIncidents

A mass casualty incident (MCI) is A mass casualty incident (MCI) is any incident that injures enough any incident that injures enough people to overwhelm the people to overwhelm the resources usually available in a resources usually available in a particular system or area.particular system or area.

It places great demands on It places great demands on resources including equipment, resources including equipment, personnel, and facilitiespersonnel, and facilities

Mass-Casualty Mass-Casualty IncidentsIncidents

Incidents where resources are Incidents where resources are stretched to their limitsstretched to their limits

May occur with an incident having May occur with an incident having more than one patientmore than one patient

Ask yourself how many patients Ask yourself how many patients can you and your team treat and can you and your team treat and transport?transport?

Call for back up.Call for back up.

Types of MCI: Natural Types of MCI: Natural DisastersDisasters

Extreme heat or Extreme heat or coldcold

FiresFires FloodsFloods EarthquakesEarthquakes Topical Storms / Topical Storms /

hurricaneshurricanes TornadoesTornadoes Epidemics Epidemics

Types of MCI: Technical Types of MCI: Technical HazardsHazards

Building collapseBuilding collapse Hazardous Hazardous

material incidentsmaterial incidents Fires & Fires &

explosionsexplosions Transportation Transportation

accidentsaccidents Major industrial Major industrial

accidentsaccidents

Types of MCI: Civil & Types of MCI: Civil & Political DisorderPolitical Disorder

DemonstrationsDemonstrations StrikesStrikes RiotsRiots Mass shootingsMass shootings Hostage takingHostage taking TerrorismTerrorism

CONFUSION

THE FACE OF EVERY DISASTER IS

Immediately Establish Immediately Establish

COMMAND

Incident Command Incident Command SystemSystem

ICS is used to help control, ICS is used to help control, direct, and coordinate direct, and coordinate resources.resources.

It ensures clear lines of It ensures clear lines of responsibility and authority.responsibility and authority.

Incident commander has Incident commander has overall responsibility for the overall responsibility for the scene.scene.

Safety officer is designated to Safety officer is designated to circulate among responders.circulate among responders.

INCIDENT COMMAND INCIDENT COMMAND SYSTEMSYSTEM

INCIDENT COMMANDER

MEDICAL RESCUE

TRIAGE OFFICERTREATMENT

OFFICEREVAC

TRANSPORTATIONOFFICER

Structure of an Structure of an Incident Command Incident Command System ExpandedSystem Expanded

FLOW OF OPERATIONFLOW OF OPERATION

1. TRIAGE

2. EVAC

MCI

3. TREATMENTSITE

5. MEDICALFACILITY

4. TRANSPORT

Incident Command Incident Command SystemSystem

Provides an Provides an orderly means of orderly means of communications communications & information & information gathering for gathering for decision makingdecision making

Makes Makes interactions with interactions with other agencies other agencies easier through a easier through a well defined well defined organizational organizational structuralstructural

Incident Command Incident Command SystemSystem

Triage PrioritiesTriage Priorities

Patients should be color coded Patients should be color coded early.early.

Patients tagged red should be Patients tagged red should be assessed in the treatment area.assessed in the treatment area.

If patients are entrapped, If patients are entrapped, extrication is required.extrication is required.

Establish a triage area for Establish a triage area for patients.patients.

Triage – is a French term that originated in the WWI

battlefields and was applied to the process of sorting

out casualties who could be returned to the front by

concentrating the limited medical resources available

to their ailment.

Today, triage has come to mean the process by

which all injured individuals are sorted and

classified according to the type and urgency of

their condition.

Triage at Impact Zone

VICTIM CLASSIFICATION AT IMPACT ZONE

Class I (critical – Immediate) Red Tag

Class II (severe – delayed) Yellow Tag

Class III (minor – non-urgent) Green Tag

Class IV (dead/dying) Black Tag

TRIAGE AT IMPACT ZONE(S.T.A.R.T. – Check: RPM)

I. Instruct all victims who are able to ambulate to move to safe area – these are the “walking wounded”, tag them green.

II. For the remaining victims, check RPM : Respiration, Perfusion, Mental

Status.

TRIAGE AT IMPACT ZONE(S.T.A.R.T. – Remember: RPM)

RESPIRATION

NO

POSITION AIRWAY

BREATHING?

NO

DECEASED

YES

>30/MINUTE

IMMEDIATEYES

<30/MINUTE

ASSESS PERFUSION

TRIAGE AT IMPACT ZONE(S.T.A.R.T. – Remember: RPM)

PERFUSION

CAPILLARY REFILL>2 SECONDS OR

NO RADIAL PULSE

CONTROL BLEEDING

IMMEDIATE

CAPILLARY REFILL<2 SECONDS OR

W/ RADIAL PULSE

ASSESS MENTAL STATUS

TRIAGE AT IMPACT ZONE(S.T.A.R.T. – Remember: RPM)

MENTAL STATUS

FAILS TO FOLLOWSIMPLE

COMMANDS

IMMEDIATE

FOLLOWSSIMPLE

COMMANDS

DELAYED

NOTE: Once a patient reaches a triage level indicator in the algorithm,(i.e. IMMEDIATE TAG box), triage should stop and the patientshould be tagged accordingly.

Triage Decision Flowchart

Assess & PositionAirway/Check Breathing

No

Reposition Airway

No Yes

DeadIf Breathing,

Check the Rate

<30 bpm >30 bpm

Check PerfusionMarked

‘I”Treat for Shock

PERFUSIONCheck Circulation &

Control Bleeding

Perform the Blanch Test

>2 sec. <2 sec.

Marked"I"

Treat for shock

Check Metal Status

MENTAL STATUS

Check Mental Status

Fails to Follow Simple

Commands

Follows Simple

Commands

Marked"I"

Treat for Shock

MOVEto the next

victim

RESPIRATION

Factors Influencing Factors Influencing Incident ManagementIncident Management

MagnitudeMagnitude

ResourcesResources

Factors Influencing Factors Influencing Incident ManagementIncident Management

Magnitude - size of the eventMagnitude - size of the event

number of patients involvednumber of patients involved

areaarea

Factors Influencing Factors Influencing Incident ManagementIncident Management

ResourcesResources

response & support personnelresponse & support personnel

equipment & vehiclesequipment & vehicles

facilitiesfacilities

Goals of MCI Goals of MCI ManagementManagement

Greatest goodGreatest good

Resource ManagementResource Management

Don’t move the disasterDon’t move the disaster

-Search

-Rescue

-Triage

-First Aid

Disaster Area Transportation Hospitalization

BASIC RESCUE CHAIN

BASIC RESCUE CHAIN

in practice…

Disaster Area Transportation Hospitalization

more realistically… “Multi Bottle Neck” Chain

FieldTransport

A&ED(Surgery, IC)

Hospitalization

Immediate Care

Pre-Hospital Hospital

Access

Resources

Location

ResourcesSpace

ResourcesSpace

Resources

Space

Resources

BASIC RESCUE CHAIN

MEDICAL RESCUE CHAIN

SearchRescue

TriageStabilization

RegulationEvacuation

TriageDefinitive Care

Disaster Area AdvancedMedical

Post

Transport Hospitalization

realistically…