MCI Evaluator Sheet Per Sector

8/22/2019 MCI Evaluator Sheet Per Sector

1/17

MCI Evaluator Sheet

Val Reyes

Extrication Group 1 (1st

Arriving Company)

Task Please

Check

Remarks

Perform a rapid hazard assessment (Scene size up) YE

S

NO

Initiate crowd, traffic control & provide for occupant protection

(scene size-up)

Determine the location, number and condition of all patients

(coordinate with triage group)

Send of information to command post/operation center & call

for any additional resources

Secure adequate space for working extrication

Initiate START TRIAGE or coordinate properly with triage group

Relocate green patients properly

Assigning and supervision extrication teams/ coordinate with

Extrication Group 2

Prioritize removal of IMMEDIATE patients without delay

followed by DELAYED patients without delay for transport

Extricate properly (immobilize, stabilize and treat patients

properly) and deliver (safe handling and proper carry) of

patients to transportation

Provide frequent progress reports to Command/Operation

Center

Ensure safety and accountability of all patients and

assigned personnel.

Were rescue tools used effectively?

Were litter-bearers used to move patients to the treatment

area?

Did extrication report an All Clear indicating that all patients

were extricatedCoordinate activities with transport sector in proper transporting

of patients

Terminate extrication activities and report to Command

for reassignment.

Over-all Remarks:


2/17

MCI Evaluator Sheet

Neil Nituda

Extrication Group 2 (2nd

- Arriving Company)

(3 minutes after first extricating group was dispatched)

Task Please

Check

Remarks



Were triage tape were used?


Assigning and supervision extrication teams/ coordinate with

Extrication Group 2

Prioritize removal of IMMEDIATE patients without delay

followed by DELAYED patients without delay for transport

Extricate properly (immobilize, stabilize and treat patients

properly) and deliver (safe handling and proper carry) of

patients to transportation


Center

Ensure safety and accountability of all patients and

assigned personnel.

Coordinate activities with transport sector in proper

transporting of patients

Terminate extrication activities and report to Command

for reassignment.

Over-all Remarks:


3/17

MCI Evaluator Sheet

Jack / Mark Dapal

Triaging Group 3 (2nd - Arriving Company)

(3 minutes after first extricating group was dispatched)

Task Please

Check

Remarks

Determine the location, number and condition of patients.

Determine resources needed for triage.

Assign and supervise triage teams.

Ensure triage is based on S.T.A.R.T & pts. tagged

appropriately.

Ensure safety and accountability of all assigned personnel.


Center.

Coordinate activities with other sectors (extricating and

transport)

Provide the Operation Center/Central Command a Triage

Report

Terminate triage activities and report to Command for any

reassignment

Over-all Remarks:


4/17

MCI Evaluator Sheet per sector/group

Kokoi

Transport /Ambulance Group 4

Task Please

Check

Remarks

Determine/request resources

Determine ambulance/vehicle loading area

Determine hospital availability status

Coordinate patient allocation & destination with Triage &

Extricating Groups

Aggressively supervise the movement of patients from the

treatment area to the loading area

Load red patients first, then yellow, then green.

Conduct first aid /emergency treatment inside the vehicle

Request members of triage or extrication to move patients from

and assist in loading properly.

Keep the medical group, receiving hospital and treatment

informed.

Provide progress reports, allocations, & ETA's, to receiving

hospitals.


Center

Ensure the safety and accountability of all assigned

personnel.

Notify Command when all IMMEDIATE patients have been

transported

Coordinate activities with other sectors

Over-all Remarks:


5/17

MCI Evaluator Sheet

Dr. Regie Dompor

Cabadbaran City Operation Center/Central ICS Group 5

Central Incident Commander, Public Information Officers , Planning Liason Officers, Hospital

Task Please

Check

Remarks

Give good briefing and guide instructions to all groups /

sectors

Make an initial assessment and pass it to dispatch

Control and maintain communications.

Assign and re-assign resources

Evaluate progress

Give orders properly

Produce tactical and progress reports

Keep teams informed and gather them for a post-incident

meetings

Terminates activities and produced reports

Over-all Remarks:


6/17

Tactical Worksheet for Operation Center/Operation Section/ICS

Incident - The name or number of the Incident as currently being used. This may be a facility name, a location, asequential number or other identifier.

Date - Todays date.

Time - The time in 24-hour clock time that this particular worksheet page was initiated.

Scene Sketch - Make a rough sketch of the scene, indicating major elements. Draw and label areas ofresponsibility assigned to the teams, locations of command, and other information that will help you manage theincident.

Time and Task - Record times key tasks are started.

Unit - List all responding groups.

Assignment - Note current assignment of each unit.

Casualties

Time - Note the time of the report.

RD, YE, GN, BK - Record number of red, yellow, green and black patients.

Trans - Record total number transported so far.


7/17

Extrication Group

Roles & Responsibilities

Perform a rapid hazard assessment (Scene size up)Initiate crowd, traffic control & provide for rescuers protection (scene size-up)

Determine the location, number and condition of all patients (coordinate with triage

group)

Send of information to command post/operation center & call for any additional

resources




Assigning and supervision extrication teams/ coordinate with other Extrication Group (#2)Prioritize removal of IMMEDIATE patients without delay followed by DELAYED patients

without delay for transport

Extricate properly (immobilize, stabilize and treat patients properly) and deliver (safe

handling and proper carry) of patients to transportation

Provide frequent progress reports to Central Command/Operation Center

Ensure safety and accountability of all patients and assigned personnel.

Coordinate activities with transport group in proper transporting of patients

Terminate extrication activities and report to Command for any reassignment.


8/17

Triage Sector/Group


Determine the location, number and condition of patients.

Determine resources needed for triage.

Assign and supervise triage teams.

Ensure triage is based on S.T.A.R.T & pts. Tagged appropriately.

Ensure safety and accountability of all assigned personnel.

Provide frequent progress reports to Command/Operation Center.

Coordinate activities with other sectors (extricating and transport)

Provide Command with a Triage Report

Forward triage tracking slips to Command or Operation Center

Terminate triage activities and report to Command for reassignment


9/17

Transport /Ambulance Sector or Group


Determine/request resourcesDetermine ambulance/vehicle loading area

Determine hospital availability status

Coordinate patient allocation & destination with Triage & Extricating Groups

Aggressively supervise the movement of patients from the treatment area to the

loading area

Load red patients first, then yellow, then green.

Conduct first aid /emergency treatment inside the vehicle

Request members of triage or extrication to move patients from and assist in loading

properly .

Keep the medical group, receiving hospital and treatment informed.

Provide progress reports, allocations, & ETA's, to receiving hospitals.

Provide frequent progress reports to Command/Operation Center

Ensure the safety and accountability of all assigned personnel.

Notify Command when all IMMEDIATE patients have been transportedCoordinate activities with other sectors, (esp. Treatment).


10/17

Operation Center Center/Central ICS Group


Give good briefing and guide instructions to all groups / sectors

Make an initial assessment and pass it to dispatch

Control and maintain communications.

Assign and re-assign resources

Evaluate progress

Give orders properly

Produce tactical and progress reports

Keep teams informed and gather them for a post-incident meetings

Terminates activities and produce reports


11/17

Triage Worksheet

Incident The name or number of the Incident as currently being used.

DateTodays date.

TimeThe time in 24-hour clock time that this particular worksheet page was initiated.

Scene SketchMake a rough sketch of the scene, indicating major elements. Draw and labelareas of responsibility assigned to the Triage Teams or individuals.

TeamIdentify the units assigned to triage. If individuals are assigned to areas, identify individuals.

Red, Yellow, Green, Black Record the number of patients reported in each category by eachTeam.

Total Total up the number of patients reported

Notes Note additional information as needed.

Time and TaskRecord the times key tasks are started.


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MCI Evaluator Sheet Per Sector

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