Palm Beach County Fire Rescue - Amazon S3 for the First In units with respect to initial...

Palm Beach County Fire Rescue

MCI Dispatch Protocol Revisions

The following packet contains the changes to the MCI Dispatch Protocol along

with a brief review of Scene Size Up involving an MCI, Declaration of an MCI and

Scene Management Priorities.

The first section in this packet contains the New MCI Dispatch Protocol showing

the number of units that will be paged for Level (1-3) MCI. Included in this section

is a Note page for pertinent clarification, Wire Diagrams/Command Flow Charts

for Level 1-3 and a Blank Template Wire Diagram/Command Flow Chart to be

utilized by Command Units. This change in number of units responding for Levels

1-3 was created by utilizing a Wire Diagram/Command Flow Chart format for each

Level 1-3. They were created by simulating the number of units it would take to

efficiently manage and process the given number of victims per each Level 1-3. It

must be noted that these diagrams are examples only of where units can be

assigned to efficiently manage an MCI. The Incident Commander is responsible for

assigning units as needed based on incident priorities.

The second section contains a brief review of Scene Size Up involving an MCI,

Declaration of an MCI and Scene Management Priorities. Although there are

many considerations in the management of an MCI, this document reviews some

coaching points for the First In units with respect to initial assignments, scene

safety (hazards) and scene security, Triage, Treatment and Transport. The last

part in this section lists some plans for Future Changes to the Management of the

MCI being developed and tested by the MCI committee.

Effective date for this MCI Dispatch Protocol change is February 1 2011, in the

CAD system.

Purpose- Enhance the Number of Emergency Vehicles responding to MCI’s, Engines,

Rescues, Command Units and Support Units - (Support 81, TCU, DRU1, etc…), Include Wire

Diagrams for Levels of MCI to show the utilization of units that will be responding. (Wire

Diagrams are Examples Only- Incident Commander to assign units as needed). Review MCI

Scene Size-Up, MCI Scene Declaration and Scene Management Priorities

Revisions- Increased number of units responding to the Declared Level of MCI

Level 1(5-10 patients) Level 2(11-20 Patients) Level 3(21-100 Patients)

4- Engines

7- Engines

8- Engines

6- Rescues

11- Rescues

19- Rescues

2- EMS Captains

3- District Chiefs (1- Sp/Ops D/C)

4- District Chief (1- Sp/Ops D/C)

1- District Chief

3- District Captains

4- District Captains

1- Battalion Chief

2- Battalion Chiefs

3- Battalion Chiefs

1- Helicopter-Standby

1- Division Chief

1- Division Chief

2- Helicopters- Standby

2- Helicopters – Standby

1- Special Operation Team

1- PIO

2- Special Operations Team

1-PIO

Special Deployment Units

1- Support 81

1- TCU (Tactical Command Unit)

1- DRU2 and DRU3

1-Tactical 34

*Note – The number of units responding for each Level MCI is based on the

maximum number of Victims / Patients for that Level MCI

*Note - Incident Commander can downsize level of response per numbers of

victims/patients based on the severity of injuries/illnesses

*Note: When an MCI is upgraded to the next Level MCI the Incident Commander

will receive the balance from the previous Level MCI to supplement the

requested Level MCI

*Note: For MCI Level 4 (101-1000patients) and Level 5(OVER 1000 patients)

refer to Level 3 Wire Diagram (command flow chart) repeat Level 3 MCI for

every 100 patients –Below Operations

*Note: Wire Diagrams are Examples Only- Incident Commander to assign units

as needed

* Wire Diagrams are Examples Only- Incident Commander to assign units as

needed

Wire Diagram/ Command Flow Chart Level 1

The dashed lines illustrate the movement of units from their initial assignment

to possible additional assignments.


needed




Blank Template

Will be on Division Chief, Battalion Chief, District Chief, and District Captain

Vehicles on a 12x18 board

Scene Size- up involving an MCI, Declaration of an MCI

and Scene Management Priorities and Plans for Future

Changes

This section contains a brief review of Scene Size- Up involving

an MCI, Declaration of an MCI and Scene Management

Priorities. Although there are many considerations in the

management of an MCI, this document reviews some coaching

points for the First In units with respect to initial assignments,

scene safety and security, Triage, Treatment and Transport.

The last part in this section lists some plans for Future Changes

to the Management of the MCI being developed and tested by

the MCI committee.

There are many SOG’s that can apply to an MCI but here a few

that we should review with our crews.

Incident Command SOG # 1105

Staging SOG# 1310

Disaster Response Units SOG # 1322

Personal Protective SOG # 1510

Traffic Operations SOG # 1740

Vehicle Accident SOG # 2310

MCI SOG # 2315

Response to Violent Incidents SOG # 2320

Response to HAZ MAT/WMD Incidents SOG # 2401

Emergency/ Gross Decontamination SOG # 2407

Review MCI Scene Size-Up/MCI Declaration/ Scene Management Priorities

MCI may have been declared prior to First in Unit arrival based on caller/dispatch

information

• Important that First in Units stage other responding units for assignment to allow for

proper scene size-up

Perform Outer and Inner Circle/Scene Survey for Potential Hazards- Address Immediate

Safety Concerns – Not Limited To -

• Wind Direction, Product Clouds, Placards, Unstable Vehicles, Leaking Fuels, Number

of Vehicles, Hybrid logos, Number of Distressed Civilians Visualized, Electrical

Hazards etc…

Determine number involved versus number of victims/patients

• Persons with No Injury/Illness should not be counted to Declare Level of MCI

• Proper scene size up is important in declaring the correct level of MCI Begin Triage using S.T.A.R.T. and Jump S.T.A.R.T. process

• Refer to MCI Triage F.O.G. including the S.T.A.R.T. / Jump S.T.A.R.T. algorithm

Declare Level of MCI with Type

• Level 1 (5-10 patients)




• Level 5 (over 1000 patients)

• Type- Traumatic, Chemical, Medical, Pediatric etc… Law Enforcement to secure area/establish perimeter

• Control scene to eliminate the potential of anybody involved leaving the scene

• Important they keep road clear for Entry and Exit of Transport Vehicles

Assignment Priorities

• Hazards, Triage, Treatment, Transport, Staging area, etc…

• Special Resources Available – Support 81, TCU, DRU Trailers Triage Leader/Supervisor priorities

• Follow MCI F.O.G. #3

• Ensure entire scene is checked for victims/patients

• Assign enough personnel(litter bearers) to efficiently move patients to

Treatment Area

• Initially, Coordinate with Law Enforcement per Command to secure

scene/preserve potential crime scene until liaison is assigned

• Backboards should be staged for easy access of liter bearers Treatment Area Leader/Supervisor priorities

• Follow MCI F.O.G.# 4

• Indentify Entry and Exit points within treatment area

• Treatment area leader/supervisor should secure entry point to direct the

movement of patients to the proper location within the treatment area based on

color categories for secondary triage/treatment/transport

• Refer to PBCFR ALS/BLS Protocols 2009 and Trauma Transport Criteria

Treatment and Transport area established close as safety will allow to Initial Triage

area

• Reduce patient movement distances Transport Area leader/supervisor priorities

• Follow MCI F.O.G.# 5

• Communication with hospitals

• Communication with Air Transport

• Transportation of patients by priority

• Needs documentation aid for patient tracking

• Assigned Transport Units need to leave extra Backboards and any extra supplies

requested

Future Enhancements to Manage MCI Responses

New Documentation procedures

• Possible use of hospital type wristbands with barcode stickers in initial triage

• Eliminate the use of ribbons in the initial triage

• New tag/report with bar code in conjunction with EPCR(tablet)

• New MCI bag/pouch in a safety vest style with updated MCI F.O.G.’s Enhancements to the process of color coding (Green, Yellow and Red)

• Green category to indicate Involved with no obvious injury/Illness

• Victims with any Injury/Illness will be either a Red or Yellow

• Pilot program in Bat 7

• Train the Trainer for future MCI Drills

Revised 01/01/2011

FIRST ARRIVING _ MCI FIELD OPERATIONS GUIDE 1

Perform Initial Size –Up and Establish Command

Begin “Triage”- Using START/ JUMP START process

Scene Declaration of MCI with TYPE of MCI - Traumatic, Chemical

Exposure, Medical, etc…

Level of MCI- Approximate number of victims/patients

Level 1 (5-10 victims/patients) Level

2 (11-20 victims/patients) Level 3

(21-100 victims/patients) Level 4


(over 1000 victims/patients)

Involved/Minor Injury/Illness- relocate to safe area (Green Tagged) for

Secondary triage

Assign Incoming Units- Hazards, Triage, Treatment, Transport

Consider additional resource needs- Special Deployment Units

(DRU’s, TCU, Support 81, Tactical 34)

Establish Staging Area to accommodate the number of units responding

Revised 01/01/2011

COMMAND _ MCI FIELD OPERATIONS GUIDE 2

Establish Command in a Fixed and Visible Location

Radio designation “COMMAND”

Confirm/Declare Level of MCI- Approximate number of victims

Level 1 (5-10 victims/patients) Level

2 (11-20 victims/patients) Level 3



(over 1000 victims/patients)

Set up Command Board/MCI work board

Assign Units to perform following functions

Immediate Hazards

Triage (Should be OIC of First Arriving Unit)

Treatment

Transport

Assign Staging Area Manager

Advise dispatch of the number of victims and their categories

Have a liaison from each involved agency at the command post

Large scale or complex MCI’s, designate a “MEDICAL BRANCH”

Revised 01/01/2011

TRIAGE_ _

MCI FIELD OPERATIONS GUIDE 3

Radio designation “TRIAGE”

Organize triage personnel to begin initial Triaging of Victims using

S.T.A.R.T and Jump S.T.A.R.T. System

Ensure all involved with no Injury/Illness stay on scene for incident

documentation

Ensure that all areas of the incident have been checked for victims and

all victims have been triaged

Ensure enough triage personnel are assigned for Litter Bearers for victim

movement to treatment area

Advise Command of the number of victims, their categories and need for

additional resources

Coordinate with Treatment the movement of victims based on priority

Request Law Enforcement to maintain security of Triage Area

When Triage is completed contact Command or Medical Branch for

further assignment of personnel

02/01/2011

Dece ased

(Black)

Involved minor injury/illness

(Needs secondary triage)

START TRIAGE

Minor

(Green)

Respirations

NO YES

Position Airway

NO YES (RED)

Immediate

(RED)

Radical Pulse ABSENT

or

Capillary Refill

Greater than 2 seconds

Radical Pulse PRESENT

or

Capillary Refill

Less than 2 seconds

Control Bleeding Mental Status

Immediate

(RED)

CANNOT

Follow Simple

Commands

CAN

Follow Simple

Commands

Immediate

(RED)

Delayed

(Yellow)

02/01/2011

Respirations

JUMP START TRIAGE

Involved minor injury/illness

(Needs secondary triage)

Minor

(Green)

Respirations

NO YES

Position Airway Over 15/min

Under 45/min

Under 15/min

Over 45/min

NO YES (RED)

Palpate

Peripheral Pulse

Immediate

(RED)

Peripheral Pulse

ABSENT

Peripheral Pulse

PRESENT

YES PULSE

Give 5

Ventilations

(15 seconds)

Via barrier

NO PULSE NO

Spontaneous

Respirations

Immediate

(RED)

Control Bleeding

Mental Status

Spontaneous

Respirations

YES NO

Deceased

(Black)

Unconscious or

Responds only

to Painful

Stimuli

Alert

or Alert to

Verbal Stimuli

Immediate

(RED)

Deceased

(Black)

Immediate

(RED)

Delayed

(Yellow)

Revised 01/01/2011

TREATMENT


Radio designation “TREATMENT”

Establish a centralized TREATMENT area with access to TRANSPORT area

capable of accommodating the number of victims encountered

Supervise on- site medical care, utilizing PBCFR ALS/BLS Protocols 2009

and Trauma Transport Criteria

Ensure enough personnel and equipment is available to effectively

treat all victims

Ensure contaminated patients have moved through the Decon Area

Coordinate with TRIAGE (Litter Bearers) for victim movement to

TREATMENT area

Red tagged victims should be transported immediately when transport

units are available

Establish communication with TRANSPORT to coordinate transport of

victims by priority

Update COMMAND or MEDICAL BRANCH of any changes in the victim

count or category

Revised 01/01/2011

TRANSPORT


Radio designation “TRANSPORT”

Assign a Documentation and Medical Communication Aide early

Ensure TRANSPORT area has efficient Entry and Exit for Transport Units

with easy access to TREATMENT area

Request Law Enforcement to secure TRANSPORT area

Establish early contact with Hospitals. Request designated Med Channel

for all Hospitals

Establish contact with Landing Zone for Air Transport needs

Coordinate the Transport of Victims by Priority and Hospital Capabilities

Record on TRANSPORT LOG victim ID number, destination Hospital

and transport unit number prior to victims leaving the scene

Advise destination Hospitals of number of victims, their Triage status

and mode of transportation to that facility

Request additional Units from COMMAND or MEDICAL BRANCH

Revised 01/01/2011

STAGING


Radio designation “STAGING”

Establish a safe location for the STAGING area and advise COMMAND

Organize units by type to allow for easy deployment when requested

Ensure personnel stay with their vehicle unless otherwise directed and

keep keys with the vehicle

Maintain a Unit Staging Log. Assign a Documentation Aide if available

Maintain a reserve of at least 2 Transport Units

Have knowledge of Incident location to advise best route to scene as

units are assigned

Contact COMMAND or OPERATIONS for additional resource needs

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