MASS CASUALTY
INCIDENTS
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness
MCI RESPONSE
Potential Danger
 Major and catastrophic
incidents are a potential in any
community. With the great
variety of natural and manmade disasters that face us
everyday, something major can
happen almost anywhere.
 Whether it is a natural disaster
or terrorist incident there can
be significant impact on the
community
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness
MCI RESPONSE
Familiarization with Target Hazards
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Site that have great potential for
significant loss of life or monetary
loss:
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Public assembly facilities
Hospitals
Nursing homes
Theaters
Industrial sites using hazardous
materials
Railroads
Highways
Schools
Malls
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness
MCI Response
Prepare
 Train in ICS / UICS
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Understand your
responsibilities
Understand the vocabulary
Train in mock disasters
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness
MCI Response
Primary concern must be to save
as many lived as possible and
protect responders
 Response
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First unit establishes command and
sizes-up the scene
The IC determines need for
additional resources
Triage
Treatment
Transport
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness
MCI Response
Scene Organization
 Ensure an effective response
Secure the area (limit access)
 Determine scene safety (is decon required)
 Assign personnel
 Establish staging and T-3 areas
 Establish communications
 Determine ingress and egress (flow of traffic)
 Maintain records
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August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness
MCI Response
Potential for Terrorism
 The IC must be cognizant of the
possibility the MCI was deliberate
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Preserve evidence
Watch for secondary devices
PIO releases only necessary
information
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness
MCI Response
Decontamination
 PPE may be needed if
the scene includes:
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Nuclear
Biological
Chemical
Determined by HazMat
Team
Victims must be deconed
prior to T-3
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness
MCI Response
T-3
Triage
Treatment
Transport
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness
Triage
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The concept of triage is simply a method of
quickly identifying victims who have
immediately life-threatening injuries
AND who have the best chance of surviving so
that when additional rescuers arrive on scene,
they are directed first to those patients.
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness
START
(Simple Triage and Rapid Treatment)
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Developed by Hoag Hospital and the Newport
Beach Fire Department (Newport Beach, CA)
Relies on making a rapid assessment (taking less
than a minute) of every patient
Determining which of four categories patients
should be in
Visibly identifying the categories for rescuers who
will treat the patients
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness
MCI Response
Triage
 Victims are divided in the following categories:
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Immediate (RED)
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Delayed (YELLOW)
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Serious but not life-threatening
Minor (GREEN)
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Life-threatening
Walking wounded
Deceased (BLACK)
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August 2005
Includes non-salvageable
EMS & Trauma Systems Section
Office of Public Health Preparedness
MCI Response
START Triage
 Simple Triage and Rapid Treatment
 Designed to assess a large number of victims
objectively, efficiently and rapidly
 Can be used by personnel with limited training
 30 – 60 seconds per victim
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness
MCI Response
Medical Treatment During Triage
 Only life-threatening problems are corrected
Opening the airway
 Attempt to control exsanguation
 Resuscitation is not attempted
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August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness
MCI Response
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Triage Categories
START
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RED – Immediate
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RPM outside of desired
values
YELLOW – Delayed
RPM within desired values
 Significant injuries
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GREEN – Minor
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August 2005
Ambulatory, able to move
with instructionEMS
from
EMS
& Trauma Systems Section
Office of Public Health Preparedness
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness
Respirations
No
Yes
Position Airway
No Respirations
Deceased
< 30/m
Respirations
> 30/m
Immediate
Immediate
Perfusion
Radial Pulse Absent OR
> 2 Sec.
Radial Pulse Present
Capillary Refill
< 2 Sec.
Mental Status
Control Bleeding If Nec.
Immediate
August 2005
Follows Simple Instr.
Cant Follow Simple Instr.
Delayed
Immediate
EMS & Trauma Systems Section
Office of Public Health Preparedness
MCI Response
Treatment
 Patients are re-evaluated using
more in-depth assessment
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Secondary triage
Separate treatment areas; Red,
Yellow, Green
Definitive/stabilizing emergency
care
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ABC’s
Wound care
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness
MCI Response
Transport
 Transported by triage
determination
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Green patients made be
transported by alternative
means (Bus)
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Red go first
Accompanied by medical
personnel
Transportation Officer
designates facility
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness
MCI Response
Long-Term Operations
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EMS among last to leave
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Stand by during search
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Maintain rehab care
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness
MCI Response
Reports and Records
 IC must assemble all reports and records
Resources requested and received and where
assigned
 Incoming and outgoing ambulances (times)
 Triage log
 Staging log
 Patient destination log
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August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness
REGIONAL MEDICAL
COORDINATION CENTER (MCC)
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MCC Responsibilities
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Provide initial and update alerts via appropriate
communication resources
Provide frequent updates to on-scene EMS ICS
Directors/Supervisors/Leaders regarding hospital casualty
care capacity
May assist with relay casualty transport information to
receiving facilities
May assist with relay urgent and routine communications to
appropriate entities
May assist in coordination and distribution of resources
Other appropriate tasks as necessary for an effective regional
medical response
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness
SCENE MANAGEMENT
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EMS personnel should accomplish the following
actions upon arrival.
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Survey the scene
If Incident Command has not been established the senior
EMS personnel shall assume the role of IC. The IC shall
assume to role of all other elements of the ICS until she/he
as assigned other personnel to their roles.
Advise dispatch who has assumed command and who has
EMS Branch Director/Group Supervisor and their exact
location.
August 2005
EMS & Trauma Systems Section
Office of Public Health Preparedness
SCENE MANAGEMENT
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EMS personnel should accomplish the following
actions upon arrival. (cont.)
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Organize the scene and ensure an effective response
including:
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August 2005
Securing the area and limiting access to nonessential personnel
Determining whether the incident scene is safe to enter and whether
decontamination is required
Assigning personnel to the necessary tasks and roles
Establishing staging, triage, treatment, and transportation areas
Establishing communication between areas
Establishing traffic pattern that provided for the smooth flow of
patients and vehicles
Ensure that appropriate record-keeping takes place
EMS & Trauma Systems Section
Office of Public Health Preparedness
SCENE MANAGEMENT
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EMS personnel should accomplish the following
actions upon arrival. (cont.)
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Call for additional resources
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August 2005
EMS personnel
Any specialized equipment
MEDDRUN
CHEMPACK
Regional Medical Coordination Center (MCC)
Other available resources
Inform the “Coordinating Resource” of nature and scope of incident
EMS & Trauma Systems Section
Office of Public Health Preparedness