What is an MCI ? by 1VU2MW92

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									Mass Casualty Incidents
   What is an MCI ?


It is any incident where the number of
  patients and/or the severity of their
  injuries prohibits immediate patient
  care provided to all at that moment.
Multiple Casualty Incident


It will never happen to me right ?

High Risk/Low Frequency events
MCI Events in King County:

 Highland Ice Arena, Shoreline: 76 patients
  from a CO leak .
 Chlorine leak at a County Pool, 26 Patients
 School bus accident in Redmond 60 patients
 Several MVA’s ranging from 5 to 10
  Patients
 Seattle Aurora Bridge Bus Incident. 33
  Patients.
Common Problems at an MCI
 Personnel not fully understanding their roles
  in an MCI setting.
 Failure to identify the incident as an MCI
 Failure to triage properly
 Improper numbering of treatment tags /Pt’s
 Inappropriate, time consuming treatment
 Clogging at the transportation site.
Problems…
 Scene access problems
 Ineffective response plan for the size of
  incident.
 Lack of a large equipment cache on hand
 Congested treatment areas
 Transport vehicles left unattended
Misconceptions of MCI:
   Every MCI requires a Medical Group to be set up.
   I.C. does not need an “Medical Group Supervisor”
    in a large event.
   You cannot down grade a patient once they have
    been triaged.
   All Immediate or red patients must be transported
    first.
   Patients have to go the the closest Hospital.
   Yellow patients equal BLS patients always.
Multiple Casualty Definitions:
   Ambulance Staging          Morgue area
   Staging Manager            Plan C
   Colored flagging Tape      Triage
   Funnel Point               Tracking Boards
   Hospital Control
                               Treatment Area
   Medical group
    Supervisor or Branch       Transport Area
    director                   Treatment Tags
   Medical Support Unit       Triage Belt
Incident Management System
 MCI plan is based on the same principles of
  the IMS system.
 Allows for creation of an organizational
  structure for the most effectiveness of
  resources, personnel and equipment.
 Span of control 3 to 7 with optimal being 5
 Is a “Medical Group” or “Medical Branch”
  needed to effectively manage the incident ?
Activation of an MCI
 Incident Commander’s responsibility to
  declare an MCI and provide a verbal size up
  of the incident.
 Additional resources should be requested
  early on by the I.C.
 The I.C. or designee is responsible for
  initial “Hospital Control” contact and plan
  activation.
Activation of Hospital Control
   Request “Activation of the MCI Hospital Control
    Plan” done by the I.C.
   Transportation Team Leader communicates with
    Hospital Control
   PRIMARY: Harborview Medical Center
   Ask for the “Charge Nurse”
   This will result in notification of HMC E.R. staff,
    HMC Physician portable 55, and area Hospitals if
    necessary.
   Is a “Lock Down” needed at local Hospitals ?
Secondary Hospital Control
 Overlake Medical Center
 Request Charge Nurse and provide the same
  information as you would to HMC.
Incident Commander
   Develop a “Incident action plan” necessary to
    control the incident.
   Establish a Medical Group or branch if needed.
   Ensure that adequate resources are requested for
    both incident manpower and transport capabilities.
   Direct incoming resources
   Establish Command post/location and necessary
    staging /base areas
Incident Management
Considerations:
 Is “Gross Decon” and “Lock Down”
  notification for hospitals needed ?
 Buses for shelter and patient transport.
 Crowd control, separating injured from non.
 Separate walking wounded from non
  ambulatory patients.
 Separate tactical channel for medical
Gross Decon Procedure
 I.C. establishes “gross decon group”
 Location: prior to funnel point.
 Once clean, patient is given a Tyvek suit.
 Disposable blanket if Back Boarded.
 Attach white flagging tape to wrist.
 Proceed to funnel point or green holding
  area.
Medical Group/Branch
Supervisor
   Filled by a “Medical Services Officer”or first in
    Medic Unit officer.
   Responsible for the over all coordination of the
    medical group and Hospital control
   Recommend early activation of Hospital control
   Ensure proper resources and manpower for the
    medical group.
   Responsible for accountability
Medical Group
 Medical Branch vs.    Transportation Team
  Medical Group          Leader / ambulance
 Medical group          staging manager
  supervisor            Morgue Team Leader
 Triage Team Leader
 Treatment Team
  Leader
Triage Team Leader
   Filled by a Company Officer
   Accountable for litter barriers and equipment for
    back boarding.
   Responsible for setting up a funnel point
   Responsible for proper triage including
    numbering/flagging of patients
   Responsible for clearing Patients after gross
    deacon needs are complete prior to treatment area.
Funnel Point Procedure
   V shape set up with saw horses, and a white flag
    to identify the funnel point.
   Pre number treatment tags prior to Patients
    arriving.
   Use division numbers for multiple funnel points.
   Re-triage “ Safety Net”
   Mark the treatment card, and patients forehead,
    cheek or arm.
   Attach the tag to the colored tape
Treatment Team leader
   Filled by driver of first in medic Unit
   Sets up Treatment area using supplies from Medic
    Units and MSU vehicles.
   Responsible for the over all treatment in all areas.
   Appoints treatment area leaders.
   Ensure adequate resources and proper
    documentation is complete on each tag.
   Coordinates Pt. Loading with Transport.
Transport Team Leader
   Filled by experienced EMT, Medic or MSO
   Responsible for the loading, transporting and
    accountability of all patients.
   Coordinates the destination with Hospital Control.
   Ensures proper transport resources.
   Documents all information on a tracking form
    using an aid.
   Consider using an ambulance supervisor
Hospital Control
 Utilize cell phones or 800 radios
 Make contact with HMC Charge nurse.
 Transport Team leader advises them of the
  condition of the patient. Hospital control
  advises to which hospital to transport to.
 Hospital controls calls ahead, not the unit
  transporting.
Communication Problems
 If no phone access, use the following
  guidelines.
 First 10 patients go directly to HMC
 1 or 2 red patients may be sent to other
  regional level 3and 4 trauma centers.
 Use caution transporting to local hospitals.
  They may be inundated with self-directed
  patients.
Ambulance staging
 Separate from manpower staging.
 Assign a Staging manager. Consider using
  the Ambulance supervisor for that.
 All personnel stay with their vehicles
 Position units in staging to allow easy
  access to the transport post.
Morgue Team Leader
 Filled by an EMT, P.D. or KC M.E.
 Responsible for scene security of the
  deceased. i.e.. personal effects
 Coordinates duties with Police and the
  Medical Examiner.
 Documents Morgue activities
 If body is moved, mark the spot with a flag.
First Arriving Unit
   Size-up the incident. MCI Yes or No?
   Announce you have an MCI to incoming
    resources
   Call for additional resources. Consider the need
    for specialty equipment such as an MSU vehicle.
   Establish command. BE Command
   Make assignments for incoming companies.
   Base units. Secure ingress and egress routes.
   Initiate triage
Triage Equipment
 Triage Belt with triage tape with red,
  yellow, green, black/white rolls.
 First Aid Bag attached to belt to provide 5
  pressure dressings.
 Two inch Tape
 Marker “water resistant”
Triage Criteria
 30 seconds per patient
 Using the ABC or RPM approach.
 Awake / Airway
 Breathing
 Circulation, “presence of a radial pulse”
 Attach the proper triage colored tape to the
  wrist. Document onto a piece of 2” tape.
Harvesting Patients:
   Recommended four litter barriers per back board
    for an adult patient.
   Recommended two litter barriers per back board
    for a pediatric patient
   Three straps per board for an MCI
   Duct Tape may be used in place of cloth straps.
   Large resources needed for litter barriers. Labor
    intensive.
Remember…
   The Key to the success of an MCI is early
    recognition that you have an MCI and to
    respond the appropriate resources early on.

   Be Familiar with your own Departments
    polices/procedures. Know your equipment.

   Train on MCI. BE PREPARED !!

								
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