EDMG541

Mass Casualty Incident Management: The Parameters Mass Casualty Incidents and preserve lives. The system is designed to protect, not only the victims, but responders as well. The premise behind the concept is that effective organization and communication will prevent unwanted injuries and loss of life.

The military has long been using such a strategy. The Incident Command System is a hierarchical structure designed to facilitate uniform communication and control. One basic ICS principle is that a task must be delegated to a subordinate or it is one's responsibility to perform. The "delegate or it's yours" philosophy is to prevent tasks from being promised but not accomplished, or worse, to prevent a loss of connection to the task, so that it is not even realized that the job has not been done. The other key principal is the unity of command provided in the system, which means that each person only has one supervisor and the chain of command and communication must follow this structure. While we have learned that enacting collaboration into the system is very important, in the first few minutes of an event, the strict structure of the ICS system ensures safety through accountability.

The ICS operates on the premise of "all-hazard approach," i.e., one approach to all emergencies. The system, while flexible, is a standard framework that does not change with the type, size, or scope of the incident. The process and reporting structure remains the same, and it is adapted appropriately to fit the specific incident.

Related to MCI's, the incident commander must understand the components within the EMS branch, which include the triage, treatment, and transportation groups. In addition to placing the proper personnel in these command positions, logistically, the scene must be designed out to move the patients to the treatment area and allow the transportation group to have ambulance access to the scene for patient removal.

Active Shooter/violence events will bring about the use of more unified command structures. Advanced planning and exercising will ensure that agencies responding to active shooter events are comfortable in working with other agencies and integrating police, fire, and EMS operations simultaneously. The specifics of the unified command model can vary by jurisdiction, as initial staffing is limited in both EMS and police agencies outside of metropolitan areas.

ICS success hinges on proficiency of the system. In mass casualty events, entities that have the training, but lack day- to-day experience in the use of the system will have difficulty operating in the system based on historical events. Beyond adopting the structure, it is imperative as the current and future practitioners that you help ensure proficiency in the ICS system.

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Incident Command for EMS

Drew Fried, EMT-B, CHSP, CHEP Certified Healthcare Safety Professional

Certified Healthcare Emergency Professional

Incident Command for EMS

This is not ICS 100 and will not cover

that material

This course does not satisfy the

NIMS implementation

requirements

Incident Command for EMS

Objectives

This course will discuss

• The role of Emergency Medical Services within the ICS

• Discuss the functional roles of the EMS Branch

• Will focus on command, operations, planning, and logistics, responsibilities of EMS personnel

Modern Management

Principle

• Modern disasters can and must be

managed

• Management principles used in routine

functions must be applied to the non

routine emergency

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Mitigation

Preparedness

Response

Recovery

Emergency Management Cycle Unity of Command

More than one agency with

statutory/jurisdictional responsibility

Unified Command

Fire

Safety Officer Information Officer

Liaison Officer

Planning Operations Logistics Finance and Administration

Unified Command

EMS

Unified Command

Law Enforcement

Disasters overwhelm EMS and

community responses because

critical infrastructure has been

damaged or destroyed

A mass causality incident (MCI)

is an event in which the number

of patients exceeds the

resources available to the initial

responders The ICS system is designed to control

duplication of effort and free lancing.

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Span of Command

The number of subordinates responsible

to a leader is called the “span of

command”.

Supervisor

Resource 1 Resource 3

Resource 2

Chain of Command

“Chain of command” is linked to unity of

command and span of control and is defined

as the flow of information from one command

level to the next.

In the EMS Incident

Command System balance

between operations functions

and support functions is vital

EMS Incident Management

System (EMS / ICS)

The key components are triage,

treatment and transport.

Staging is an additional section in a

medical disaster.

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Where will EMS usually fall in the IMS Structure?

Triage Treatment Transport

EMS Branch

Operations

Incident Commander

Tactical activities are coordinated in an

EMS Branch

Incident Command System

EMS Branch Director

Staging Officer

Transport Officer

Treatment Officer

Triage Officer

Hospitals

Dispatch

In a large scale incident an

Incident Management System is a

must.

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• A supervisor must assume command.

This supervisor should not be touching

patients.

• There will be a need for a team to begin

triage to prioritize patient care

Incident Commander • What does the IC do?

• The IC does not command

• The IC coordinates and leads

• Ensures there is a flow of information, personnel and resources between support and operational functions.

• The IC is responsible for the outcome of an MCI

Incident Commander

Responsibilities

• Manages the EMS response to the incident

• Establishes the command post

• Works in cooperation with fire and police command officers

• Ensures the safety, of all EMS personnel

• Designates sector officers

Command Level Officers

Safety Liaison Public information

Incident Commander

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Safety Officer

• A staff level position appointed as

necessary by the EMS Incident

Commander

• Reports to the IC

• Needs to have the authority to stop all

work if necessary

Safety Issues

• Proper lifting

• Safe operations of tools and equipment

• Use of protective equipment

– Head gear

– Proper clothing

• Personnel accountability

Requirement / Qualifications

• The safety officer should be an

emergency service professional familiar

with disaster operations.

Requirement / Qualifications

• The safety officer should also be

familiar with nationally accepted safety

standards.

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Liaison Officer

• Serves as a link between the management system and other EMS agencies

• The primary function of the LO is to funnel outside agency resources into the appropriate section of the EMS / ICS

Public Information Officer

• This position is not always needed

• Expedites the effective and accurate dissemination of information

• Obtain and communicate accurate information

EMS Operations

• In the EMS Incident Command System

the treatment of patients is the mission.

• All of the functions exist to support

treatment operations

EMS Operations

• Medical treatment operations involves

triaging patients, treating them in a

logical order and transporting them to a

medical facility.

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EMS Branch

EMS Branch

Operations

Incident Command

• Responsible for all EMS sectors (triage,

treatment, transportation) and coordinating

with operations

Medical Incident Command

• Branch leader supervisors the primary

roles of the medical group.

• Responsible for the • Triage

• Treatment

• Transportation

Triage Treatment Transportation

EMS Branch

Triage

Responsible for receiving patients and

utilizing the START triage system to

determine triage categories

Triage

• As the number of patients increase the triage

rules change.

• At normal incidents the best level of care is

possible.

• At large scale incidents we need to do the

great good for the greatest amount of people.

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Triage Officer / Unit

• Ultimately in charge of counting and prioritizing patients.

• The triage units primary duty is to ensure that every person receives initial assessment of his or her condition.

• Treatment should not begin until all patients are triaged or you will compromise your triage efforts

• The treatment sector is divided into units

based on triage categories

• RED

• YELLOW

• GREEEN

• BLACK

RED Area

Yellow Area

Grean Area

Black Area

Treatment Area

Triage Treatment Transportation

EMS Branch

“Greatest good for the greatest number of casualties”

Psychological impact

Classification:

Red Yellow Green Black

Limitations:

Time consuming

User variability

Lack of familiarity

Triage

Treatment areas must be staffed to adequately handle patient

flow

Treatment must be properly supplied

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Treatment Officer

• The treatment officer reports to the EMS Branch Officer and supervises all medical treatment units.

• Responsible for all treatment activities, coordinates with triage, transport and medical supply.

• Do not allow any one area to become overwhelmed.

Treatment Unit

• Separate patients by each priority category

• Assign crews to treat patients

• Communicate with transportation officer

• Responsible for safety of all members in area

• Ensure sufficient supplies and personnel

• Provide update to EMS Branch Director

Morgue • The morgue area is for patients with no

vital signs and should be segregated

from treatment areas and bystanders

• Will need security to control entry

• Rotate personnel to avoid stress

• Every disaster team should have a

funeral director as a consultant.

Transportation

Staging Area

Transportation

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Transportation

• Moves patients from treatment section

to ambulances

• Coordinates transportation of patients to

medical facilities in priority order.

Staging Officer

• Establishes staging

areas for

ambulances,

maintains record of

available units, assigns ambulances

based on requests

from transport

Logistics

Security

Facilities

Communications

Medical Supply

Logisitics • Obtains EMS resources, supplies, and equipment. Coordinates volunteer operations, communications, and facilities.

• Logistics section should operate at the command post, position requires intense communications.

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Management of EMS Supplies

• Maintains inventory and distributes EMS

supplies to all sections, coordinates

directly, with treatment, coordinates with

logistics.

Medical Supply

Logisitiies

Facilities

• Facilities is responsible for all facilities

including rehabilitation, food, water,

sanitation and aux. power.

Facilities

Logistics

EMS Communications

• Services as a single point of contact .

Reports to transport the patients

information from transportation to

medical control and others.

Communicatons

Transportation

EMS Mass Casualty Incident

Management System

Site Management

• Command and communication

– Should be in an area to provide overall

scene assessment and coordination

– Provides overall EMS command and

control leadership, direction and resource

allocation.

– Provides central location for arriving units.

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• Command allocates and assignees

resources

• Establishes and maintains security

• Control s information release.

Effective Disaster Assistance

• Careful preplanning

• The ability to quickly implement a plan

• The application of effective triage

• The ability to organize and utilize fully all emergency personnel.

• The ability to adapt the plan to meet special conditions, such as inclement weather or isolated locations.

Drew Fried

Pre-Hospital Care Concepts

[email protected]