mci evaluator sheet per sector
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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:
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MCI Evaluator Sheet
Neil Nituda
Extrication Group 2 (2nd
- Arriving Company)
(3 minutes after first extricating group was dispatched)
Task Please
Check
Remarks
Secure adequate space for working extrication
Initiate START TRIAGE or coordinate properly with triage group
Were triage tape were used?
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.
Coordinate activities with transport sector in proper
transporting of patients
Terminate extrication activities and report to Command
for reassignment.
Over-all Remarks:
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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.
Provide frequent progress reports to Command/Operation
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:
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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.
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
transported
Coordinate activities with other sectors
Over-all Remarks:
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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:
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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.
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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
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 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.
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Triage Sector/Group
Roles & Responsibilities
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
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Transport /Ambulance Sector or Group
Roles & Responsibilities
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).
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Operation Center Center/Central ICS Group
Roles & Responsibilities
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
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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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