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Chapter 44

Multiple-Casualty Incidents and

Incident Management

Copyright ©2010 by Pearson Education, Inc.

All rights reserved.

Prehospital Emergency Care, Ninth Edition

Joseph J. Mistovich • Keith J. Karren

Objectives

1. Define key terms introduced in this chapter (slides 12-

13).

2. List situations that might result in multiple trauma

casualties and situations that might result in multiple

medical casualties (slides 12-13).

3. List aspects important to effective management of an

MCI (slide 14).

4. Explain the purposes for establishment of the National

Incident Management System (NIMS) (slides 15-16).

5. Describe the purposes and desirable features of the

incident command system (ICS) (slides 17-18).

Objectives

6. Identify responsibilities that may be assigned to EMS

(units that might be established) at a multiple-casualty

incident (slides 19-20).

7. Describe the principles of a triage system (slide 21).

8. Describe and contrast primary triage with secondary

triage (slides 22-23).

9. Given a scenario with multiple patients, categorize

patients according to a color-coded triage system (slide

24).

10. Explain the principles and assessment categories used

in START triage (slides 25-26).

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Objectives

11. Explain why JumpSTART was developed for triage of

pediatric patients, contrast JumpSTART with START,

and explain how to identify a “child” for triage purposes

at the scene of an MCI (slides 27-29).

12. Explain the important principles of a patient tagging

system to be used during triage (slides 30-31).

13. Explain the interrelationship of triage and treatment

within the treatment unit at an MCI (slides 32-33).

14. Discuss the logistics of staging and transport at an MCI

(slides 34-37).

15. Discuss common issues with communications in MCI

and disaster situations (slides 38-39).

Objectives

16. List measures that can be taken to reduce rescuer

stress during and after an MCI response (slides 42-43).

17. Describe requirements of effective disaster assistance

(slides 44-51).

18. Anticipate psychological reactions of disaster victims

and describe ways in which EMS providers can assist

disaster survivors (slides 52-54).

Multimedia Directory

Slide 44 Children During Disasters Video

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Topics

Multiple-Casualty Incidents

National Incident Management System

Triage

Disaster Management

CASE STUDY

Dispatch

Respond to the Firebird Raceway, We have

reports that two race cars have crashed through

a fence into a bleacher full of people. Initial

reports indicate as many as ten dead and 40

critical injuries.

EMS Unit 105

Time out 1612

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• Two demolished vehicles on a collapsed bleacher

• People screaming; bystanders helping the injured

• You estimate at least 50 injuries

• Since you’re the senior EMT, according to your

MCI plan, you’re the incident manager for EMS

operations

Upon Arrival

How would you proceed with the assessment of these patients?

Back to Topics

Multiple-Casualty

Incidents

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Multiple-Casualty Incident (MCI)

Event that places excessive

demands on personnel and

equipment

(© Rob Crandall/The Image Works) Back to Objectives

Multiple-Casualty Incident

• Get help early

• Too many rescuers is

better than too few

(© Rob Crandall/The Image Works) Back to Objectives

National Incident

Management System

Back to Topics

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National Incident Management

System (NIMS)

• Standardized approach

• Provides both flexibility and

standardization

• Agencies required to be

NIMS-compliant since 2006

(© AP Photo/Dennis Paquin) Back to Objectives

Incident Command System

Back to Objectives

• Safety of responders and

others

• Achievement of tactical

objectives

• Efficient use of resources

ICS

ensures:

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Back to Objectives

Triage

Back to Topics

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Primary and Secondary

Triage

Back to Objectives

• Primary triage is performed

upon arrival of first EMS unit

• Secondary triage

reevaluates initial triage

determination

Back to Objectives

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START Triage System

Back to Objectives

JumpSTART Pediatric

Triage System

Back to Objectives

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(© Lou Romig, MD, FAAP, FACEP, 2002)

(© Lou Romig, MD, FAAP, FACEP, 2002)

Patient Tagging

Back to Objectives

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Treatment

Back to Objectives

• Treat only salvageable

patients

• Focus on life-

threatening injuries

• Move to treatment in

order of priority

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Staging and Transport

Back to Objectives

A staging unit leader

monitors, inventories,

and directs available

ambulances to the

treatment unit at request

of transport unit leader.

(© Benjamin Benschneider /THE SEATTLE TIMES)

• Patient distribution to

medical facilities

• Hospital surge capacity

• Specialty medical

facilities

• Constant coordination

and communication

Transport Unit

(© Benjamin Benschneider /THE SEATTLE TIMES)

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• Transport high-priority first

• Use preferred route

• Transport unit leader should

perform report

• Consider mass transit vehicle

for ambulatory patients

Effective Transport

(© Benjamin Benschneider /THE SEATTLE TIMES)

Communications

Back to Objectives

Communications

• One of the most difficult aspects of incident

management

• Confusion diminishes with ICS establishment

• Radio communications may be difficult due to

gridlock and “dead spots”

• Don’t become distracted from patient care

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Follow-Through

Follow-Through

• Following removal of all patients from the

scene, assist hospital personnel

• Seek direction from facility incident manager

• If your services are not needed, prepare your

vehicle for service

Reducing Posttraumatic and

Cumulative Stress

Back to Objectives

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• Rest regularly

• Monitor workers for stress

• Assign tasks appropriate to

skills and experience

• Provide food and beverage

• Encourage talking to relieve

stress

• Make professional counselors

available

(© Tim Fadek/Gamma)

Children During Disasters

Return to Directory

Click here to view a video with information about children during disasters.

Disaster Management

Back to Topics

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Requirements of Effective

Disaster Assistance

Back to Objectives

• Communication

• Quick implementation

• Adaptability

• Preplanning

• Triage

• Community preparation (© AP Photo/Vincent LaForet/POOL)

Warning and Evacuation

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Evacuation Message

• Nature of emergency and time of impact

• Safe route out of area

• Appropriate destinations where assistance is

available

• Use as many media as possible to send

message

Disaster Communications

System

Disaster Communication

• Establish details of system ahead of time

• Appoint one person to communicate with

those outside of disaster area

• Maintain area-wide communications

• Establish central registration station

• Make travel information available

• Monitor all health care resources

• Transport officer at scene should handle

hospital report

• Record communications for later review

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The Psychological Impact

of Disasters

Helping Disaster

Patients

Back to Objectives

Age Considerations

• Preschoolers tend to cry, lose control of bodily

functions, and suck their thumbs

• Elementary-age children suffer extreme fears

about their safety and show confusion,

depression, withdrawal, and the tendency to

fight with their peers

• Preadolescents and adolescents may show

the same reaction as elementary-age children,

coupled with extreme aggression and stress

that is severe enough to disrupt their lives

Other Considerations

• The families of patients need and deserve

accurate information

• Reunite families as soon as possible

• Group people with families and neighbors

• Encourage people to do necessary chores

• Provide structure for emotionally injured

• Help patients confront reality

• Do not give false assurances

• Identify high-risk patients

• Provide care for rescuers as well

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CASE STUDY

Follow-Up

Scene Size-Up

• Raceway officials extinguish fires

• Multiple burn patients

• Bystanders directed off the bleachers

• Assume incident command

• Request 20 ambulances

CASE STUDY

Scene Size-Up

• Request ten rescue units with

extrication ability

• Establish extrication, treatment,

transport, staging, supply, and triage

units

CASE STUDY

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Triage

• START Triage

• Ten people walk away when called with bullhorn

• Classify remaining patients as red or yellow

• Move red patients to treatment unit first

CASE STUDY

Supply and Extrication Units

• Determine amount of medical materials needed

• Obtain necessary extrication equipment

• Distribute supplies, equipment, and personnel to area of greatest need

CASE STUDY

Triage and Treatment Units

• 40 patients total – 10 deaths = 30 patients in the treatment unit

• Classify five patients as red and treat first

• Classify remaining 25 yellow

• Move yellow patients to priority two treatment area

CASE STUDY

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Staging and Transport

• Request three ambulances for red patients

• Transport unit contacts hospital

• Request 13 ambulances for yellow patients

CASE STUDY

Staging and Transport

• Request five ambulances for green patients

• Remaining EMTs assist with clean-up

• All crews take periodic breaks for rest and nourishment

CASE STUDY

• Dispatched to a residential neighborhood

for a report of a natural gas explosion

• You’re the first EMS unit to arrive on scene

• You report to the incident commander

• The IC believes approximately 30 patients

have been identified so far

• He designates you as the EMS branch

director

Critical Thinking Scenario

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1. What responsibilities would you have as

the EMS branch director?

2. What units would you establish?

3. How should triage be conducted?

4. What patients would be moved into the

treatment unit first and moved out of the

treatment unit first?

5. How would you manage all of the

responding EMS units?

Critical Thinking Questions

Reinforce and Review

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