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Volume II

Mass Casualty Operations

Incidents resulting in a large number of casualties pose a variety of problems for the emergency services system and the community as a whole. A method should exist for directing the response to the incident by emergency services personnel, government agencies, and by the private sector. Adequate personnel and supplies should be available to carry out fire suppression, rescue activities, patient care and transportation functions. However, these resources should be obtained in a manner that minimizes reduction of emergency services to the surrounding area.

Resources available at the scene for patient treatment and transport should be allocated according to a system of priorities based upon need. Resource allocation is necessary due to the limitations on time and availability of trained personnel, equipment, and supplies that exist during multiple casualty situations. Since patients cannot all be treated immediately, patient care operations should be organized to provide optimum care as quickly as possible, according to need.

The Erie County Mass Casualty Incident (MCI) Plan has been developed as an operations guide for the management of field medical operations. This plan is based on the Incident Command System (ICS) and the components may be expanded, or contracted, as necessary. The plan may be initiated any time that the resources available at the incident are insufficient to meet the needs of the operation or structured organization is required.

These operating guidelines have been developed for use as a framework by fire departments, EMS agencies, dispatch centers, hospitals, non-government organizations and other governmental agencies that may assist or support a mass casualty incident.

This plan is not meant to replace traditional training in Incident Command, Mass Casualty, Hazardous Materials or any other applicable disciplines. Rather it is designed to establish a framework to which responders should base their agency response and on-scene operations. This plan has been divided into 3 volumes to better prepare responders for a mass casualty event. Some information is contained in all three volumes.

Volume I – Mass Casualty Incident Preparations

Volume II – Mass Casualty Incident Operations

Volume III – Mass Casualty Incident Field Guide

Remember…not all ICS positions need to be filled at every incident. With a few exceptions individuals can hold multiple positions at once.

Purpose

This plan is intended to be activated and utilized for actual/potential mass casualty incidents. It should be implemented whenever a situation occurs that requires resources beyond the normal day-to-day operations and overwhelms the resources of an EMS provider. This MCI plan provides for a uniform guideline for handling mass casualty incidents within the structure of the Incident Command System (ICS). It is also meant to serve as an informational guide for future planning, training, exercises, and equipment procurement.

MCI Overview

Early organization of an MCI is crucial to obtain the desired outcome. This early organization is dependent upon the actions of the first arriving units, which may include EMS, fire and law enforcement agencies. It is critical that a Unified Command be established as quickly as possible. As units arrive on the scene, personnel from these varied groups assume, or are assigned, positions with specific responsibilities and tasks, based on the best use of available personnel resources.

However, although each person’s tasks are specific, these individuals do not operate in a void, but must interact with other team members to accomplish the joint goals of rapid triage, treatment, and transportation. For this reason, it is important to understand the overall progression of an MCI and the contributions of each team member.

The following outline summarizes the actions that occur during an MCI. This outline is, of necessity, vague. It is intended to be used as a framework against which the more detailed tasks of each team member can be compared.

1. Pre-Arrival

a. MCI occurs

b. Dispatch is notified

c. Dispatch send appropriate personnel/equipment, advising of potential MCI

d. Responding units notify dispatch en-route of possible hazards, alternate response routes, etc.

2. Arrival

a. First arriving unit confirm/denies actual MCI

b. First arriving unit establishes command, notifies dispatch of size up, including approximate number/category of patients, wind direction, incident location, and requests additional resources if needed.

c. Dispatch activates MCI plan after receiving “ground truth” confirmation of MCI

d. First available personnel begin triage, using START

e. Additional units arrive

f. MCI positions are established per ICS/NIMS standards

g. Dispatch is advised of the exact number of victims and their categories

3. General Tasks

a. Additional assistance is requested as needed

b. Medical command and area hospitals are notified

c. Staging area, manpower pool, and equipment pool are established

d. Media area is established

e. Scene is secured

f. Decontamination area is established

g. Treatment area is established

h. Transportation area is established

4. Patient Flow

a. Patients are properly tagged prior to movement

b. Patients are prioritized to undergo decontamination procedures, if needed

c. Patients are directed to appropriate treatment area

d. MINOR (green tag)

e. DELAYED (yellow tag)

f. IMMEDIATE (red tag)

g. MORGUE (black tag)

h. Personnel treat patients and document injuries/treatment

i. Patients are moved to the load zone

j. Transportation Group Supervisor receives hospital capabilities report from PSAP

k. Transportation Group Supervisor directs patient(s) transport, making sure all patients are transported to the assigned area hospital(s)

5. De-escalation

a. After action typically held within 5 days after occurrence

b. County EMA, in conjunction with the Authority Having Jurisdiction (AHJ), may coordinate the process, or may delegate the process to the Regional EMS Council

c. Agencies requesting a QI review should contact the AHJ. Should a participating hospital desire a review they should contact the County EMA

d. The QI process may be informal, or formal, depending on the nature of the review

e. All participating agencies are invited to send a representative, the coordinator may elect to request specific personnel to be in attendance

Zone “A”

Zone “B”

Zone “C”

Zone “D”

Note: Zones are based on

transport time to hospital and

number of transportable units

in area

Mass Casualty Levels

These recommendations should be adjusted taking into account; weather, transport time, EMS coverage. It is better to turn units around rather than to wish you had more.

ZONE A

Level 1 (Up to 10 Patients)

Relatively minor incident involving 3-10 surviving persons. Local resources stressed for a short period of time.

Level 2 (11-20 Patients)

Mass Casualty Incident involving 11-20 surviving persons. County resources stressed for an extended period of time.

Level 3 (21-50 Patients)

Catastrophic Casualty Incident involving 21-50 surviving persons. Regional Resources stressed for an extended period of time.

Respond to Scene

Respond to Scene

Respond to Scene

2 BLS Transportable Units

2 ALS Transportable Units

2 Medic Units (Fly Car)



2 Medic Cars (Fly Car)



2 Medic Units (Fly Car)

EMMCO West EMS Strike Team

Place on Standby

Place on Standby

Place on Standby

Air Medical



Air Medical



2 Air Medical



Mass Transit Vehicle

Transfer Assignment

Transfer Assignment

Transfer Assignment

Upon Request

1 BLS Squad to 1 Central stations of affected Area.

1 BLS Squad to 2 Central stations of affected area.

Zone B – Add 1 Ambulance

Zone C – Add 2 Ambulances

Zone D – Add 3 Ambulances

**PLEASE NOTE: Fire Department response shall be dictated by local dispatch protocol

General Organization Positions and Responsibilities

In determining staffing of each position, the IC must take into account both the qualifications of the available personnel and the demands of the particular incident. Positions should be staffed based on the best use of available resources. Position check sheets are located after this section.

First Arriving Unit (Officer)

· Performs size-up

· Gives a brief radio report

· Initiates the MCI Plan when necessary

· Directs MCI scene set-up

· Requests additional personnel for purposes of triage

· Calls for additional assistance if necessary

· Maintains role of Incident Commander until relieved

· Supervises litter bearers

First Arriving Unit (Driver)

· Isolates walking wounded, if possible

· Triages remaining patients, using the START system

· Establishes a funnel point

· Maintains role of Triage Team Leader until relieved

Incident Commander (IC)

Consistent with the Incident Management System the IC is responsible for all activities at an incident.

· Ensuring clear authority and knowledge of agency policy

· Ensuring incident safety

· Establishing an Incident Command Post

· Obtaining a briefing from the prior IC and/or assessing the situation

· Establishing immediate priorities

· Determining incident objectives and strategy (ies) to be followed

· Establishing the level of organization needed, and continuously monitoring the operations and effectiveness of that organization

· Managing planning meetings as required

· Approving and implementing the Incident Action Plan

· Coordinating the activities of the Command and general staff

· Approving requests for additional resources or for the release of resources

· Approving the use of participants, volunteers, and auxiliary personnel;

· Ordering demobilization of the incident when appropriate

· Ensuring incident after-action reports are complete

· Authorizing information release to the media

Safety Officer

· Reports directly to the Incident Commander

· Must have incident specific training/knowledge

· Identifies and causes correction of occupational safety and health hazards

· Ensures safety messages and briefings are made

· Exercises emergency authority to stop and present unsafe acts

· Review the IAP for safety implications

· Assign assistants qualified to evaluate special hazards

· Initiate preliminary investigations of accidents within the incident area

· Review and approve the Medical Plan

Public Information Officer (PIO)

· Responsible for formulating and disseminating factual and timely information about the incident to the news media and other appropriate agencies

· Prepares public information releases (upon IC’s approval)

· Establishes a single phone number that should be released to the public for information

· Other personnel should not give statements to the media unless authorized by the PIO

· Determines according to directions from the IC, any limits on information released

· Arranges for tours and other interviews or briefings that may be required

· Maintains current information, summaries, and/or displays on the incident

Liaison Officer

· Responsible for interacting (by providing a point of contact) with the other agencies and organizations involved in a disaster

· Maintains a list of assisting and cooperating agencies and agency representatives

· Assists in setting up and coordinating inter-agency contacts

· Monitors incident operations to identify current potential inter-organizational problems

· Provides agency specific demobilization information and requirements

Operations Section Chief

· Responsible for managing all tactical operations at an incident

· Must have incident specific training/knowledge

· Performs duties as directed by the Incident Commander

· Ensures safety of tactical operations

· Develops operations portion of the IAP

· Requests additional resources to support tactical operations

· Makes or approves changes to the IAP

Staging Officer

· Keeps a current inventory of all resources for his/her staging area

· Arranges a staging area where personnel and resources that are not immediately needed can be positioned to await an assignment

· Maintains communications with the Transport Team Leader to supply necessary ambulances, as well as to advise on available resources and send requested resources to the scene

Medical Group Supervisor

· Responsible for developing a Medical Group necessary to manage multiple casualty patients

· Coordinates triage, treatment, transportation, staging, and morgue operations

· Ensures adequate resources are requested/assigned within Medical Group

· Accounts for the personnel assigned to the Medical Group

· Maintains records and forward them to the IC

Treatment Team Leader

· Responsible for supervising treatment and prioritizing patients for transport

· Establishes treatment area(s) and/or patient loading area(s)

· Ensures adequate resources to treat patients

· Coordinates patient loading with Transportations Officer

· Maintains documentation of activities within treatment area

· Identifies and directs specific treatment unit leaders as necessary

Triage Team Leader

· Responsible for directing and coordinating triage activities

· Assigns early arriving EMTs to initiate field triage

· Ensures that all patients are tagged

· Directs movement of patients to treatment/transport area

· Ensures adequate resources necessary to conduct triage activities

Transportation Team Leader

· Responsible for coordinating the loading and transporting of all patients from the incident site

· Ensures adequate resources for transportation of all patients

· Directs the movement of transport units between staging and loading areas.

· Documents patient destination, departure time, and transporting agency

Morgue Team Leader

· Responsible for coordinating the management of the deceased

· Coordinates morgue duties with local police and County Coroner

· Assures security of the personal effects and bodies of the deceased

· Coordinates disposition of patients who die in the treatment area

· Maintains documentation of morgue activities

FIRST UNIT ON SCENE

First unit on scene gives visual size-up, assumes and announces command, and confirms incident location, then…the 5 S's

SAFETY assessment. Assess the scene observing for:

· Electrical hazards

· Flammable liquids

· Hazardous Materials

· Secondary Devices

· Other life threatening situations

SIZE UP the scene: How big and how bad is it? Survey incident scene for:

· Type and/or cause of incident

· Approximate number of patients

· Severity level of injuries (either Major or Minor)

· Area involved, including problems with scene access

SEND information:

· Contact dispatch with your size-up information

· Clearly state “THIS IS A MASS CASUALTY INCIDENT”

· Request additional resources

SETUP the scene for management of the casualties:

· Establish triage

· Identify access and egress routes

· Identify adequate work areas for Triage, Treatment, and Transportation

START (Simple Triage and Rapid Treatment) and JumpSTART (pediatric patients)

· Begin where you are

· Ask anyone who can walk to move to a designated area

· Use surveyor’s tape/triage tags to mark patients

· Move quickly from patient to patient

· Maintain patient count

· Provide only minimal treatment

· Keep moving!

Remember… ESTABLISH COMMAND, SAFETY, SURVEY, SEND, SET-UP AND START/JumpSTART

FIRST UNIT ON SCENE

FIRST UNIT ON SCENE

NOTES

ACTIVITY LOG (ICS 214)

1. Incident Name:

2. Operational Period: Date From: Date To:

Time From: Time To:

3. Name:

4. ICS Position:

5. Home Agency (and unit)

6. Resources Assigned:

Name

ICS Position

Home Agency (and unit)

7. Activity Log:

Date/Time

Notable Activities

8. Prepared by: Name:____________________Position/Title:__________________Signature:________________

ICS 214, Page 1

Date/Time: ________________________________


1. Incident Name:


Time From: Time To:

3. Name:

4. ICS Position:



Name

ICS Position


7. Activity Log:

Date/Time

Notable Activities


ICS 214, Page 1

Date/Time: ________________________________

INCIDENT COMMANDER

(Preferred Level: Appropriate training and experience for incident type, supervisory experience)

MISSION: Responsible for the overall management and coordination of personnel and resources responding to the incident.

Tasks:

· Assumes command and announces name and title to the communication center

· Dress in identifying vest

· Identify potentially hazardous situations

· Assess current situation

· Estimate number of patients

· Request additional manpower and equipment as appropriate

· Mark Incident Command Post (ICP) with green light

· Transition to Unified Command when appropriate

· Initiate, maintain and control communications

· Assign ICS functions

· Develop, evaluate and revise operational plans

· Coordinate with other agencies

Name/Unit

Position

Radio Frequency

Operations

Staging

EMS/Medical Branch

Triage

Treatment

Transport

Safety

Extrication

Public Information

HELPFUL HINTS

* Use face-to-face contact when possible

* Many units will be coming in so be sure to establish a staging area

* Appoint a STAGING OFFICER early on to handle this for you if necessary

* Remember the ICS concept – you cannot do it all!

* As tasks are completed, move people onto other tasks

* Extended incidents will require many planning and tactics meetings

INCIDENT COMMANDER

INCIDENT COMMANDER

NOTES


1. Incident Name:


Time From: Time To:

3. Name:

4. ICS Position:



Name

ICS Position


7. Activity Log:

Date/Time

Notable Activities


ICS 214, Page 1

Date/Time: ________________________________


1. Incident Name:


Time From: Time To:

3. Name:

4. ICS Position:



Name

ICS Position


7. Activity Log:

Date/Time

Notable Activities


Date/Time: ________________________________

OPERATIONS SECTION CHIEF

(Preferred level: Appropriate training and experience for incident type, supervisory experience)

MISSION: Responsible for the implementation of the IAP and creating tactics

Tasks:

· Meets with IC/UC to assist in creating IAP


· Identify potentially hazardous situations

· Create tactics to accomplish incident objectives

· Brief key personnel on tactics

· Request additional manpower and equipment as appropriate

· Maintain and control communications

· Assign ICS functions as directed by IC

· Develop, evaluate and revise operational plans with IC

· Coordinate with other agencies

Name/Unit

Position

Radio Frequency

Operations

Staging

EMS/Medical Branch

Triage

Treatment

Transport

Safety

Extrication

Public Information

HELPFUL HINTS

* Use face-to-face contact when possible

* Many units will be coming in so be sure to establish a staging area

* Appoint a STAGING OFFICER early on to handle this for you if necessary

* Remember the ICS concept – you cannot do it all!

* As tasks are completed, move people onto other tasks

OPERATIONS SECTION CHIEF


1. Incident Name:


Time From: Time To:

3. Name:

4. ICS Position:



Name

ICS Position


7. Activity Log:

Date/Time

Notable Activities


ICS 214, Page 1

Date/Time: ________________________________


1. Incident Name:


Time From: Time To:

3. Name:

4. ICS Position:



Name

ICS Position


7. Activity Log:

Date/Time

Notable Activities


ICS 214, Page 1

Date/Time: ________________________________

EMS/MEDICAL BRANCH DIRECTOR

(Preferred level: Paramedic, PHRN, or Pre-Hospital Physician with supervisory experience)

MISSION: To ensure that supervision and coordination is provided for triage, treatment, transportation and extrication of all patients.

Tasks:

· Assume command of EMS/MEDICAL BRANCH

· Report and provide frequent updates to the OPERATIONS CHIEF

· Determine main Base/Coordinating Hospital

· May also have the role of Incident Command on small incidents


· Locate in a visible position

· Coordinate, direct and manage all EMS/MEDICAL BRANCH departments

· Account for all personnel assigned to this group

· Monitor safety and welfare of group personnel

· Consider relief crews

· Request separate ambulance staging area if needed

· Consider Casualty Collection Point or Alternate Care Sites

· Appoint and assign EMS/MEDICAL BRANCH SUPERVISORS and support staff:

Name/Unit

Position

Radio Frequency

Incident Command

Operations

Staging

Triage

Treatment

Transport

Safety

Extrication

Public Information

*On small incidents this position may also be the INCIDENT COMMANDER position

HELPFUL HINTS

* Consider having a Medical Command Physician report to the scene for onsite medical direction

* The EMS/MEDICAL BRANCH DIRECTOR is not to be confused with the MEDICAL UNIT LEADER. The MEDICAL UNIT LEADER is responsible for responder medical needs, and reports to LOGISTICS OFFICER.

EMS/MEDICAL BRANCH DIRECTOR


1. Incident Name:


Time From: Time To:

3. Name:

4. ICS Position:



Name

ICS Position


7. Activity Log:

Date/Time

Notable Activities


ICS 214, Page 1

Date/Time: ________________________________


1. Incident Name:


Time From: Time To:

3. Name:

4. ICS Position:



Name

ICS Position


7. Activity Log:

Date/Time

Notable Activities


ICS 214, Page 1

Date/Time: ________________________________

STAGING BRANCH DIRECTOR


MISSION: To maintain separate stockpiles of manpower, reserve equipment and expended equipment at a staging area away from the incident.

Tasks:

· Establish STAGING AREA in coordination with OPERATIONS and/or COMMAND

· Establish the STAGING AREA at a site away from the scene.

The STAGING AREA should:

· Be large enough to handle the expected number of units

· Have easy access and egress

· Be close to major transportation routes

· Have easy access to the TRANSPORTATION AREA

· Provide appropriate vehicles, equipment, and resources as requested

· Order all personnel to remain with their vehicles

· Maintain and document the status of number and types of resources in STAGING

HELPFUL HINTS

*Maintain communications with EMS/MEDICAL BRANCH and TRANSPORTATION LEADER

*Consider options for alternate transportation vehicles (buses, etc.)

*Consider options for removing medical supplies from vehicles for relocation to equipment

stockpile area:

Backboards/StrapsSplints/Bandages

BlanketsOxygen Supplies

IV SuppliesOthers as needed

**ENSURE THAT AMBULANCE COTS ARE NOT REMOVED FROM UNITS

EQUIPMENT CHECKLIST

“STAGING MANAGER” Vest

“STAGING” Vest(s)

Barricade Tape

Portable Radio

Staging Sector Forms

Clipboard(s)

Road Cones

STAGING BRANCH DIRECTOR


1. Incident Name:


Time From: Time To:

3. Name:

4. ICS Position:



Name

ICS Position


7. Activity Log:

Date/Time

Notable Activities


ICS 214, Page 1

Date/Time: ________________________________


1. Incident Name:


Time From: Time To:

3. Name:

4. ICS Position:



Name

ICS Position


7. Activity Log:

Date/Time

Notable Activities


ICS 214, Page 1

Date/Time: ________________________________

TRIAGE UNIT LEADER

(Preferred level: Paramedic, PHRN, Pre-Hospital Physician with supervisory experience)

MISSION: To assess and sort casualties to appropriately establish priorities for treatment and transportation.

Tasks:

· Report and provide updates to EMS/MEDICAL BRANCH DIRECTOR


· Locate in a visible position between the incident site and the treatment area

· If danger exists, ensure all patients are moved out of INCIDENT AREA before establishing TRIAGE

· Establish controlled pathway (“cattle shoot”) from the incident site to the treatment area

· Direct walking wounded to designated treatment area

· If START/JumpSTART not yet completed by first arriving crews, appoint triage teams to perform START/JumpSTART using triage tags

· Coordinate the transfer of patients to TREATMENT area with EXTRICATION. Request “porters” from INCIDENT COMMAND (or EMS/MEDICAL BRANCH DIRECTOR)

as necessary

· Appoint “porters” to transport patients via backboards to treatment area. This function may be performed by personnel from the EXTRICATION/RESCUE Group. Coordinate with EXTRICATION/RESCUE

· Maintain communications with EMS/MEDICAL BRANCH DIRECTOR and other OFFICERS

HELPFUL HINTS

*Continue START/JumpSTART until all patients have been triaged. Have triage teams work in an orderly fashion.

*Move all RED patients to the TREATMENT AREA first, unless tight quarters necessitate moving others first in order to gain access to RED patients

*Move YELLOW patients next

*Have GREEN patients walk to a designated location at the TREATMENT AREA

*Leave all BLACK tag patient(s)

*Once a triage tag is applied and color identified the triage ribbons may be removed.

EQUIPMENT CHECKLIST

TRIAGE KIT(S)

“TRIAGE TEAM LEADER” Vest

Triage tags

“TRIAGE” Vest(s)

4x4 Dressings (25)

Portable Radio

2” Tape (2)

Clipboard(s)

4” Kling (2)

Lighting

Oral Airway Set

Grease Pencils/Marking Pens

Vaseline Gauze (3)

Colored Ribbons


1. Incident Name:


Time From: Time To:

3. Name:

4. ICS Position:



Name

ICS Position


7. Activity Log:

Date/Time

Notable Activities


ICS 214, Page 1

Date/Time: ________________________________


1. Incident Name:


Time From: Time To:

3. Name:

4. ICS Position:



Name

ICS Position


7. Activity Log:

Date/Time

Notable Activities


ICS 214, Page 1

Date/Time: ________________________________

EXTRICATION/RESCUE UNIT LEADER


MISSION: To ensure the safe and rapid removal of entrapped patients and their prompt delivery to treatment area.

*Note* Contaminated patients must be decontaminated prior to being moved to triage or treatment areas

Tasks:

· Report to and provide updates to OPERATIONS OFFICER or EMS/MEDICAL BRANCH DIRECTOR


· Locate in a visible position with clear view of overall extrication operation

· Supervise and coordinate the EXTRICATION process

· Assist TRIAGE UNIT LEADER in determining if triage can be conducted at the incident site or if victims must be moved to a safe area prior triage

· Locate and remove trapped victims/patients and deliver them to the treatment area

· Assist in determining need for emergency medical care for patients undergoing extended/delayed extrication and request additional medical resources

· Maintain patient and team safety during all phases of the EXTRICATION

· Request relief crews to maintain progress towards extrication objectives

· Request specialized equipment and/or supplies through OPERATIONS or LOGISTICS

· Request additional manpower and/or fire suppression personnel to protect entrapped victims during the EXTRICATION process.

· Provide essential and frequent progress reports to TRIAGE and EMS/MEDICAL BRANCH DIRECTOR as appropriate

HELPFUL HINTS

*If in hazardous are, EXTRICATE patients rapidly and move to TREATMENT AREA

*Maintain close contact with TRIAGE and TREATMENT UNIT LEADERS

*Assist TRIAGE in orderly transfer of patients to TREATMENT area moving ALL RED TAGS FIRST

*Assist TREATMENT and TRANSPORTATION OFFICERS in moving patients when all extrications are complete (if needed)

EXTRICATION/RESCUE UNIT LEADER


1. Incident Name:


Time From: Time To:

3. Name:

4. ICS Position:



Name

ICS Position


7. Activity Log:

Date/Time

Notable Activities


ICS 214, Page 1

Date/Time: ________________________________


1. Incident Name:


Time From: Time To:

3. Name:

4. ICS Position:



Name

ICS Position


7. Activity Log:

Date/Time

Notable Activities


ICS 214, Page 1

Date/Time: ________________________________

TREATMENT UNIT LEADER

Preferred level: Paramedic, PHRN, Pre-hospital Physician with supervisory experience

MISSION: Provide continuing assessment, triage, and care to patients awaiting transportation

Tasks:

· Report and provide updates to the EMS/MEDICAL BRANCH DIRECTOR



· Establish TREATMENT area

· Triage patients constantly. Initially use the START/JumpSTART method, but apply more detailed assessments as Secondary Triage is initiated

· Verify triage tags as patients are moved into the treatment area

· Appoint immediate, delayed and minor care managers as needed

· Work with TRANSPORTATION UNIT LEADER to determine appropriate order of transport

· Constantly reassess patients’ conditions and priorities

· Consider requesting medical Command Physician to area for on-site medical direction

HELPFUL HINTS

*Arrange and clearly mark TREATMENT Area. Patients should be placed in parallel rows based on triage category

*Identify areas for each triage category using colored tarps, flags, tape, etc.

*Isolate emotionally disturbed patients

*Have “WALKING WOUNDED” (GREEN) move to an out-of-the-way area

*Continuously triage ALL patients. Remove ribbons once tags applied since patient conditions may have changed

*Assign appropriate medical personnel to treatment area. Consider establishing special teams (i.e. IV teams. Bandaging teams, etc.)

*Maintain contact with TRANPORTATION UNIT LEADER and assist in moving patients to transportation area

*Establish “cattle chutes” staffed with triage personnel as “gatekeepers” at entrance to and exit from TREATMENT AREA to control patient flow

EQUIPMENT CHECKLIST

“TREATMENT TEAM LEADER VEST”

Treatment Sector Forms

“TREATMENT” Vest(s)

Grease Pencils/Marking Pens

Portable Radio

Barricade Tape

Clipboard(s)

Treatment Flags/Tarps

Lighting

Treatment Supplies


1. Incident Name:


Time From: Time To:

3. Name:

4. ICS Position:



Name

ICS Position


7. Activity Log:

Date/Time

Notable Activities


ICS 214, Page 1

Date/Time: ________________________________


1. Incident Name:


Time From: Time To:

3. Name:

4. ICS Position:



Name

ICS Position


7. Activity Log:

Date/Time

Notable Activities


ICS 214, Page 1

Date/Time: ________________________________

Triage Color

TREATMENT LOG

Tag #

Sex

Age

Primary Problem

Tube

IV

Meds

Arrival Time

Departure Time

Total Each Category

Triage Color

TREATMENT LOG

Tag #

Sex

Age

Primary Problem

Tube

IV

Meds

Arrival Time

Departure Time

TRANSPORTATION UNIT LEADER

Preferred level: EMT or above with appropriate experience

MISSION: To coordinate all patient transportation and maintenance of records relating to patient injuries as noted on triage tag

Tasks:

· Report and provide updates to the EMS/MEDICAL BRANCH DIRECTOR



· If not already accomplished establish ambulance STAGING area and appoint STAGING OFFICER, ensuring that drivers remain with units

· Arrange transport for those patients whom TREATMENT has selected for transport

· Record each patient’s triage tag number and destination

· Utilize different modes of transport based on patient needs and capabilities at the STAGING AREA

· Inform transport crews of their destination and of refueling/restocking sits (if necessary)

· Remind ambulance crews that they do not need to contact receiving facility

· Document patient and unit movements and destination

· Appoint LANDING ZONE OFFICER as necessary

· Maintain close communications with TREATMENT, ambulance STAGING and with EMS/MEDICAL BRANCH DIRECTOR

HELPFUL HINTS

*Suggest means of transport to EMS/MEDICAL BRANCH DIRECTOR (e.g. buses, helicopters, etc.)

*Ensure that transport ambulances are parked to allow easy patient loading and egress without being blocked by other vehicles. Avoid the need to have vehicles operate in reverse.

*Maximize use of resources; 1 RED + 1 YELLOW, 2 YELLOW. Avoid ambulances leaving with only 1 patient.

EQUIPMENT CHECKLIST

“TRANSPORATION TEAM LEADER VEST”

Grease pencils/Marking Pens

“TRANSPORTATION” Vest(s)

Barricade Tape

Portable Radio

Landing Zone Identification

Clipboard(s)

Spray Paint

TRANSPORTATION UNIT LEADER


1. Incident Name:


Time From: Time To:

3. Name:

4. ICS Position:



Name

ICS Position


7. Activity Log:

Date/Time

Notable Activities


ICS 214, Page 1

Date/Time: ________________________________


1. Incident Name:


Time From: Time To:

3. Name:

4. ICS Position:



Name

ICS Position


7. Activity Log:

Date/Time

Notable Activities


ICS 214, Page 1

Date/Time: ________________________________

Hospital Patient Capability Tracking

Use hash-marks to track number of patients transported

Hospital

Accepting Trauma Alerts

Trauma Alerts Transported

Accepting REDS

REDS Transported

Accepting YELLOW

YELLOWS Transported

Accepting GREENS

GREENS Transported

SAFETY OFFICER

(Preferred level: Appropriate training and experience for the incident type, supervisory experience)

MISSION: To monitor and assess hazardous and unsafe situations and develop measures for ensuring personnel safety.

Tasks:

· Report to the INCIDENT COMMANDER


· Provide a ring of safety around the incident

· Identify hazardous associated with the incident. Ensure adequate levels of PPE is available and being used properly

· Take immediate corrective action or stop unsafe situations or practices

· Notify COMMAND and OPERATIONS if unsafe situations are observed

· Observes the rescue ground for:

· Unsafe practices

· Use of protective equipment

· Need for relief crews

· Need for personnel rehab

· Observes structural integrity

· Monitors hazardous/toxic environments and exposure levels of emergency personnel

· Investigates injuries to department personnel and ensures proper levels of care are provided

· Ensures that personnel accountability system is in use and operating effectively

· Coordinate CISM/Mental Health debriefings

HELPFUL HINTS

*Consider use of Assistant Safety Officers

*Coordinate with subject matter specialists (i.e. public works, HazMat)

SAFETY OFFICER


1. Incident Name:


Time From: Time To:

3. Name:

4. ICS Position:



Name

ICS Position


7. Activity Log:

Date/Time

Notable Activities


ICS 214, Page 1

Date/Time: ________________________________


1. Incident Name:


Time From: Time To:

3. Name:

4. ICS Position:



Name

ICS Position


7. Activity Log:

Date/Time

Notable Activities


ICS 214, Page 1

Date/Time: ________________________________

PUBLIC INFORMATION OFFICER

(Preferred level: Appropriate training and experience for incident type)

MISSION: To disseminate factual and timely reports to the news media concerning the nature and extent of the incident and emergency medical care and treatment of victims.

Tasks:

· REPORT TO THE incident commander


· Contact the INCIDENT COMMANDER for a briefing

· Develop complete and accurate information regarding the incident

· Establish a media area away from the COMMAND POST

· Act as a liaison to the press

NAMES OF PATIENTS SHOULD NEVER BE RELEASED!!!!

· The media should be given:

· Time of incident

· Type of incident

· Extent of incident

· Location of incident

· Number of public safety personnel on scene

· Rescue efforts underway

· Amount of equipment

· Number of people rescued/injured

· Nature of injuries

· Hospital(s) to which injured patients(s) are taken

· The Information Officer should:

· Prepare Press Releases with the IC

· Be the only person to deal with the media

· Releases accurate information in a timely manner

· Educate the media about Incident Command System

· Facilitate interviews, brief responders, document actions

· Provide copies of all media releases to the Documentation Unit for inclusion in the final incident package

HELPFUL HINTS

*Consider establishing a Joint Information Center (JIC)

*Establish a schedule for news briefings to reduce the amount of information requests

PUBLIC INFORMATION OFFICER


1. Incident Name:


Time From: Time To:

3. Name:

4. ICS Position:



Name

ICS Position


7. Activity Log:

Date/Time

Notable Activities


ICS 214, Page 1

Date/Time: ________________________________


1. Incident Name:


Time From: Time To:

3. Name:

4. ICS Position:



Name

ICS Position


7. Activity Log:

Date/Time

Notable Activities


ICS 214, Page 1

Date/Time: ________________________________

RESOURCES

Every area of Pennsylvania has a unique set of resources. No one person can know every resource that may be available to them at an emergency. This section is a brief listing of some of the resources available in this area.

County and local EMA coordinators are the “go-to” people to determine what resources are in the area to assist at an emergency scene. Open dialogue early with your EMA as they are an invaluable asset.

ERIE COUNTY MASS CASUALTY TRAILER INVENTORY

Quantity Item QuantityItem

1

Pace Trailer 8x20:EMS Innovation Specs

1

20 watt megaphone with siren/whistle

1

Command Center

50

Green 12 hour light stick

1

Interior Racking System: bins, binders

50

Yellow 12 hour light stick

65

Adult disposaboard, straps, auto cradle

50

Red 12 hour light stick

20

Pediatric disposaboard system

50

Orange 12 hour light stick

2

Rapid response kits

50

Blue 12 hour light stick

2

Triage flag set

10

Stethoscope

2

Triage tape system

5

Adult BP cuff

100

Triage tags

5

Pediatric BP cuff

2

5 person o2 manifold with 25’ hose

2

Trituff suit, large, 25 each

3

Master pack of 25 five patient trauma kits

2

Trituff suit, 2xl, 25 each

50

36” padded cardboard splint

100

Arm bands

20

Body bags

100

Disposable blanket

100

Adult adjustable collar

50

1000cc normal saline

50

Pediatric adjustable collar

100

IV administration sets

2

100’ cord reel

100

IV start sets

4

50’ extension cord

100

16g IV needle

2

Dual light 500 watt each with tripod

100

18g IV needle

25

Traffic cones 28”

100

20g IV needle

200

Infectious waste bags

4

10x15 push up with 4 sides

100

Sterile burn sheet

1

5 gallon gas can

100

Multi-trauma dressings

2

Pressure reducer regulators

100

Disposable splints 18”

6

O2 regulators

100

Mask with face shield

1

Fire extinguisher

2

Box of 100 gloves, Small

8

Flash lights

2

Box of 100 gloves, Medium

1

14x24 inflatable tent (half price)

2

Box of 100 gloves, Large

1

18ft awning on curbside

2

Box of 100 gloves, X-Large

1

Lightweight dry toilet

2

Airway A kit

1

Wag bag kit 100/case

3

Airway B kit

2

5pt trauma kit with quikclot

2

M cylinder

1

Quikclot first response 25g(5/box)

4

D cylinder

8

Ferno stair chairs

1

Generator 6250 peak

1

UHF Med radio

2

1000 watt light tripod

The Erie County Mass Casualty Trailer is designed to treat at most about 375 severely injured patients or 4,000 walking wounded.

EMMCO WEST MASS CASUALTY TRAILER INVENTORY

Quantity Item Quantity Item

8000

Sterile 4x4 Dressings

48

C Cell Batteries

200


48

D Cell Batteries

650


48

AA Cell Batteries

170

Multi Trauma Dressings

1

Spare Tire

50

Sterile Burn Sheets

20

Box of 50 Hand Wipes

192

Kling Rolls, 4”

1

Generator, 2500 W

240

Tape, Durmacell, 1”

1

Command Tent, 10x10

50

C-Collars/Adjustable

8

CAT Tourniquets

20

C-Collars/Pediatric

20

Rain Gear, Disposable

30

CID, Disposable

10

Tape (PPE Suits)

100

Sam Splints

10

Flashlights, Maglite

50

Isolation Kits

1

Admin Kit

8

Gallons Waterless Hand Wash

5

Clip Board, Pen, Markers

200

Alcohol Preps

5

Security Tape

100

Face Shields

2

Tarp 10’x10’ Black

3

Cases of Body Bags

2

Tarp 10’x10’ Red

50

Back Boards

2

Tarp 10’x10’ Green

25

Spider Straps for B Bags

2

Tarp 10’x10’ Yellow

4

Cases Biohazard Bags

375

Triage Tags

100

Disposable Blanket

100

Disposable Ear Plugs

1000

Gloves Latex Free Small

6

Paper Kits

1000

Gloves Latex Free Medium

1

ABC Fire Extinguisher

1000

Gloves Later Large

147

PPE Kits

2000

Cidex Wipes

6

Tents 10-Man

20/10

BP Cuff Adult/Child

3

Duct Tape

2

N-95 Mask Small

2

Electric Cord

2

N-95 Mask Medium

10

Blue Helmet

2

N-95 Mask Large

6

Hand Vac Suction

2736

N-95 Resp. Uni Size

1

150’ Extension Cord

1

Case Surgical Mask/Eye Shield

10

Mag Lights

20

Stethoscopes

8

Thermometer with Probe

5

Staff Vest

1

Western PA Hospital Map

911 COORDINATOR

Notification checklist for Mass Casualty Incidents:

MCI LEVEL 3

MCI LEVEL 2

MCI LEVEL 1

· Notify Public Safety Director and Assistant 911 Coordinator

· Report to PSAP and assist with administrative duties

· Notify department heads to report to ECDOPS for Public Safety support as needed

ASSISTANT 911 COORDINATOR


MCI LEVEL 3

MCI LEVEL 2

MCI LEVEL 1

· Report to ECDOPS as directed

· Assign Admin staff to roles in PSAP

· Report to ECDOPS for Public Safety Support

· Perform other duties as assigned

TRAINING ADMINISTRATOR


MCI LEVEL 3

MCI LEVEL 2

MCI LEVEL 1



Q/A COORDINATOR


MCI LEVEL 3

MCI LEVEL 2

MCI LEVEL 1



HOSPITAL REPRESENTATIVES


MCI LEVEL 3

MCI LEVEL 2

MCI LEVEL 1

· Liaison between Dispatch, EOC, and hospitals

· Obtain available bed count

· Number of patient able to handle and class of patients

SHIFT COMMANDER


MCI LEVEL 3

· Change/Decrease in Operations

· Coordination of Operations/TAC Freq., including EMS Command Freq

· Additional PSAP Staffing

· Knowledge Center Report

· EMA Coordinator

· 911 Coordinator

· Notify EMMCO-West

MCI LEVEL 2





· EMA Coordinator

· 911 Coordinator


MCI LEVEL 1





· EMA Coordinator

· 911 Coordinator


· American Red Cross

FIRE DISPATCHER


MCI LEVEL 3

· Dispatch First Alarm Assignment

· Assignment of Operations/TAC Freq., including EMS Command Freq

· Notification of al area hospital ER’s

· How many patients can each hospital handle?

· Local EMC’s via page

· Advise OIC and transportation/triage officer of hospital capabilities

· Work with transportation/triage officer to route patients accordingly, if transportation/triage officer not appointed ECDOPS will advise on disbursement of patients to area hospitals according to hospital capabilities

MCI LEVEL 2






· Local Transportation (buses, etc.)

· Advise OIC and transportation/triage officer of hospital capabilities

· Work with transportation/triage officer to route patients accordingly, if transportation/triage officer not appointed ECDOPS will advise on disbursement of patients to area hospitals according to hospital capabilities

MCI LEVEL 1






SQUAD

HEAVY RESCUE

NOTES:

DISPATCH

WARREN COUNTY

Sugar Grove

X

16 Miles to the county line

Warren County

Youngsville

X

X


Warren County

Grand Valley

X


Warren County

EmergyCare Warren

X

From Warren City

Warren County

Springboro

X

X

West

Crawford County

Conneautville

X

X

West

Crawford County

Summit

X

X

West

Crawford County

Venango

X

Central / West

Crawford County

CLASS

(Conneaut Lake Area Ambulance)

X

West

Crawford County

CAVAS

(Cambridge Springs Ambulance)

X

Central

Crawford County

Cambridge Springs

X

Central

Crawford County

Saegertown

X

Central

Crawford County

Meadville Area Ambulance

X

Central

Crawford County

Blooming Valley

X

Central

Crawford County

Bloomfield

X

Central / East

Crawford County

Spartansburg

X

Central / East

Crawford County

Centerville

X

Central / East

Crawford County

EmergyCare Titusville

X

Central / East

Crawford County

ASHTABULA COUNTY (OHIO)

Conneaut

X

X

3 Ambulances

Conneaut City FD

North Kingsville

X

2 Ambulances

Ashtabula Twp. FD

Kingsville

X

2 Ambulances

Ashtabula Twp. FD

Ashtabula Twp.

X

2 Ambulances

Ashtabula Twp. FD

Pierpont

X

Ashtabula Twp. FD

Community Care Ambulance

X

3-4 Units (30-40 Min ETA)

Community Care Ambulance

CHAUTAUQUA COUNTY (NEW YORK)

Ripley

X

North

Chautauqua County

South Ripley

X

North

Chautauqua County

Westfield

X

X

North

Chautauqua County

Findley Lake

X

North

Chautauqua County

Chautauqua

X

Closer to Lake Chautauqua

Chautauqua County

Mayville

X


Chautauqua County

Sherman

X

Off I-86

Midway to Lake Chautauqua

Chautauqua County

Ashville

X


Chautauqua County

Clymer

X

X

Closer to Corry

Chautauqua County

Panama

X

Closer to Corry

Chautauqua County

AllStar Ambulance

X

AllStar Ambulance