volusia county fire chiefs association model …

VOLUSIA COUNTY

FIRE CHIEFS

ASSOCIATION

MODEL OPERATING GUIDELINE

POLICY # SUBJECT: Mass Casualty Incident Response Plan

DATE ISSUED: January 25, 2016 REVIEW DATE:

I. Purpose The following procedures have been adopted to address responses to, and the special

problems in dealing with mass casualty incidents. Command responsibilities, and

Command options must still be met as covered previously in this manual.

II. Policy These procedures are adopted by the Volusia County Fire Chiefs’ Association to aid

agencies with interoperability at large scale incidents involving life and property. All

countywide adopted policies concerning Command, accountability, and employee safety

should be considered when using this policy.

III. Definitions Mass Casualty Incident (MCI) – Any incident that generates sick or injured patients that

taxes the immediate capability of on scene EMS resources.

IV. Procedures

This page intentionally left blank

Volusia County Mass Casualty Incident (MCI) Response Plan

Volusia County Mass Casualty Incident (MCI) Response Plan was formed to be a working

document to guide all EMS assets and resources in the County of Volusia to respond and operate

cohesively during a mass casualty event. This document is intended to guide incident

commanders to the appropriate steps, systems, and responders to utilize in specific roles during

an incident. As with any MCI/Disaster situation flexibility must be afforded to those participants

to allow for the infinite variables associated with situation of this type. No two MCI/Disaster

situations are alike and adaptations must be made for each circumstance.

All EMS response agencies in Volusia County have adopted and work under the National

Incident Management System (NIMS) and its Incident Command Structure (ICS). Volusia

County’s EMS Agencies has the ability and willingness to work under a Unified Command and

an Incident Action Plan (IAP) using appropriate forms as designed for this type of activity.

Volusia County’s EMS Agencies utilize the START Triage system for adult patients and Jump

START triage system when triaging pediatric patients. All agencies have been requested by the

Volusia County EMS Medical Director to utilize the Florida SERT Triage Tags.

An MCI level 1 can be declared on scene by Volusia County EMS (VCEMS) Lieutenants or

VCEMS Supervisory personnel, Fire Chiefs, Battalion Chiefs, Commanders, or the Incident

Commander. An MCI can be declared at levels above Level 1 by on scene VCEMS Lieutenants

or VCEMS Supervisory personnel, on scene Fire Chiefs, on scene Battalion Chiefs, on scene

Commanders, and the VCEMS System Status Controller. An MCI declaration should be based

on resource needs and not purely on patient count.

The positions identified in the plan include (for detailed responsibilities see position worksheet):

EMS Branch Supervisor will manage the medical operations under the Operations

Section Chief. EMS Branch Director oversees Triage, Treatment, Transport, and Staging

Managers.

Triage Supervisor is responsible for the sorting, identification of triage levels of

patients, and movement of patients from the area they are initially located to the

treatment or transport area.

Treatment Supervisor is responsible for the treatment areas designated by the triage

levels green, yellow, red, and black and having the supplies on hand to provide necessary

initial care for those patients.

Transport Supervisor is responsible for the transport area tracking patient flow to

receiving facilities, & assigning the appropriate destination to transporting units.

Staging Area Supervisor is responsible for the gathering and staging of incoming units

and tracking which resources are at the scene and what resources are anticipated to be at

the scene.

Volusia County Mass Casualty Incident (MCI) Response Plan

This plan is a flexible plan based on the size and scope of the incident, the layout of this manual

includes:

1. First Responding Unit Priorities

2. MCI Response Assignments

3. EMS Communications Plan

4. MCI Resources and Assets in Volusia County

5. MCI Management Forms

Incident Commander

Operations Section Chief

EMS Branch Supervisor

Triage

Treatment

Transport

Staging

Logistics Planning Finance

Safety

First Responding Unit Priorities

First in EMS Unit should be assigned / or assume the initial Triage Officer role.

A size up of estimated patient count should be provided to Command and to the

Communications Center on the Tac Channel as soon as possible.

Updates should be given every 5 minutes for the first 15 minutes at minimum, then every 10

minutes for the first hour, and then every half hour for the first three hours from the EMS Branch

/ Incident Commander on the Tac Channel. This should include total patient count, including

count of each triage color (red, yellow, green, black) and current count of patients transported or

refused transport.

Triage Officer should anticipate additional resource needs and relay those requests to the

Incident Commander as early as possible.

MCI Response Assignments

* P.I.P. - Patient Intake Point - Section of MCI where all triaged victims are routed to for treatment based on

triage designation. All patients are tracked through the Treatment Unit.

** P.E.P - Patient Extraction Point - Section of MCI where all triaged and treated patients are routed for transport.

All patients are tracked through the Air/Ground Transport Unit

UNIT MCI PRIORITIES

1ST EMS Capable Unit

1ST Unit ‐Triage Unit Leader ‐Initiate & Complete Primary Patient Triage, this may be passed to the next

unit if Hazard Mitigation is needed this would then be done by first arriving VCEMS unit

2ND EMS Capable Unit

2ND Unit ‐Transport Group Supervisor

3RD EMS Capable Unit

3RD Unit ‐ Treatment Unit Leader‐Establish & Set‐up Patient Treatment Area(s) Establish & announce

“P.I.P”*, if not needed report to Triage

4TH EMS Capable Unit

4TH Unit Report to Triage Unit Leader


5TH Unit ‐Report to Treatment Unit Leader if needed, if not report to Staging


6th Unit Report to Staging or Establish same, if not already done

All other Units Report to Staging, including all EMS transport units 2nd arriving and above

1ST EMS Transport

1ST EMS Transport unit ‐Establish Transport Group & Transport Recorder. Establish & announce

“P.E.P.”** May be relieved by Second VCEMS Supervisor

1ST VCEMS

SUPERVISOR

1ST EMS SUPERVISOR – Establish EMS Branch

1ST CHIEF OFFICER

1ST CHIEF OFFICER ‐Assume Incident Commander, initial EMS Branch until arrival of VCEMS

Supervisor

2ND EMS

SUPERVISOR/ CHIEF

OFFICER

2ND EMS SUPERVISOR – Assume Transport Group Supervisor

3RD EMS

SUPERVISOR/ CHIEF

OFFICER

3RD EMS SUPERVISOR - Assume Treatment Unit Leader

EMS Communications Plan

Primary EMS Operations – EMS operations will be conducted on the assigned Tac Channel.

When an additional Tac channel is needed one will be assigned by the Communications Center,

if possible one Tac Channel up from the Channel in use for this incident. This can also happen if

a third channel is needed. If more than 3 Tac channels are needed the Command Staff should

move to a VCWIDE channel and leave both Fire and EMS operations on the TAC Channel they

are currently assigned to. (VCWIDE 11 is reserved for Fire and VCWIDE 12 is reserved for

EMS)

EMS Channels may be needed for the following functions: EMS Command Staff, Triage

Division, Treatment Division, Transport Division with System Status Controller, and Staging

which may be combined with Fire Staging whenever possible. The number of channels in use

should be kept to a minimum whenever possible, and only expanded for extensive incidents

when the radio traffic dictates additional channels. Most incidents can be managed with only one

Tac Channel for EMS Command Staff and the EVAC Admin channel for the EMS Branch /

Transport Supervisor to communicate with System Status Controller. This will make the incident

easier for the EMS Branch and Incident Commander to monitor and manage.

Volusia County Emergency Communications Talk Groups (800 MHz)

Fire / Rescue:

Fire 1 or Fire 2– Primary Dispatch Talk Group

Tac 3- 28 – Working tactical talk groups for responding fire apparatus to be utilized for event

while on scene. Can be patched if necessary

National Conventional Channels – Working talk group for all responding fire agencies. Can be

patched if necessary.

Specific Agency Talk Group(s) – Each agency has a designated talk group utilized for talk around

purposes during ground activity.

Volusia County EMS:

Evac Admin – primary SSC talk group

Tac 3-28 – Working tactical talk groups for responding EMS apparatus to be utilized for event

while on scene. Can be patched if necessary. May need to go up by one channel as the need for

channels initially expand.

Countywide Disaster:

VC Wide 2-9 – Reserved for tactical assignment

VC Wide 10 – Command

VC Wide 11 – Fire

VC Wide 12 – EMS

VC Wide 13 – Law Enforcement

VC Wide 14 – Support

VC Wide 15 – Haz Mat

System Status Controller (SSC / VCEMS Lieutenant in Communications Center) – SSC

will provide initial notification to the receiving hospitals of the number and severity of patients.

They will also be the contact between the EMS Transport Officer and the Hospitals assisting

with coordination of patient assignment and tracking. This can be done on the EVAC Admin

Channel.

When the request for an incident to be called as a Mass Casualty Incident (MCI) the VCSO

Communications operator will manage the resources as an “MCI” to track the resources assigned

to that call.

The county MCI Assets will be broken into two response groups based on geography:

East MCI Resource group will include the VCFS Daytona Beach Airport MCI trailer, &

Daytona International Speedway Emergency Services trailer.

West MCI Resource group will include the VCFS Deland Airport MCI trailer, and

Deltona Fire MCI Trailer.

A request for the MCI resource group on a side of the county will initiate a page to all units in

that Resource group. Requests for MCI resource groups should be limited to pre-staged events

and events of greater than 15 patients.

APPENDIX

Appendix A - Volusia County MCI Assets

Volusia County EMS / Fire MCI Resources

Agency Backboards Mobile/Traile

r/Station Fanny Packs Other Kits Additional Equipment

Daytona Beach Shores 2 Mobile No Triage Kit

Daytona Intl Speedway 100 Mobile (2

units) Yes 3 roll around

boxes for

resupply

2 sets of DMS Triage

Tarps/Kits,

2 Command units

with Sound s

Commander public

address set up

Deland 10 Stations Yes Cert Trailer

(bandaging, triage

bags

with tags)

Deltona 30* Trailer Yes MCI Kit include

flags, tarps,tags Trailer has O2 hook

up for MCI

Edgewater 6 * Mobile Yes EMS/MCI

Command

Equipment

MCI Tarps, 6 BLS

Treatment Kits,

and spare "E" tank

systems

Holly Hill 0 No No None None

New Smyrna Beach 20 Station Yes Mega Phone Kit

Orange City 23 station Yes limited MCI

supplies

Ponce Inlet 4 N/A Yes Blue MCI Kit

(State funded)

Port Orange 0 Warehouse Yes

2 Sets of MCI

MGMT

Systems, MCI

Tarps, 10 Vinyl

Tape Holders

South Daytona

Volusia County Fire 2 trailers

Volusia County EMS

(EVAC) 80 Yes

2 sets of tarps

and MCI vests

on each Lt.

vehicle (210 &

211)

Appendix B - MCI Management Forms

1. EMS Branch Procedure

2. EMS Branch Worksheet

3. Staging Officer Procedure

4. Staging Officer Worksheet

5. Triage Officer Procedure

6. Triage Officer Worksheet

7. Treatment Officer Procedure

8. Treatment Area Log Sheet

9. Transport Officer Procedure

10. Transport Officer Worksheet

This page intentionally left blank

EMS BRANCH PROCEDURE

Radio Designation “EMS BRANCH”

o Vest “MEDICAL”

o Co-Join with COMMAND / Operations Section Chief in command post; If command is

not established, set up in safe, secure and visible location

o Brief with COMMAND to request:

o Appropriate number of units based on patient count

o Appropriate number of Air transport units

o Establish EMS STAGING area

o Request EMS radio channel (VC Wide 11); if possible also request an EMS staging channel

o Confirm notification pages made

o Request additional medical resources as needed

MCI Trailer

Personnel

o Assign the following functions as needed:

o TRIAGE

Litter Bearers

Patient insertion points (PIP) / Patient exit points (PEP)

o TREATMENT AREA if appropriate

Red / Yellow/ Green

Area Managers for each treatment area

o TRANSPORT OFFICER

o EMS SAFETY OFFICER

o EMS BRANCH AIDE to assist in communications and documentation

o Advise Comm. Center of exact number of victims and categories as reported by triage

o Coordinate with SSC to notify area Hospitals of incident and get count of patients they can

accept

o Stage incoming units for assignment

o Determine if additional medical supplies will be needed

o Supply Officer

AST on OPS Channel

o Demobilize resources to meet incident needs

o Complete EMS BRANCH paperwork and secure any other paperwork that may have

been created by other EMS operations on scene. (Treatment logs, Triage sheets,

Transport log)

o The Air Medical Helispot Coordinator role will be fulfilled by Volusia County Sheriff’s

Office (VCSO).

MCI Procedure Predetermined Response Plan

MCI LEVEL 1 (5-10 VICTIMS)

4 ALS Transport Units 1 Battalion Commander

2 Fire Suppression units 1 EMS Supervisor

Note: The 2 closest hospitals and Trauma Center will be notified by System Status Controller


6 ALS Transport Units 2 Battalion Commanders

3 Fire Suppression units 2 EMS Supervisors

Note: The 3 closest hospitals and 2 Trauma Centers will be notified by System Status Controller


8 ALS Transport Units 3 Battalion Commanders MCI Trailer

4 Fire Suppression units 3 EMS Supervisors

Note: The 4 closest hospitals and 2 Trauma Centers will be notified by System Status Controller. County Warning

Point will be notified by Communication Center Fire Dispatch Supervisor.


5 MCI Task Forces (25 units) 2 ALS Transport Strike Teams (10 Units)

1 Suppression Unit Strike Teams (5 Units) 5 Battalion Commanders

2 BLS Transport Strike Teams (10 Units) 3 EMS Supervisors

2 Mass Transit Busses 1 EMS Chief

Command Vehicle Operations Chief

2 MCI Trailers Communications Trailer


Point will be notified by Communication Center. In an on-going long term MCI the Metropolitan Medical Response

System (MMRS) and the Disaster Medical Assistance Team (DMAT) may be notified.

MCI LEVEL 5 (Over 1000 VICTIMS)

10 MCI Task Forces (50 units) 4 ALS Transport Strike Teams (20 Units)

2 Suppression Unit Strike Teams (10 Units) 10 Battalion Commanders

4 BLS Transport Strike Teams (20 Units) 6 EMS Supervisors

4 Mass Transit Busses 2 EMS Chiefs

2 Command Vehicles 2 Operations Chiefs

4 MCI Trailers Communications Trailer (MARC)


Point will be notified by Communication Center. In an on-going long term MCI the MMRS, DMAT, International

Medical & Surgical Response Team (IMSuRT) and the Medical Reserve Corp (MRC) may be notified.

Strike Team = 5 of the same type of units including; common communication and leader

Task Force = 5 different type units including; common communication and leader

MCI Task Force = May be 2 ALS transport units, 2 BLS transport units, 1 Suppression unit; including; common

communication and leader, consider support vehicle such as MCI trailer.

EMS Branch Worksheet

Triage Totals Red Yellow Green Black Total Date

Initial Incident

Secondary Operational

Period

Hospitals 701/

HHPO 702/ FHOS

703/ FHM

704/ HHDB

705/ BF

706/ FHD

710/ CFR

802/ FHF

Flagler ORMC Fl South

Min Away Trauma Center X X X

Burn Center X

Peds Center X X X

Can Accept

Red

Yellow

Green

Sent

Red

Yellow

Green

Triage Complete Air Units Avail On

Scene Channel

All Pt's in Treatment Area Air 1

All Pts Transported Air 2 Position Name Ch Phone Air Care

Command

Operations

Triage Treatment Supervisor Channel

Treatment Transport

Staging

Resource Requested Staging Assigned Notes

Resource Requested Staging Assigned Notes

TIME NOTES

STAGING PROCEDURE

Radio Designation “STAGING”; Vest “STAGING”

Maintain staging area assigned by Command or establish a location and advise

COMMAND/EMS BRANCH

Establish yourself in visible location within staging area

Maintain EMS Unit Staging Log

Ensure personnel stay with their vehicle until assigned or directed to leave

Organize arriving units keeping like vehicles together with easy access out of area.

If personnel are called to scene for manpower only, secure their vehicle and maintain

control of the keys

Coordinate with TRANSPORT the need for units and direct units to the patient

exit/loading points

Continually update EMS BRANCH on units available in staging area; if needed request

additional resources

When all patients in treatment areas have been transported and staging area is clear of

vehicles, contact EMS BRANCH for further assignment

VCSO will manage Heli spot Management

UNIT STAGING WORKSHEET

Date: ________ Incident: __________________________________

Operational Period _____________________ pg. ____of____

UNIT # DRIVER/OFFICER TYPE ARRIVED IN

STAGING

ASSIGNED

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

TRIAGE PROCEDURE

o Radio Designation “TRIAGE”; Vest “TRIAGE”

o Assign personnel to triage “walking wounded” using PA/Bullhorn to direct victims to a

specific location

o If scene is safe, direct personnel to triage tag remaining victims where they lay

o Prioritize victims using triage tags until tags are gone then use triage ribbon

o Advise COMMAND/EMS BRANCH the number and category of victims

o Coordinate movement of victims to the Treatment area with the TREATMENT AREA

MANAGER

o Request litter bearers from COMMAND/EMS BRANCH to assist with

movement

o Black tagged/Deceased victims should be left where they are found and LEO informed

o Ensure that all areas of the incident have been checked for victims and triaged

o Advise when all victims have been triaged and/or movement/ treatment of patients have

begun

o When triage and victims are all moved into treatment areas/being treated, contact EMS

BRANCH for further assignment

This Page Intentionally Left Blank

TREATMENT PROCEDURE

o Radio Designation “Treatment”

o Assign personnel to act as Managers for Red/Yellow/Green treatment areas

o Assure that victims are moved and placed in appropriate treatment areas based on triage

designation

o Ensure that any patients upgraded or downgraded during treatment are moved to

appropriate area

o Consult with TREATMENT AREA MANAGERS on the need for medical supplies

o Coordinate with EMS BRANCH and TRANSPORT to ensure the most efficient use of

transport resources

o Advice EMS BRANCH/TRANSPORT OFFICER when each treatment area has had

all patients transported.

o Ensure completion of TREATMENT AREA LOG SHEET for each colored area

o When all patients in treatment areas have been transported contact EMS BRANCH for

further assignment.

o Request any needed supplies or resources from EMS Branch who will make the request

through the Incident Commander.

TREATMENT AREA WORKSHEET

Date: _______ Incident: ______________________ Area: ___________

Tag # Age Sex Name Time In Time Out Unit Hospital

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

TRANSPORT PROCEDURE

o Radio Designation “TRANSPORT”; Vest “TRANSPORT”

o Establish a victim loading area (Pt exit point- PEP) that has easy access to the treatment

areas and a clear entrance and exit route from the scene

o Confirm with EMS Branch and the TREATMENT area the number and category of

victims to be transported.

o Coordinate with VCEMS System Status Controller to get the Hospital Availability Status

so that appropriate destinations can be assigned to each transporting ambulance.

o Coordinate the loading of patients by priority to transport units and helicopters

o Assign 2-3 victims to each unit, ensuring adequate transport crews. If multiple victims are

assigned to a single unit, the severity/injury category should be mixed to ensure adequate

care during transport

o Assign a hospital destination to each transporting unit. Provide transport unit with written

or verbal confirmation of patient count and destination

o Keep the TRANSPORT portion of each victims triage tag

o Maintain EMS TRANSPORT LOG, to include: triage tag number, injury category, age,

sex, name, transporting unit and destination

o Request additional transport units as needed from EMS Branch/Staging

o Advise EMS Branch when all victims have been transported and request additional

assignment

This Page Intentionally Left Blank

EMS Transport Officer Log Sheet

Triage Totals Red Yellow Green Black Total Date

Initial Incident

Secondary Operational

Period

Hospitals 701/

HHPO 702/ FHOS

703/ FHM

704/ HHDB

705/ BF

706/ FHD

710/ CFR

802/ FHF

Flagler ORMC Fl South

Min Away

Trauma Center X X X X

Burn Center X

Peds Center X X X

Can Accept

Red

Yellow

Green

Sent

Red

Yellow

Green Position Name Ch Phone Air Units Avail On Scene

Command Air 1

Operations Air 2

Triage Air Care Treatment Transport

Staging

Area Managers

TRANSPORT LOG

TAG # Age Sex Name Red Yellow Green Hospital Unit

TAG # Age Sex Name Red Yellow Green Hospital Unit

Date:_______________ Incident:_____________________________ Pg________ of __________

volusia county fire chiefs association model …

Documents