BATT CHIEF MARTY LA FAVE B E L L E V U E F I R E D E PA RT M E N T

King County MCI Plan2011 Updates

A Review of Mass Casualty Management

Company Officer: First five minutesMCI Plan: New ChangesDivision of Labor: Groups and Units

Initial Size-up Phase 1

Look for SLUDGE Identify immediate hazardsConsider access/egress optionsObserve base/staging optionsEstimate number of patients

More Size-up Phase 2

Estimate number of non-ambulatory patients

Consider extrication/relocation issuesScene status: Static or Dynamic?

Decide: Complex…not complex

No SLUDGE

No Fire, stable scene

Southbound lanes open

Overpass intact

Patients walking around

6-10 Reds

Simple extrication

Static scene

Commanding the radio

Provide size-upInitiate commandInitial assignments

Safety & handline Triage Treatment

Request “base” resources

Request “transport” resources

Requesting Resources

Basic MCI Activities Rescue/Extrication Treatment/Transport Ambulance staging

Complex Activities Fire Hazard Material CBRNE Collapse

Maintain the Transportation Corridor!

Physical Actions of the First-in Crew

Engine/Ladder Company Recon / Risk Assessment Mitigate immediate high risks Secure Transportation Corridor Begin Triage Direct movement of “Green” Walking wounded Implement Rescue Group

Medic Units/MSO Decide: Patient or Scene mgmt Medical Group Treatment Unit Transport Unit

Revised 2011 MCI Plan: WHY?

Reduce choke points Suspend unnecessary actionsImprove division of laborIncrease plan scalability for all eventsSimplify patient trackingAlign plan with NIMS Concepts

MCI Changes at a glance

Develop “Rescue Group” to move patientsEliminate formal funnel pointEliminate use of treatment tagsElimination of patient numbering (felt pen)NIMS Terms: Hospital Control is now

Disaster Medical Control Center (DMCC)

Changes

Changes

The Previous MCI Plan

COMMAND

MEDICAL GROUP

TRIAGE

TREATMENT

TRANSPORT

Typical MCI Org Chart 2011

COMMAND

RESCUE GROUP

EXTRACTION UNIT

EXTRICATION UNIT

MEDICAL GROUP

TREATMENT UNIT

TRANSPORT UNIT

GREENUNIT

Are you doing the job…or leading it?

Unit Leader/Group Supervisor

Don the vestUnderstand Action PlanDetermine supervisors role Develop organizationDevelop relationships Maintain accountabilityProvide progress reports

So, who does Triage?

Rapid Field Triage -BLS

Minimal TreatmentWho Supervises

Triage: Medical Group Rescue Group

Secondary Triage – ALS

First Order Second Order

STARTABCSick/Not SickJump STARTTriage Sieve (UK)

Triage Sort (UK)SAVE (Secondary

Assessment of Victim Endpoint) Those who will die anyway Those who will survive

anyway Move only those who will

have a condition change

Current Triage Systems

Treatment Unit

Locate suitable area

Secure suppliesDevelop

treatment teamsDetermine

transport priorities

Treatment Unit

Reasons for a Treatment Area Visual indicator for injured No transportation available Immediate life-saving treatment Move the reds, hold others

Assure appropriate treatmentUse Aid/Medic Units for suppliesPrioritize patients for transport

Use a “Treatment Dispatch Manager”Benchmarks:

All reds transported All patients transported

Expanding the Treatment Unit

Treatment Unit Leader

Red Manager

Yellow Manager

Treatment Dispatch Manager

Transport Unit

Assure DMCC activation

Establish Ambulance Staging

Confirm transporting resources are inbound

Coordinate patient loading

Track Destinations

Transportation Unit

Apply patient trackersCommunicate with

DMCCReceive patient

destinationManage documentationBenchmarks:

All reds transported All patients transported

Tracking

All transport capable vehicles in King County will have tracking bands

Typically applied at the ambulance loading or DMCC activity area.

Ensures that all patients have a tracking band

Tracking

Retain one peel-off sticker on a tracking board

All MSO’s and Medic Units will have tracking sheets

Tracking sheets allow for sticker or Barcode tracking

Tracking

Instruct all transporting personnel to place a tracking sticker on the portion of the MIRF that will stay with the hospital.

The transporting agency will also retain one sticker

Expanding the Transport Unit

Transport Unit Leader

Ambulance Staging Manager

DMCCCoordinator

Ambulance Loading Manager

Tracking Aide

Rescue Group/Unit

DisentanglementMoves all patients to

Treatment areaPersonnel IntensiveMay report to Medical or

OperationsMay provide field triage

Expanding the Rescue Group

Rescue Group

Extrication Unit

Extraction Unit

Expanding the Medical Group

Medical Group

Treatment Unit

Transport Unit

Green Patient Unit

Incident Command

SafetyPIO

Liaison

Operations

Medical

Treatmen

tYellow Uni

t

Red

Unit

Dispatch Manager

TransportAmbulance

Staging

Ambulance

LoadingD

MCCCoordinatorTracking Aide

Green

Patients

Rescue

Extraction

Extrication

Hazard Mitigation

Decon

Haz Mat Fire

Recon

Summary of Key Points for MCI

Secure the transport corridorKeep transport units staged separatelyMedics focus on

Medical/Treatment/TransportEarly notification of DMCCSuppression focus on Rescue/ExtractionPerform secondary triage before transportSeparate loading from DMCC activities

Questions?