Is your MCI plan ready for take-off? Lessons From Asiana 214

Clement Yeh MDMedical Director

San Francisco Fire DepartmentSan Francisco Department of Emergency Management

UCSF Department of Emergency Medicine

Disclaimer

“The opinions expressed in this presentation are those of the authors and may not reflect the official analyses or opinions of the San Francisco Fire Department, American Medical Response, San Francisco Department of Emergency Management, University of California San Francisco, San Francisco International Airport, San Francisco City & County, County of San Mateo, San Mateo County EMSA or the National Transportation Safety Board.”

SF General Hospital Foundation Video

Overview & Objectives

• Incident Overview

• Melding of MCI Plans

• Considerations for change in your area

• Pediatric considerations

Take Home Points

• Make Disasters “Normal”

• Plans + Planning + Practice

• Interoperability Challenges

• Overall System Management

July 6th, 2013 11:27AM PST

Audio: Dispatch SM

Audio: MCI

Mass Casualty Transport

• Ambulance Bus

• 15 beds + 10 seated

• 26 seated

• MCI/Evacuation

• Fireground rehab

• Mass gathering medical care

SFFD MCT-1 & MCT-2

Incident Timeline

1132 SF Dispatch Notified of Crash1134 Initial Dispatch1134 First Alarm Struck1140 Yellow Alert Declared 1145 First SFFD Units On-Scene1146 Second Alarm Struck1147 Red Alert Declared, First Amb On Scene, IC Established1151 Third Alarm Struck1159 Modified Response Declared1215 Passenger Count & Manifest Reported1259 All Patients transported from tarmac1917 IC Closes Incident

1129 Dispatch Notified of Crash1130 Dispatch of Level 1 MCI1130 Activation of EMSystems1130 First Amb On-Scene (AMR NICU Unit)1134 First 911 Amb On-Scene1137 Level 8 MCI Requested AMR Supervisor1142/5 SMC EMSA On-Call Notified1304 All Passengers/Crew Off Tarmac1326 SMC 911 Ambulances Released to System1338 Ground Amb Coordinator; declared sufficient ground transport resources on-scene1746 EMS Branch Secured

City & County of SF San Mateo County

Communications

• Language barriers

• Instantaneous

• Comm overload should be expected

• Mitigating factors

• Interpreters

• Redundancy

• Fallback plans

Communications

Patient Characteristics

• 307 on board

• 291 Passengers

• 16 Crew

• 175+ patients transported to area hospitals

Patient Distribution

• Language resources

• Reunification

• Special populations

• Trauma

• Burns

• Pediatrics

Patient Distribution: Counties

50%

16%

32%

1%

(88)

(2)

San Francisco

Eden

Stanford

(57)

San Mateo

(29)

Patient Distribution: Hospitals

• Stanford: 56

• SFGH: 53

• Mills Peninsula: 14

• UCSF: 14

• Kaiser Redwood City: 10

• CPMC (all campuses): 9

• Kaiser San Francisco: 5

• St. Francis: 7

• Sequoia Hospital: 5

• St. Mary’s: 4

• Eden: 2

Patient Distribution: Timeline (SFGH)

• 1300 First Wave:

10 patients: 5 critical, 5 serious

• 1600 Second Wave:

17 patients: critical to good condition

• 1700-1900 Third & Fourth Wave

25 patients

• Sunday 2100: 5th Wave

9 patients

• Monday: 6th Wave

4 patients, all children

Patient Distribution

Surge Capacity

• Increased space

• Increased resources

• Increased staffing?

• Reverse Triage

SF 911 System Impact

SF System Impact

• UHU = Utilization/ Units x Staffed Hours

• Goal Transport UHU = 0.35 - 0.44

• SF 2013 YTD UHU = 0.38 (SD 0.04)

• SF 2013 Saturdays UHU = 0.40 (SD 0.04)

• Saturday 7/6/13 UHU = 0.41 0

0.125

0.25

0.375

0.5

Goal YTD Sat 7/6/13

0.4 0.38 0.400.41

San Mateo 911 System Impact

7 of 16 911 Ambulances Sent to Crash

AMR Surge Plan and MCI PlansInter-Facility Surge UnitIn County Mutual Aid South SF FireInter-Facility BLSInter-Facility Network Providers Special Operations Team Call BackCorporate Resources

Response Time Compliance 92.1%

The End?

• Patient Reunification

• Law Enforcement

• Post Incident Analysis

• CISD

Take Home Points

• Make Disasters “Normal”

• Plans + Planning + Practice

• Interoperability Challenges

• Overall System Management