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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
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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 EMS Capable Unit
5TH Unit ‐Report to Treatment Unit Leader if needed, if not report to Staging
6TH EMS Capable Unit
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
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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
MCI LEVEL 2 (11-20 VICTIMS)
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
MCI LEVEL 3 (21-100 VICTIMS)
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.
MCI LEVEL 4 (101-1000 VICTIMS)
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
Note: The 10 closest hospitals and 5 Trauma Centers will be notified by System Status Controller. County Warning
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)
Note: The 20 closest hospitals and 10 Trauma Centers will be notified by System Status Controller. County Warning
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
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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
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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 __________