1 zone 4 mass casualty training 1. to assure all crews within central zone understand the roles and...
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ZONE 4 MASS CASUALTY TRAINING
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To assure all crews within Central Zone understand the roles and responsibilities of operating in the framework of a MCI
incident.
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FIRESCOPE
COUNTY SAN DIEGO
CENTRAL ZONE POLICY
ZONE TRAINING OFFICERS
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Review MCI vs MPI Review ICS Positions and Responsibilities Review DMS “New” Triage Tag Review START Guidelines Table Top Exercise Debrief
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MPI - Multi-Patient Incident
MPI is any number greater than one patient.
Agency has sufficient resources to handle
Patients often numbered in sequence
Most common system used each day
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MCI – MASS CASUALTY INCIDENT
MCI is an incident with multiple patients which will overwhelm the resources of the responding agencies or the area hospitals.
This can and will differ from agency to agency depending upon the size and scope of their respective resources.
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Often confusion between the two modes.
The difference between MPI and MCI is “AGENCY” driven.
Resource driven
Different Radio Formats
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Example A six patient accident place in San Diego
City may be determined by the IC to be a MPI.
While the same six patient incident in a rural setting would most likely be deemed a MCI due to lack of relative resources.
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Med Com must supply clear and concise report.
Requires a more comprehensive radio report than an MCI per policy S-140
PAMSCATE format (Pt. Number, Age, Mechanism, Sex, Chief Complaint, Abnormal Findings, Transporting Unit and ETA)
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Patient Triage Tag Number (Last 4 digits)
Patient Status (WW, Immediate, Delayed)
Transporting Unit
ETA
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Specialty patients, such as Burn or Pediatric should be communicated to the base in an effort to get those patients to the best location for those types of patients.
Med Com must be disciplined and avoid extraneous radio information.
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Size up (Scope of the incident) Safety Determine and order Resources Establish Traffic Flow (early) for incident Declare MCI (Annex D) Make Assignments Establish Staging Clear Direction ICS Vests (if possible)
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Goal of triage is to sort patients rapidly Use START Guidelines ID Walking Wounded Begin with closest patient Consider Recon to get better
understanding of scope. Tag patients Relay number of patients in each
category to Transportation and Med Com
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Provide extrication and patient movement to either Transport Area or Treatment Area
Consider using Triage Team after they have completed Triage assignment.
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Responsible for communication between incident and the CLOSEST BASE HOSPITAL (not necessarily the trauma center unless they are
closest)
Initial contact with hospital uses unit number Additional contacts use ICS terminology
IE: “Greenfield Med Com”
Must be able to relay scope and size of incident to hospital.
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The Med Com and the Transportation Unit leader or Group Supervisor should be co-located near the patient loading zone for effective communications.
Scribe is highly recommended
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Med Com can quickly get overwhelmed
Highly recommend a scribe
Scribe works as a buffer
Information should be funneled through scribe
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Med Com and Scribe should work side by side
Scribe fields information
Scribe maintains accurate records ( bed counts, Patient acuity, Unit ID with destinations
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Establish early
Ambulance Staging Manager reports to the Transportation Group Supervisor
Responsible for organizing the staging area, resource accountability, briefing units on the situational awareness and maintains unit documentation.
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Staging should organize the available supplies from waiting ambulances in the staging area
Load up one ambulance with supplies collected in staging and send to scene
When organizing the staging area, the staging manager should separate the transportation resources by patient care capabilities when possible
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The Staging Manager should monitor the number of units in staging and advise Operations or the IC when resources fall below minimum levels
The Staging Manager should also coordinate resource levels with the Transportation Unit Leader
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Assign early
This role requires leadership and organization skills to perform the critical tasks required for this position
ID best location (ingress/egress)
Communicates with Med Com
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Transportation Group supervisor use natural barriers, cones or banner tape to identify and create a funnel where patients move though.
Transportation Group supervisor should request a scribe early to assist with the documentation.
In a coordinated process the Transportation Group supervisor will request an ambulance from the ambulance staging manager
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Transportation Group supervisor will request a destination from Med Com and assign the patients to the transporting ambulance
The County’s Annex D policy requires that every receiving hospital will accept a minimum of 1 Immediate and 1 Delayed patient and every Trauma Center to accept a minimum of 2 Immediate patients
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An important but not always necessary position
Set up areas, (WW, Immediate, Delayed) Assure Treatment Areas have sufficient
supplies Communicates with Triage, Med Com and
Transport
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Triage
Pt. Is triaged as immediate
Litter Bearers
Treatment (if activated)
Transport
Sends AMB upon request from Transport
Med Com
Reports number of patients by category to Hospital(info from Triage)
Advises hospital when AMB departs:
-Pt Numbers-AMB number-Destination
Receive list of destination hospitals and bed count from Base Hospital– advises Transport
Ambulance is assigned destination
Assigns patient to ambulance
Gets AMB from staging
Ambulance leaves
-Stabilizes-Treats-Documents
Staging
-Extricates-carry to treatment area
Contact Base Hospital-Declare MCI-establish Med Com
--Patient Flow --Comm Flow
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A simple approach
Where to START
One patient at a time
START Triage Algorithm
Patient scenarios
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Simple
Triage
And
Rapid
Treatment
In the early 1980’s the START method was developed in California by Hoag hospital and Newport Beach Fire and Marine.
It provided rescuers with an easy, simple step-by-step approach to assessing and treating a large number of patients with varying degrees of injuries.
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Simple
Triage
And
Rapid
Treatment
The Initial assessment and treatment of each patient is accomplished within 30 seconds.
Initial treatment is limited to correcting immediate life-threatening conditions (i.e. opening an airway and controlling severe bleeding)
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Simple
Triage
And
Rapid
Treatment
The Triage TagA Tag is placed on each patient once they have been assessed. The tag displays the patient’s current status and advises those providing treatment with one of the four possible treatment priorities:MinorDelayedImmediateDeceased
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Simple
Triage
And
Rapid
Treatment
The Triage TagEach tab is distinctly color-coded allowing fast patient priority identification from a distance
DECEASED
IMMEDIATE
DELAYED
MINOR
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Simple
Triage
And
Rapid
Treatment
Triage Tags are designed with tear-offtabs. There is two tabs per category.
One tag gets torn off by Triage Team and one tab is left with the patient.
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Start where you stand - begin the triage process with the patient closest to you. Solicit the help of bystanders and/or uninjured victims. They can be utilized to control bleeding, help maintain an open airway or hold c-spine traction.
Do not spend too much time on any one patient. Move quickly from one patient to the next.
Assess each patient’s RPMs
RespirationsPerfusion
Mental Status
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Upon your arrival, first make sure the scene is safe. Then begin by directing the walking wounded away from the immediate scene to a pre-determined evaluation and treatment area.
Tag them as MINOR (GREEN)
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R PM
ASSESS RESPIRATIONS
If the patient is not breathing then Open the Airway
If the patient is still not breathingthen tag them as DECEASED (BLACK)
Move on to the next patient...
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R PM ASSESS RESPIRATIONS
If breathing is present then Assess the Rate
If the rate is greater than >30then tag them as IMMEDIATE (RED)
Move on to the next patient…
If the rate is less than <30then assess PERFUSION
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R P M ASSESS PERFUSION
If a radial pulse is absent (or)the capillary refill is greater than > 2 secondsthen tag them as IMMEDIATE (RED)
Move on to the next patient…
If a radial pulse is present (or)the capillary refill is less than < 2 secondsthen assess MENTAL STATUS
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RP M ASSESS MENTAL STATUS
If the patient cannot follow simple commands (or)has an altered mental status (or)is unconsciousthen tag them as IMMEDIATE (RED)
Move on to the next patient…
If patient is able to follow simple commandsthen tag them as DELAYED (YELLOW)
Move on to the next patient…
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Simple
Triage
And
Rapid
Treatment
This patient states he cannot move or feel his legs
His respirations are 24
He has a radial pulse of 100
He is awake are oriented
How would you triage this patient?
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Simple
Triage
And
Rapid
Treatment
This patient states he cannot move or feel his legs
His respirations are 24
He has a radial pulse of 100
He is awake are oriented
DELAYED (YELLOW)
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Simple
Triage
And
Rapid
Treatment
This patient has a blood soaked shirt on
His respirations are 36
His capillary refill is less than 2 seconds
He is awake are oriented
How would you triage this patient?
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Simple
Triage
And
Rapid
Treatment
This patient has a blood soaked shirt on
His respirations are 36
His capillary refill is less than 2 seconds
He is awake are oriented
IMMEDIATE (RED)
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Simple
Triage
And
Rapid
Treatment
This patient has some minor abrasions on his forehead
His respirations are 16
His capillary refill is less than 2 seconds
He is very slow in recalling his name and whereabouts
How would you triage this patient?
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Simple
Triage
And
Rapid
Treatment
This patient has some minor abrasions on his forehead
His respirations are 16
His capillary refill is less than 2 seconds
He is very slow in recalling his name and whereabouts
IMMEDIATE (RED)
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Simple
Triage
And
Rapid
Treatment
This patient appears to have no injuries
Her respirations are 20
Her capillary refill is less than 2 seconds
She is unconscious
How would you triage this patient?
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Simple
Triage
And
Rapid
Treatment
This patient appears to have no injuries
Her respirations are 20
Her capillary refill is less than 2 seconds
She is unconscious
IMMEDIATE (RED)
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Simple
Triage
And
Rapid
Treatment
This patient is lying quietly on the floor
He is not breathing
His capillary refill is more than 2 seconds
He is unconscious
What is the first thing you would do?
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Simple
Triage
And
Rapid
Treatment
This patient is lying quietly on the floor
He is not breathing
His capillary refill is more than 2 seconds
He is unconscious
REPOSITION THE AIRWAY!
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Simple
Triage
And
Rapid
Treatment
He gurgles a couple of times as you attempt to open his airway but does not resume breathing on his own
His capillary refill is still more than 2 seconds
He is still unconscious
How would you triage this patient?
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Simple
Triage
And
Rapid
Treatment
He gurgles a couple of times as you attempt to openhis airway but does not resume breathing on his own
His capillary refill is still more than 2 seconds
He is still unconscious
DECEASED (BLACK)
DVD 8 MINUTES in length
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First Tuesday of the month, start date not yet set
Why?: Most field mis-classify patients as “acute” or “delayed” and aren’t comfortable or familiar with triage tags
To make Pre-Hospital and Hospital personnel more familiar with triage tags and terminology
Will report patient tag number and provide a triage report on every call (including medical calls)
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Exercise our understanding of a MCI scene management
Exercise our communication skills as it relate to MCI.
Review large scale MCI ICS management.
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Engage as a role player.
Communicate as you would in a real incident.
Obtain a ICS Vest
Track patients
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IC Determines other positions
Facilitator
Dispatcher
Companies
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1830 hours Wednesday July 14th
El Cajon Car Show Report Auto v. Ped
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Was objectives met? Were communications and orders clear? Were proper lines of communications
used? Were sufficient resources ordered? Was START guidelines used? Was patient transport effective? Was patient tracking done?
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