chelan & douglas county mass casualty incident...

Chelan & Douglas County 2018 Revision

Mass Casualty Incident Management Plan 10/03/2018

Chelan & Douglas County

Mass Casualty Incident Management Plan

2018 Revision

Chelan & Douglas County Mass Casualty Incident Management Plan

2 Chelan & Douglas County 2018 Revision


Table of Contents

1.0 Purpose p.3

2.0 Scope p.3

3.0 MCI Management Principles p.3

4.0 Communications p.4

5.0 First Arriving Unit p.5

6.0 First Arriving Chief Officer p.6

7.0 Medical Branch Director p.7

8.0 Appendixes p.8 - 27

8.1 S.T.A.R.T. Model p.8

8.2 Jump S.T.A.R.T. p.9

8.3 Stop The Bleed p.10

8.4 MCI – Incident Safety Officer p.11

8.5 MCI Trailer Equipment / Procedures p.12

8.6 Medical Branch Position Responsibilities p.13 - 15

8.7 Medical Branch Position Worksheets p.16 - 20

8.7.1 Medical Branch Organization Worksheet p.16

8.7.2 Triage Organization Worksheet p.17

8.7.3 Treatment Worksheet p.18

8.7.4 Transport Worksheet p.19

8.7.5 Patient Tracking Worksheet p.20

8.8 Agency Responsibilities p.21

8.9 MCI Fire Response Plans p.22 - 27

8.9.1 Wenatchee Area p.22

8.9.2 Cashmere Fire Department p.23

8.9.3 Leavenworth (CCFD#3) Area p.24

8.9.4 Chelan (CCFD#7 & #5) Area p.25

8.9.5 Entiat (CCFD#8) p.26

8.9.6 Orondo (DCFD#4) p.27

8.10 MCI Plan Definitions p.28 - 29




1.0 Purpose

The Chelan & Douglas County Mass Casualty Incident (MCI) Management Plan provides standard operating guidelines for emergency service personnel for the response and incident management of mass casualty incidents in Chelan and Douglas Counties. The Plan has been developed to provide standard procedures for appropriately classifying various levels of MCI response alarms. The plan also provides dispatch response standards for emergency personnel and equipment resources needed for the incident based upon the size or nature of the mass casualty incident.

2.0 Scope

This plan is based on the principles of the National Incident Management System (NIMS) and the use of the Incident Command System (ICS) to manage the personnel, apparatus and equipment to achieve successful incident management. The MCI emergency response will initially be determined by the number of patients or by the potential rapid escalation in the number of patients. It is intended to be an all-hazard plan to meet the needs of any MCI regardless of the incident’s cause, including the evacuation of non-ambulatory patients. If necessary, these procedures can be modified based on the number of patients, the cause or severity of injuries and special circumstances involved in the incident.

3.0 MCI Management Principles

The 2nd, 3rd and 4th alarm emergency response for an MCI will be based on patient count or request from an Incident Commander. 8-12 patients – 2nd Alarm MCI (6 transporting ambulances to include at least one

medic unit) 13-18 patients – 3rd Alarm MCI (10 transporting ambulances to include at least two or

more medic units) 19+ patients – 4th Alarm MCI (Emergency Management assistance for regional or state

response) MCI response plans have been developed by geographic areas that correspond with existing response zones for all Fire and EMS nature codes with potential for an MCI. These include:

EMS Fire Active Assailant Industrial Accident Accident Injury Fire Structure Carbon Monoxide Overdose / Poison Aircraft Hazmat Drowning Stab / Gunshot Fire Brush Train Freight Inaccessible Accident Water Rescue Fire Commercial

The number of transporting ambulances corresponding to patient counts in a geographic area may be modified based upon local capability and mutual aid agreements.




4.0 Communications

Communications play an important role in every phase of MCI management. Its importance before, during, and after an MCI must be emphasized. Early attention to communications will maximize time, coordination, and the use of available resources.

A. Common MCI Communication Issues

The under-response to initial reports of an MCI incident.

Early communication and coordination with hospitals

B. Radio Communication Guidelines

On-scene radio communications should be kept to a minimum. When possible, direct verbal contact, or runners should be used.

The Incident Commander (radio call sign “COMMAND” should be the only person communicating with “RIVERCOM”.

The Incident Commander will assign tactical frequencies for the incident.

All EMS communications on HEAR should be limited to the Medical Branch Director (radio call sign “MEDICAL”).

Central Washington Hospital will be contacted early in the incident and will coordinate patient transport to CWH or patient distribution to other medical facilities.

C. Alert Sense Notification System

RiverCom 911 sends an Alert Sense (Emergency Notification System) page to emergency management and all law enforcement, fire and EMS agencies via the

MCI Group when a 2nd, 3rd, or 4th alarm MCI is toned out.

D. Sample Radio Communication Plan

Command: _____________________

Fire TAC: ______________________

Fire TAC : ______________________

Medical Branch: HEAR (Medical/CWH)

EMS TAC:______________________

Ground / Air: LERN

Law: __________________________




5.0 First Arriving Unit

A. Make an initial size-up of the emergency incident

Report the: Location – Mechanism - Approximate number of patients - Major hazards

B. The first arriving unit may declare the incident an “MCI” to initiate the level of MCI response that is needed – based on estimated patient count.

2nd Alarm 8-12 patients 3rd Alarm 13-18 patients 4th Alarm 19+ patients

C. Initiate Command

D. Begin the START Triage system for classifying trauma patients.

• Red – Immediate life threat and highest priority for treatment and transport.

• Yellow – Second highest priority for treatment and transport. Could be delayed up to 1-2 hours.

• Green – Lowest priority for treatment. Walking wounded or self- rescue victims. Transport of these victims should occur after all other patients have been transported. These patients may also be transported using a “mass-transit” type of vehicle, i.e. school bus.

• Black – Deceased or those impossible to save. These victims should be left where they are found and not moved. If necessary, have a morgue area for those who die in a treatment or who must be moved.

E. Establish a Funnel Point and assign a Funnel Point Manager

Assign a number to each patient.

Log the number on the tracking board.

Number patients in one of the following locations using an indelible marker (by priority).

Cheek / Chest / Arm / Hand / Leg

Review START Model (Appendix 8.1, page 9)

Pediatric patients ages 8 and under will be better served by using Jump START. (See Jump START - Appendix 8.2, page 9)

F. Active Assailant (Shooter) Incidents - change our rules (Appendix 8.3, page 10)

1. Be prepared to STOP the Bleed for Active Shooter Incidents

2. Increased Law Enforcement (LE) Involvement for Scene Safety

Hot Zone (Not Safe – Law Enforcement Search and Threat Suppression)

Warm Zone (LE provides perimeter and protection) Stop Bleed & Extricate

Cold Zone (Treatment and Transport areas established)

The color-coding will insure standardization of patients for both treatment and transport




6.0 First Arriving Chief Officer

6.1 Initial Response Objectives

ICS procedures will be used to coordinate incident management and manage the personnel, equipment, and other resources during an MCI

Establish Command / Unified Command (Location) ____________________________

Affirm MCI Level - Call for additional resources

Establish Staging for incoming resources (Location) ___________________________

Establish Medical Branch Director __________________________________________

Set up scene for casualty management

o Establish a Transportation Corridor

Identify and set up access and egress routes for treatment / transportation flow

Develop Incident Action Plan (IAP)

Establish “Safety” (ISO) – Site Safety Plan ______________________________________

6.2 Large MCI Command System

6.3 Sample Radio Communications

Command: ___________________ EMS TAC:___________________

Fire TAC: _____________________ Ground / Air: LERN

Fire TAC : ________________ Law: _______________________

Medical Branch: HEAR (Medical/CWH)

Incident Command Command Staff PIO (JIC)

Safety (Group) Liaison

Operations

Staging Manager

Medical Branch Director

Law Enforcement Branch

Traffic Control Scene Control

Security Investigation

Coroner/ Morgue

Fire Branch Director

Fire Suppression Scene Hazards

HazMat / Decon Extrication / Rescue

Equipment Manager

Treatment Officer

Triage Officer

Triage Officer

Funnel Point

Red Area

Green Area

Yellow Area

Transportation Officer

Ambulance Staging Manager

Helicopter LZ Coordinator




7.0 Medical Branch Director The Medical Branch Director is an extremely important MCI position assignment. The

Medical Branch Director “MEDICAL” establishes communications with the hospital

(CWH) through the H.E.A.R. radio frequency and manages the tactical elements for

triage, treatment, and patient transport. (See Appendix 8.6 Position Responsibilities)


Notify Hospital of MCI / Provide Status Updates

Determine Treatment and Transport Areas

Assign and Manage Triage, Treatment, Transport Supervisors

Establish Equipment & Personnel Pool Areas

Establish Ambulance Staging for Transport

Request status up-dates, as necessary, from Triage, Treatment and Transportation Supervisors

Provide updates to the Operational Section Chief

Request medical Examiner/Coroner and communicate need for temporary morgue if needed

Work with Command (or Operations) to set up the scene for casualty management

Establish a “Transportation Corridor”

Identify and set up access and egress routes for treatment / transportation flow

Establish the best staging and work areas to manage the MCI scene

Identify and set up adequate work areas for triage, treatment, transportation

Establish an effective staging for EMS ambulances / personnel / equipment


Triage GroupTreatment

GroupTransporation

Group




Appendix 8.1 - START Model




Appendix 8.2 Jump Start Model




Appendix 8.3 - STOP the Bleed (Active Shooter Incidents)




Appendix 8.4 MCI – Incident Safety Officer Checklist




Appendix 8.5 MCI Equipment / MCI Trailer Equipment / Procedures

MCI Equipment Staging / MCI Trailer Equipment and Procedures

When personnel are moved from staging or a base: EMS and rescue equipment should be taken to the site of equipment pools for rescue, moving, and treatment of patients prior to the MCI trailer arrival.

FIRE / RESCUE / EMS Equipment Full PPE / Gloves Suction Cones/Flags Thermal Imaging Camera (TIC) Scoop basket stretcher Gas Monitor (CGI) Triage kits SCBAs / Extra bottles Blankets Masking tape Trauma kits Safety vests C- collars Backboards Backboards Pediatric kits O2 Bottles Stretcher EKG Monitor

MCI Trailer Procedures Location: The MCI Trailer is located at the CC PUD fenced area at N Miller St. and Hawley St.

Lock Code: 0911 Hitch: Inside trailer (front) Chelan County EM: Transport agency Contact RiverCom to request and confirm dispatch and ETA of the MCI trailer.




Appendix 8.6 Medical Branch Position Responsibilities

A. Medical Branch Director - Person in charge of overall Medical Operations who reports to the IC (or Operations Chief if established). Supervises the unit(s) who triage, treat, and transport patients. 1. Size-up incident area (including scene safety) 2. Put on the EMS Branch Director Vest 3. Remain in contact with the operations Section Chief 4. Supervise personnel assigned to EMS branch 5. Assign and direct Triage, Treatment, Transportation Supervisors 6. Request patient count, including the number of pediatric patients, by triage code from the

Triage Group Supervisor. Information is then relayed to the transportation supervisor. Notify closest/medical control hospital with the total patient count by category and obtain information regarding hospital capacity to accept patients.

7. Request additional medical supplies as needed. 8. Estimate and request additional personnel from Operations Section Chief, indicate type and

function needed 9. Request status up-dates, as necessary, from Triage, Treatment and Transportation

Supervisors 10. Provide updates to the Operational Section Chief 11. Request medical Examiner/Coroner and communicate need for temporary morgue if needed

B. Triage Group Supervisor

1. Size-up incident area (including scene safety). 2. Put on Triage Group Supervisor vest 3. Remain in contact with the EMS Branch Director 4. Triage patients using the START System. Request adequate personnel to provide triage and

movement of all patients 5. Assign staff, select and mark GREEN collection area and announce that anyone who is

able to walk is to get up and move to the GREEN collection area. 6. Leave BLACK patients 7. Get patient count, including the number of pediatric patients, by triage category and report

numbers to EMS Branch Director. 8. Establish a funnel point. 9. Establish system to move patients from Triage to Treatment 10. Monitor the supply of patient triage supplies and tags/marking system 11. Report to EMS Branch Director when assignment is completed

C. Funnel Point Manager

1. Oversees re-triaging of patients. 2. Assigns a number to each patient. 3. Logs the number on the tracking board. 4. Numbers patients in one of the following locations using an indelible marker (by priority).

Cheek / Chest / Arm / Hand / Leg




D. Treatment Group Supervisor

1. Size-up incident area (including scene safety) 2. Put on the treatment Group Supervisor Vest 3. Supervise personnel assigned to treatment group 4. Select and mark treatment. Advise EMS Branch Director of treatment area locations, and

when they have been established 5. Assign and brief treatment team leaders to each area if personnel allows 6. Ensure Accountability of Patients 7. Monitor supply of patient treatment equipment and supplies. Request additional equipment

and supplies, as needed, from the EMS Branch Director. 8. Prioritize patients for movement to Transport Area. Direct patient movement from Treatment

area to Transport area.

E. Transport Group Supervisor - Direct and coordinate patient loading and dispatching to medical facilities.

1. Size-up incident area (including scene safety) 2. Put on the Transportation Group Supervisor Vest 3. Establish ambulance staging in a safe area. Clearly define ingress and egress. 4. Assemble Transport Patient Movement Teams. 5. Assign LZ coordinator to manage landing zone if needed. 6. Request hospital capability information from EMS Branch Director. 7. ACCOUNTABILITY!! 8. Direct movement of transport vehicles in Transport area. One member of the transport unit

must remain in the vehicle. 9. Direct removal of patient care equipment and supplies from transport units, if needed.

Populate the equipment staging area. 10. Direct movement of patients from Transport area to transport vehicles. The stretchers/cots

must be matched to their home vehicles for transport safety. 11. Direct Transport units to designate hospitals based on capabilities 12. Notify Hospital of Incoming Patients

F. Morgue Team Leader - Directs protection and identification of bodies in cooperation with Medical Examiner’s Office (when on scene).

1. Obtain Situation briefing from immediate supervisor. 2. Don position identification vest if available. 3. Review the entire duty checklist. 4. Assess situation. 5. Appoint and brief staff as needed (aides, litter bearers). 6. Maintains integrity of bodies and scene. 7. Do not allow removal of bodies or personal effects without Medical Examiner’s authorization. 8. If necessary to move bodies, designates Morgue area. 9. Coordinates disposition of patients who die in the Red Area. 10. Advises Medical Examiner’s office of situation if Medical Examiner is not on the scene. 11. Attempts identification, tags and covers bodies. 12. Maintains security of all personal belongings and keeps such items with the individual body.




13. Ensures that the original position of bodies and personal effects are identified and well documented before moving. Note: photos, grid drawings, etc.

14. Maintains records.

G. Ambulance Staging Manager

1. Obtain Situation briefing from immediate supervisor. 2. Don position identification vest if available. 3. Review the entire duty checklist. 4. Assess situation. 5. Appoint and brief staff as needed. 6. Establishes ambulance staging area for ambulance to report before being sent into loading

area. 7. Ambulance staging area should be outside of the emergency operations area, but provide

easy and direct access. 8. Coordinates with Transportation Team Leader for patient loading and transporting. 9. Ensures that all drivers and ambulance techs stay with their vehicles. 10. Ensures that the staging area is well organized, and that vehicle movement is

unrestricted and smooth flowing.




Appendix 8.7.1 Medical Branch Organization Worksheet




Appendix 8.7.2 Triage Organization Worksheet




Appendix 8.7.3 Treatment Worksheet




Appendix 8.7.4 Transport Worksheet




Appendix 8.7.5 Patient Tracking Worksheet




Appendix 8.8 Agency Responsibilities Fire Departments

Fire departments engage in activities that include fire suppression, search and rescue, EMS, and mitigation of

hazardous conditions. Responsibilities Include: Scene and community assessment of damage and casualties Mitigation of physical hazards and scene safety Establish ICS / Unified Command Set Incident Objectives and develop Incident Action Plan (IAP) Public Information Officer Triage and treatment of patients Determine additional resources / Request additional resources Communications with dispatch and ICS Communication Plan Manage fire, rescue and air operations

EMS / Ground & Air Transportation Provider Responsibilities include:

Ambulances Companies Scene assessment Patient triage Establish communications with hospital Initiate and coordinate the MCI / Coordinate Medical Group/Branch development Set up and staff treatment areas Medical supplies (initial and ongoing) On-going triage Patient care documentation Transport patients to appropriate medical facilities Determine resource needs Scene documentation

LifeFlight / AirLift Transport critically injured patients Provide additional ships as needed

Law Enforcement responsibilities include:

Active Assailant (Shooter) - Search and Threat Supression Scene control / Traffic control Management of deceased (morgue) Incident investigation PIO (coordinate with fire as needed)

Coroner responsibilities include: Morgue management Removal of deceased victims Deceased victim documentation Coordination with other law enforcement agencies Family notifications

Hospitals Communications between Central Washington Hospital and other area hospitals Determine initial bed availability Determine patient destinations in conjunction with Medical Branch (Transportation Supervisor) Activate Surge Plan (as determined by hospital protocol) Coordinate with EMS and/or Health District




Appendix 8.9.1 CCFD#1




Appendix 8.9.2 Cashmere Fire Department




Appendix 8.9.3 Leavenworth (CCFD#3) Area




Appendix 8.9.4 Chelan (CCFD#7 & #5)




Appendix 8.9.5 Entiat (CCFD#8)




Appendix 8.9.6 Orondo (DCFD#4)




Appendix 8.10 MCI Plan Definitions

Definitions 1. Active Assailant: An Active Assailant is an individual or individuals engaged in killing or attempting to kill

people in a confined and populated area; in most cases, there is no pattern or method to their selection of victims. Active Assailants typically use firearms (an “Active Shooter”), however, knives, machetes and vehicles have been used. Active Assailant situations are unpredictable and evolve quickly. The immediate deployment of law enforcement is required to stop the assailant and mitigate harm to victims.

2. Equipment Pool: An area designated by the Incident Commander or Medical Group Supervisor for the

gathering of equipment such as backboards, trauma kits, oxygen etc. 3. Funnel Point: A central point designated by the Triage Team Leader that every patient filters through

prior to movement into the Treatment area. (This location usually is located at the entrance of the treatment area). Patients will be numbered for tracking and receive a triage ribbon if they have not yet done so.

4. Extraction & Rescue Functions: The safe and rapid removal of entrapped patients, or from dangerous

situations and their prompt delivery to a treatment area. In incidents where technical rescue/extraction is not needed, these resources should be utilized to move patients.

5. H.E.A.R. Radio (Hospital Emergency Administration Radio): used to communicate from mobile to hospital

and from hospital to hospital.

6. Incident Command System (ICS): A standardized system to be utilized at all emergency scenes that includes roles, responsibilities, operating requirements, guidelines and procedures for organizing and operating an on-scene management structure.

7. Incident Commander: The person in overall command of an emergency incident; this person is

responsible for the direction and coordination of the response effort.

8. JumpSTART Triage: The JumpSTART pediatric triage MCI triage tool (usually shortened to JumpSTART) is a variation of the simple triage and rapid treatment (START) triage system. Both systems are used to sort patients into categories at mass casualty incidents (MCIs). However, JumpSTART was designed specifically for triaging children in disaster settings.

9. Litter Bearers: Individuals assigned by the medical group supervisor to assist in movement of injured

patients to the designated triage area.

10. Manpower Pool: An area designated by the Incident Commander for incoming personnel or rehab personnel to assembly prior to assignment.

11. Mass Casualty Incident: An incident in which the number of patients or the severity of their injuries

prohibits immediate patient care provided to all and taxes the initial responding resources.

12. Medical Group Supervisor: The person in charge of overall medical operations who reports to the IC (or

https://en.wikipedia.org/wiki/START_triage

https://en.wikipedia.org/wiki/Triage


https://en.wikipedia.org/wiki/Mass_casualty_incident





Operations Chief if established). Supervises the unit (s) who triage, treat and transport patients. In a major MCI the incident may expand to assign a Medical Branch (Director).

13. NIMS (National Incident Management System): A comprehensive national approach to incident

management; it establishes a standard incident management process, procedures and protocols that are applicable to all jurisdictional levels across functional disciplines so responders can work together with maximum effectiveness.

14. Simple Triage and Rapid Transport (START): The START system is a color- coded triage system that is

based on four levels of medical/trauma prioritization: immediate (red), delayed (yellow), minor (green), and deceased (black).

15. Staging Area: A designated area where vehicles will be held until requested by the Incident Commander.

All units responding to the incident shall report to Staging until assigned.

16. Staging Area Manager: An individual assigned to coordinate the movement of vehicles as requested by Incident Command.

17. Staging Function: Assembly, coordination and control of resources awaiting tactical assignment.

18. Transportation Team Leader: Person assigned to organize and supervise the transportation of all

patients to medical facilities.

19. Treatment Area: An Area specified by the Incident Commander or Medical Group Supervisor for the treatment of casualties.

20. Treatment Functions: To provide on-site medical treatment based on patient priority while awaiting

transportation.

21. Treatment Team Leader: Person assigned with organizing the treatment area.

22. Triage Area: The designated area where the casualties are triaged. This may be the area where the casualties are initially found, or a designated point to where the casualties are transported for appropriate triage.

23. Triage Functions: To assess and sort casualties and appropriately establish priorities for treatment

and transportation. The method of initial field triage to be utilized is the START (Simple Triage and Rapid Treatment) system.

24. Triage Team Leader: The person assigned with organizing the triaging of all patients.

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