mass casualty management
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Mass Casualty Management. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman. At the end of the session the participants will be able to: Explain the concept of Mass Casualty Define Mass Casualty Management System Describe Field Management - PowerPoint PPT PresentationTRANSCRIPT
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Mass Casualty Management
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Learning Objectives
At the end of the session the participants will be able to:
• Explain the concept of Mass Casualty • Define Mass Casualty Management System• Describe Field Management• Elaborate the management of victims• Elucidate the concept of transfer organization• Be familiarized with the concept of Surge Capacity
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
• Produces several patients
• As few as six or as many as several hundred
• Affects local hospitals
• Patients are greater than resources of the initial responders
Overview of Mass Casualty
Mass Casualty Incident
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
• Pre-planning and training are critical
• Establish guidelines and procedures
• Early implementation of Incident Command
• First five minutes will determine next five hours
Overview of Mass Casualty
Preparation for Mass Casualty
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
• Mass Casualties can occur in a variety of ways
• Effect on emergency response and community impact
• Include transportation, violent crimes and building collapse
Overview of Mass Casualty
Response Categories for Mass Casualties
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
• Hazardous materials incidents
• Civil disturbances• Natural disasters• Major fires• Terrorist attacks
Overview of Mass Casualty
Response Categories of Mass Casualties
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Most common being:• Who is in command of the incident• Location of the Command Post• Lack of communication between agencies
leading to conflicting priorities and orders
Overview of Mass Casualty
Problems in Mass Casualty Incidents
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
• Perimeter establishment delayed or not done at all
• Large crowds of people• Media involvement• Political involvement• Inadequate resources
Overview of Mass Casualty
Problems in Mass Casualty Incidents
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Establishing Mass Casualty Management
System
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Any event resulting in a number of victims large
enough to disrupt the normal course of emergency and health care services
Establishing a Mass Casualty Management System
Mass Casualty Incident
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
• Management of victim of a mass casualty event
• Objective is to minimize loss of life and disabilities
Mass Casualty Management
Establishing a Mass Casualty Management System
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Establishing a Mass Casualty Management System
Mass Casualty Management System
The group of Units, Organizations, Sectors which work jointly during a mass casualty event
Based on:- Pre-established procedures- Maximization of use of existing resources- Multi-sectoral preparation and response- Strong pre-planned and tested coordination
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Establishing a Mass Casualty Management System
Different Approaches to MCI
1. “Scoop and Run”
2. Classical Approach
3. Mass Casualty Management System
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Establishing a Mass Casualty Management System
Scoop and Run
• Most common• Does not require specific technical ability from
rescuers• Justified for small numbers occurring near a
hospital• May just transfer problem to the hospital
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Establishing a Mass Casualty Management System
Classical Approach
• First responders are trained (basic triage and field care)
• Disregard the receiving hospitals from the field• Quickly result to chaos
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Establishing a Mass Casualty Management System
Mass Casualty Management Approach
• Most sophisticated approach includes pre-established procedures for:
a. resource mobilizationb. field managementc. hospital reception
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Establishing a Mass Casualty Management System
Mass Casualty Management Approach
• Training of various level of responders• Incorporates links between field and health
care facilities• Command Post• Multi-sectoral Response• Dependent on the availability of large amounts
of human & material resources
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Establishing a Mass Casualty Management System
Problems in Developing MCM• Limited human resources• limited material resources
– facility– transport– communication
• Poor communication– topography– isolation
• Political
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Activities at various levels of responses:
alerting process
initial assessment
command / control / coordinate
manage information
search/rescue
field care-- mostly health activities
transport/traffic control
facility reception at ER / A&ED
hospital mass casualty mgt. & command system
‘E’/Disaster Site/Scene
Establishing a Mass Casualty Management System
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Establishing a Mass Casualty Management System
Field Management Definition:
Encompass procedures used to organize the disaster area in order to facilitate the management of victims
Components
Alerting Process
Pre-identification ofField Areas
Safety/ Security
Command Post
Search and Rescue
Field Care
Evacuation
(EMC) Emergency Management Center
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
RESCUE CHAIN---SECTORAL
*SEARCH**RESCUE**First Aid*
Impact Zone
Command Post
TriageStabilizatio
nEvacuation
Traffic Control
Regulation of Evacuation
CP / AMP
Pre-Hospital Organization Hospital Organization
ERor
A&ED
Establishing a Mass Casualty Management System
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Establishing a Mass Casualty Management System
Field OrganizationAlerting ProcessDefinition: Sequence of activities implemented to
achieve the efficient mobilization of adequate resources
Aim:- Confirm the initial warning- Evaluate the extent of the problems- Ensure that appropriate resources are
informed and mobilized
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Establishing a Mass Casualty Management System
Field OrganizationAlerting ProcessDispatch Center:• Core of the Alerting Process
(Operation/Communication Center)• Functions:
– receives all warning messages (radio/phone)– mobilize a small assessment team (Flying
Team) from police, fire or ambulance services
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
• Precise location of the event• Time & type of the event• Estimated number of casualties• Added potential risk• Exposed population• Resources needed
Establishing a Mass Casualty Management System
Initial Assessment
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Establishing a Mass Casualty Management System
• Impact Zone• Command Post• Collecting Area in unstable location• Advance Medical Post Area (3-T Principle)• Evacuation Area • VIP & Press Area (Information Officer)• Access Roads (geographical presentations if
available)• Check point for resources (Staging Area)
Pre-Identification of Field Areas
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Establishing a Mass Casualty Management System
Safety• Best practice technique to protect victims,
responders & exposed population: immediate/potential risk
• Measures:Direct action:
- risk reduction - fire fighting- contain hazardous material- evacuation of exposed population
Preventive actions: establish field areas- primary- impact zone- secondary- rescue/ICP/AMP- tertiary-“buffer zone”; tri-media
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Establishing a Mass Casualty Management System
Safety
• Personnel: fire services; specialized units hazardous materials & explosives (bio-nuclear and
radioactive materials) experts, etc., airport manager, chemical plant expert
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Establishing a Mass Casualty Management System
Security Measures • Non-interference of external elements: - crowd/traffic control• Contribute to safety:
– protect workers from external influence; additional stress
– free flow: victims/resources– protect general public from risk exposure
• ensured by police officers / special units (security: airport/building/hospital/establishments, etc..)
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Establishing a Mass Casualty Management System
Command Post ( CP / or ICP)Multi-sectoral control unit to:• Coordinate sectors involved in field/scene management• Linked w/ back-up system: provide information &
mobilization resources• Supervise victim management
REQUISITE: radio communication network: main criterion to be effectivePurpose: coordination / communication hub of people who don’t work routinely (pre-hospital setting)Location: external boundary of restricted area (impact zone) close to AMP/ Evacuation Area/ accessible/easily identified * should accommodate: com./visuals/maps/boards
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Establishing a Mass Casualty Management System
• High ranking officer (government police, fire, health, defense)- plant manager/ airport manager/ chief security, etc…- fire officer / police officer skilled in ICS / MCM
• Identified by name/position, coordinator / commander• May depend on what type of incident• Must be familiar with each other’s roles during
previous meetings/ drills/ simulation exercises (policy)• This core group cooperate with volunteer organizations
Personnel
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Establishing a Mass Casualty Management System
• The communication / coordination hub of the pre- hospital organization. By constant re-assessment, CP will identify needs to increase / decrease resources:o organize timely rotation of rescue workers
exposed to stressful/exhausting conditions in close coordination w/ back-up system
o ensure adequate supply of equipment / manpower
o ensure welfare / comfort of rescue workerso provide info to back-up system, other officials, and
tri-media thru an Information Officero release as soon as situation allows “E” staff
and re- establish normal operationso determine termination of field operations
METHOD
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Establishing a Mass Casualty Management System
• Search & Rescue- locate victims- remove victims from unsafe locations – collecting area - assess victim’s status (on-site triage)- provide first aid , if necessary (no CPR on-site in MC Event)- transfer victims to AMP thru entry triage (medical triage)- under supervision of the CP/ IC/ or Commander/Coordinator- may in special situation, require medical personnel (trained)- to stabilize/resuscitate/amputate (trapped) victim before
extrication.
MANAGEMENT OF VICTIMS
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Establishing a Mass Casualty Management System
Management of Victims
• Field Care
- Pre-established capabilities / inventory: pre-planning
- Integrated community plan: practiced w/ policy support
- The “Golden Hour” Principle
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Establishing a Mass Casualty Management System
Establish AMP with specially skilled /trained ---- “disaster field medical teams”- good triage / stabilization capacity- specifically trained / up-skilled medical teams- good (radio) communications between the field scene & medical facility “ Don’t transfer chaos in the scene,
to the hospital……”
Recent progress in pre-hospital emergency / disaster medicine
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Establishing a Mass Casualty Management System
Basis: urgency (victim’s status)survival (chance or likelihood)care resource availability and capability
Objectives:Quick identification for immediate
stabilizationfor life-saving (measures) and surgery
Levels:On-site–----- ‘where they lie’Medical ----- at Advance Medical PostEvacuation --- transport
TRIAGE
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
On-site T: AcuteNon-acute
Medical T: RedYellowGreenBlack
Evacuation T - transport:RedYellowGreenBlack
Red: transferred as soon as possible to tertiary
facilities in an equipped ambulance with medical escortYellow: after evacuation of Red,
without life-threatening problem
Green: ‘walking wounded’-to AS/OPD
Black: to morgue Forensic Services Public Health & Psycho-Social interventions to relatives/kin
Establishing a Mass Casualty Management System
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Establishing a Mass Casualty Management System
Personnel: – volunteers, fire, police staff, special units,
EMT’s, and medical personnelLocation:
– on-site, before moving victim– at collecting point/ area in an unstable
environment.– “Green Area” of “AMP” – ambulance in transit to facility
Action: – primarily to transfer with consideration of
the ABC’s order of priority
First Aid
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Establishing a Mass Casualty Management System
Purpose:• reduce loss of life & limb - save as many as
possible in the context of existing & available resources/ situation
• victim’s status; chance of survival; resourcesLocation:• 50-100 meters from Impact Zone (walking distance
)• direct access to: Evacuation Road. / Command Post• Clear Radio-Com Zone… and SAFE (Upwind)• tent / bldg / open / mobile field hospital..??
Advance Medical Post (AMP)
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Establishing a Mass Casualty Management System
Role: • Provide “entry” medical triage • Effective stabilization for victims of a MCI/Situation
– intubation, tracheostomy, chest drainage,– shock mgt , analgesia , fracture immobilization– fasciotomy, control external bleed & dressing
• Convert red to yellow category as maybe possible• Organize patient transfer to designated care
facility/ties• AMP 3-T principle: Tag – Treat – Transfer….Personnel:• ER (A&ED), physicians/ nurses (trained & skilled)• support: Anesthetists / Surgeons / EMT’s / Nurses /
Aiders, etc.
Advance Medical Post (AMP)
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
AMP NON-ACUTE
Black Green
Red Yellow ACUTE
NON-ACUTE
ACUTE
evacuation
TRIAGE
C
P
C P– Collecting Point
Establishing a Mass Casualty Management System
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
COLLECTION AREA
TRIAGE AREA
TREATMENT AREA
PRIORITY II PRIORITY I
(color tagging of victims)
T R A N S P O R T A R E A
PRIORITY III
COMMAND POST
Establishing a Mass Casualty Management System
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(in unstable condition)
(management and stabilization)
1st2nd3rd
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Field Management Plan: Diagram
Working Area
Triage
Impact Zone
Evacuation
AMP
Command Post
Strictly Restricted
Restricted
Access RouteTraffic
Traffic
Control
Establishing a Mass Casualty Management System
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Establishing a Mass Casualty Management System
• Procedures used to ensure that victims of a MC situation is safely, quickly, and efficiently transferred by appropriate vehicles to the appropriate and prepared facility
• Preparation for Evacuation:1. Single Reception Facility2. Multiple Reception Facilities * type of vehicle required * type of escort required * destination
Transfer Organization
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Establishing a Mass Casualty Management System
Transfer Organization
• Preparation for TransportEvacuation Officer reporting to ATM:
• assess patient’s status: vital signs, ventilation / hemostasis
• check security of equipment / & accessories• ensuring efficiency of immobilization measures• ensure triage tags: secure/& clearly visible
• Evacuation Procedures: RegulationPrinciples- not to overwhelm care facility- avoid spontaneous evacuation of unstable patients.
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Establishing a Mass Casualty Management System
• Evacuation Procedures: RegulationRules:- victim is in most possible stable condition- victim is adequately equipped for transfer - receiving facility correctly informed and ready- the best possible vehicle and escort– availableVictim Flow- “Noria” Principle, Spanish word from Arabic--… ”wheel” WW I Battle of Chemin de Dames, Verdun, France* conveyor belt’ flow from first aid to the most sophisticated care level..
Transfer Organization
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Victim Flow : “Conveyor Belt” Management Diagram
3-T
Tag
Treat
and
Transfer
Triage TreatmentTriage Evacuation
Impact Zone
Collecting Point AMP TRANSFER
HOSPITAL
Victims Flow Transport Resource Flow
Establishing a Mass Casualty Management System
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Establishing a Mass Casualty Management System
- Ambulance Traffic ControlRadio Links:*Transport Officer at AMP*Hospital Admission / ER Department*Command Post*Ambulance HeadquartersResponsibility of Ambulance Driver*takes order from the Transport Officer
Victim Flow
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Road Control: Police Officers ----- crowd and traffic
control• Evacuation of Non-Acute Victims
- use available mass transport - as much as possible, to primary care
centre
Establishing a Mass Casualty Management System
Victim Flow
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Establishing a Mass Casualty Management System
Situation Assessment Report to Central Level Work Areas Pre-identification Safety Primary Area: Impact Zone Secondary Area Units: CP/AMP/EVAC/TRANSFER Radio Communications Crowd & Traffic Control Search and Rescue Triage & Stabilization Controlled Evacuation
Field Organization Checklist
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Fallacy
“IT CAN’T HAPPEN TO US”
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Thank you
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Incident Command System
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Performance Objectives
• Discuss the advantages of using the Incident Command System
• Discuss the two types of command• Discuss the Incident Command Process• Discuss Incident Priorities
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Performance Objectives
• Discuss the components of the Incident Command System
• Discuss the Incident Command System organization
• Discuss the use of the Incident Command checklist
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman 55
Incident Command System• Developed in the 1970’s during the California
wildfires
• Business management practices of planning, directing, organizing, coordinating, delegating, communicating and evaluating
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• Framework necessary to manage resources, personnel and equipment
• Designed to be flexible and can be used in large or small incidents
• Creates a safe environment for all involved
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Incident Command System
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Benefits of Incident Command
• Common terminology
• Position titles and Chain of Command for decision making
• Responder accountability
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Basic Command Types
• Single Command
• Unified Command
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Single Command• Based on first arriving emergency units
• Initial Incident Commander begins assessment of incident
• Rescue, Triage, Treatment, Transport
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Basic Command StructureSingle Command
R E S C U E /E X TR IC A TIO N
TR IA G E TR E A TM E N T TR A N S P O R T
IN C ID E N TC O M M A N D E R
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Unified Command• Incidents that involve jurisdictions or agencies
involved in the decision making and planning process
• Ensures plan is communicated and supported by all resources assembled
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INCIDENT CO M M AND SYSTEM
SA FE T Y O FF ICE R L IAIS ON OFF ICER
P UB LIC IN FORM AT IONOF F ICE R
STAG ING O F F ICE R
TR EATM EN T ME MB E RSIMME DIATE
TR EATM EN T ME MB E RSDE LAY E D
TR EATM EN T ME MB E RSMIN O R
TRE ATME NT TE AMLE ADE R
TR IAG E MEMB ER S
MO RG UE MANAG E R
TRIAG E TEAMLE ADE R
ME D ICAL G RO U PS UP E RVIS O R
G RO UN D AMBULANCE
AIR AMB ULAN CE
TRAN SP O RT G RO U PSU PE R VIS O R
OP E RAT IONS OF F IC ERFIE L D M E D ICAL COM M A NDE R
RE SO URC ES
S ITU ATIO N
DO CU MEN TATIO N
DE MO BILIZATIO N
P LAN NING OFFICE R
CO MMUN ICATIO N S
ME D ICAL
FO O D
SE RVICE
SU P PLY
FACILITIE S
G RO UN D S UP P O RT
SU P PO R T
LOG IST ICS OFF ICER
TIME
PR O CURE MEN T
CO MP EN S ATIO N
CO S T
AD MINIS TR ATIVE O F F IC E R
INC ID E NTC O M M A ND
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman 63
Overview of Incident Command Process
Process is based on:
• Size up
• Setting Incident Priorities
• Predicting incident course and harm
• Strategic goals and tactical objectives
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Size Up
• Rapid mental evaluation of factors influencing an incident
• Must continue throughout incident with ongoing evaluation
• Incident situation, incident cause and incident status
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Incident Situation
May be one or combination of:
• Biological• Nuclear• Fire • Chemical• Explosion or natural event• Natural disaster with MCI
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Incident Cause
• Incident Cause is important because additional or specialized resources may be needed
• The Incident Commander must determine if
the incident was accidental or intentional
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Incident StatusIs the incident:
• In a somewhat controlled state or
• Does it remain uncontrolled
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Setting Incident Priorities
• After size up of the incident a course of action is determined
• High priority is life safety for the public and responders
• Incident stabilization
• Protection of critical systems
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Estimating Potential Incident Course and Harm
• Responder is making a prediction on what will likely occur during the incident
• Based on available information
• Responder’s experience
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Strategic Goals
• Broad general statements of desired outcome of the incident
• Example: mass casualty overturned school bus
- extrication, triage, treatment, transport
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Incident Command System
• Comprised of two major categories which assist in organizing functions into an effective design:
- Command Staff- General Staff
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Organization
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Command Staff
Consists of the :
• Incident Commander• Safety Officer• Liaison Officer • Public Information Officer
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IN C ID E N TC O M M A N D E R
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Incident Commander
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Incident Commander
• First person on the scene with communications capability
• Remains in command until transferred or incident is terminated
• Complete authority and responsibility
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Incident Commander
• Must assume and announce command, rapidly evaluate incident, identify resources on hand, request additional resources and establish incident action plan
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• Fill command staff and functional areas
• Must approve all information releases to the media
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Transfer of Command• Based on the initial responders experience and
comfort level• Higher ranking officer does not need to assume
command• Transfer procedures should be predetermined• Detailed briefing is required• Face to Face is best method• Include: current status, strategies and tactics
employed, progress, safety, accountability and resources assigned or needed
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General Staff
Consists of:
• Operations (includes staging)• Planning• Logistics• Administrative/Finance
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Operations Section
O P E R A TIO N S
IN C ID E N TC O M M A N D E R
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Operations Section• Operations officer functions under direction of the
Incident Commander• Deploys tactics to control and resolve the incident• Responsible for execution of the incident action plan • Makes recommendations for changes to plan based
on incident status• Oversees and is in direct contact with the staging
manager• Task supervisors report to Operations not Incident
Command
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Planning Section
O P E R A TIO N S P L A N N IN G
IN C ID E N TC O M M A N D E R
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• Responsible for collection, evaluation, distribution and use of information about the incident
• Forecast and develop plans to contain and resolve incident
• Communicates with logistics section
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Planning Section
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O P E R A TIO N S P L A N N IN G L O G IS TIC S
IN C ID E N TC O M M A N D
82
Logistics Section
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• Responsible for providing facilities, services and materials in support of incident
• Includes equipment, personnel and associated materials and tools
• Support branch and Services branch
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Logistics Section
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman 84
Administrative / Finance Section
O P E R A TIO N S P L A N N IN G L O G IS TIC S A D M IN IS TR A TIV EF IN A N C E
IN C ID E N TC O M M A N D E R
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Administrative/Finance Section• Generally not located at incident site
• Responsible for financial, administrative and cost analysis
• Divided into four units: time, procurement, compensation/claims and cost
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman 86
Summary• Incident Command created to deal with any
incident in an organized manner• Manages resources, personnel and equipment to
mitigate the incident• Builds from first responder• Expandable to manage hundreds• Implementation is critical for safe and effective
operation• Allows for multi-agency operations and response
based on incident type
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Thank you 87
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CRITICAL INCIDENT MANAGEMENT
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Performance Objectives
• Discuss critical incident stages
• Discuss decision making in a critical incident
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• Demands a coordinated response to prevent incident from getting worse
• This includes unresolved element of danger such as additional bomb, a threat to citizens and responders or an unusual incident
• Often random in nature and disrupt normal life• Terrorist organizations use opportunity as a tool for
civil disturbance• A mass casualty is a critical incident
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Critical Incident Management Characteristics
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman 91
Mass Casualty Incident Overview
• Produces several patients
• As few as six or as many as several hundred
• Affects local hospitals
• Patients are greater than resources of the initial responders
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Preparation For Mass Casualty
• Pre-planning and training are critical
• Establish guidelines and procedures
• Early implementation of Incident Command
• First five minutes will determine next five hours
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Functional Systems Approach
• Three levels of function: strategic, tactical and task (operation)
• Management is strategic
• Team leaders are tactical
• Resources not involved in supervision are task
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Critical Incident Stages
They consist of:
• Initial Response• Incident Control using the Six Step Response• Recovery Stage
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Initial Response Stage
• Ability to establish command and control• Faced with confusion and panic• Crucial to develop a team and place a plan
in action• Protecting citizens and rescue of victims• Limit incident growth• Protect arriving responders• Identify ingress and egress routes
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Initial Response Objectives
As soon as possible:
• Gain control of the scene
• Restore order
• Prevent target opportunities
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Incident Control Using The Six-Step ResponseThe Six-Step response is based on the Incident
Command System. It includes:
1. Assume Command, 2. Situation Assessment, 3. Identify and Set Perimeters, 4. establish Command Post, 5. assign Safety Officer and 6. establish Staging Area and assign a Staging
Officer
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# 1 – Assume Command
• Must advise incoming responders of incident location
• Secure tactical frequency
• Request supervisory support
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# 2 – Situation Assessment• Size up of the incident that includes the type of
threat, approximate number of injured, size of threatened area and possibility of secondary event.
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# 2 – Situation Assessment
In simple terms the assessment describes:
• What do you have
• What are you doing
• What do you need
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# 3 - Identify and Set Perimeters
• Divide the incident into manageable divisions (geographical areas)
• Allows command to provide resources where they are needed
• Critical incidents have three standard perimeters. All perimeters are divisions
• Expand perimeters based on weather• Perimeters are the hot zone, inner perimeter
and outer perimeter
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The Hot Zone• Area in which the incident has occurred
• May be a street corner or spread over a large area
• Secured by placing responders in positions of controlling ingress and egress
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Inner Perimeter• Protects responders in hot zone• Uniformed personnel only• Used as decontamination area, treatment area
and evacuation area for walking wounded
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Outer Perimeter• Provides last line of defense from internal incident acceleration• Provides first line of defense from external acceleration• Secure area for command post, resources and control of the media
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Perimeter Placement Illustration
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# 4 – Establish Command Post• Typically begins at first responders vehicle• Incident dynamics will require Incident
Commander to shift to a fixed command post• Must be away from hot zone• The command post will ensure support for field personnel, create a controlled environment and improve communications
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# 5 - Establish Safety Officer• Should be filled as soon as possible• Officer selected on operational experience and
ability to recognize acceptable and unacceptable risk
• Operations can be stopped or modified
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# 6 - Establish Staging Area • Effective tool in correct and safe deployment of resources• Staging Supervisor must track, rotate and relieve resources as appropriate• Area established within inner or outer perimeter. Avoid congestion
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Inter Agency Planning • Failure to include all agencies during planning
process may compromise responders• Identify and establish liaisons with all agencies
and coordinate tactical operations
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Secondary Incidents• May be more destructive and damaging than
initial incident• World Trade Center crashes were primary
incident with collapse of the towers as secondary incidents claiming more lives
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Recovery Stage
• Begun when aggressive threats of incident are neutralized
• Incident is not over when last patient is transported
• Recovery must be managed aggressively• Planning Section of incident command is
responsible for initial recovery• Typically the longest and most poorly managed
part of the incident• May require months to years
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Goals in the Recovery Stage
• Most important goal is document collection• Information can assist in Post Incident Analysis,
cost recovery and tracking responder injuries or deaths
• Provide critical incident stress management for responders
• Collect and properly dispose of used medical supplies and biohazard waste from the incident
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Post Incident Analysis
Critical for operational review. Benefits include:• Operational performance• Organizational needs• Procedure modification• Additional training
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Summary• Critical Incident Management can place a heavy
burden on responders• Requires a coordinated response from all
agencies involved• Mass casualty incident is a critical incident,
terrorist related or not • Identifying critical stages will give the responder
a better chance of dealing with the incident• Six – Step response is a tool for incident
management• Humanitarian Assistance
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9-11-01
112
9-11-01
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TRIAGE
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• This lesson provides participants with methods of prioritizing care delivery in mass casualty situations.
• The decision- making process is explored with the goal being the maximum positive effect for the greatest number of patients.
2
Description
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman 115
QUESTION 1
What is the meaning of Triage ? What is the basis of triage ?
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman 116
QUESTION 2
In the MCMS, how many times do you triage and where ?
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• Describe the basic concepts of sorting and allocating treatment to patients in a triage situation
• Demonstrate the decision-making process in determining priority of care
3
Objectives• Describe the basic concepts of sorting and
allocating treatment to patients in a triage situation
• Demonstrate the decision-making process in determining priority of care
3
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What is Triage ?• French word meaning to “Sort”• Utilized to identify treatment priorities• Process by which a decision is made on which
victim receives treatment and which does not• Four basic priorities of patient treatment and
transport
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman 119
PrioritiesHighest Priority
• Patients that require immediate care and transportation
• Patients receive treatment at the scene for life threatening injuries
• First to be sent to available medical facilities
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Intermediate Priority
• Patient treatment and transport can be delayed
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman 120
PrioritiesDelayed or Low Priority• Referred to as “walking wounded”• Injuries require medical care at some point• Treatment and transport can be delayed• Monitor patients and reassessLowest Priority• Patients have either died or are near death• If still alive they have suffered severe or serious injuries with little chance of survival• When resources are limited, patients must be ignored
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Initial Triage Officer
• Must size up situation• Ensure safe approach and scene survey• Activate additional resources
o Number of victimso Size of the incidento Better off requesting more equipment
and personnel than not enough
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Simple Triage and Rapid Transport System
This system focuses on three areas :1. Respirations2. Pulse Rate and Quality3. Mental Status
System requires first responders to have tags, ribbons or tape in four colors
Priority One (Highest Priority )Red – Immediate care : Life threatening injuries
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Simple Triage and Rapid Transport System
Priority Two (Intermediate Priority) Yellow – Urgent care: delay treatment
and transport up to one hour
Priority Three (Delayed or Low Priority) Green – Walking wounded: delay
treatment and transport up to three hours
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Simple Triage and Rapid Transport SystemPriority Four (Lowest Priority)
• Black – No care required: patient is dead or near death
• Hardest priority to deal with emotionally• Necessary for others to survive
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Simple Triage and Rapid Transport System
• First Step is to make an announcement for all people able to get up and walk to specific area
• Allows responder to focus on injured
• People who successfully move should be tagged “Green”
• Tell people to look out for each other and notify responders of any significant changes
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Simple Triage and Rapid Transport System
• Second step is to conduct an orderly survey of remaining victims
• Decide how to move through area• Perform quick assessment on each person and
label or tag• No more than 10 seconds per patient
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Simple Triage and Rapid Transport System
• Correct life threatening : airway or breathing problem and profuse bleeding
• The objective is to: locate, identify and tag priority one patients who require immediate care and transportation
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Respiration
Assess breathing rate
• Greater than 30 per minute, patient is priority one and tagged red
• Less than 30 per minute, move on to assessing pulse and mental status
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Patient Assessment
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Not Breathing
• Quickly make sure mouth is clear• Open airway with head tilt method• During mass casualty incident, cervical spine
immobilization may not be able to be done• Open patients airway and position so it
remains open
• If patient does not start to breath with simple airway maneuvers, tag priority four - black
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Patient Assessment
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First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman 130
Patient AssessmentPulse Rate and Quality
• Check radial pulse• No more than 5 second check• Pulse is weak or irregular - Red Tag Priority
One
• If pulse is strong, move on to assess mental status
• If there is NO pulse, Black tag priority four
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Patient Assessment
Mental Status• Breathing and pulse should have already been
checked• Have patient respond to simple commands such
as “open your eyes” or “squeeze my hand”
• If patient can perform this function, is breathing and has a pulse, yellow tag priority two
• If patient is unresponsive and cannot follow simple commands, red tag priority one
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START TRIAGE
MINOR
all walking wounded
RESPIRATION
IMMEDIATE
YES NO
Position Airway
YES NO
IMMEDIATE DECEASED
over under30/min 30/min
PERFUSIONRadial Pulse Present
Radial Pulse Absent
Capillary Refill
Over Under2 2
ControlBleeding
IMMEDIATE
Secs Secs
Respirations 30/min
Perfusion 2 secs
Mental Status can do
MENTAL STATUS
Can’t Follow Can FollowSimple Commands Simple Commands
IMMEDIATE DELAYED
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Thank You