mci products response training 2nd edition

Everyday EMS Tips Focus on Mass Casualty Incidents Products, Training, and Response

March 23, 2010 2nd edition

Greg Friese, MS, NREMT-P

EverydayEMSTips.com tips, resources, study aids, and ebooks

2 © 2010 EverydayEMSTips.com

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©2010 EverydayEMSTips.com ALL RIGHTS RESERVED. You may give this publication away, offer it on your website or share it with your peers as long as you maintain the original formatting and author attribution. Please invite interested individuals to become subscribers at EverydayEMSTips.com. For permission questions and clarifications contact [email protected]. Much of the content in this article was originally prepared for and adapted from my regular column at EMS1.com and blog posts at EverydayEMSTips.com. DISCLAIMER AND/OR LEGAL NOTICES: The information presented herein represents the views of the author as of the date of publication. Because of the rate with which conditions change, the author reserves the right to alter and update this information based on the new conditions. The publication is for informational purposes only. While every attempt has been made to verify the information provided in this publication, neither the author nor its affiliates/partners assume any responsibility for errors, inaccuracies or omissions. Any slights of people or organizations are unintentional. If advice concerning medical, legal or related matters is needed, the services of a fully qualified professional should be sought. You should be aware of any laws/practices or local policies which govern emergency care or other pre hospital care practices in your country and state. Any reference to any person or business whether living or dead is purely coincidental.



Mass Casualty Incident Response Ebook Introduction

Mass casualty incident response for EMS is one of my favorite topics as a trainer and as a student. I have had the good fortune to work on several MCI for EMS consulting projects throughout my home state of Wisconsin that have involved writing/rewriting EMS plans, developing training materials, and delivering training exercises. The purpose of these projects has generally been to improve responder knowledge of MCI response tools, minimize risks to emergency responders, increase the efficiency of patient triage, and ensure that patients, especially critical patients, are transported early to the facilities best capable for caring for them.

I have also had the good fortune to travel to Israel and study MCI response and suicide bomber terrorism in a small group seminar format. The real-life experience of my instructors was the best week of EMS related training I have ever had.

This ebook is a compilation of my articles and experiences that relate to MCI response, preparation, products, and training. I presented an MCI Concepts for EMS lesson for EMSBootCamp.com. The archived session is a compilation of sessions I have presented at numerous EMS training sessions. It represents a "best of the best." The archived training video includes my PowerPoint presentation, slide handouts, and a MCI tabletop

exercise that I have conducted dozens of times. I give you all the materials you need to adapt and deliver the exercise in your service area. About Greg Friese, MS, NREMT-P Greg is a paramedic, presenter, author, blogger, podcaster, and elearning designer. To read more tips visit everydayemstips.com. Reader tips are being compiled for future ebooks. Please submit your tips and suggestions by email to [email protected]. Ebook Advertising EverydayEMSTips.com hosts an outstanding and growing selection of content for students, EMTs, Paramedics, EMS educators, and EMS mangers. Daily we deliver patient assessment tips, product reviews, audio podcasts, and video segments. EverydayEMSTips.com has a growing list of double-opt-in subscribers, daily visitors, and RSS subscribers. To discuss your advertising goals and outcomes email to [email protected].

Ebooks can be available as a premium item for new subscribers, any site visitor, or distributed through other channels. An ebook, underwritten by advertising, has the potential for wide distribution through social media networks like Facebook, Twitter, and Scribd. We can also produce and distribute an ebook based on content supplied by an advertiser.



Table of Contents Mass Casualty Incident Response Ebook Introduction .................................................................. 3

MCI Response Tips......................................................................................................................... 5

Mass Casualty Supply Kits ............................................................................................................. 6

MCI Response in Israel Workshop Articles and Podcasts .............................................................. 7

Mass Gathering Sporting Events are Predictable MCIs ................................................................. 8

Mass Casualty Trailers .................................................................................................................... 9

MCI Training ................................................................................................................................ 10

Debriefing Patient Assessment Scenarios ..................................................................................... 11

How to Buy: Communications...................................................................................................... 12

Emergency Response Guidebook Training .................................................................................. 13

Emergency Response Guidebook Smartphone Apps ................................................................... 13

About Everyday EMS Tips ........................................................................................................... 14

About the Author .......................................................................................................................... 14



To learn more about MCI Concepts for EMS browse the www.EMSBootCamp.com archives for an online training session I

delivered on the topic. The session is a compilation of sessions I have presented at numerous EMS training sessions and includes the

materials for a twenty patient tabletop triage exercise you could facilitate for your service.

MCI Response Tips

What does a MCI look like for your agency? Is it five patients? Or ten? Or more than twenty? MCI is defined by responder capabilities, not patient numbers. To better understand what would or would not be an MCI for your service talk through past or potential scenarios with your co-workers to better understand what an MCI would look, sound, and feel like.

When responding to an MCI remember these Everyday EMS Tips:

1. An MCI is defined by responder capabilities, not patient numbers. Thus what is or is not an MCI varies from day-to-day and region to region. Talk through potential scenarios to understand what an MCI might mean for your service.

2. Plan and prepare using an all hazards approach versus a specific plan for all potential incidents.

3. MCI response is not all or nothing. Use plan components, equipment, and ICS positions appropriate for the actual incident.

4. Communicate with receiving hospitals early and often about the number and severity of patients.

5. The first emergency responder(s) on scene need to identify and confirm the MCI, initiate the MCI plan, and initiate command. Next complete a scene size-up of hazards before starting triage or treatment.

6. Establish functional areas like staging, command post, and treatment areas early. Mark functional areas with flags, signs, tape, and lights.

7. Finally, make sure the Incident Commander stays put in an incident command post which could be a vehicle, trailer, or specific area.



Having a designated incident command post helps keep the incident commander stationary.

Mass Casualty Supply Kits Where are the mass casualty supplies in your ambulance or first response vehicles? I am guessing they are tucked in a cabinet behind the back-up airway kit or obstetrics kit, like most infrequently used items. Am I right? With space at a premium inside the ambulance, these are important items for your mass casualty supply kit. The first step in any mass casualty situation is declaring an MCI and initiating the incident command system (ICS). As this is done, the ICS personnel should don vests that are labeled with their position. Vests should be highly visible with reflective marking. Since many MCIs occur on roadways make sure vests meet current ANSI guidelines for visibility. Some vest collections color code the vests by the function area in the EMS branch. For example, the transportation group supervisor might be assigned a green vest and triage group supervisor a yellow vest. The next step for any ICS member is to review and understand the immediate responsibilities of their position. A job action sheet is a quick reference of the position’s immediate and long-term tasks, span of control, and reporting responsibilities. For example, the triage group supervisor leads triage teams and reports the number of patients to the EMS Branch Director (or Operations Section Chief or Incident Commander depending on the size of the incident). A job action sheet is not the full mass casualty response plan for the agency. Instead it is focused on the accomplishment of specific tasks. Job action sheets can be laminated or in a clear plastic folder for durability and protection. Include a pen, grease marker, or a marker with the job action sheet depending on its format. Depending on the size and duration of the incident, EMS professionals may need to deploy other incident management supplies. Colored flags, scene lights, cones, tarps, and tape can be used to designate different locations at the incidents. Two important areas to clearly designate are the incident command post and the patient treatment areas. Having a designated incident command post helps keep the incident commander stationary. There are a variety of products for patient triage. Tags, wrist bands, and even different colors of surveyor’s tape can be used to designate patient’s triage category. A triage product should be durable, have a number or bar code system for patient tracking, and allow recording of basic patient demographic or assessment data. Additional triage tag features to consider include tear-off portions to designate a patient’s contamination status and a tag patient’s belongings like clothing, bags, and other potential contaminated evidence. Also evaluate the current or future ability of the triage tag to integrate with an electronic record keeping system.



Pre-packaged or made-to-order Mass Casualty Supply kits are available for purchase. Another option is to make your own kit with a small or medium size duffle bag and then pack it with vests, scene supplies, job action sheets, and triage tags. Which do you use – pre-packaged or build-your-own? What are supplies are essential for incident management? Share your experiences and ideas by sending an email to [email protected] with your feedback.

MCI Response in Israel Workshop Articles and Podcasts

EMS has given me some amazing opportunities. One of the most incredible was visiting Israel in early 2007 to attend a week-long training seminar on terrorism and mass casualty response. While I was in Israel I recorded a podcast each day that was posted at EMSResponder.com. I also wrote an article for EMS Magazine. I would recommend learning about EMS in other countries to any EMS professional.

Article: Principles of Mass Casualty Response to Terrorist Attacks

Podcasts: Daily audio report recording during workshop and travel in Israel

Where have you traveled to learn more about EMS in another country?



Mass Gathering Sporting Events are Predictable MCIs As challenging as marathons can be, no one expects to collapse from cardiac arrest while engaging in competition. Having completed six marathons, I know the challenges that both runners face to get to the finish and EMS professionals face to provide special event coverage. Whether you're a marathoner or a paramedic, attention and preparation are essential to maximize the chance of safe outcomes. Seeing as major marathons often draw crowds equivalent to the population of a medium city, EMS professionals should prepare by considering the event a predictable MCI. In planning, ask yourself the following questions: What kind of medical support will the race organization provide? How many medical staff and volunteers will there be? What are their credentials? Where will they be located on the race course? What type of equipment and how much will be on site? Don't even think about not having an AED. The question is how many you need, and where they should be placed. Make sure everyone involved in the response effort has what they need to do their job. What will the protocol be for transport? Does the emergency plan include transport? Some events are so big that they possess their own medical team without the help of local county responders; however, they might not include transport. Make sure a plan to get ambulances on and off the course is in place, with designated entry and exit points. With thousands of people packed onto a narrow road, it may not be possible to run lights and sirens and blaze down the street to the patient. Think strategically about making easily accessible pick-up locations. How will the volunteers be trained? If every volunteer has even the most basic training and knowledge – such as where the AED is located or how to do chest compressions – chances for survival can be greatly increased. Despite even the best preparation, circumstances exist that are beyond our control. However, a clear and comprehensive preplan never hurts, and more often than not, drastically helps.



The amount of supplies will expand

to fit the trailer.

Mass Casualty Trailers Mass casualty supply trailers are mobile caches of equipment for rapid response to mass casualty incident (MCI) scenes. During an MCI, supplies on responding ambulances may not be adequate for on-scene treatment. Unless those ambulances are unloaded before they initiate transport, many of the extra supplies they contain will not be available for the remainder of the incident. The primary purpose of an MCI trailer is rapid delivery of supplies for decontamination and personal protection, treatment of life threats, and incident management supplies like tarps, lighting, and long-term patient care supplies like cots and blankets. Secondary purposes might include the delivery of supplies for EMS professional sustenance like water, food, and clothing –or treatment of patients with minor injuries like small wounds. Because of the high cost for the trailer or trailers, as well as the initial equipment, a needs analysis should be conducted to confirm the need for a mass casualty trailer, the size of the trailer, and the contents for the trailer. If the need for a trailer is confirmed, do these things before actually purchasing the trailer and stocking it with supplies:

1. Create a protocol or adapt the existing MCI plan to specify the type and size of the incident that would trigger deployment of the trailer.

2. Identify locations where the trailer or trailers will be stored and, if needed, agree to mutual aid response agreements for transport of MCI trailers to the incident scene.

3. Ensure that the public safety answering point understands the protocol and has the capability to dispatch an MCI trailer and track its times like any other response resource.

4. Prepare an equipment specifications list that can be submitted to vendors.

Most MCI trailers are provisioned for multiple patients that have a trauma mechanism, including patients from a multiple vehicle collision, building collapse, or mass shooting. Work with local and regional emergency responder groups to conduct a hazard analysis for the trailer’s response area. Other mechanisms, like chemical exposures, influenza pandemic, or foodborne illnesses - may be higher risk and higher probability. The supplies of the trailer should reflect the local hazard analysis. You can either determine what you want and find a trailer to hold those contents or pick a trailer and then fill it with contents. The amount of supplies will expand to fit the trailer. While having lots of supplies may seem advantageous, make sure to consider the cost of restocking outdated supplies or rotating unused inventory off the trailer and into ambulances to use it before it expires.



When a trailer is used during an MCI there will probably be little thought to tracking the equipment used. A plan needs to be in place before deployment for tracking and replacing inventory from the MCI trailer. Also consideration should be given as to how supplies from the trailer will be billed. Finally, educate EMS professionals and other emergency responders about the availability of MCI trailers and their contents. Include deployment of the trailers in all functional and full-scale exercises. After the initial purchase make sure to orient new personnel to the trailers. What is in your agency’s MCI trailer? What advice would you give to an agency considering an MCI trailer? Share your ideas by sending an email to [email protected] with your feedback.

MCI Training

Since mass casualty events are infrequent for most EMS professionals we have limited opportunities to practice and improve our incident management skills. Didactic training can help us become familiar with concepts, but regular hands on practice through table top exercises, functional drills, and full-scale simulations is needed to achieve incident management competency. Here are some tips for MCI training:

1. Scenario planning. A scenario is a story that needs to have a beginning, middle, and end. The beginning is usually what happened before EMS arrives. The middle is the actual EMS response including triage, patient assessment, treatment, and transport. The end is the resolution of the MCI and the demobilization of EMS.

2. Identify clear training objectives. What do you want personnel to accomplish during the training program? Create objectives that are specific, attainable, and measurable.

3. Document the training for analysis and debrief. Use a digital camera and/or handheld camcorder to record the training program. I usually record short bursts of action, such as quick moments of triage, extrication, and treatment. Video and photos allow personnel to see other parts of the scene that they could not see during the actual training.

4. Debrief what went well. Most debrief sessions quickly devolve into discussion about the short comings of the training plan and the negative performance actions. Focus the debrief on positive lessons learned and how to apply those lessons to future trainings and actual incidents.

Finally, make incident management roles and responsibilities part of your routine. Some services conduct Triage Tuesday and use triage tags on every patient one Tuesday a month.



Debriefing Patient Assessment Scenarios Patient assessment scenarios are great opportunities for students to see injuries and illness within the context of the assessment. They also allow students to practice applying treatments. The final phase of any patient assessment scenario is debriefing. During this phase, the instructor’s role is to review what happened and begin the process of transferring the lessons learned from the performance phase to future training activities or real incidents. If you are instructor or facilitator, follow these general guidelines for debriefing:

1) Don’t attempt to debrief every component of the scenario. Focus discussion on the components most important to the objectives of the scenario.

2) Ask questions to stimulate discussion about the scenario objectives while avoiding statements that judge performance.

3) Make sure to ask what went well. It is often more difficult for instructors and students to talk about successes.

4) Ask specific questions to specific people. All students need to be ready for giving hand-off reports. Specific questions – i.e. “What was your first set of vital signs for this patient?” -- prepares the student for the work environment.

5) Use a question that teaches and elicits new information. If every group assessed a chest pain patient, each student reporting during the debriefing should add new information to the discussion.

As you near the conclusion of the debriefing ask, “What questions do you have?” Instead of asking “do you have any questions?” A ‘yes’ or ‘no’ question almost always results in a ‘yes’ or ‘no’ answer. Asking, “What questions do you have?” almost always leads to a question.



How to Buy: Communications Guidelines for purchasing Communications products The after action report for every major incident or training exercise invariably includes “Improve Communications” as one of the top three lessons learned. I am confident we could review decades of after action reports and find recommendations to improve communications by purchasing new radios, better radios, more radios, fancier radios, programmable radios, digital radios, stronger radios, encrypted radios, and lots of other assorted radio infrastructure. Despite purchasing billions of dollars of radio equipment, clear communication continues to be a problem and a lesson learned at major incidents and training exercises for all emergency responders. It has become apparent to me that the solution – buying radios – is not fixing the problem. As you review your department’s needs to improve internal and external communication, make sure you correctly understand the problem and then pick the appropriate solution. Communications hardware is just part of the problem and likely a much smaller part than we realize. When improving communications, make sure you also address the teamwork, trust, and knowledge issues that are at the core of solving communication problems. Here are three things to consider when making a communications purchase:

1. Clearly understand the problem you are solving. New radios will not resolve distrust among mutual aid partners.

2. Stay true to an accountability system on every incident. New radios will not prevent freelancing.

3. Improve and monitor listening skills. Radio batteries last a lot longer in the receive mode than they do in the transmit mode.

4. Focus on completing the task you are assigned. Radios that scan multiple frequencies don’t improve our ability to multi-task.

In the 7 Habits of Highly Effective People, author Steven Covey teaches, “Seek first to understand, then to be understood.” Focus communications training, purchases, and solutions on first listening to solve the underlying communications problem and to appropriately distribute scarce purchasing resources to the areas of greatest need. How would you improve communications without purchasing communications equipment? Any other suggestions? Anything we missed in the list above? Send an email to me at [email protected] with your feedback.



Emergency Response Guidebook Training Where is the Emergency Response Guidebook (ERG) in your ambulance, rescue vehicle, fire truck or personal scene response vehicle? The Department of Transportation’s stated goal is to make sure there is an ERG in every emergency response vehicle. Before you do anything, go out to your vehicle and make sure you have the most up-to-date copy of the ERG. If you need more free copies, contact your state coordinator. How do you deliver ERG training to EMT students and new members? The U.S. DOT Pipeline and Hazardous Materials Safety Administration has an excellent video available that you can view online or download. The video is designed for new emergency responders that are unfamiliar with the ERG. However, I have received numerous classroom lectures and refreshers on the ERG, and even I have learned several new things from watching this video. Remember that any ERG training program should include hands-on opportunities to look up information in the ERG and discuss how it applies to different scenarios described by the trainer. Visit the U.S. DOT PHMSA website to download a PDF of the ERG. There are also versions available for PDAs and in Spanish.

Emergency Response Guidebook Smartphone Apps

There is an ERG app for the iPhone, Blackberry, and Droid. Links to the three apps I have found are:

iPhone Emergency Response Guidebook by Gary Huntress

Blackberry Emergency Response Guidebook by Frank Hodum

Droid Emergency Response Guide by Agilus



About Everyday EMS Tips EverydayEMSTips.com and Every Day EMS Tips are brands developed by Emergency Preparedness Systems LLC. (http://eps411.com). EverydayEMSTips.com provides tips, resources, study guides, and ebooks for students, EMTs, Paramedics, and EMS managers. The Everyday EMS Tips and Everyday EMS Products are regular features at EMS1.com.

About the Author Greg Friese, Plover, Wisconsin, is the founder and president of Emergency Preparedness Systems LLC. He founded EPS to deliver innovative and efficient emergency preparedness solutions. Greg helps clients create, design, distribute and facilitate rapid e-learning for emergency responders. Greg is a paramedic, EMS instructor, conference speaker, EMS author, and a Wilderness Medical Associates Lead Instructor. Greg is the Everyday EMS tips columnist at EMS1.com. His tips are featured on the EMS1.com homepage and EMS1.com subscriber newsletter. Greg has recently written for JEMS.com, Wilderness Medical Associates, JEMS Magazine, EMSResponder.com and EMS Magazine, the NAEMSE Educator Newsletter, and EMSLive.com. Connect with Greg at http://gregfriese.com

mci products response training 2nd edition

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