ualty training

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ZONE 4 MASS CASUALTY TRAINING

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To assure all crews within Central Zone understand the roles and responsibilities of operating in the framework of a MCI

incident.

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FIRESCOPE

COUNTY SAN DIEGO

CENTRAL ZONE POLICY

ZONE TRAINING OFFICERS

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Review MCI vs MPI Review ICS Positions and Responsibilities Review DMS “New” Triage Tag Review START Guidelines Table Top Exercise Debrief

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MPI - Multi-Patient Incident

MPI is any number greater than one patient.

Agency has sufficient resources to handle

Patients often numbered in sequence

Most common system used each day

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MCI – MASS CASUALTY INCIDENT

MCI is an incident with multiple patients which will overwhelm the resources of the responding agencies or the area hospitals.

This can and will differ from agency to agency depending upon the size and scope of their respective resources.

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Often confusion between the two modes.

The difference between MPI and MCI is “AGENCY” driven.

Resource driven

Different Radio Formats

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Example A six patient accident place in San Diego

City may be determined by the IC to be a MPI.

While the same six patient incident in a rural setting would most likely be deemed a MCI due to lack of relative resources.

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Med Com must supply clear and concise report.

Requires a more comprehensive radio report than an MCI per policy S-140

PAMSCATE format (Pt. Number, Age, Mechanism, Sex, Chief Complaint, Abnormal Findings, Transporting Unit and ETA)

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Patient Triage Tag Number (Last 4 digits)

Patient Status (WW, Immediate, Delayed)

Transporting Unit

ETA

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Specialty patients, such as Burn or Pediatric should be communicated to the base in an effort to get those patients to the best location for those types of patients.

Med Com must be disciplined and avoid extraneous radio information.

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Size up (Scope of the incident) Safety Determine and order Resources Establish Traffic Flow (early) for incident Declare MCI (Annex D) Make Assignments Establish Staging Clear Direction ICS Vests (if possible)

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Goal of triage is to sort patients rapidly Use START Guidelines ID Walking Wounded Begin with closest patient Consider Recon to get better

understanding of scope. Tag patients Relay number of patients in each

category to Transportation and Med Com

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Provide extrication and patient movement to either Transport Area or Treatment Area

Consider using Triage Team after they have completed Triage assignment.

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Responsible for communication between incident and the CLOSEST BASE HOSPITAL (not necessarily the trauma center unless they are

closest)

Initial contact with hospital uses unit number Additional contacts use ICS terminology

IE: “Greenfield Med Com”

Must be able to relay scope and size of incident to hospital.

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The Med Com and the Transportation Unit leader or Group Supervisor should be co-located near the patient loading zone for effective communications.

Scribe is highly recommended

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Med Com can quickly get overwhelmed

Highly recommend a scribe

Scribe works as a buffer

Information should be funneled through scribe

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Med Com and Scribe should work side by side

Scribe fields information

Scribe maintains accurate records ( bed counts, Patient acuity, Unit ID with destinations

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Establish early

Ambulance Staging Manager reports to the Transportation Group Supervisor

Responsible for organizing the staging area, resource accountability, briefing units on the situational awareness and maintains unit documentation.

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Staging should organize the available supplies from waiting ambulances in the staging area

Load up one ambulance with supplies collected in staging and send to scene

When organizing the staging area, the staging manager should separate the transportation resources by patient care capabilities when possible

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The Staging Manager should monitor the number of units in staging and advise Operations or the IC when resources fall below minimum levels

The Staging Manager should also coordinate resource levels with the Transportation Unit Leader

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Assign early

This role requires leadership and organization skills to perform the critical tasks required for this position

ID best location (ingress/egress)

Communicates with Med Com

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Transportation Group supervisor use natural barriers, cones or banner tape to identify and create a funnel where patients move though.

Transportation Group supervisor should request a scribe early to assist with the documentation.

In a coordinated process the Transportation Group supervisor will request an ambulance from the ambulance staging manager

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Transportation Group supervisor will request a destination from Med Com and assign the patients to the transporting ambulance

The County’s Annex D policy requires that every receiving hospital will accept a minimum of 1 Immediate and 1 Delayed patient and every Trauma Center to accept a minimum of 2 Immediate patients

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An important but not always necessary position

Set up areas, (WW, Immediate, Delayed) Assure Treatment Areas have sufficient

supplies Communicates with Triage, Med Com and

Transport

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Triage

Pt. Is triaged as immediate

Litter Bearers

Treatment (if activated)

Transport

Sends AMB upon request from Transport

Med Com

Reports number of patients by category to Hospital(info from Triage)

Advises hospital when AMB departs:

-Pt Numbers-AMB number-Destination

Receive list of destination hospitals and bed count from Base Hospital– advises Transport

Ambulance is assigned destination

Assigns patient to ambulance

Gets AMB from staging

Ambulance leaves

-Stabilizes-Treats-Documents

Staging

-Extricates-carry to treatment area

Contact Base Hospital-Declare MCI-establish Med Com

--Patient Flow --Comm Flow

A simple approach

Where to START

One patient at a time

START Triage Algorithm

Patient scenarios

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Simple

Triage

And

Rapid

Treatment

In the early 1980’s the START method was developed in California by Hoag hospital and Newport Beach Fire and Marine.

It provided rescuers with an easy, simple step-by-step approach to assessing and treating a large number of patients with varying degrees of injuries.

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Simple

Triage

And

Rapid

Treatment

The Initial assessment and treatment of each patient is accomplished within 30 seconds.

Initial treatment is limited to correcting immediate life-threatening conditions (i.e. opening an airway and controlling severe bleeding)

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Simple

Triage

And

Rapid

Treatment

The Triage TagA Tag is placed on each patient once they have been assessed. The tag displays the patient’s current status and advises those providing treatment with one of the four possible treatment priorities:MinorDelayedImmediateDeceased

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Simple

Triage

And

Rapid

Treatment

The Triage TagEach tab is distinctly color-coded allowing fast patient priority identification from a distance

DECEASED

IMMEDIATE

DELAYED

MINOR

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Simple

Triage

And

Rapid

Treatment

Triage Tags are designed with tear-offtabs. There is two tabs per category.

One tag gets torn off by Triage Team and one tab is left with the patient.

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Start where you stand - begin the triage process with the patient closest to you. Solicit the help of bystanders and/or uninjured victims. They can be utilized to control bleeding, help maintain an open airway or hold c-spine traction.

Do not spend too much time on any one patient. Move quickly from one patient to the next.

Assess each patient’s RPMs

RespirationsPerfusion

Mental Status

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Upon your arrival, first make sure the scene is safe. Then begin by directing the walking wounded away from the immediate scene to a pre-determined evaluation and treatment area.

Tag them as MINOR (GREEN)

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R PM

ASSESS RESPIRATIONS

If the patient is not breathing then Open the Airway

If the patient is still not breathingthen tag them as DECEASED (BLACK)

Move on to the next patient...

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R PM ASSESS RESPIRATIONS

If breathing is present then Assess the Rate

If the rate is greater than >30then tag them as IMMEDIATE (RED)

Move on to the next patient…

If the rate is less than <30then assess PERFUSION

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R P M ASSESS PERFUSION

If a radial pulse is absent (or)the capillary refill is greater than > 2 secondsthen tag them as IMMEDIATE (RED)


If a radial pulse is present (or)the capillary refill is less than < 2 secondsthen assess MENTAL STATUS

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RP M ASSESS MENTAL STATUS

If the patient cannot follow simple commands (or)has an altered mental status (or)is unconsciousthen tag them as IMMEDIATE (RED)


If patient is able to follow simple commandsthen tag them as DELAYED (YELLOW)


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Simple

Triage

And

Rapid

Treatment

This patient states he cannot move or feel his legs

His respirations are 24

He has a radial pulse of 100

He is awake are oriented

How would you triage this patient?

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Simple

Triage

And

Rapid

Treatment

This patient states he cannot move or feel his legs


He has a radial pulse of 100


DELAYED (YELLOW)

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Simple

Triage

And

Rapid

Treatment

This patient has a blood soaked shirt on


His capillary refill is less than 2 seconds



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Simple

Triage

And

Rapid

Treatment

This patient has a blood soaked shirt on




IMMEDIATE (RED)

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Simple

Triage

And

Rapid

Treatment

This patient has some minor abrasions on his forehead



He is very slow in recalling his name and whereabouts


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Simple

Triage

And

Rapid

Treatment

This patient has some minor abrasions on his forehead



He is very slow in recalling his name and whereabouts

IMMEDIATE (RED)

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Simple

Triage

And

Rapid

Treatment

This patient appears to have no injuries

Her respirations are 20

Her capillary refill is less than 2 seconds

She is unconscious


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Simple

Triage

And

Rapid

Treatment

This patient appears to have no injuries

Her respirations are 20

Her capillary refill is less than 2 seconds

She is unconscious

IMMEDIATE (RED)

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Simple

Triage

And

Rapid

Treatment

This patient is lying quietly on the floor

He is not breathing

His capillary refill is more than 2 seconds

He is unconscious

What is the first thing you would do?

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Simple

Triage

And

Rapid

Treatment

This patient is lying quietly on the floor

He is not breathing

His capillary refill is more than 2 seconds

He is unconscious

REPOSITION THE AIRWAY!

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Simple

Triage

And

Rapid

Treatment

He gurgles a couple of times as you attempt to open his airway but does not resume breathing on his own

His capillary refill is still more than 2 seconds

He is still unconscious


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Simple

Triage

And

Rapid

Treatment

He gurgles a couple of times as you attempt to openhis airway but does not resume breathing on his own

His capillary refill is still more than 2 seconds

He is still unconscious

DECEASED (BLACK)

DVD 8 MINUTES in length

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First Tuesday of the month, start date not yet set

Why?: Most field mis-classify patients as “acute” or “delayed” and aren’t comfortable or familiar with triage tags

To make Pre-Hospital and Hospital personnel more familiar with triage tags and terminology

Will report patient tag number and provide a triage report on every call (including medical calls)

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Exercise our understanding of a MCI scene management

Exercise our communication skills as it relate to MCI.

Review large scale MCI ICS management.

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Engage as a role player.

Communicate as you would in a real incident.

Obtain a ICS Vest

Track patients

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IC Determines other positions

Facilitator

Dispatcher

Companies

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1830 hours Wednesday July 14th

El Cajon Car Show Report Auto v. Ped

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Was objectives met? Were communications and orders clear? Were proper lines of communications

used? Were sufficient resources ordered? Was START guidelines used? Was patient transport effective? Was patient tracking done?

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