1	Chapter 9 Medical Incident Management
2	Topics Origin of the Incident Command System Command at a Mass-Casualty Incident Divisions of Command Command System Support The START System
3	Multiple-Casualty Incident An incident that generates large numbers of patients Makes traditional EMS response ineffective Also called a “mass-casualty incident” (MCI)
4	On February 26, 1993, the incident command system was used in response to the bombing of the World Trade Center in New York.
5	Incident Management System A national system used for the management of multiple-casualty incidents Involves assumption of command and the designation and coordination of elements such as triage, treatment, transport, and staging
6	The scene of the April 19, 1995, bombing of the Alfred P. Murrah Federal Building in Oklahoma City
7	Crews with various kinds of protective gear attempting to locate and extricate victims from the debris.
8	A Uniform, Flexible System (C-FLOP) C—Command F—Finance/administration L—Logistics O—Operations P—Planning
9	Command at Mass-Casualty Incidents
10	Incident Commander (IC) A single person is responsible for ALL incident activities. Chain of command – delegation of authority. All non-delegated functions are left to command. Coordinates all scene activities. Also called Incident Manager (IM) or Officer in Charge (OIC).
11	The first on-scene unit must assume command and direct all rescue efforts at a mass-casualty incident (MCI).
12	Singular vs. Unified Command Singular command One person coordinates the incident. Most useful in smaller, single-jurisdictional incidents. Unified command Managers from different jurisdictions share command. Fire, EMS, law enforcement
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14	Establishing Command First arriving unit establishes command. Assign command early in an incident. Establish a command post.
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16	Incident Priorities Life safety Incident stabilization Property conservation
17	Identifying a Staging Area Primary Staging As close to the scene as possible Quick, easy access to the scene Good access and exit areas Secondary Different direction than primary staging Provides a contingency plan if conditions change
18	Communications Communication forms the cornerstone of the Incident Management System.
19	Resource Utilization The primary role of an incident commander is the strategic deployment of all necessary resources at an incident.
20	Using command vests at a mass-casualty incident makes it easier to identify personnel. The incident manager or commander directs the response and coordinates resources.
21	An EMS incident tactical worksheet from the town of Colonie, New York
22	Transfer of Command Command is transferred face-to-face, with current incident commander conducting a short but complete briefing on the incident status.
23	Termination of Command Resources are reassigned or released as an incident progresses.
24	Support of Incident Command Safety Liaison Public information (PIO) Mental health support Finance/ administration Logistics Operations Planning
25	Safety Officer Monitors risk management activities and corrects hazardous conditions Observes all personnel for inappropriate behavior Provides a safe work environment at all times
26	Liaison Officer Functions as contact person for outside agencies and representatives Coordinates with county EOC Communicates with any outside agency representatives
27	Public Information Officer (PIO) Provides information to the news media as directed by the IC Establishes media area Prepares media briefings and releases Coordinates tours of incident area
28	Mental Health Support Rotates personnel to facilitate rest Evaluates for signs and symptoms of stress
29	Finance/Administration Coordinates financial and administrative activities Time assessment Authorizes procurement Cost analysis
30	Logistics Supports incident operations Coordinates procurement and distribution of all medical resources
31	Operations Patient tracking Employs all directives Carries out tactical objectives Maintains plan of action
32	Planning Coordinates planning activities for future incident operational needs Monitors situation status Supervises personnel allocation Coordinates resources
33	Basic elements of the incident management system
34	Examples of branches that may operate in a major incident
35	EMS Branch Functions Triage Treatment Transport
36	Triage Sorting of patients based upon the severity of their injuries Primary triage Secondary triage
37	Organization for a small- to medium-sized incident
38	Operation of the START system, the most widely used triage system
39	The START System Simple Triage and Rapid Transport Based on Ability to walk Respiratory effort Pulses/perfusions Neurological/mental status
40	START Direct the “walking wounded” to a primary treatment site for further evaluation and treatment if necessary. Walking wounded should be tagged as “minor” patients.
41	After the Walking Wounded… Assess RPMs Respirations Perfusion Mental Status
42	Respirations None – Open the airway Still none – Deceased Present – Immediate Present Rate >30 – Immediate Rate <30 – Check perfusion
43	Perfusion Radial pulse absent or delayed capillary refill – Immediate Radial pulse present or normal capillary refill time – Check mental status
44	Mental Status Cannot follow simple commands – Immediate Can follow simple commands – Delayed
45	Triage Tags Alert care providers to patient priority Prevent re-triage of the same patient Serve as a tracking system
46	The METTAG
47	Treatment Red treatment unit Yellow treatment unit Green treatment unit Supervision of treatment units
48	Treatment sector at an incident (MCI)
49	Other Areas On-scene physicians Staging Transport Extrication/Rescue Rehabilitation
50	A hazardous materials team may be involved in the extrication and rescue phases of some mass-casualty incidents.
51	Communications EMS communications officer Alternative means of communications
52	Disaster Management Mitigation Planning Response Recovery
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55	Disaster Mental Health Services Psychological first aid to meet providers’ emotional needs Screening of rescuers and victims for abnormal signs and symptoms of traumatic stress
56	Sample command structure for an MCI at a rest home
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58	Summary Origin of the Incident Command System Command at a Mass-Casualty Incident Divisions of Command Command System Support The START System