SAN LUIS OBISPO CITY FIRE EMERGENCY OPERATIONS MANUAL E.O MULTI-CASUALTY INCIDENTS Revised: 8/14/2015 Page 1 of 10. Purpose.

Transcription

1 Revised: 8/14/2015 Page 1 of 10 Purpose The establishment of these procedures is designed to provide an organized, coordinated and expandable resource management approach to be utilized by the numerous public and private agencies that each plays a vital role in the successful mitigation of a multi-casualty incident. This Guideline encompasses the body of the San Luis Obispo County MCI Plan, with specific guidelines for San Luis Obispo City operations. MCI s occurring within San Luis Obispo City jurisdiction must incorporate the County MCI plan so that all agencies will be working off of the same Operating Guideline. All SLOFD officers must be familiar with both the County MCI plan, and Firescope FOG Multi-Casualty Incident section. Definition A multi-casualty incident (M.C.I.) is any incident where the numbers of injured people, in combination with the types and severity of their injuries, overwhelms the initial responders ability to provide adequate pre-hospital emergency medical care. MCI Priorities Early request for additional resources. Timely triage of patient using START Triage system (See Triage hyperlink Training Manual 11.41). Appropriate and timely treatment with the realization that the level of care possible may not be the same as that provided in the initial response mode due to the sheer numbers involved. Rapid transport of properly packaged and (ideally) stabilized patients to an appropriate receiving facilities. Timely designation of a properly trained and equipped individual who can initiate and coordinate medical communications between transporting units and receiving facilities. Initially this role should be filled by the Patient Transportation Unit Leader. Documentation Each assigned position responsible for a specific area within the organization framework should document activities utilizing a Unit Log ICS 214. Initial Notification To dispatch the appropriate emergency medical resources, the first public safety or EMS unit to arrive at the scene should provide Med-Com, through routine channels (i.e. SLO Dispatch), with the following condition report of the situation, including, but not limited to: Notification that a multi-casualty incident is being declared; Confirmation on the type and nature of the incident;

2 Revised: 8/14/2015 Page 2 of 10 Initial estimate on the number of injured and extent of injuries; Initially needed additional resources; Any special reporting instructions such as access or staging location. Dispatch and Response Considerations In all likelihood, SLO City Dispatch will receive information from initial callers that a potential MCI has occurred. Dispatch will tone out for a standard medical response, but will advise the on-duty Battalion Chief of the potential MCI. If the Battalion Chief concurs that there is a potential MCI, the BC should request an Initial MCI Response comprised of the following: o SLOFD First Alarm including one engine from County Fire. o 2 additional ambulances, code 3, for a total of 3 ambulances. o The Ambulance Field Supervisor, code 3. o (Law enforcement will be responded as per jurisdictional authority) SLO City Dispatcher will contact MedCom and relay the above information regarding the MCI. Also note that destination hospitals must be alerted as soon as possible so they can ready their staff. Initially, this notification can be accomplished via SLO Dispatch or MedCom, who will advise that patient counts will be forthcoming when EMS units arrive on scene. Resource Considerations Relative To The MCI The IC will need to order resources as needed to mitigate hazards and other scene requirements, but the following information is intended to provide a guideline to requesting resources specific to the treatment and transport of patients in the MCI. Note that there should be a central ordering point, coordinated by the IC, for all resources. An important distinction should be made between the number of patients needing treatment and the number of people involved in the incident. Estimating minimum rescuers for treatment needs (always round up) Two rescuers for each immediate patient. One rescuer for every two delayed patients. One rescuer for every five minor or walking wounded patients. Example: 4 immediates, 8 delayed, and 12 minor patients = 15 rescuers (i.e. five 3- person engine crews or 1 strike team) needed for treatment. Estimating transport needs One ambulance for each immediate patient. One ambulance for every two delayed patients. Consider ordering public transport for delayed or walking wounded Consider turnaround time transporting to and returning from hospital for ambulances to be about minutes per trip.

3 Revised: 8/14/2015 Page 3 of 10 Overhead considerations The IC should request the Ambulance Supervisor for use (typically) as Patient Transportation Unit Leader. A Safety Officer should be ordered/assigned early in the incident. A Public Information Officer should be ordered/assigned early in the incident. Note that most MCI s can quickly become national news items, and as such the media pressure will probably be significant. Recent history has shown that the impacts to and from traumatized or inquiring family members become overwhelming at MCI s, and additional overhead personnel should be assigned to meet these needs. Additional resource considerations Cal Fire Rescue 21 will provide backboards, EMS supplies, and patient packaging for up to 50 patients, as well as several additional personnel to assist on scene. Arroyo Grande and Paso Robles have Mass-Casualty Trailers for 100 patients each. PD will be required for traffic control, crowd control, media control, investigation, etc. There is only one Ambulance Field Supervisor, who may be anywhere in the County at the time of the incident. Therefore, early request of this person is essential for transport and communication operations. Note that San Luis Ambulance Company, depending on time of day, can realistically respond approximately 5 ambulances immediately, with an additional 2 within an hour, for MCI s within the County. Early notification will be required for ambulances from other counties. The IC should consider staffing SLOFD Squad 1 during MCI s. Communications The County MCI plan suggests on scene tactical radio communications should use CALCORD (Channel 7) as a Tactical Channel, since ambulances and other agencies can access this channel. The hospital communication channel will be different than the Tactical or Command channels in order to have fluid communications with transportation and receiving resources. City Net will serve as the Command Channel for the incident, unless otherwise determined by the IC. Staging Areas An area to stage incoming resources may be needed in order to maintain on-scene coordination of response equipment and personnel. On large incidents the staging area should have a staging area manager assigned. The IC should consider staging additional arriving ambulances and their personnel in preparation for transport only. This will avoid the problem of ambulance personnel committed to on-scene treatment when transport and turnaround time may be critical.

4 Revised: 8/14/2015 Page 4 of 10 Position Checklists For Primary MCI Roles See Full List In ICS Medical Group Supervisor The Medical Group Supervisor reports to the Operations Section Chief and supervises the Triage Unit Leader, Treatment Unit Leader and Patient Transportation Unit Leader. The Medical Group Supervisor establishes command and controls the activities within a Medical Group: Review common responsibilities. Participate in Operations Section planning activities. Establish Medical Group with assigned personnel, request additional personnel and resources sufficient to handle the magnitude of the incident. Designate Unit Leaders and Treatment Area locations as appropriate. Isolate Morgue and Minor Treatment Area from Immediate and Delayed Treatment Areas. Request law enforcement/coroner involvement as needed. Determine amount and types of additional medical resources and supplies needed to handle the magnitude of the incident (medical caches, backboards, litters, and cots). Ensure activation or notification of Med-Com to determine receiving facility bed availability. Direct and/or supervise on-scene personnel from agencies such as Coroner's Office, Red Cross, law enforcement, ambulance companies, county health agencies, and hospital volunteers. Request proper security, traffic control, and access for the Medical Group work areas. Direct medically trained personnel to the appropriate Unit Leader. Maintain Unit/Activity Log - ICS Form 214. Triage Unit Leader The Triage Unit Leader reports to the Medical Group Supervisor and Supervises Triage Personnel/Litter Bearers and the Morgue Manager. The Triage Unit Leader assumes responsibility for providing triage management and movement of patients from the triage area. When triage has been completed, the Unit Leader may be reassigned as needed: Review Common Responsibilities. Review Unit Leader Responsibilities. Develop organization sufficient to handle assignment. Inform Medical Group Supervisor of resource needs. Implement triage process. Coordinate movement of patients from the Triage Area to the appropriate Treatment Area. Give periodic status reports to Medical Group Supervisor. Maintain security and control of the Triage Area. Establish Morgue.

5 Revised: 8/14/2015 Page 5 of 10 Morgue Manager The Morgue Manager reports to the Triage Unit Leader and assumes responsibility for Morgue Area functions until properly relieved: Review Common Responsibilities. Assess resource/supply needs and order as needed. Coordinate all Morgue Area activities. Keep area off limits to all but authorized personnel. Coordinate with law enforcement and assist the Coroner or Medical Examiner rep. Keep identity of deceased persons confidential. Maintain appropriate records. Treatment Unit Leader The Treatment Unit Leader reports to the Medical Group Supervisor and supervises Treatment Managers and the Treatment Dispatch Manager. The Treatment Unit Leader assumes responsibility for treatment, preparation for transport, and directs movement of patients to loading location(s): Review Common Responsibilities. Review Unit Leader Responsibilities. Develop organization sufficient to handle assignment. Direct and supervise Treatment Dispatch, Immediate, Delayed, and Minor Treatment Areas. Coordinate movement of patients from Triage Area to Treatment Areas with Triage Unit Leader. Request sufficient medical caches and supplies as necessary. Establish communications and coordination with Patient Transportation Unit Leader. Ensure continual triage of patients throughout Treatment Areas. Direct movement of patients to ambulance loading area(s). Give periodic status reports to Medical Group Supervisor. Medical Communications Coordinator The Medical Communications Coordinator reports to the Patient Transportation Unit Leader, and maintains communications with the hospital alert system to maintain status of available hospital beds to assure proper patient transportation. The Medical Communications Coordinator assures proper patient transportation and destination: Review Common Responsibilities. Establish communications with the hospital alert system. Determine and maintain current status of hospital/medical facility availability and capability. Receive basic patient information and condition from Treatment Dispatch Manager. Coordinate patient destination with the hospital alert system. Communicate patient transportation needs to Ambulance Coordinators based upon requests from Treatment Dispatch Manager.

6 Revised: 8/14/2015 Page 6 of 10 Communicate patient air ambulance transportation needs to the Air Operations Branch Director based on requests from the treatment area managers or Treatment Dispatch Manager. Maintain appropriate records and Unit/Activity Log (ICS Form 214). Patient Transportation Unit Leader The Patient Transportation Unit Leader reports to the Medical Group Supervisor. The Patient Transportation Unit Leader is responsible for the coordination of patient transportation and maintenance of records relating to the patient s identification, condition, and destination. The Patient Transportation function may be initially established as a Unit and upgraded to a Group based on incident size or complexity: Review Common Responsibilities. Insure the establishment of communications with hospital(s). Designate Ambulance Staging Area(s). Direct the off-incident transportation of patients. Assure that patient information and destination are recorded. Request additional ambulances as required through the Medical Group Supervisor. Coordinate requests for air ambulance transportation through the Air Operations Branch Director. Coordinate the establishment of the Air Ambulance Helispots. Determine and maintain current status of hospital/medical facility availability and capability. Receive basic patient information and condition from Treatment Area Managers. Coordinate patient destination with Med-Com. Establish routes of travel for ambulances for incident operations. Establish and maintain communications with the Air Operations Branch Director regarding Air Ambulance Transportation assignments. Assure that necessary equipment is available in the ambulance for patient needs during transportation. Request additional transportation resources (non-ems) as appropriate through the Medical Group Supervisor. Provide an inventory of medical supplies available at ambulance Staging Area for use at the scene. Maintain records as required utilizing ICS MC 306 Patient Tracking Form (see last page), and Unit/Activity Log - ICS Form 214.

7 Revised: 8/14/2015 Page 7 of 10 MCI Response Organization The following organizational structures are included in both Firescope FOG and the County MCI plan, and are designed to provide the IC with a basic, expandable system to manage a large number of patients during an incident. If incident conditions warrant, Medical Groups may be established under the Operations Section Chief. The degree of implementation is dependent upon the complexity of the incident. ICS FOG MCI Initial Response Organization (suggested) This example depicts the arrival of an Engine/Truck Company and Ambulance (based upon the standard medical response in the City of San Luis Obispo). These units find conditions warranting a Multi-Casualty response. The IC (first-in engine or truck captain) manages initial response resources as well as the command and general staff responsibilities. Notification of MCI is made to Dispatch, and additional resources requested. The first arriving ambulance should be assigned as the Patient Transportation Unit leader, with the immediate priority of fulfilling the Medical Communications Coordinator role. The first arriving SLOFD crew would become triage personnel, and handle initial hazard control issues (fuel spills, unstable vehicles, etc.) The second ambulance member (Paramedic or EMT) begins establishing Treatment Areas beginning with the Immediate Treatment Area. Police Department (not listed) controls traffic, site access, etc.

8 Revised: 8/14/2015 Page 8 of 10 ICS FOG MCI Reinforced Response Organization (suggested) This corresponds to a first-alarm response for San Luis Obispo City Fire Department. In addition to the initial response, the IC (now the duty Battalion Chief) establishes a Safety Officer, Triage Unit Leader, Treatment Unit Leader and Patient Transportation Unit Leader. The IC reviews the resources ordered and requests additional resources as needed, such as PIO, Red Cross, etc. Consideration must be made by the IC for sufficient resources for rehab of on-scene crews, and for ambulance numbers that factor in patient count and turnaround time from hospitals. The IC has requested the Ambulance Field Supervisor, who will typically become either the Patient Transportation Unit Leader or Medical Communications Coordinator. Patient treatment areas are reinforced by incoming Fire Department crews. Ambulances and their personnel must be directed toward transportation of patients instead of on-scene treatment of victims.

9 Revised: 8/14/2015 Page 9 of 10 MCI Multi-Group Response Organization (example) The Medical Group Supervisor is managing treatment and transportation of patients. The Patient Transportation Unit Leader is managing the transportation of patients to receiving facilities. In most cases, triage would be winding down and those personnel can be assigned to a treatment area. The Operations Section Chief has sufficient resources to turn their attention to those patients that are entangled or entombed and established an Extrication Group. Other elements of the Command Staff are activated as well as selected elements of the Planning and Logistics Sections. Not shown (and recommended) is a Disaster Welfare Unit for the purpose of informing and counseling victims and families.

10 Revised: 8/14/2015 Page 10 of 10