CLARK COUNTY MULTI-JURISDICTIONAL MASS CASUALTY PLAN

Transcription

1 CLARK COUNTY MULTI-JURISDICTIONAL MASS CASUALTY PLAN 2005

2 ACKNOWLEDGMENT This plan is a Clark County Public Safety Coordination Team project coordinated by the Clark County Office of Emergency Management in cooperation with the following organizations: American Medical Response American Red Cross Boulder City Fire Department / Emergency Management Boulder City Hospital Inc. Clark County Coroner s Office Clark County Fire Department Clark County Health District Clark County Office of Emergency Management Clark County Public Works Clark County Social Service Desert Springs Hospital Henderson Emergency Management Henderson Fire Department Henderson Police Department Las Vegas Fire & Rescue / Emergency Management Las Vegas Metropolitan Police Department McCarran Airport (Department of Aviation) Mesquite Fire Department / Emergency Management Mike O Callaghan Federal Hospital MountainView Hospital Nevada Highway Patrol North Las Vegas Fire Department / Emergency Management North Vista Hospital Medical Center Spring Valley Hospital Southern Hills Hospital Southwest Ambulance St. Rose Hospital - De Lima Campus St. Rose Hospital - Siena Campus Summerlin Hospital Medical Center Sunrise Hospital & Medical Center University Medical Center (UMC) Valley Hospital Medical Center

3 TABLE OF CONTENTS BASIC PLAN Purpose...Basic 1 Assumptions...Basic 1 Plan Development and Maintenance...Basic 1 Instructions/Information on Plan Use...Basic 2 Life Cycle of a Mass Casualty Incident...Basic 3 Life Cycle of an MCI Flow Chart...Basic 4 MCI Operations...Basic 5 Concept of Operations...Basic 5 Mass Casualty Incident (MCI) Level/Guidelines...Basic 6 Level 1...Basic 6 Level 2...Basic 6 Level 3...Basic 6 Fire Services Alarm Office (FAO) Responsibilities...Basic 7 Health District Responsibilities...Basic 7 Mass Casualty Events Field to Hospital Emergency Communications...Basic 8 EMSystem Emergency Alert Functions...Basic 9 MCI Definitions...Basic 10 ADVANCED PLAN Purpose... Advanced Plan 1 Assumptions... Advanced Plan 1 Life Cycle of An Advanced Mass Casualty Incident... Advanced Plan 2 The Life Cycle of an Advanced MCI Includes... Advanced Plan 2 If Necessary... Advanced Plan 2 Extreme MCI Operations... Advanced Plan 3 Concept of Operations... Advanced Plan - 3 MCI ORGANIZATION Mass Casualty Incident Command on Scene...MCI 1 MCI Organization Chart...MCI 2 Incident Command Organization/Position Descriptions...MCI 3 Air Operations Leader...MCI 3 Ambulance Staging Manager...MCI 3 Crisis Counseling...MCI 3 Delayed Treatment Manager...MCI 3 Finance Section Chief...MCI 3 i

4 Helispot Manager...MCI 4 Hospital Reception and Care...MCI 4 Immediate Treatment Manager...MCI 4 Incident Commander...MCI 4 Information Officer...MCI 4 Law Enforcement Group Supervisor...MCI 5 Liaison Officer...MCI 5 Logistics Section Chief...MCI 5 Medical Communications Manager...MCI 5 Medical Group Supervisor...MCI 6 Medical Supply Manager...MCI 6 Minor Treatment Manager...MCI 6 Morgue Manager...MCI 6 Mortality Management Guidelines During Disaster...MCI 6 Operations Chief...MCI 7 Planning Section Chief...MCI 7 Safety Officer...MCI 7 Scene Security Leader...MCI 8 Traffic Control Leader...MCI 8 Transportation Recorder...MCI 8 Transportation Unit Leader...MCI 8 Treatment Unit Leader...MCI 8 Triage Area Manager...MCI 9 Triage Unit Leader...MCI 9 Unified Command...MCI 9 Single Command Structure...MCI 10 APPENDIX A Emergency Management Agencies... Appendix A 1 Policy and Regulatory Control... Appendix A 1 EMS Provider Agencies... Appendix A 2 Volunteer Services... Appendix A 3 Volunteer Ambulance Services... Appendix A 3 Air Ambulance Services... Appendix A 4 Clark County Hospital Resources... Appendix A 5 Clark County Hospital Emergency Reception... Appendix A 6 ii

5 APPENDIX B Casualty Management... Appendix B 1 APPENDIX C Casualty Collection Points...Appendix C 1 APPENDIX D Metropolitan Medical Strike Team (MMST)...Appendix D 1 Mission Statement...Appendix D 1 Concept of Operations...Appendix D 1 Staffing/Membership...Appendix D 1 Additional MMST Assistance...Appendix D 2 MMST Notification/Call Tree...Appendix D - 2 iii

6 BASIC PLAN

7 BASIC PLAN PURPOSE The purpose of the multi-jurisdictional Mass Casualty Incident plan (MCI) is to provide guidance and procedures for the pre-hospital response and mitigation for any incident involving multiple casualties. The MCI Plan is considered to be an annex to the Emergency Operations Plan for Clark County and the incorporated Cities of Boulder City, Henderson, Las Vegas, Mesquite, and North Las Vegas. ASSUMPTIONS A disaster of such magnitude that would create mass casualties would be beyond the immediate capability of this community s ability to respond without the implementation of the Mass Casualty Incident plan. PLAN DEVELOPMENT AND MAINTENANCE Plan development and maintenance is the responsibility of the Office of Emergency Management in cooperation with Clark County Public Safety Coordination Team. Coordination of plan development and updates is conducted with all agencies, public and private, that have emergency assignments under this plan. Plan updates are to be continuous, but not less than once annually. Training and testing of the plan for accuracy, reliability, and functionality is a continuous process facilitated by reviews, new information, emergency exercises, and emergencies themselves as they occur. All sections of this plan are to be evaluated against these criteria and activities, and then updated as required. Basic - 1

8 INSTRUCTIONS/INFORMATION ON PLAN USE This plan has been carefully formatted to be as functional and user friendly as possible. It is divided into four sections Basic, Advanced, MCI Organization, and Appendices. The Basic Plan contains the fundamental information common to all of the following sections. It should be read carefully for a general understanding of MCI Operations, and for purposes of implementing various sections of the Plan itself. The Advanced Plan contains the information necessary to respond to an extreme mass casualty incident. The MCI Organization Section provides the reader with an overview of the onscene emergency organization framework necessary for effective coordinated multiple agency response to an MCI. The Appendix Section provides readily accessible information on medical transport capabilities, hospital capabilities, and extreme MCI response capabilities available in Clark County, Nevada. Basic - 2

9 LIFE CYCLE OF A MASS CASUALTY INCIDENT The Life Cycle of an MCI includes: 1. Initial reporting of an incident. 2. Public Safety first responders arrive on scene of incident. 3. Brief Initial report by arriving Incident Commander given over 800 Mhz radio command channel stating significance and estimated magnitude of incident. 4. Dispatcher in receipt of Brief Initial Report transfers information into EMSystem and alerts all area hospitals of potential MCI. 5. Casualties are sorted, triaged. 6. Resources demands are identified and prioritized. 7. Transportation needs are identified and prioritized - Transportation Unit established. 8. Transportation Unit Leader contacts all area Health Care Facilities via Hospital All Call channel. 9. Hospital care facilities treat the casualties. 10.Final reporting of the MCI prepared.. See details on following flow chart. Basic - 3

10 Basic - 4

11 MCI OPERATIONS A Mass Casualty Incident (MCI) is defined as any situation where there is or there may be a need to mobilize EMS resources beyond those responding to everyday emergencies. Declaration of a MCI will result in notification of selected persons from the agencies identified in the resource section. These individuals, upon arrival at the site of the emergency, will establish and operate a system to provide an adequate level of medical support commensurate with the number of casualties encountered. This level of support may range from a standby status of personnel and equipment to full mobilization of all Clark County Medical resources. CONCEPT OF OPERATIONS A MCI will normally be declared by the on-scene incident commander through the Fire Services Alarm Office (FAO), who will in turn notify selected persons from the agencies identified in the resource section. A MCI may also be declared by other emergency services and by key EMS personnel should a fire incident commander not be present or involved at the incident scene. Before taking action, the FAO supervisor will determine the validity of a request for a MCI declaration coming from any source other than those individuals known by the FAO or on the key EMS personnel list on file with the FAO. Basic - 5

12 MASS CASUALTY INCIDENT (MCI) LEVEL/GUIDELINES When a MCI level is determined and transmitted to a dispatch center, it will include a brief justification (Example: Rescue 14 on scene, this is a Level 3 MCI we have 30 serious burn victims and an additional casualties requiring minor to immediate treatment. ) Level 1: Routine, non-critical operations performed as normal emergency response involving departments that operate according to established support arrangements. These are not major multiple incidents that require extended use of multi-agency resources. The Incident Commander will confirm the incident level with the Operations Chief and notify FAO of any changes. The Emergency Operations Center (EOC) does not usually operate during a Level 1 response. The Incident Commander may request the Emergency Management Coordinator (EMC), or designee, to activate the EOC during a Level 1 response. The activation is in accordance with EOC, Clark County Emergency Operations Plan (EOP) or jurisdiction EOP. Level 2: An incident producing large number of casualties, for which routinely available regional or multi-jurisdictional medical mutual aid is necessary and adequate for further diagnosis and treatment. The Incident Commander will confirm the incident level with the Operations Chief and notify FAO of any changes. The Incident Commander may request the EMC, or designee, to activate the EOC during a Level 2 response. This activation is in accordance with EOC, Clark County EOP or jurisdiction EOP. Level 3: An incident that produces an overwhelming number of casualties and overwhelms the capabilities and resources routinely available in Clark County and other jurisdictions even when acting together to cope with the incident s effects. A Level 3 operating level signifies the existence of an all-out effort where resource use priorities require a concerted multi-agency coordination effort. The incident may result in an extreme mass casualty that will require the implementation of the Advanced Plan. The Incident Commander will confirm the incident level with the Operations Chief and notify FAO of any changes. The Incident Commander will notify the jurisdiction s EMC, or designee, during a Level 3 response to implement jurisdiction s EOP. Basic - 6

13 The jurisdiction EMC will coordinate a critique of any declared MCI in which the EOC is activated. FIRE SERVICES ALARM OFFICE (FAO) RESPONSIBILITIES When a request for an MCI declaration is received, the FAO will take the following actions: 1. Notify appropriate Fire Department EMS personnel to report to the scene of the incident, and confirm MCI level with Incident Command. 2. Alert hospitals to standby for possible implementation of their disaster plans based on the level of the incident, and request they prepare a count of available emergency department beds. 3. Notify the Clark County Health District for Level 2 and Level 3 MCI s. HEALTH DISTRICT RESPONSIBILITIES Upon notification of an MCI declaration request the Health District will perform as determined necessary the following: 1. At a level 2 or level 3 coordinate procurement of resources as needed from the EOC of the responsible jurisdiction. 2. Monitor patient transport and hospital divert status. 3. Act as backup to the FAO for notifying key personnel and hospitals. 4. Be ready to notify FAO to dispatch Clark County Volunteer Ambulance/Personnel Resources, if needed. 5. Coordinate information and resource requests with area hospitals. Basic - 7

14 MASS CASUALTY EVENTS FIELD TO HOSPITAL EMERGENCY COMMUNICATIONS 1. Emergency occurs. 2. Responders arrive and establish incident command. 3. Incident Command notifies Fire Alarm Office (FAO) of situation and requests notification of area hospitals. 4. FAO notifies area hospitals via EMSystem to: report the level of MCI declared by Incident Command. advise that they will be contacted by the Transportation Unit Leader to obtain the number of available patient beds. 5. Transportation Unit Leader obtains patient bed counts from each of the area hospitals via the 800 mhz radio system and relays the information to the Medical Communications Manager at the scene. 6. Communications continue between the Medical Communications Manager at the scene and the primary ambulance dispatch center regarding details of patients. These details should include the following: number and triage category of patients being transported to hospitals approximate arrival time(s) 7. Upon transport of all patients the Transportation Unit Leader will conduct an all-call of all hospitals and verify the number of patients received and cross reference this number against the number of patients sent. The Transportation Unit Leader will inform all hospitals that the Transportation Unit is closing down and all further communication should be with the EOC. The Transportation Unit Leader will then notify the Incident Commander and the FAO that the scene is clear. Basic - 8

15 EMS SYSTEM EMERGENCY ALERT FUNCTIONS The EMSystem provides a web-based conduit for communications in the event of an MCI or the need for rapid notification of the regional hospitals for emergency purposes. The process of information sharing is described in the below bulleted list: An event has occurred and a brief initial report given by arriving first responders. The event is deemed significant (MCI). The EMS Dispatcher obtains the event information. The EVENT tab is clicked on the EMSystem screen. The SYSTEM ANNOUNCEMENT tab is clicked on the EVENT screen. The dispatcher will fill in the EVENT information and send the event notification to those hospitals selected using by clicking the SAVE tab. It is recommended the EMS Dispatcher utilize the MCI Alert wave file as the alert tone for Clark County. The EMS Dispatcher may also attach files to the alert if emergency management selects to do so. Updates to the event alert will occur if there is any significant change in event status. The EMS Dispatcher will terminate the alert at the time specified by the IC. Within the hospitals the EMSystem computer will display the emergency alert tone and alert box notifying the ER staff of an emergency. Patient bed availabilities can be entered into the comment boxes to be shown on the VIEW or divert screen. Basic - 9

16 MCI DEFINITIONS Action Plan A plan containing general control objectives reflecting the overall incident strategy, and specific action plans for the next operation period. Air Operations The operation responsible for providing logistical support to helicopters operating at an incident. He will perform operational planning for air operations. Ambulance Staging Manager The individual responsible for the ambulance staging area. Provide ambulances and maintain records as required. Assigned Performing an active assignment. Available Ready for assignment. Benchmark Benchmarks are task completion reports that are understood and communicate levels of accomplishment. Branch A grouping of divisions and/or groups to limit span of control in larger operations. Casualty Collection Point A facility or location of convenience where victims may be transported for initial evaluation and treatment. Clear Text The use of plain English in radio communications transmissions. Command Position or positions responsible for overall management of the incident. Command Post (CP) The physical location from which the incident commander exercises direction over the entire incident. Command Staff Positions of Information Officer, Safety Officer, and Liaison Officer. Communications Unit A unit responsible for developing plans to make the most effective use of incident assigned communications equipment and facilities. Company Any piece of equipment having a full complement of personnel. Delayed Treatment Manager The individual responsible for the treatment and triage of the victims assigned to the Delayed Treatment Area. Basic - 10

17 Delegation The act of empowering someone to act for another. Demobilization Unit A unit responsible for developing an incident demobilization plan. Division A division of an incident into geographical areas of operation. Documentation Unit A unit responsible for maintaining accurate and complete incident files. Engine Company Any ground vehicle providing specified levels of pumping, water, and hose capacity. Facilities Unit A unit responsible for establishing, setting up, maintaining and demobilizing all facilities used in support of incident operations. Finance Section A section, directly under the IC, responsible for time recording, procurement, compensation, claims, and incident cost determination. Food Unit A unit responsible to determine food and water requirements, menu planning, food ordering, determining cooking facilities, cooking, serving and general maintenance of food service areas. This unit primarily used in wild land fires. Fuel Tender Any vehicle capable of supplying fuel. Goals The purpose or purposes toward which incident activities are directed. Gross Decontamination The process of removing potential contaminants through the use of water alone, a combination of soap and water, or other decontamination solution. Group A division of an incident into functional areas of operation. Helispot Manager The individual responsible for managing resources, supplies, and dispatch to helispot. Immediate Treatment Manager The individual responsible for the treatment and triage of the victims assigned to the Immediate Treatment Area. Incident An occurrence or event, either human-caused or natural phenomena, that requires action by emergency service personnel to prevent or minimize loss of life or damage to property and/or natural resources. Basic - 11

18 Incident Commander The individual responsible for the management of all incident operations. Incident Priorities Considerations of life safety, incident stabilization, and property conservation which are prioritized in formulating an action plan. Incident Stabilization Actions taken to interrupt the chain of incident events and in most cases consist of a direct attack to the seat of the fire. Information Officer A position to develop accurate and complete information regarding incident cause, size, current situation, resources committed and other matters of general interest. Law Enforcement Group Supervisor The individual responsible for protection of citizens, crime suppression and investigation, maintenance of public peace. Level 1 Mass Casualty Incident A localized mass casualty emergency wherein local medical resources are available and adequate to provide for field medical treatment and stabilization, including triage. The patients will be transported to the appropriate local medical facility for further diagnosis and treatment. Level 2 Mass Casualty Incident A mass casualty emergency where the large number of casualties and or lack of local medical care facilities are such as to require multi-jurisdictional medical mutual aid. Level 3 Mass Casualty Incident A mass casualty emergency wherein local and regional medical resources capabilities are exceeded and or overwhelmed. Deficiencies in medical supplies and personnel are such as to require assistance from state or federal agencies. Liaison Officer Is the point of contact for representatives from other agencies. Logistics Section A section, directly under the IC, responsible for providing support needs to the incident. Medical Communications Manager The individual responsible for maintaining communications with hospitals or other medical facilities to assure proper patient transportation and destination. Medical Group Supervisor The individual responsible for managing all the activities in the medical group. Basic - 12

19 Medical Supply Manager The individual responsible for acquiring and maintaining appropriate medical equipment and supplies assigned to the medical group. Medical Unit A unit responsible to develop the medical plan, develop the procedures for handling any major medical emergency, provide medical aid and transportation for injured and ill personnel, and assist in the processing of all related paperwork. Minor Treatment Manager The individual responsible for the treatment and triage of the victims assigned to the Minor Treatment Area. Morgue Manager The individual responsible for the morgue area until relieved by the Coroners office. Objectives Those specific actions carried out to accomplish goals. Operations Section A section, directly under the IC, responsible for directing all tactical resources to accomplish the goals and objectives developed by Command. Out-of-Service Not ready or available for assigned status. Planning Section A section, directly under the IC, responsible for the collection, evaluation and dissemination of tactical information about the incident. Primary All Clear A benchmark indicating that a quick search has been accomplished in all affected areas and verifies the removal and/or safety of all occupants. Proactive Mode The officer correctly identifies the problem(s) and takes the necessary measures to control the situation. Property Conservation The mitigation or reduction of loss by the application of conservation tactics. Reactive Mode The incident changes and the officer reacts to change. The incident has the leadership pole. Resources Unit A unit with the responsibility to make certain that all assigned personnel and resources have checked in at the incident. Safety Officer A position to assess hazardous and unsafe situations and develop measures for assuring personnel safety. Basic - 13

20 Scene Security Leader The individual responsible for identifying and taking the necessary measures to provide MCI scene security. Single Command A single Incident Commander is solely responsible to establish objectives and overall management strategy. Single Resources A single unit used for initial attack in first response situation. A single unit can be used for many special assignments requiring limited manpower. Situation Unit A unit with the responsibility for collecting, processing and organizing situation information. Span of Control The supervisor to worker ratio. One supervisor to three to five direct reports is recommended with five being ideal. Staging Areas Staging areas are temporary locations of available resources available on two to three minutes notice. Status Condition A designation of assigned, available, or out-of-service for a tactical resource. Strike Team A set number of resources of the same kind and type. Supply Unit A unit responsible for ordering, receiving, storing and processing of all incident-related resources, personnel and supplies. Tactics The operations that must be performed to satisfy strategic goals. Task Force Any combination of resources which can be temporarily assembled for a specific mission. Technical Specialists Specialists who may be called upon depending upon the need of the situation. Traffic Control Leader The individual responsible for traffic management functions. Transportation Recorder The individual responsible for recording patients, injuries, mode of transportation and patient status. Coordinates patient information and movement. Basic - 14

21 Transportation Unit Leader The individual responsible for coordination of patient transportation and maintaining records relating to patient, injuries mode of transportation and destination. Treatment Unit Leader The individual responsible for controlling proper triage management, treatment and coordination of all casualties in the Treatment Area. Triage Area Manager The individual responsible for supervising the triage teams. Ensuring patients are properly triaged, tagged, and placed in appropriate treatment areas. Triage Unit Leader The individual responsible for controlling proper triage management, treatment and coordination of all casualties in the Treatment Areas. Unified Command Individuals designated by their jurisdiction jointly establish objectives and overall management strategy. Basic - 15

22 ADVANCED PLAN

23 ADVANCED PLAN PURPOSE To enhance existing procedures and structures for the systematic, coordinated, and effective delivery of local assistance to address the human health consequences of any disaster, including Weapons of Mass Destruction events. The Mass Casualty Incident Advanced plan (MCI-A) provides guidance and procedures for the response to any incident involving 300 or greater casualties hereinto referred to as an extreme mass casualty. ASSUMPTIONS A. An extreme mass casualty incident will cause numerous fatalities and injuries, property losses, disruption of normal life-support systems, and will have an impact on the regional economic, physical, and social infrastructures. B. The extent of casualties and damage will be influenced by factors such as the time of occurrence, severity of impact, weather conditions, population density, building construction, type and magnitude of weapon, if used, and the possible triggering of secondary events such as fires and civil unrest. C. A large number of casualties, heavy damage to buildings and basic infrastructures, and disruption of essential pubic service may overwhelm the capabilities of the local government to meet the needs of the situation; therefore the responsible jurisdiction may declare a major disaster and request State and/or Federal assistance. D. Local agencies will need to respond on short notice to provide timely and effective services. Advanced Plan - 1

24 LIFE CYCLE OF AN ADVANCED MASS CASUALTY INCIDENT The life cycle of an Advanced MCI includes: 1. Initial reporting of an incident(s). 2. Public Safety first responders arrive on scene of incident(s). 3. Brief Initial report by arriving Incident Commander given over 800 Mhz radio command channel stating significance and estimated magnitude of incident. 4. Dispatcher in receipt of Brief Initial Report transfers information into EMSystem and alerts all area hospitals of potential extreme MCI. 5. Incident Commander delegates ICS duties. 6. Resources demands are identified and prioritized. 7. Casualties triaged by use of time and distance sorting. 8. Holding Area established for worried well (include waterless decontamination options). 9. Salvageable victims rescued (includes rapid decontamination utilizing apparatus water and swift clothing removal). 10. Transportation needs are identified and prioritized - Transportation Unit established. 11. Transportation Unit Leader contacts all area Health Care Facilities via Hospital All Call channel. 12. Only critical patients are transported to Health Care Facilities (HCF) for treatment. 13. If necessary: 14. Casualty Collection Point(s) established, prepared, staffed, and opened. 15. Holding Area patients are prepared and transported via provided mass transit to Casualty Collection Points. 16. Patients checked in at the Casualty Collection Point and triaged to treatment areas or section seating. 17. Patients treated and educated. 18. Patients checked out and transported back to area of residence. 19. Final reporting of the MCI prepared and sent. Advanced Plan - 2

25 EXTREME MCI OPERATIONS An Extreme Mass Casualty Incident is defined as any situation where the casualty count has the potential of 300 victims or greater. Declaration of an Extreme MCI will result in emergency notification of all area hospitals and key EMS personnel trained in onsite disaster medical operations. These individuals, upon arrival at the site of the emergency or Casualty Collection Point, will establish and operate a system to provide an adequate level of medical support commensurate with the number of casualties encountered. This level of medical support may range from a standby status of personnel and equipment to full mobilization of all Clark County resources. CONCEPT OF OPERATIONS Alerting: A level 3 MCI will normally be declared by the on-scene incident commander through the Fire Services Alarm Office (FAO), who in turn will utilize EMSystem and internal paging networks to notify key persons and agencies to implement tasks as outlined in this plan. Advanced Plan - 3

26 MCI ORGANIZATION

27 MASS CASUALTY INCIDENT COMMAND ON SCENE On scene mass casualty incident command provides the emergency organization framework necessary for effective coordinated multi-agency response. The following organization chart and position descriptions illustrate the operational concept of operations. MCI Organization - 1

28 MCI Organization - 2

29 INCIDENT COMMAND ORGANIZATION/POSITION DESCRIPTIONS (Alphabetical Order) AIR OPERATIONS LEADER The Air Operations Leader is responsible for providing logistical support to helicopters operating in support of the MCI. He will perform operational planning for air operations. In most instances, air operations are limited to the permitted helicopter services within the county. However, when there is an overwhelming demand for ambulance equipped helicopter transport which exceeds local resource capabilities the Incident Commander may request support from the jurisdiction OEM. AMBULANCE STAGING MANAGER The Ambulance Staging Manager is responsible for the operation of the ambulance staging area. The position coordinates closely with the Transportation Unit Leader, the Transportation Recorder, and the Medical Communications Manager. CRISIS COUNSELING Crisis Counseling is available to incident victims and emergency response personnel through ARC, Southern Nevada Chapter. Debriefings of emergency response personnel are strongly recommended in situations involving mass casualties. DELAYED TREATMENT MANAGER The Delayed Treatment Manager is responsible for coordinating the triage and treatment of casualties assigned to delayed treatment area. On scene delayed treatment teams may be designated by the Delayed Treatment Manager. FINANCE SECTION CHIEF The Finance Section Chief is established on incidents when the agencies who are involved have a specific need for financial services. In the ICS, not all agencies will require the establishment of a separate Finance Section. In some cases where only one specific function is required, that position could be established as a Technical Specialist in the Plans Section. MCI Organization - 3

30 HELISPOT MANAGER The Helispot Manager is responsible for the management of all helicopter resources, supplies, and dispatch to and from the helispot which is in support of the MCI. The Helispot Manager reports to and is under the authority of the Air Operations Leader. When necessary, temporary flight restrictions are authorized by the Federal Aviation Authority (FAA) regulations. This type of flight restriction applies to a very specific air space location that is typically above the scene of the MCI. Temporary flight restriction requests are handled through the Las Vegas Metropolitan Police Department (METRO) Air support section and coordinated with the appropriate Air Traffic Control Tower. HOSPITAL RECEPTION AND CARE Area hospitals will receive patients according to their individual emergency plans based on bed capacity and resource capabilities. IMMEDIATE TREATMENT MANAGER The Immediate Treatment Manager is responsible for coordinating the triage and treatment of casualties assigned to immediate treatment area. On scene immediate treatment and/or hospital teams may be designated by the Immediate Treatment Manager. INCIDENT COMMANDER The effective utilization of public safety response units and other responding personnel at the scene of an MCI requires clear decisive action on the part of the Incident Commander (IC). The IC is responsible for the command function at all times. He in conjunction with assigned staff, is the response strategist. Strategy, resource allocation, and coordination are their primary responsibility. The officer in command of the first arriving company, task force, or strike team is the IC at the start of the incident. Initially, the IC is responsible for both strategy and tactics. INFORMATION OFFICER The Information Officer s function is to develop accurate and complete information regarding incident cause, size, current situation, resources committed MCI Organization - 4

31 and other matters of general interest. The Information Officer will establish an area away from the Command Post and be the point of contact for the media and other governmental agencies that desire information directly from the incident. In either a single or unified command structure, only one Information Officer should be designated. LAW ENFORCEMENT GROUP SUPERVISOR The Law Enforcement Group Supervisor is responsible for protection of citizens, crime suppression and investigation, maintenance of public peace at the scene of an MCI. Most law enforcement operations are handled according to the Emergency Operations Plan for the law enforcement agency within the jurisdiction. LIAISON OFFICER At any emergency where multiple agencies are operating, there needs to be coordination of efforts. The Liaison Officer is the contact point for assistance, communication, and coordination between the various agencies. LOGISTICS SECTION CHIEF The Logistics Section Chief is responsible for providing all support needs to the incident. The Logistics Section Chief would order all resources from off-incident locations. She would also provide facilities, transportation, supplies, equipment maintenance, fueling, feeding, communications, and medical services for first responders. The Logistics Section Chief may designate a Resources Unit to make certain that all personnel and resources have checked in at the Incident Command Post. MEDICAL COMMUNICATIONS MANAGER The Medical Communications Manager is responsible for establishing and maintaining communications with the hospital alert system and/or other resource medical facilities to assure proper patient placement. This position coordinates closely with the Transportation Unit Leader, the Transportation Recorder, and the Ambulance Staging Manager. Medical Communications Manager and the Clark County Health District will provide the points of coordination between the incident site and area hospitals. MCI Organization - 5

32 MEDICAL GROUP SUPERVISOR The Medical Group Supervisor is responsible for assuring the best possible emergency medical care and transport of patients during a mass casualty incident. This includes providing access to all necessary medical supplies and manpower required to support triage, treatment, and transport of casualties. The Medical Supply Manager, Treatment Unit Leader, Triage Unit Leader, Transportation Unit Manager, and the Morgue Manager positions report to and are under the direction of this position. The Incident Commander will assign the Medical Group Supervisor. MEDICAL SUPPLY MANAGER The Medical Supply Manager is responsible for coordinating the acquisition and distribution of appropriate medical equipment and supplies from units assigned to the Medical Group Supervisor. MINOR TREATMENT MANAGER The Minor Treatment Manager is responsible for coordinating the triage and treatment of casualties assigned to minor treatment area. On scene minor treatment teams may be designated by the Minor Treatment Manager. MORGUE MANAGER The Morgue Manager is responsible for the operation of the on-scene morgue area. The Office of the Coroner/Medical Examiner assumes this position. MORTALITY MANAGEMENT GUIDELINES DURING DISASTER OPERATIONS Upon notification, the Office of the Coroner/Medical Examiner will implement their Multiple Death Situations and Disaster Procedure. No bodies are to be moved prior to arrival of the Coroner/Medical Examiner personnel. However, under extraordinary circumstances, the Coroner/Medical Examiner may delegate some level of authority to on scene responders for handling the bodies. Proper protocols and some level of training will be provided by the Coroner/Medical Examiner representative prior to authorization being granted on scene. Media who request information on fatalities should be directed to the Coroner/Medical Examiners Office. The Coroner/Medical Examiners Office will designate a representative who is authorized to respond to the Media. MCI Organization - 6

33 Upon notification, the Office of the Public Administrator/Guardian will implement their Department Emergency Plan. The office provides protection for deceased persons personal and estate properties. OPERATIONS CHIEF The Operations Chief is responsible for the direct management of all tactical activities. The Operations Chief assists in the formulation of the action plan with the Planning Chief. The Operations Chief communicates the action plan through the structured branches, divisions, and groups below them. He communicates status reports from implementation of the action plan back to the IC on a regular basis. Resource needs and established benchmarks are communicated to the IC. PLANNING SECTION CHIEF The Planning Section Chief is responsible for collection, evaluation and dissemination of tactical information about the incident. She maintains information on the current forecast situation, and on the status of resources assigned to the incident. The Planning Section Chief is also responsible for the preparation and documentation of action plans. The Planning Section Chief has four primary units and may have a number of technical specialists to assist in evaluating the situation and forecasting requirements for additional personnel and equipment. The Planning Section Chief is responsible for the gathering and analysis of all data regarding incident operations and assigned resources, developing alternatives for tactical operations, conducting the planning meetings, and preparing the action plan for each operational period. SAFETY OFFICER The Safety Officer is responsible for seeing that safety procedures and safe practices are observed at the emergency scene. The Safety Officer is responsible for identifying present and potential health and safety hazards and cause correction of the same. When imminent hazards are determined to exist, the Safety Officer will have the authority to alter, suspend, or terminate those activities. MCI Organization - 7

34 The Safety Officer will immediately inform the IC of any actions taken to correct imminent hazards at an emergency. In situations of non-imminent hazards, the Safety Officer will bring plans to resolve the hazard to the IC. If a unified command is used, each entity may maintain its own Safety Officer. SCENE SECURITY LEADER The Scene Security Leader is responsible for providing MCI scene security. This role is typically assumed by the law enforcement agency which has jurisdiction. All operations are conducted in accordance with the law enforcement agency s emergency operations plan. TRAFFIC CONTROL LEADER The Traffic Control Leader is responsible for ground-based traffic management functions. All operations are conducted in accordance with the jurisdiction s emergency plan. TRANSPORTATION RECORDER The Transportation Recorder coordinates and is responsible for maintaining a record of each patient, their injuries, the mode of transportation and destination. Records hospital status. TRANSPORTATION UNIT LEADER The Transportation Unit Leader is responsible for the coordination of patient transportation and maintenance of casualty transportation records. Records include but are not limited to the following list: patient identification, injuries, mode of transportation and destination. Incident Command is responsible to see that a Transportation Unit Leader is identified based on the circumstances of the MCI. In most instances, this position will be delegated to the ambulance franchises. TREATMENT UNIT LEADER The Treatment Unit Leader is responsible for coordinating available resources to provide for the immediate, delayed, and minor treatment of all casualties assigned to immediate, delayed, and minor treatment area(s). An Immediate Treatment Manager, Delayed Treatment Manager, and Minor Treatment Manager report to the Treatment Unit Leader as the MCI may require. MCI Organization - 8

35 TRIAGE AREA MANAGER The Triage Area Manager is responsible for the triage of casualties on-scene and their subsequent assignment to either the immediate, delayed, or minor treatment area. This position performs the coordination and support for any triage team on-scene. Medical triage is the sorting of disaster victims and allocation of medical treatment according to the S.T.A.R.T system of priorities designed to optimize the number of survivors. The Triage Area Manager may designate several Triage Teams based on their assessment of the triage area needs. TRIAGE UNIT LEADER The Triage Unit Leader is responsible for coordinating and providing triage management of the casualties. When triage is completed, he may be reassigned as needed. UNIFIED COMMAND When more than one entity has a jurisdictional responsibility at an MCI, the incident management is shared by representatives of the various entities. Although more than one person makes up the IC position, decisions are joint decisions and communicated through an Incident Commander designee. Unified Commanders share in the process of: 1. Determining overall incident objectives. 2. Selection of strategies. 3. Ensuring that joint planning for tactical activities will be accomplished. 4. Ensuring that integrated tactical operations are conducted. 5. Making maximum use of all assigned resources. The need for a unified command is brought about because: 1. Incidents have no regard for jurisdictional boundaries. 2. Individual agency responsibility and authority is normally legally confined to a single jurisdiction. MCI Organization - 9

36 Single Command Structure In cases in which there is no overlap of jurisdictional boundaries, a single Incident Commander will be designated by the jurisdictional agency who has overall management responsibility for the incident. MCI Organization - 10

37 APPENDICES

38 APPENDIX A EMS PROVIDER AGENCIES EMERGENCY MANAGEMENT AGENCIES Agency Office Telephone # 24 Hour # Boulder City Emergency Management 1101 Elm Street Boulder City, NV Clark County Office of Emergency Mgmt. 500 S. Grand Central Pkwy, 6 th Floor Las Vegas, NV City of Henderson Emergency Mgmt. 223 Lead Street Henderson, NV City of Las Vegas Emergency Mgmt. 500 N. Casino Center Blvd. Las Vegas, NV City of Mesquite Emergency Mgmt. 10 E. Mesquite Blvd. Mesquite, NV North Las Vegas Emergency Mgmt Civic Center Drive North Las Vegas, NV (702) (702) (702) (702) (702) (702) (702) (702) (702) (702) (702) POLICY AND REGULATORY CONTROL Agency Office Telephone # 24 Hour # Clark County Health District 625 Shadow Lane Las Vegas, NV Emergency Medical Services Environmental Health Office of Public Health Preparedness (702) (702) (702) (702) or 1212 (702) Appendix A 1

39 Company EMS PROVIDER AGENCIES American Medical Response 1200 S. Martin Luther King Blvd Las Vegas, NV American Medical Response - Laughlin PO Box Laughlin, NV Armagosa Valley Volunteer Fire Department (Nye County Ambulance Service) Fire Station Boulder City Fire Department 1101 Elm Street Boulder City, NV Central Region EMS Field Representative James (Bear) Statler PO Box 1227 Tonopah, NV Clark County Fire Department 575 E. Flamingo Road Las Vegas, NV Henderson Fire Department 240 S. Water Street Henderson, NV Las Vegas Fire Department 500 N. Casino Center Blvd Las Vegas, NV North Las Vegas Fire Department 2626 E. Carey Ave North Las Vegas, NV Pahrump (Nye County) 300 Hwy 160 Pahrump, NV Specialized Medical Services 1146 Spooner Court Henderson, NV Southwest Ambulance 9 West Delhi Avenue North Las Vegas, NV Telephone 911 (702) (702) (775) (702) (775) (EMS Office) 911 (702) (702) (702) (702) (775) (cell) Gary Dudley Appendix A 2

40 EMS Provider Agencies Continued: VOLUNTEER SERVICES Company Motor Sports Medical Rodney Gamble 4220 Crater Street Las Vegas, NV National Park Service Lake Mead National Recreation Area 601 Nevada Hwy Boulder City, NV Southern Nevada Volunteer First Aid and Rescue Association (SNVFARA) 4425 E. Sahara, Ste 8 Las Vegas, NV Telephone (pager) Rodney Gamble (702) (702) (dispatch) (702) (cell) Jim Derrick VOLUNTEER AMBULANCE SERVICES Company Telephone Blue Diamond Fire Dept. 911 (702) Bunkerville Fire Dept. 911 (702) Cal-Nev-Ari Fire Dept. 911 (702) Goodsprings Fire Dept. 911 (702) Indian Springs Fire Dept. 911 (702) Logandale Fire Dept. 911 (702) Mesquite Fire & Rescue 911 (702) Moapa Fire Dept. 911 (702) Mt. Charleston Fire Dept. 911 (702) Overton Fire Dept. 911 (702) Sandy Valley Fire Dept. 911 (702) Searchlight Fire Dept. 911 (702) Appendix A 3

41 EMS Provider Agencies Continued: Mercy Air Boulder City, NV Company Med Flight Air Ambulance, Inc W. Cheyenne Ave., Ste 606 North Las Vegas, NV AIR AMBULANCE SERVICES Telephone (dispatch) (909) David Dolstein, President (702) (cell) Paul Kimball, Program Director Appendix A 4

42 CLARK COUNTY HOSPITAL RESOURCES Hospitals Telephone Boulder City Hospital 901 Adams Boulder City, NV Desert Springs Hospital 2075 E. Flamingo Road Las Vegas, NV North Vista Hospital 1409 E. Lake Mead Blvd North Las Vegas, NV Mike O Callaghan Federal Hospital 4700 Las Vegas Blvd North Las Vegas, NV MountainView Hospital 3100 North Tenaya Way Las Vegas, NV Southern Hills Hospital 4616 W. Sahara Ave #335 Las Vegas, NV Spring Valley Hospital 5400 S. Rainbow Blvd Las Vegas, NV St. Rose de Lima Campus 102 E. Lake Mead Drive Henderson, NV St. Rose Siena Campus 3001 St. Rose Parkway Henderson, NV Summerlin Hospital 657 Town Center Drive Las Vegas, NV Sunrise Hospital 3186 S. Maryland Parkway Las Vegas, NV University Medical Center 1800 W. Charleston Blvd Trauma CenterLas Vegas, NV Valley Hospital 620 Shadow Lane Las Vegas, NV *ED Emergency Department *ED *ED *ED *ED *ED *ED *ED *ED *ED *ED *ED *ED Appendix A 5

43 Hospital CLARK COUNTY HOSPITAL EMERGENCY RECEPTION Decontamination Capability Air Ambulance Accommodations Boulder City Hospital Yes* Yes** Desert Springs Hospital Yes* No North Vista Hospital Yes* No Mike O Callaghan Federal Hospital Yes* Yes** MountainView Hospital Yes* Yes** Spring Valley Hospital Yes* Yes** Southern Hills Hospital Yes* Yes** St. Rose de Lima Campus Yes* Yes** St. Rose Siena Campus Yes* Yes** Sunrise Hospital Yes* Yes** University Medical Center Yes* Yes** Valley Hospital Yes* Yes** * Yes response indicates some level of decontamination capability exists at that location. Coordination between field response personnel and the hospital is required prior to transport of a contaminated patient(s). Appendix A 6

44 ** Before transporting patients with NAFB PAVE Hawk helicopters to area hospitals, coordination between field response personnel and the hospital is required. Existing Helipads cannot support PAVE Hawk military aircraft due to size and weight considerations. Appendix A 7

45 APPENDIX B CASUALTY MANAGEMENT Extraction of Victims The Extraction (Rescue) Group as assigned in the incident command system will conduct extraction. The Extraction Group shall consist of the personnel needed to effectively remove patients from a hazardous site. Only personnel in appropriate PPE will handle non-ambulatory victims located in the hot or warm zones. Hot and warm zone rescues will be accomplished/supervised by Hazmat personnel. Triage of Victims The Las Vegas Valley utilizes the START method for categorizing triaged patients. However in large scale events that yield extreme numbers of patient the START triage method may be too time consuming. In an extreme MCI, initial triage is carried out prior to first responder arrival as patients will self evacuate from the incident site. This is considered self-triage based on time and distance. Triage can be established as follows: Deceased Non-ambulatory Minor DECEASED Hot Zone First Responders will likely be on scene and have an operational plan established within 10 to 15 minutes after initial dispatch. Patients in the immediate area of the incident may not survive this initial time delay. These individuals should be considered deceased and heavily contaminated. They reside within the Hot Zone and are NOT to be approached by first responders. Hot Zone entry is to be conducted by the Hazardous Materials Team. The delay created by set-up time and deployment time will decrease the likelihood of anyone surviving. Appendix B- 1

46 NON-AMBULATORY Warm Zone First Responders will likely be on scene and have an operational plan established within 10 to 15 minutes after initial dispatch. Patients that attempt to self-evacuate or make only limited progress outside of the venue (having difficulty evacuating due to their condition) are considered non-ambulatory. These patients will self evacuate to just outside the entrance of a venue site but will not be able to move with or keep up with the evacuating crowd. Warm Zone patients should be considered contaminated, however, they may be viable. Consideration must be given to the fact that several minutes have past and the patient is still alive, meaning the contamination is not as severe as in the hot zone but still potentially life threatening. These patients require rapid clothing removal and thorough gross decontamination. A Rescue Group (Extraction Group), in required PPE, should be used to move amongst the Warm Zone patients assessing, decontaminating and packaging for transport. Following completion of this process the patient may be moved to a loading area for ambulance transfer. MINOR First Responders will likely be on scene and have an operational plan established within 10 to 15 minutes after initial dispatch. It is assumed that persons within the venue, and that are capable, will self evacuate and move to a place of comfort. This inherently is outside the venue and out of the Hot or Warm Zone. However, first responders must establish a triage officer(s) and a holding area (sizeable) for the large number of individuals seeking safety. The fact that these patients have been ambulatory for several minutes post event, can follow directions and will walk the short distance to the holding areas, supports the assumption that they are less contaminated than those in the Hot and Warm Zone and quite likely are not contaminated at all. The Triage Officer(s) will position themselves in a manner to direct all minor patients to an established holding area. The distance from the venue is part of the triage process as is the time from dispatch. If required, the most likely decontamination for these individuals is the waterless decontamination procedure. Waterless decontamination equipment is carried on all Fire Department Truck Companies and Field Coordinator Units. SECOND OPINION PERSONS Cold Zone Heavily contaminated patients may make it into the cold zone. This may occur in the following ways: Non-ambulatory patients may be moved to the cold zone by bystanders. Appendix B- 2

47 Patients may struggle out of the Hot or Warm Zone and make it to the Triage Officer. In these instances the Triage Officer will direct the Second Opinion Group to quickly evacuate the patient to a rescue area. The Second Opinion Group, although uniquely named, is designed and established to wait in a separate area designated by the Triage Officer in case an instance such as described occurs. The group must be outfitted in required PPE and will operate just like the Rescue Group (Extraction Group) mentioned above. Administration of Appropriate Antidotes/Treatment All Fire Department Paramedics are adequately trained to perform emergency delivery of antidotes in the field. Furthermore all Fire Department Paramedics have been provided the antidote inventory necessary to perform their duties. The Chief Health Officer has at his/her disposal the ability to emergently convene an emergency management team to discuss extended patient treatments and therapy. Administration of antidotes may require persons to work outside their scope of practice. The legal requirements and waivers pertaining to this topic are addressed in the primary MMRS plan under Emergency Management of Legal Issues and Credentialing. Decontamination of Victims Several options for decontamination may have to be considered at any given site. The Las Vegas MMRS strongly supports the use of existing facilities, which may supply fire sprinkler water in an area adequate for water runoff. However, this option does not always exist. HOT ZONE DECONTAMINATION Will be delayed as entry teams arrange and equip Patients within this zone are considered heavily contaminated It is assumed that the ambulatory will self evacuate Hot zone entry is not meant for first responders Decontamination should follow guidelines related to patient condition Waterless decontamination is not used within the Hot Zone WARM ZONE DECONTAMINTAION The warm zone is defined as the general area where the alive but non-ambulatory or those having difficulty have positioned Appendix B- 3

48 themselves. This is typically just outside the entrance to venue site. Patients within this zone should be considered heavily contaminated Patients should be extracted from the area to a gross decontamination area. Gross decontamination with rapid clothing removal is the best option PPE shall be of a type to meet the NFPA 1994 standard Patients must be decontaminated prior to placement within an ambulance for evacuation. COLD ZONE DECONTAMINATION The Cold zone is defined as the location where patients self evacuate and congregate outside the venue site. Patients within this area are NOT likely to be heavily contaminated, but may be exposed. Patients numbers can be in the thousands. Patients may be worried, yet well. Waterless decontamination is the primary option for decontaminating these individuals. Patients must be organized and held within the holding area and a Holding Area Manager must be assigned by the IC. The Holding Area Manager will need many assistants to aid in organizing patients and maintaining order. Cold Zone patients are NOT likely candidates for hospital transfer, but rather they ARE candidates for removal to a Casualty Collection Point (CCP). Provision of Primary Care Prior to Transportation to Definitive Care The provision of primary care (Advanced Life Support Level) prior to the transportation to definitive care is a natural duty of the first response system in the Las Vegas valley. All Fire Service personnel in the Las Vegas valley have been educated in the Department of Justice Domestic Preparedness awareness level course, and all Fire Department Paramedics within the service area of the Las Vegas MMRS are trained to deliver pre-hospital care for the large majority of WMD consequences. Appendix B- 4

49 EMS Transport The MCI-A plan hinges on reducing patient flow to hospitals. Only those patients identified as critical will be taken to emergency rooms. Casualty Collection Points/Alternate Care Sites will be set up in order to deal with the large number of minor patients. Emergency and Inpatient Services In Hospitals The Las Vegas valley, although represented by twelve (12) hospitals, does not have the capability to significantly expand to meet the needs of an extreme MCI. The Las Vegas MMRS is designed to enhance emergency and inpatient services with Casualty Collection Points. The Las Vegas MMRS defines a Casualty Collection Point as: One of several sites across the Las Vegas valley sufficiently sized and configured to hold large numbers of sick, injured or persons otherwise in need of medical assistance. Each Casualty Collection Point is addressed in Appendix B that is illustrated with a structural diagram and pre-determined operational areas (i.e., entry points, decontamination areas, triage areas, treatment areas, etc). Each Casualty Collection Point will be augmented by a Metropolitan Medical Strike Team (MMST) for staffing as defined in Appendix C. Management of Patients Arriving At Hospitals Without Prior Field Treatment/Screening or Decontamination Each area hospital has been provided a portable waterless decontamination box containing enough supplies to decontaminate 400 persons. Each area hospital will maintain the capability of augmenting the decontamination box to handle 1000 patients. Each area hospital has been provided and maintains a decontamination plan for 1000 patients or greater. Procurement and Provision of Appropriate Pharmaceuticals, Equipment, and Supplies The Las Vegas MMRS has provided the necessary pharmaceuticals to all Valley hospitals and participating public agencies. The Las Vegas MMRS has provided planning for the receipt of the CDC Strategic National Stockpile. Appendix B- 5

50 Each area hospital has been urged to maintain contracts with vendors capable of supply basic items in a reasonable time frame during an MCI/WMD incident. Appendix B- 6

51 APPENDIX C CASUALTY COLLECTION POINTS In the event of an extreme MCI casualty collection points may be utilized to ease the burden on the local healthcare system. The following bullets illustrate the concerns behind initiating a casualty collection point. Opening a Casualty Collection Point Select appropriate Casualty Collection Point (CCP) Thomas and Mack Center Cashman Field Las Vegas Convention Center Las Vegas International Speedway Sam Boyd Silver Bowl Dispatch a Metropolitan Medical Strike Team First Alarm Fire Response 911 Fire Dept. Haz-Mat Team 911 Clark County Health District Nursing Staff/Clerical Support Collection Point Incident Commanders need to provide: o Staging area all incoming rescue workers will report to staging and be assigned from there. o Secure Responder route of entry Assure a secure vehicle parking area and driveway to enter the complex. (This entry is closed to patients and bystanders) o Patient entry points Assure a patient vehicle entry point and parking area. Assure patient flow into the casualty collection point (Typically through the main entrance of the facility). o Patient Decontamination Area (if necessary) - Assure an area for at least a dry decontamination area. o Patient seating area/worried Well holding Area Each seating area (i.e. Section 101) should be assigned an authorized attendant. o Immediate and Minor Treatment areas (if necessary) Only the most critical patients should be transported from the CCP to the hospitals. ALL OTHERS MUST REMAIN ON PREMISES. o Transportation Area Manager - Assure a secure corridor for ambulance traffic (entrance and exit). o Security Both for patients and rescuers Appendix C-1

52 Casualty Collection Point Locations and Index Each Casualty Collection Point represented in this plan is accompanied with: Address and location Emergency Contact Number Site area in square feet Occupancy maximum Site diagram of Casualty Collection Point layout to include: o Entry Point o Check in area o Triage o Decontamination area o Transportation section - arriving/departing o Treatment areas o Education area (lecture seating) o Facilities o Check out o Office space LOCATION OCCUPANCY CONTACT NUMBER Thomas and Mack Center Las Vegas Convention Center Dependent on set up. 3.2 million square feet of floor space Cashman Field Complex 1940 seat theatre 98,000 sq ft of exhibit hall space 16,000 sq ft meeting room space 9,260 seat ballpark with 148,000 sq ft natural grass field Sam Boyd Silver Bowl Las Vegas Speedway 135,000 to 175,000 seating capacity Appendix C-2

53 Casualty Collection Points Thomas and Mack Center Location: Swenson and Tropicana Occupancy: 16,000 + Responder Staging Area Responders arriving at the Thomas and Mack Center shall utilize the entrance off Harmon and access Responder Entry/Staging via Jerry Tarkanian Way. This shall be a secure entrance and protected from civilian use or access. Responders may park their vehicles in the designated responder parking area shown as production parking on the map. Responders must check-in with the Staging Area Manager for assignment and have their agency ID Badge with them. The Staging Area Manager must be supplied with a layout map in order to guide responders to their assigned locations. Entry Point VICTIMS: The entry point suggested for the Thomas and Mack Center is the Tropicana entrance. This will allow for an organized flow of victims from the parking lot to the entrance. Only one entrance is suggested and its use should be heavily enforced. The Swenson Entrance should not be used IF the Triage area and Decontamination Area may be set up in the Main Entrance Drive Way. RESPONDERS: The entry point for Responders/Workers is rear tunnel entrance off of Jerry Tarkanian Way. This entrance will allow for the protection of workers and still provide needed access to apparatus in the parking area. Check in area VICITMS: The victim check in area can be established at the main entrance and is marked on the layout. It is important that this entrance be the only entrance used in order to stop multiple access points from developing and maintain coordination of efforts and organization of the CCP. Appendix C-3

54 Triage Area Victim Check-in Area Transportation Corridor Exit Decontamination Area Responder Staging Area Victim Checkout Area Triage The triage area is located in area is located in the main entrance drive way and is clearly marked on the layout. Triage areas will be staffed in accordance with the Multi-jurisdictional Mass Casualty Plan. The triage area is located near the decontamination area. This proximity will allow triage teams to assess patients and decide which patients should proceed through which decontamination line. Additionally, a registered nurse will staff each triage area. It will be the nurse s responsibility to decide which patients shall be held at the CCP and which shall be sent to the immediate area for transport to emergent care sites. Decontamination area Decontamination can be offered by three differing means. Decontamination is clearly marked on the layout. Appendix C-4

55 1. Decontamination options from the decontamination section can be utilized to provide mass decontamination along the main entrance driveway or adjacent parking lots. 2. Decontamination can be provided by using the team locker rooms on the ground floor (Backstage Area) of the Thomas and Mack Center. The decontamination area shall provide MALE and FEMALE areas as well as provision for rapid decontamination. For WET DECON: It is believed the decontamination area marked on layout will not allow water runoff to enter any other operational area. The Decontamination Area Manager will need to assure the victims in line awaiting decontamination are not corralled in water runoff. Transportation section - arriving/departing The ambulance transportation route leads from the production parking area and the rear of the Cox building to the exit of the green lot onto Swenson and is clearly marked on the layout. Transportation areas will be staffed in accordance with the Multi-jurisdictional Mass Casualty Plan. The transportation area is designed to accommodate transportation units in a systematic organized fashion. This area must maintain a clear thoroughfare at all times. Treatment areas The treatment areas are located in the following: 1. Worried well can be seated in the section seating of the Thomas and Mack Center. 2. A Delayed Treatment Area can be established on the second floor gymnasium of the Cox Cable Building. 3. An Immediate Treatment Area can be established on the first floor of the Cox Cable Building. Appendix C-5

56 (Cox Pavillion) Treatment areas will be staffed in accordance with the Multi-jurisdictional Mass Casualty Plan. Only patients held in the immediate treatment area will be considered for transportation to area hospitals. All delayed patients will be held at the CCP until the status of bed availability at area hospitals is accessed. Extreme mass casualty events yielding very large numbers of patients may prompt a request through Emergency Management for the Forward Movement of Patients. Staffing for a CCP can be augmented with an MMST. Appendix C-6

57 Education area (lecture seating) The education areas are located in the section seating and are clearly marked on the layout. The education area is established to hold worried well. Constant information and mental support must be forwarded to these individuals until checkout procedures can begin. (Thomas & Mack) Facilities The facilities areas are located in area the concourse area and are clearly marked on the layout. The Logistics Officer must contact the site facilities manager as soon as possible in order to maintain site operations. Appendix C-7

58 Check out The checkout area is located at the Northeast or rear exit of the Thomas and Mack Center and is clearly marked on the layout. The final checkout or patients must assure patient disposition and instructions on follow-up care and mental support. Office space Office space is located on the ground floor and is clearly marked on the layout. Las Vegas Convention Center Location: 3150 Paradise Rd. Total Exhibit Space: 1,900,000 sqft Total Meeting Space: 189,950 sqft Lobby size: 109,515 sqft Banquet services for 12,000 Onsite restaurant: 14,623 sqft seats 623 Contact Number: Responder Staging Area Responders arriving at the Convention Center shall utilize the entrance off Joe W Brown Drive. This shall be a secure entrance and protected from civilian use or access. Responders may park their vehicles in the designated responder parking illustrated on the map. Responders must check-in with the Staging Area Manager for assignment. The Staging Area Manager must be supplied with a layout map in order to guide responders to their assigned locations. Entry Point VICTIMS: The entry point suggested for the Convention Center is: Main entrance off Paradise. This will allow for an organized flow of victims from the parking lot to the entrance. Only one entrance is suggested and its use should be heavily enforced. Appendix C-8

59 RESPONDERS: The entry point for Responders/Workers is Bay 11. This entrance will allow for the protection of workers and still provide needed access to apparatus in the parking area. Check In Area VICITMS: The victim check in area is marked on the layout. It is important that this entrance be the only entrance used in order to stop multiple access points from developing and maintain coordination of efforts and organization of the CCP. Triage The triage area is located in the concourse area inside the Main Entrance off of Paradise Road and is clearly marked on the layout. Triage areas will be staffed in accordance with the Multi-jurisdictional Mass Casualty Plan. A registered nurse will staff each triage area. It will be the nurse s responsibility to decide which patients shall be held at the CCP and which shall be sent to the immediate area for transport to emergent care sites. Decontamination Area Waterless decontamination is the method of choice for mass decontamination requirements. The Las Vegas Convention Center is poorly suited for WET decontamination of patients. Currently there are no pre-existing decontamination areas. However, the entire building has fire sprinklers as well as an under ground tunnel which leads from one side of the property to the other. The decontamination area shall provide MALE and FEMALE areas as well as provision for rapid decontamination. Transportation Section - Arriving/Departing The transportation area is located between the Immediate and Delayed Treatment Areas (North Halls) and the Las Vegas Hilton and is clearly marked on the layout. Transportation areas will be staffed in accordance with the Multi-jurisdictional Mass Casualty Plan. Appendix C-9

60 The transportation area is designed to accommodate several transportation units in a systematic organized fashion. This area must maintain a clear thoroughfare at all times. Treatment Areas The treatment areas are located in areas labeled as Central Halls and North Halls. These are clearly marked on the layout. Treatment areas will be staffed in accordance with the Multi-jurisdictional Mass Casualty Plan. Only patients held in the immediate treatment area will be considered for transportation to area hospitals. All delayed patients will be held at the CCP until the status of bed availability at area hospitals is accessed. Extreme mass casualty events yielding very large numbers of patients may stimulate a request through Emergency Management for the Forward Movement of Patients. Staffing for a CCP can be augmented with an MMST. Education Area (lecture seating) The Las Vegas Convention Center does not provide pre-existing lecture seating such as a theatre. The Worried Well Holding Area can be used as an education area. The education area is established to hold worried well. Constant information and mental support must be forwarded to these individuals until checkout procedures can begin. Facilities The facilities areas are located throughout the Convention Center property. The Logistics Officer must contact the site facilities manager as soon as possible in order to maintain site operations. Check Out The checkout area should be located near the Worried Well Holding Area. The final checkout or patients must assure patient disposition and instructions on follow-up care and mental support. Appendix C-10

61 Office Space Office space is located just inside bay door #11. Additionally, office space can be found directly across from bay door #11. This space is clearly marked on the layout. Storage Space Storage space can be found in several locations throughout the Convention Center property. Appendix C-11

62 (Las Vegas Convention Visitors Authority) Appendix C-12

63 Responder Staging Area Incident Command Center & Office S Apparatus Staging Area Parking off Joe W. Brown Entrance at Bay # 11 Worried Well Holding Area Ambulance Transportation Corridor Delayed Treatment Area Triage Area Immediate Treatment Area Victim Check-in Area NOTE: Because of the lack of decontamination possibilities on-site, Victim Parking Area Las Vegas Convention Appendix Center C-13 Casualty Collection Point

64 Cashman Field Complex Location: 850 N. Las Vegas Blvd Contact Number: Responder Staging Area Responders arriving at the Thomas and Mack Center shall utilize the LOT B entrance off of Washington Avenue. The security and isolation of this entrance must be established early in the incident and protected from civilian use or access. Responders may park their vehicles in the designated responder parking area shown as LOT B on the map. Responders must check-in with the Staging Area Manager for assignment. The Staging Area Manager must be supplied with a layout map in order to guide responders to their assigned locations. Entry Point VICTIMS: The entry point suggested for the Cashman Center is located on the North East side of the baseball field. This will allow for an organized flow of victims from parking LOT D to the check in point. Only one entrance is suggested and its use should be heavily enforced. RESPONDERS: The entry point for Responders/Workers is the MEETING ROOMS entrance on the North West side of the EXHIBIT HALL A. This entrance will allow for the protection of workers and still provide needed access to apparatus in the parking area. Check In Area VICITMS: The victim check in area is marked on the North East side of the Baseball field and is illustrated on the Collection Point Schematic. It is important that this entrance be the only entrance used in order to stop multiple access points from developing and maintain coordination of efforts and organization of the CCP. Triage The triage area is located in area baseball field area and is clearly marked on the layout. Triage areas will be staffed in accordance with the Multi-jurisdictional Mass Casualty Plan. Appendix C-14

65 The triage area is located near the decontamination areas. This proximity will allow triage teams to assess patients and decide which patients should proceed through which decontamination line. Additionally, a registered nurse will staff each triage area. It will be the nurse s responsibility to decide which patients shall be held at the CCP and which shall be sent to the immediate area for transport to emergent care sites. Decontamination Area The Decontamination areas are located in areas clearly marked on the Cashman Field Casualty Collection Point Schematic. The decontamination areas provide MALE and FEMALE areas as well as provision for immediate patients needing rapid decontamination. MALE DECONTAMINATION: Entry point through the 3rd base side dugout (North side), down hallway to the team room. This team room will allow for privacy, shower facilities, drying and changing areas. FEMALE DECONTAMINATION: Entry point through the 1st base side dugout (South side), down hallway to the team room. This team room will allow for privacy, shower facilities, drying and changing areas. IMMEDIATE DECONTAMINATION: Entry point through the Maintenance ramp North of the 3 rd base side dugout (South side). This ramp will be supplied with emergency decontamination equipment and will for rapid access to the Immediate Treatment Area.. Patients, when completed with the decontamination process, will then continue to the Theater (worried well), HALL B (delayed patients), or HALL A (immediate patients). It is believed the decontamination area marked on layout will not allow water runoff to enter any other operational area. The Decontamination Area Manager will need to assure the victims in line awaiting decontamination are not corralled in water runoff. Transportation Section - Arriving/Departing The transportation area driveway/corridor is located in the front of the area marked LOT B and is clearly illustrated on the layout. Transportation areas will be staffed in accordance with the Multi-jurisdictional Mass Casualty Plan. Appendix C-15

66 The transportation area is designed to accommodate several transportation units in a systematic organized fashion. This driveway/corridor must maintain a clear thoroughfare at all times. Treatment Areas The treatment areas are located in area HALL A (Immediate) and HALL B (Delayed) and are clearly marked on the Cashman Field Casualty Collection Point Schematic. *WORRIED WELL: Additional treatment areas for the worried well have been provided for by use of the Theater and baseball field seating. Every attempt should be made to seat by alphabetical order of last name. This will aid in reacquainting families separated by the decontamination process. Treatment areas will be staffed in accordance with the Multi-jurisdictional Mass Casualty Plan. Only patients held in the immediate treatment area (HALL A) will be considered for transportation to area hospitals. All delayed patients will be held at the CCP until the status of bed availability at area hospitals is accessed. Extreme mass casualty events yielding very large numbers of patients may stimulate a request through Emergency Management for the Forward Movement of Patients (Deliverable # 4). Staffing for a CCP can be augmented with an MMST. Education Area (lecture seating) Mass education or lecture areas are located in the theater and baseball field seating and are clearly marked on the layout. The education area is established to hold worried well. Constant information and mental support must be forwarded to these individuals until checkout procedures can begin. Facilities The facilities areas are located throughout the complex and are clearly marked on the layout. These include: Appendix C-16

67 Bathrooms Showers Food preparation areas The Logistics Officer must contact the site facilities manager as soon as possible in order to maintain site operations. Check out The checkout area is located at the theater exits and is clearly marked on the layout. The final checkout for patients must assure patient disposition and instructions on follow-up care and mental support. Patients processed out of HALL B shall be checked out upon exiting. Patients transported out of HALL A shall be tracked by normal EMS means. Office space Office space is located in the administration area and is located near the elevators at the front of the baseball field entrance. Storage space Storage space can be found throughout the complex. Appendix C-17

68 Transportation Area Delayed Treatment Immediate Treatment Area Male Decontamination area Female Decontamination area Worried Well / Walking Wounded Immediate Patient Decontamination Male Decontamination Line TRIAGE AREA Female Decontamination Entry Point / Check In Patient/Victim Parking Patient Entry (Cashman Field Complex) Appendix C-18

69 Sam Boyd Silver Bowl Location: 7000 East Russel Responder Staging Area Responders arriving at the Sam Boyd Silver Bowl shall utilize the entrance off Tropicana. This shall be a secure entrance and protected from civilian use or access. Responders may park their vehicles in the designated responder parking area shown as Bus/Band Parking on the map. Responders must check-in with the Staging Area Manager for assignment. The Staging Area Manager must be supplied with a layout map in order to guide responders to their assigned locations. Entry Point VICTIMS: The entry point suggested for the Silver Bowl is the Main Gate off the Russell Road entrance. This will allow for an organized flow of victims from the parking lot to the entrance. Only one entrance is suggested and its use should be heavily enforced. RESPONDERS: Responders/Workers can be provided a secure entrance via the North Lot entrance gates. This entrance will allow for the protection of workers and still provide needed access to apparatus in the parking area. Check In Area VICITMS: The victim check in area is marked on the layout. It is important that this entrance be the only entrance used in order to stop multiple access points from developing and maintain coordination of efforts and organization of the CCP. Triage The triage area is located near the main gate entrance and is clearly marked on the layout. Triage areas will be staffed in accordance with the Multi-jurisdictional Mass Casualty Plan. Appendix C-19

70 The triage area is located near the decontamination area. This proximity will allow triage teams to assess patients and decide which patients should proceed through which decontamination line. Additionally, a registered nurse will staff each triage area. It will be the nurse s responsibility to decide which patients shall be held at the CCP and which shall be sent to the immediate area for transport to emergent care sites. Decontamination Area The Decontamination area is located near the main gate entrance and is clearly marked on the layout. Options for decontamination are provided in the decontamination section. Waterless decontamination is the method of choice for mass decontamination requirements. WET decontamination procedures may utilize the team locker rooms. The decontamination area shall provide MALE and FEMALE areas as well as provision for rapid decontamination. It is believed the decontamination area marked on layout will not allow water runoff to enter any other operational area. The Decontamination Area Manager will need to assure the victims in line awaiting decontamination are not corralled in water runoff. Transportation Section - Arriving/Departing The transportation area is located at the North Gate area with ambulance traffic routed out on to Tropicana Blvd. Transportation areas will be staffed in accordance with the Multi-jurisdictional Mass Casualty Plan. The transportation area is designed to accommodate ## transportation units in a systematic organized fashion. This area must maintain a clear thoroughfare at all times. Treatment Areas Treatment areas can be provided as follows: Worried well may be seated in the Silver Bowl section seating. Delayed and Immediate patients may be cared for on the field area. Appendix C-20

71 Treatment areas will be staffed in accordance with the Multi-jurisdictional Mass Casualty Plan. Only patients held in the immediate treatment area will be considered for transportation to area hospitals. All delayed patients will be held at the CCP until the status of bed availability at area hospitals is accessed. Extreme mass casualty events yielding very large numbers of patients may stimulate a request through Emergency Management for the Forward Movement of Patients (Deliverable # 4). Staffing for a CCP can be augmented with an MMST. Checkout Area Check-in Area Decontamination Area Triage Area (Sam Boyd Silver Bowl) Appendix C-21

72 Education Area (lecture seating) The education areas are located the section seating area and are clearly marked on the layout. The education area is established to hold worried well. Constant information and mental support must be forwarded to these individuals until checkout procedures can begin. Facilities The facilities areas are located in the concourse area and are clearly marked on the layout. The Logistics Officer must contact the site facilities manager as soon as possible in order to maintain site operations. Check out The checkout area is located at the East gate and is clearly marked on the layout. The final checkout of patients must assure patient disposition and instructions on follow-up care and mental support. Office space Office space is located on the Mezzanine level. Appendix C-22

73 Las Vegas International Speedway Location: 6001 Las Vegas Blvd. North Responder Staging Area Responders arriving at the Las Vegas International Speedway shall utilize the entrance off Las Vegas Blvd (Gates 4 and 7). This shall be a secure entrance and protected from civilian use or access. Responders may park their vehicles in the designated responder parking area shown as Responder Parking on the map. Responders must check-in with the Staging Area Manager for assignment. The Staging Area Manager must be supplied with a layout map in order to guide responders to their assigned locations. Entry Point VICTIMS: Victims will gain access to the Las Vegas International Speedway by using Hollywood Boulevard and Interstate 15. This will allow for an organized flow of victims from the parking lot to the entrance. Only one entrance is suggested and its use should be heavily enforced. RESPONDERS: The entry point for Responders/Workers is the staff entrance located near the Gate 7 entrance. This entrance will allow for the protection of workers and still provide needed access to apparatus in the parking area. Apparatus may enter through an emergency entrance between turn 3 and the main grandstand. Additionally, apparatus can make access though the three (3) tunnels off of the gate 4 entrance. Check In Area VICITMS: The victim check-in area is located at the main entrance and is marked on the layout. It is important that this entrance be the only entrance used in order to stop multiple access points from developing and maintain coordination of efforts and organization of the CCP. Appendix C-23

74 Triage The triage area is located just inside the Main Entrance to the main speedway and is clearly marked on the layout. Triage areas will be staffed in accordance with the Multi-jurisdictional Mass Casualty Plan. The triage area is located near the decontamination area. This proximity will allow triage teams to assess patients and decide which patients should proceed through which decontamination line. Additionally, a registered nurse will staff each triage area. It will be the nurse s responsibility to decide which patients shall be held at the CCP and which shall be sent to the immediate area for transport to emergent care sites. Worried well patients will be directed to the worried well holding area located in the drag strip grandstands. Decontamination Area The Decontamination area is located in main speedway and is clearly marked on the layout. Waterless decontamination is the method of choice for mass decontamination requirements. (If water is to be used) Wet decontamination can be provided by using the four (4) usually vacant garages located inside the raceway. Each garage has several sprinkler heads, which can be activated. Water run off is grade dependant and should carry water to sewer drains located along the fence line and along the team RV parking area. The wet decontamination area shall provide MALE and FEMALE areas as well as provision for rapid decontamination. It is believed the decontamination area marked on layout will not allow water runoff to enter any other operational area. The Decontamination Area Manager will need to assure the victims in line awaiting decontamination are not corralled in water runoff. Transportation Section - Arriving/Departing The transportation area/corridor is clearly marked on the layout. Appendix C-24

75 Transportation areas will be staffed in accordance with the Multi-jurisdictional Mass Casualty Plan. The transportation area is designed to accommodate several transportation units in a systematic organized fashion. This area must maintain a clear thoroughfare at all times. Treatment Areas The treatment areas are located within the speedway and are clearly marked on the layout. Treatment areas will be staffed in accordance with the Multi-jurisdictional Mass Casualty Plan. Only patients held in the immediate treatment area will be considered for transportation to area hospitals. All delayed patients will be held at the CCP until the status of bed availability at area hospitals is accessed. Extreme mass casualty events yielding very large numbers of patients may initiate a request through Emergency Management for the Forward Movement of Patients (Deliverable # 4). Staffing for a CCP can be augmented with an MMST. Education Area (lecture seating) The education areas can be put together using other race track grandstand seating and are clearly marked on the layout. The education area is established to hold worried well. Constant information and mental support must be forwarded to these individuals until checkout procedures can begin. 3/8 Oval and the dirt oval hold 5000 persons each. Drag strip grandstand holds 15,000 persons Speedway grandstand hold 135,000 persons Facilities The facilities areas are located throughout the speedway complex. Appendix C-25

76 The Logistics Officer must contact the site facilities manager as soon as possible in order to maintain site operations. Check out The checkout area is located on the North end of the grandstand seating area and is clearly marked on the layout. The final checkout or patients must assure patient disposition and instructions on follow-up care and mental support. Office space Office space is located in speedway medical building. Appendix C-26

77 Responder Parking / Staging Area Responder Check -in Gate 7 Worried Well Holding Area To Drag strip Seating Immediate Treatment Area Victim Check-in Triage Area Tunnel Ambulance Transportatio n Corridor Delayed Treatment Area Underground Tunnel Pedestrian Access to Infield Decontamination areas Four (4) garages with four (4) bays each. Water runoff predicted to flow toward infield. Sewer inlets line fence between garages and the infield. Medical Building/ Office Space (Las Vegas International Speedway) Appendix C-27

78 Victim Parking Worried Well Holding Area Drag Strip Grandstands Area Victim Check-in (Main Entrance) Triage Checkout Area Female Decontamination Responder Parking & Staging Male Decontamination Helipad Gate 7 Responder Immediate Treatment Delayed Treatment Area Ambulance Transportation Corridor Gate 4 Appendix C-28