Chelan & Douglas County Mass Casualty Incident Management Plan

Chelan & Douglas County Mass Casualty Incident Management Plan Updated 6/2016

1.0 Purpose 2.0 Scope 3.0 Definitions 4.0 MCI Management Principles 4.1 MCI Emergency Response Standards 4.2 MCI START System 4.3 MCI Scene Considerations 4.4 Communications 4.5 ICS Incident Management 4.6 Medical Branch 5.0 Appendixes 5.1 Agency Responsibilities 5.2 S.T.A.R.T. Model 5.3 Jump S.T.A.R.T. 5.4 First Arriving Chief Officer 5.5 MCI - Incident Safety Officer Checklist Table of Contents 5.6 MCI Equipment - MCI Trailer Equipment / Procedures 5.7 Medical Branch Position Responsibilities 5.8 Medical Branch Position Worksheets 5.8.1 Medical Branch Organization Worksheet 5.8.2 Triage Organization Worksheet 5.8.3 Treatment Worksheet 5.8.4 Transport Worksheet 5.8.5 Patient Tracking Worksheet 5.9 Area MCI Response Standards 5.9.1 Wenatchee Area 5.9.2 Cashmere Fire Department 5.9.3 Leavenworth (CCFD#3) Area 5.9.4 Chelan (CCFD#7 & #5) Area 5.9.5 Entiat (CCFD#8) 5.9.6 Orondo (DCFD#4)

1.0 Purpose The Chelan & Douglas County Mass Casualty Incident (MCI) Management Plan provides standard operating guidelines for emergency service personnel for the response and incident management of mass casualty incidents in Chelan and Douglas Counties. The Plan has been developed to provide standard procedures for appropriately classifying various levels of MCI response alarms. The plan also provides dispatch response standards for emergency personnel and equipment resources needed for the incident based upon the size or nature of the mass casualty incident. 2.0 Scope This plan is based on the principles of the National Incident Management System (NIMS) and is intended to serve as a flexible guide to achieve successful incident management. The MCI emergency response will initially be determined by the number of patients or by the potential rapid escalation in the number of patients. It is intended to be an all-hazard plan to meet the needs of any MCI regardless of the incident s cause, including the evacuation of non-ambulatory patients. If necessary, these procedures can be modified based on the number of patients, the cause or severity of injuries and special circumstances involved in the incident. 3.0 Definitions 3.1 Equipment Pool: An area designated by the Incident Commander or Medical Branch Director for the gathering of equipment such as backboards, trauma kits, oxygen etc. 3.2 Extraction & Rescue Functions: The safe and rapid removal of entrapped patients, or from dangerous situations and their prompt delivery to a treatment area. In incidents where technical rescue/extraction is not needed, these resources should be utilized to move patients. 3.3 Funnel Point: A central point designated by the Triage Team Leader that every patient filters through prior to movement into the Treatment area. (This location usually is located at the entrance of the treatment area). Patients will be numbered for tracking and receive a triage ribbon if they have not yet done so. 3.4 H.E.A.R. Radio (Hospital Emergency Administration Radio): used to communicate from mobile to hospital and from hospital to hospital. 3.5 Incident Command System (ICS): A standardized system to be utilized at all emergency scenes that includes roles, responsibilities, operating requirements, guidelines and procedures for organizing and operating an on-scene management structure. 3.6 Incident Commander: The person in overall command of an emergency incident; this person is responsible for the direction and coordination of the response effort. 3.7 Litter Bearers: Individuals assigned by the medical group supervisor to assist in movement of injured patients to the designated triage area. 3.8 Manpower Pool: An area designated by the Incident Commander for incoming personnel or rehab personnel to assembly prior to assignment. 1

3.9 Mass Casualty Incident: An incident in which the number of patients or the severity of their injuries prohibits immediate patient care provided to all and taxes the initial responding resources. 3.10 Medical Branch Director: The person in charge of overall medical operations who reports to the IC (or Operations Chief if established). Supervises the unit (s) who triage, treat and transport patients. In a major MCI the incident may expand to assign a Medical Branch (Director) 3.11 NIMS (National Incident Management System): A comprehensive national approach to incident management; it establishes a standard incident management process, procedures and protocols that are applicable to all jurisdictional levels across functional disciplines so responders can work together with maximum effectiveness. 3.12 Simple Triage and Rapid Transport (START): The START system is a color- c o d e d triage system that is based on four levels of medical/trauma prioritization: immediate (red), delayed (yellow), minor (green), and deceased (black). 3.13 Staging Area: A designated area where vehicles will be held until requested by the Incident Commander. All units responding to the incident shall report to Staging until assigned. 3.14 Staging Area Manager: An individual assigned to coordinate the movement of vehicles as requested by Incident Command. 3.15 Staging Function: Assembly, coordination and control of resources awaiting tactical assignment. 3.16 Transportation Group Supervisor: Person assigned to organize and supervise the transportation of all patients to medical facilities. 3.17 Treatment Area: An Area specified by the Incident Commander or Medical Group Supervisor for the treatment of casualties. 3.18 Treatment Functions: To provide on-site medical treatment based on patient priority while awaiting transportation. 3.19 Treatment Group Supervisor: Person assigned with organizing the treatment area. 3.20 Triage Area: The designated area where the casualties are triaged. This may be the area where the casualties are initially found, or a designated point to where the casualties are transported for appropriate triage. 3.21 Triage Functions: To assess and sort casualties and appropriately establish priorities for treatment and transportation. The method of initial field triage to be utilized is the START (Simple Triage and Rapid Treatment) system. 3.22 Triage Group Supervisor: The person assigned with organizing the triaging of all patients. 3.23 Command Officer- Agency On Duty Officer 2

3.24 Active Shooter- Any weapon active event declared from law enforcement or dispatch. 4.0 Mass Casualty Incident (MCI) Management Principles 4.1 MCI Emergency Response Standards The 2 nd, 3 rd and 4 th alarm emergency response for an MCI will be based on patient count or request from an Incident Commander. 8-12 patients 2 nd Alarm MCI (6 transporting ambulances to include at least one medic unit) 13-18 patients 3 rd Alarm MCI (10 transporting ambulances to include at least two or more medic units) 19+ patients 4 th Alarm MCI (Emergency Management assistance for regional or state response) MCI response plans have been developed by geographic areas that correspond with existing response zones for all fire and EMS nature codes with potential for an MCI. These include: EMS: Fire: Carbon Monoxide Overdose / Poison Accident Injury Fire Structure Drowning Stab / Gunshot Aircraft Hazmat Inaccessible Accident Water Rescue Fire Brush Train Freight Industrial Accident Fire Commercial The number of transporting ambulances corresponding to patient counts in a geographic area may be modified based upon local capability and mutual aid agreements. (See attached Appendixes 5.9 Area MCI Response Standards) 4.2 MCI START (Simple Triage and Rapid Treatment) System A. The method of initial field triage to be utilized is the START (Simple Triage and Rapid Treatment) system. B. The START System allows a large number of patients to be triaged and identified by seriousness of injury in a very short period of time. C. Characteristics of the include: No special skills necessary Simple equipment Rapid evaluation of each patient (60 seconds or less) No specific diagnosis made Quick stabilization provided (attention to airway and serious bleeding) Easy to teach, learn, and remember D. Using the START triaging system patients are given a color-coded triage ribbon. Red Immediate life threat and highest priority for treatment and transport. All red patients should be transported prior to other patients. Yellow Second highest priority for treatment and transport. Could be delayed up to 1-2 hours. Green Lowest priority for treatment. Walking wounded or self- rescue victims. 3

Transport of these victims should occur after all other patients have been transported. These patients may also be transported using a mass-transit type of vehicle, i.e. school bus. Black Deceased or those impossible to save. These victims should be left where they are found and not moved. If necessary, have a morgue area for those who die in a treatment or who must be moved. The color-coding will insure standardization of patients for both treatment and transport (see attached START System Appendix 5.2). E. Pediatric patients ages 8 and under will be better served by using Jump START. (see Jump START Appendix 5.3). 4.3 MCI Scene Considerations - Set up the scene for casualty management. Identify access and egress routes for treatment / transportation flow Identify adequate work areas for triage, treatment, transportation Establish effective base for extra apparatus Establish an effective staging for EMS ambulances / personnel / equipment 4.4 Communications Communications play an important role in every phase of MCI management. Its importance before, during, and after an MCI must be emphasized. Early attention to communications will maximize time, coordination, and the use of available resources. A. Common MCI Communication Issues The under-response to initial reports of the incident. Early communication and coordination with hospitals B. Radio Communication Guidelines On-scene radio communications should be kept to a minimum. When possible, direct verbal contact, or runners should be used. The Incident Commander (radio call sign COMMAND should be the only person communicating with RIVERCOM. The Incident Commander will assign tactical frequencies for the incident. All EMS communications on HEAR should be limited to the Medical Branch Director (radio call sign Medical ). Central Washington Hospital will be contacted early in the incident and will 4

coordinate patient transport to CWH or patient distribution to other medical facilities. 4.5 Incident Command System (ICS) Incident Management ICS procedures will be used to coordinate incident management and manage the personnel, equipment, and other resources during a MCI. 4.5.1 First Arriving Unit Make an initial size-up of the emergency incident (Report the location, mechanism, approximate number of patients, major hazards.) The first arriving unit may declare the incident an MCI and initiate the level of MCI response that is needed. o 8-12 patients: 2 nd Alarm o 12-18 patients: 3 rd Alarm o 19+ patients: 4 th Alarm Initiate Command Begin the START Triage system for classifying trauma patients. 4.5.2 First Arriving Chief Officer Establish Incident Command / Unified Command Request additional resources (Affirm MCI Level Response) Establish Staging for incoming resources Establish Medical Branch or Grouph for MCI Level Prioritize incident objectives develop Incident Action Plan Direct incoming companies and equipment to accomplish objectives 4.5.3 Large MCI Command System Command Staff PIO (JIC) Safety (Group) Liaison Incident Command Operations Law Enforcement Branch Traffic Control Scene Control Security Investigation Coroner/ Morgue Medical Branch Director Staging Manager Equipment Manager Fire Branch Director Fire Suppression Scene Hazards HazMat / Decon Extrication / Rescue Triage Officer Treatment Officer Transportation Officer Triage Officer Funnel Point Red Area Green Area Yellow Area 4.5.4 4 Keys to ICS Organization & Safety Clear assignments and objectives 5 Ambulance Staging Manager Helicopter LZ Coordinator

Accountability of personnel and resources Common on-scene radio communication channels Safety briefings for site hazards, PPE, personnel health & safety 4.6 Medical Branch Director The Medical Branch Director is an extremely important MCI position assignment. The Medical Branch Director MEDICAL establishes communications with the hospital (CWH) through the H.E.A.R. radio frequency and manages the tactical elements for triage, treatment, and patient transport. (See Appendix 5.7 Position Responsibilities) Medical Branch Director Triage Group Treatment Group Transporation Group 5.0 Appendixes 5.1 Agency Responsibilities 5.2 S.T.A.R.T. Model 5.3 Jump S.T.A.R.T. 5.4 First Arriving Chief Officer 5.5 MCI Incident Safety Officer Checklist 5.6 MCI Equipment MCI Trailer Equipment / Procedures 5.7 Medical Branch Position Responsibilities 5.8 Medical Branch Position Worksheets 5.8.1 Medical Branch Organization Worksheet 5.8.2 Triage Organization Worksheet 5.8.3 Treatment Worksheet 5.8.4 Transport Worksheet 5.8.5 Patient Tracking Worksheet 5.9 Area MCI Response Standards 5.9.1 Wenatchee Area 5.9.2 Cashmere Fire Department 5.9.3 Leavenworth (CCFD#3) Area 5.9.4 Chelan (CCFD#7 & #5) Area 5.9.5 Entiat (CCFD#8) 6

5.9.6 Orondo (DCFD#4) 7

Appendix 5.1 Agency Responsibilities Fire Departments Fire departments engage in activities that include fire suppression, search and rescue, EMS, and mitigation of hazardous conditions. The highest authority from a responding fire agency typically assumes the Incident Commander position at the scene on an MCI. Responsibilities Include: Scene and community assessment of damage and casualties Mitigation of physical hazards and scene safety Establish ICS / Unified Command Set Incident Objectives and develop Incident Action Plan (IAP) Public Information Officer Triage and treatment of patients Determine additional resources / Request additional resources Communications with dispatch and ICS Communication Plan Manage fire, rescue and air operations EMS / Ground & Air Transportation Provider Responsibilities include: Ambulances Companies Scene assessment Patient triage Establish communications with hospital Initiate and coordinate the MCI / Coordinate Medical Group/Branch development Set up and staff treatment areas Medical supplies (initial and ongoing) On-going triage Patient care documentation Transport patients to appropriate medical facilities Determine resource needs Scene documentation Airlift Northwest / MedStar Transport critically injured patients Provide additional ships as needed Law Enforcement responsibilities include: Search and rescue (SAR) Scene control / Traffic control Management of deceased (morgue) Incident investigation PIO (coordinate with fire as needed) Coroner responsibilities include: Hospitals Morgue management Removal of deceased victims Deceased victim documentation Coordination with other law enforcement agencies Family notifications Communications between Central Washington Hospital and other area hospitals Determine initial bed availability Determine patient destinations in conjunction with Medical Branch (Transportation Supervisor) Activate Surge Plan (as determined by hospital protocol) Coordinate with EMS and/or Health District 8

Appendix 5.2 START Model 9

Appendix 5.3 Jump Start Model 10

Appendix 5.4 First Arriving Chief Officer 11

Appendix 5.5 MCI Incident Safety Officer Checklist 12

Appendix 5.6 MCI Equipment - MCI Trailer Equipment / Procedures MCI Equipment Staging / MCI Trailer Equipment and Procedures When personnel are moved from staging or a base: EMS and rescue equipment should be taken to the site of equipment pools for rescue, moving, and treatment of patients prior to the MCI trailer arrival. FIRE / RESCUE / EMS Equipment Full PPE / Gloves Suction Cones/Flags Thermal Imaging Camera (TIC) Scoop basket stretcher Gas Monitor (CGI) Triage kits SCBAs / Extra bottles Blankets Masking tape Trauma kits Safety vests C- collars Backboards Backboards Pediatric kits O2 Bottles Stretcher EKG Monitor MCI Trailer Procedures Location: The MCI Trailer is located at CCFD#1, Station 11, 206 Easy Street Lock Code: 0911 Hitch: Inside trailer (front) Contact RiverCom to request and confirm dispatch and ETA of the MCI trailer. 13

Appendix 5.7 Medical Branch Position Responsibilities A. Medical Branch Director - Person in charge of overall Medical Operations who reports to the IC (or Operations Chief if established). Supervises the unit(s) who triage, treat, and transport patients. 1. Size-up incident area (including scene safety) 2. Put on the EMS Branch Director Vest 3. Remain in contact with the operations Section Chief 4. Supervise personnel assigned to EMS branch 5. Assign and direct Triage, Treatment, Transportation Supervisors 6. Request patient count, including the number of pediatric patients, by triage code from the Triage Group Supervisor. Information is then relayed to the transportation supervisor. Notify closest/medical control hospital with the total patient count by category and obtain information regarding hospital capacity to accept patients. 7. Request additional medical supplies as needed. 8. Estimate and request additional personnel from Operations Section Chief, indicate type and function needed 9. Request status up-dates, as necessary, from Triage, Treatment and Transportation Supervisors 10. Provide updates to the Operational Section Chief 11. Request medical Examiner/Coroner and communicate need for temporary morgue if needed B. Triage Group Supervisor 1. Size-up incident area (including scene safety). 2. Put on Triage Group Supervisor vest 3. Remain in contact with the EMS Branch Director 4. Triage patients using the START System. Request adequate personnel to provide triage and movement of all patients 5. Assign staff, select and mark GREEN collection area and announce that anyone who is able to walk is to get up and move to the GREEN collection area. 6. Leave BLACK patients 7. Get patient count, including the number of pediatric patients, by triage category and report numbers to EMS Branch Director. 8. Establish system to move patients from Triage to 9. Establish a funnel point. 10. Monitor the supply of patient triage supplies and tags/marking system 11. Report to EMS Branch Director when assignment is completed C. Funnel Point Manager 1. Oversees re-triaging of patients. 2. Assigns a number to each patient. 3. Logs the number on the tracking board. 4. Numbers patients in one of the following locations using an indelible marker (by priority). Cheek / Chest / Arm / Hand / Leg D. Treatment Group Supervisor 1. Size-up incident area (including scene safety) 2. Put on the treatment Group Supervisor Vest 3. Supervise personnel assigned to treatment group 4. Select and mark treatment. Advise EMS Branch Director of treatment area locations, and when they have been established 5. Assign and brief treatment team leaders to each area if personnel allows 6. Ensure Accountability of Patients 7. Monitor supply of patient treatment equipment and supplies. Request additional equipment and supplies, as needed, from the EMS Branch Director. 8. Prioritize patients for movement to Transport Area. Direct patient movement from Treatment area to Transport area. 14

E. Transport Group Supervisor - Direct and coordinate patient loading and dispatching to medical facilities. 1. Size-up incident area (including scene safety) 2. Put on the Transportation Group Supervisor Vest 3. Establish ambulance staging in a safe area. Clearly define ingress and egress. 4. Assemble Transport Patient Movement Teams. 5. Assign LZ coordinator to manage landing zone if needed. 6. Request hospital capability information from EMS Branch Director. 7. ACCOUNTABILITY!! 8. Direct movement of transport vehicles in Transport area. One member of the transport unit must remain in the vehicle. 9. Direct removal of patient care equipment and supplies from transport units, if needed. Populate the equipment staging area 10. Direct movement of patients from Transport area to transport vehicles. The stretchers/cots must be matched to their home vehicles for transport safety. 11. Direct Transport units to designate hospitals based on capabilities 12. Notify Hospital of Incoming Patients F. Morgue Team Leader - Directs protection and identification of bodies in cooperation with Medical Examiner s Office (when on scene). 1. Obtain Situation briefing from immediate supervisor. 2. Don position identification vest if available. 3. Review the entire duty checklist. 4. Assess situation. 5. Appoint and brief staff as needed (aides, litter bearers). 6. Maintains integrity of bodies and scene. 7. Do not allow removal of bodies or personal effects without Medical Examiner s authorization. 8. If necessary to move bodies, designates Morgue area. 9. Coordinates disposition of patients who die in the Red Area. 10. Advises Medical Examiner s office of situation if Medical Examiner is not on the scene. 11. Attempts identification, tags and covers bodies. 12. Maintains security of all personal belongings and keeps such items with the individual body. 13. Ensures that the original position of bodies and personal effects are identified and well documented before moving. Note: photos, grid drawings, etc. 14. Maintains records. G. Ambulance Staging Manager 1. Obtain Situation briefing from immediate supervisor. 2. Don position identification vest if available. 3. Review the entire duty checklist. 4. Assess situation. 5. Appoint and brief staff as needed. 6. Establishes ambulance staging area for ambulance to report before being sent into loading area. 7. Ambulance staging area should be outside of the emergency operations area, but provide easy and direct access. 8. Coordinates with Transportation Team Leader for patient loading and transporting. 9. Ensures that all drivers and ambulance techs stay with their vehicles. 10. Ensures that the staging area is well organized, and that vehicle movement is unrestricted and smooth flowing. 15

Appendix 5.8.1 Medical Branch Organization Worksheet 16

Appendix 5.8.2 Triage Organization Worksheet 17

Appendix 5.3.3 Treatment Worksheet 18

Appendix 5.8.4 Transport Worksheet 19

Appendix 5.8.5 Patient Tracking Worksheet 20

Appendix 5.9.1 Wenatchee Area 21

Appendix 5.9.2 Cashmere Fire Department 22

Appendix 5.9.3 Leavenworth (CCFD#3) Area 23

Appendix 5.9.4 Chelan (CCFD#7 & #5) 24

Appendix 5.9.5 Entiat (CCFD#8) 25

Appendix 5.9.6 Orondo (DCFD#4) 26