Palm Beach County Fire Rescue

Palm Beach County Fire Rescue

MCI Dispatch Protocol Revisions The following packet contains the changes to the MCI Dispatch Protocol along with a brief review of Scene Size Up involving an MCI, Declaration of an MCI and Scene Management Priorities. The first section in this packet contains the New MCI Dispatch Protocol showing the number of units that will be paged for Level (1-3) MCI. Included in this section is a Note page for pertinent clarification, Wire Diagrams/Command Flow Charts for Level 1-3 and a Blank Template Wire Diagram/Command Flow Chart to be utilized by Command Units. This change in number of units responding for Levels 1-3 was created by utilizing a Wire Diagram/Command Flow Chart format for each Level 1-3. They were created by simulating the number of units it would take to efficiently manage and process the given number of victims per each Level 1-3. It must be noted that these diagrams are examples only of where units can be assigned to efficiently manage an MCI. The Incident Commander is responsible for assigning units as needed based on incident priorities. The second section contains a brief review of Scene Size Up involving an MCI, Declaration of an MCI and Scene Management Priorities. Although there are many considerations in the management of an MCI, this document reviews some coaching points for the First In units with respect to initial assignments, scene safety (hazards) and scene security, Triage, Treatment and Transport. The last part in this section lists some plans for Future Changes to the Management of the MCI being developed and tested by the MCI committee. Effective date for this MCI Dispatch Protocol change is February 1 2011, in the CAD system.

Purpose- Enhance the Number of Emergency Vehicles responding to MCI s, Engines, Rescues, Command Units and Support Units - (Support 81, TCU, DRU1, etc ), Include Wire Diagrams for Levels of MCI to show the utilization of units that will be responding. (Wire Diagrams are Examples Only- Incident Commander to assign units as needed). Review MCI Scene Size-Up, MCI Scene Declaration and Scene Management Priorities Revisions- Increased number of units responding to the Declared Level of MCI Level 1(5-10 patients) Level 2(11-20 Patients) Level 3(21-100 Patients) 4- Engines 7- Engines 8- Engines 6- Rescues 11- Rescues 19- Rescues 2- EMS Captains 3- District Chiefs (1- Sp/Ops D/C) 4- District Chief (1- Sp/Ops D/C) 1- District Chief 3- District Captains 4- District Captains 1- Battalion Chief 2- Battalion Chiefs 3- Battalion Chiefs 1- Helicopter-Standby 1- Division Chief 1- Division Chief 2- Helicopters- Standby 2- Helicopters Standby 1- Special Operation Team 1- PIO 2- Special Operations Team 1-PIO Special Deployment Units 1- Support 81 1- TCU (Tactical Command Unit) 1- DRU2 and DRU3 1-Tactical 34

*Note The number of units responding for each Level MCI is based on the maximum number of Victims / Patients for that Level MCI *Note - Incident Commander can downsize level of response per numbers of victims/patients based on the severity of injuries/illnesses *Note: When an MCI is upgraded to the next Level MCI the Incident Commander will receive the balance from the previous Level MCI to supplement the requested Level MCI *Note: For MCI Level 4 (101-1000patients) and Level 5(OVER 1000 patients) refer to Level 3 Wire Diagram (command flow chart) repeat Level 3 MCI for every 100 patients Below Operations *Note: Wire Diagrams are Examples Only- Incident Commander to assign units as needed

Wire Diagram/ Command Flow Chart Level 1 The dashed lines illustrate the movement of units from their initial assignment to possible additional assignments. * Wire Diagrams are Examples Only- Incident Commander to assign units as needed

Wire Diagram/ Command Flow Chart Level 2 The dashed lines illustrate the movement of units from their initial assignment to possible additional assignments. * Wire Diagrams are Examples Only- Incident Commander to assign units as needed

Wire Diagram/ Command Flow Chart Level 3 The dashed lines illustrate the movement of units from their initial assignment to possible additional assignments. * Wire Diagrams are Examples Only- Incident Commander to assign units as needed

Blank Template Will be on Division Chief, Battalion Chief, District Chief, and District Captain Vehicles on a 12x18 board

Scene Size- up involving an MCI, Declaration of an MCI and Scene Management Priorities and Plans for Future Changes This section contains a brief review of Scene Size- Up involving an MCI, Declaration of an MCI and Scene Management Priorities. Although there are many considerations in the management of an MCI, this document reviews some coaching points for the First In units with respect to initial assignments, scene safety and security, Triage, Treatment and Transport. The last part in this section lists some plans for Future Changes to the Management of the MCI being developed and tested by the MCI committee.

There are many SOG s that can apply to an MCI but here a few that we should review with our crews. Incident Command SOG # 1105 Staging SOG# 1310 Disaster Response Units SOG # 1322 Personal Protective SOG # 1510 Traffic Operations SOG # 1740 Vehicle Accident SOG # 2310 MCI SOG # 2315 Response to Violent Incidents SOG # 2320 Response to HAZ MAT/WMD Incidents SOG # 2401 Emergency/ Gross Decontamination SOG # 2407

Review MCI Scene Size-Up/MCI Declaration/ Scene Management Priorities MCI may have been declared prior to First in Unit arrival based on caller/dispatch information Important that First in Units stage other responding units for assignment to allow for proper scene size-up Perform Outer and Inner Circle/Scene Survey for Potential Hazards- Address Immediate Safety Concerns Not Limited To - Wind Direction, Product Clouds, Placards, Unstable Vehicles, Leaking Fuels, Number of Vehicles, Hybrid logos, Number of Distressed Civilians Visualized, Electrical Hazards etc Determine number involved versus number of victims/patients Persons with No Injury/Illness should not be counted to Declare Level of MCI Proper scene size up is important in declaring the correct level of MCI Begin Triage using S.T.A.R.T. and Jump S.T.A.R.T. process Refer to MCI Triage F.O.G. including the S.T.A.R.T. / Jump S.T.A.R.T. algorithm Declare Level of MCI with Type Level 1 (5-10 patients) Level 2 (11-20 patients) Level 3 (21-100 patients) Level 4 (101-1000 patients) Level 5 (over 1000 patients) Type- Traumatic, Chemical, Medical, Pediatric etc Law Enforcement to secure area/establish perimeter Control scene to eliminate the potential of anybody involved leaving the scene Important they keep road clear for Entry and Exit of Transport Vehicles

Assignment Priorities Hazards, Triage, Treatment, Transport, Staging area, etc Special Resources Available Support 81, TCU, DRU Trailers Triage Leader/Supervisor priorities Follow MCI F.O.G. #3 Ensure entire scene is checked for victims/patients Assign enough personnel(litter bearers) to efficiently move patients to Treatment Area Initially, Coordinate with Law Enforcement per Command to secure scene/preserve potential crime scene until liaison is assigned Backboards should be staged for easy access of liter bearers Treatment Area Leader/Supervisor priorities Follow MCI F.O.G.# 4 Indentify Entry and Exit points within treatment area Treatment area leader/supervisor should secure entry point to direct the movement of patients to the proper location within the treatment area based on color categories for secondary triage/treatment/transport Refer to PBCFR ALS/BLS Protocols 2009 and Trauma Transport Criteria

Treatment and Transport area established close as safety will allow to Initial Triage area Reduce patient movement distances Transport Area leader/supervisor priorities Follow MCI F.O.G.# 5 Communication with hospitals Communication with Air Transport Transportation of patients by priority Needs documentation aid for patient tracking Assigned Transport Units need to leave extra Backboards and any extra supplies requested Future Enhancements to Manage MCI Responses New Documentation procedures Possible use of hospital type wristbands with barcode stickers in initial triage Eliminate the use of ribbons in the initial triage New tag/report with bar code in conjunction with EPCR(tablet) New MCI bag/pouch in a safety vest style with updated MCI F.O.G. s Enhancements to the process of color coding (Green, Yellow and Red) Green category to indicate Involved with no obvious injury/illness Victims with any Injury/Illness will be either a Red or Yellow Pilot program in Bat 7 Train the Trainer for future MCI Drills

FIRST ARRIVING _ MCI FIELD OPERATIONS GUIDE 1 Perform Initial Size Up and Establish Command Begin Triage - Using START/ JUMP START process Scene Declaration of MCI with TYPE of MCI - Traumatic, Chemical Exposure, Medical, etc Level of MCI- Approximate number of victims/patients Level 1 (5-10 victims/patients) Level 2 (11-20 victims/patients) Level 3 (21-100 victims/patients) Level 4 (101-1000 victims/patients) Level 5 (over 1000 victims/patients) Involved/Minor Injury/Illness- relocate to safe area (Green Tagged) for Secondary triage Assign Incoming Units- Hazards, Triage, Treatment, Transport Consider additional resource needs- Special Deployment Units (DRU s, TCU, Support 81, Tactical 34) Establish Staging Area to accommodate the number of units responding Revised 01/01/2011

COMMAND _ MCI FIELD OPERATIONS GUIDE 2 Establish Command in a Fixed and Visible Location Radio designation COMMAND Confirm/Declare Level of MCI- Approximate number of victims Level 1 (5-10 victims/patients) Level 2 (11-20 victims/patients) Level 3 (21-100 victims/patients) Level 4 (101-1000 victims/patients) Level 5 (over 1000 victims/patients) Set up Command Board/MCI work board Assign Units to perform following functions Immediate Hazards Triage (Should be OIC of First Arriving Unit) Treatment Transport Assign Staging Area Manager Advise dispatch of the number of victims and their categories Have a liaison from each involved agency at the command post Large scale or complex MCI s, designate a MEDICAL BRANCH Revised 01/01/2011

TRIAGE MCI FIELD OPERATIONS GUIDE 3 Radio designation TRIAGE Organize triage personnel to begin initial Triaging of Victims using S.T.A.R.T and Jump S.T.A.R.T. System Ensure all involved with no Injury/Illness stay on scene for incident documentation Ensure that all areas of the incident have been checked for victims and all victims have been triaged Ensure enough triage personnel are assigned for Litter Bearers for victim movement to treatment area Advise Command of the number of victims, their categories and need for additional resources Coordinate with Treatment the movement of victims based on priority Request Law Enforcement to maintain security of Triage Area When Triage is completed contact Command or Medical Branch for further assignment of personnel Revised 01/01/2011

START TRIAGE Involved minor injury/illness (Needs secondary triage) Minor (Green) Respirations NO YES Position Airway NO YES (RED) Deceased (Black) Immediate (RED) Radical Pulse ABSENT or Capillary Refill Greater than 2 seconds Radical Pulse PRESENT or Capillary Refill Less than 2 seconds Control Bleeding Mental Status Immediate (RED) CANNOT Follow Simple Commands CAN Follow Simple Commands Immediate (RED) Delayed (Yellow) 02/01/2011

JUMP START TRIAGE Involved minor injury/illness (Needs secondary triage) Minor (Green) Respirations NO YES Position Airway Over 15/min Under 45/min Under 15/min Over 45/min NO YES (RED) Palpate Peripheral Pulse Immediate (RED) Peripheral Pulse ABSENT Peripheral Pulse PRESENT YES PULSE Give 5 Ventilations (15 seconds) Via barrier NO PULSE NO Spontaneous Respirations Immediate (RED) Control Bleeding Mental Status Spontaneous Respirations YES NO Deceased (Black) Unconscious or Responds only to Painful Stimuli Alert or Alert to Verbal Stimuli Immediate (RED) Deceased (Black) Immediate (RED) Delayed (Yellow) 02/01/2011

TREATMENT MCI FIELD OPERATIONS GUIDE 4 Radio designation TREATMENT Establish a centralized TREATMENT area with access to TRANSPORT area capable of accommodating the number of victims encountered Supervise on- site medical care, utilizing PBCFR ALS/BLS Protocols 2009 and Trauma Transport Criteria Ensure enough personnel and equipment is available to effectively treat all victims Ensure contaminated patients have moved through the Decon Area Coordinate with TRIAGE (Litter Bearers) for victim movement to TREATMENT area Red tagged victims should be transported immediately when transport units are available Establish communication with TRANSPORT to coordinate transport of victims by priority Update COMMAND or MEDICAL BRANCH of any changes in the victim count or category Revised 01/01/2011

TRANSPORT MCI FIELD OPERATIONS GUIDE 5 Radio designation TRANSPORT Assign a Documentation and Medical Communication Aide early Ensure TRANSPORT area has efficient Entry and Exit for Transport Units with easy access to TREATMENT area Request Law Enforcement to secure TRANSPORT area Establish early contact with Hospitals. Request designated Med Channel for all Hospitals Establish contact with Landing Zone for Air Transport needs Coordinate the Transport of Victims by Priority and Hospital Capabilities Record on TRANSPORT LOG victim ID number, destination Hospital and transport unit number prior to victims leaving the scene Advise destination Hospitals of number of victims, their Triage status and mode of transportation to that facility Request additional Units from COMMAND or MEDICAL BRANCH Revised 01/01/2011

STAGING MCI FIELD OPERATIONS GUIDE 6 Radio designation STAGING Establish a safe location for the STAGING area and advise COMMAND Organize units by type to allow for easy deployment when requested Ensure personnel stay with their vehicle unless otherwise directed and keep keys with the vehicle Maintain a Unit Staging Log. Assign a Documentation Aide if available Maintain a reserve of at least 2 Transport Units Have knowledge of Incident location to advise best route to scene as units are assigned Contact COMMAND or OPERATIONS for additional resource needs Revised 01/01/2011