Oswego County EMS. Multiple-Casualty Incident Plan

Oswego County EMS Multiple-Casualty Incident Plan Revised December 2013

IF this is an actual MCI THEN go directly to the checklist section on page 14. 2

Index 1. Purpose 4 2. Objectives 4 3. Responsibilities 4 4. Incident Phases.. 5 5. Operational Concepts. 7 6. Approvals 12 Checklists 14 3

1. Purpose The intent of the Plan is to provide for effective Multi-Casualty Incident (MCI) response within Oswego County. 2. Objectives Establish a common organizational management structure for the coordination of emergency response to a MCI Establish a dynamic emergency medical response capability Establish triage, care and transportation methods that will ensure the survival of the greatest number of casualties 3. Responsibilities 3.1. EMS Establishing and maintaining communication with the Resource Hospital Patient Triage Patient Transportation Patient care management 3.2. Fire Service Incident Command (IC) (provide IC or participate in unified command) Patient Triage Patient care management Organization and coordination of rescue efforts Hazard control (safety) Disentanglement and extrication Fire suppression Helispot coordination (aircraft) 3.3. E911 Center Initial dispatch of medical resources and personnel Maintenance of normal day-to-day EMS response Ambulance dispatch to incident, zone coverage Ambulance mutual aid 4

3.4. Law Enforcement Incident Command (participate in unified command) Scene protection and security Investigation Traffic control 3.5. Resource Hospital Hospital availability determination Communication with the on scene EMS personnel Planning for patient distribution with EMS scene command and receiving hospitals Patient identification/location coordination 3.6. Receiving Hospitals Advise coordinating Resource Hospital of availabilities and capabilities Provide definitive patient medical care Assist the Resource Hospital with patient identification 4. Incident Phases 4.1. Initial Response Possible MCI occurs and is reported to County E911 Center E911 dispatches first responder(s) (EMS, Law and Fire) 4.2. Activation of the Plan 4.2.1. First EMS responder on the scene Establishes Incident Command Identifies hazards and ensures scene safety Determines number of patients Declares and MCI if appropriate Notifies E911 of the number of patients Begins triage 4.2.2. E911 notifies additional responding units of: Incident description including number of patients Incident location and/or staging area and best access routes Incident name and tactical frequency(s), if assigned Unusual circumstances/hazardous conditions 5

4.2.3. E911 Sends additional ambulances Notifies other ambulance providers and helicopters as needed Performs move-up coverage as needed 4.2.4. First In Ambulance at the scene (2 people) Assumes roles of EMS Operations and Triage Officer (unless already filled) Notifies Resource Hospital of MCI including location, description of incident, and number of patients Ensures that triage is underway Maintains communication with the Resource Hospital and updates them with the number of patients and triage category Receives report on hospital resource availability from Resource Hospital. In coordination with the Resource Hospital directs patient destination(s) Leaves the scene only after notifying the Incident Commander and Resource Hospital and all patients have been transported or the functions of EMS Operations and Triage Branch Director are transferred to another qualified party 4.2.5. Resource Hospital Assesses in-house capability and activates internal emergency plans, if appropriate Polls closest potential receiving hospitals and trauma centers both in and out of county, if necessary Advises EMS Operations at the incident scene of receiving facility patient capabilities In coordination with the EMS Operations, determine patient destination Contact receiving facilities with number and type of patients they are to receive and their estimated arrival time 4.2.6. Transporting Ambulances Report to Transportation Branch Director or Staging Director Crews stay with their ambulance and assist with loading unless otherwise directed Off load supplies that are not needed during patient transport for use in treatment areas if requested Transport patients to destination as specified by the Transportation Branch Director Provide patient care during transport Avoid contacting receiving hospital via radio unless significant patient change warrants it 6

4.3. Deactivation The Incident Commander terminates the MCI and notifies E911 The EMS Operations notifies base hospital that the incident is terminated Review of the Incident An After Action Review is a scheduled meeting called to evaluate the actions, accomplishments, and difficulties encountered by the MCI participants. It should be held for any MCI that involves multiple agencies The review is normally organized by the Incident Commander s agency, but it may also be conducted by the County EMS Coordinator The review should be held within 5 days of the incident If a Critical Incident Stress Debriefing is being conducted, it should occur before the review Findings of the review should be sent to all participants Individual department/company policies as well as the MCI Plan should be evaluated and amended as appropriate to reflect recommendations made subsequent to the MCI review Recommendations for changes to the MCI Plan should be sent to the Oswego County EMS Coordinator 5. Operational Concepts 5.1. Introduction The Operational Concepts section of this Plan covers incident authority, Incident Command System utilization, medical operations, and communications 5.2. Organization and Command MCIs shall be managed by using the National Incident Management System (NIMS) 5.3. Jurisdictional Authority Ultimately the incident authority will lie with the agency or jurisdiction that has response responsibility as established via the processes found in New York State Health Law Article 30. Until that agency is present and has assumed the role of incident command, it is the responsibility of those agencies on scene to take command and mitigate the incident. 7

5.4. Unified Command When the incident is multi-jurisdictional or when the scope of the functional areas of responsibility exceed that of a single agency, a unified command structure or a mutually agreed upon command structure may be used. The command structure must adequately reflect the policy and needs of all the participating agencies and shall be established in accordance with NIMS concepts. 5.5. Incident Commander The individual serving as the Incident Commander will generally be the highest ranking officer from EMS, Law Enforcement or Fire having jurisdictional authority. The type of incident should determine the choice of what agency will provide the incident commander. 5.6. Agency Liaison When the MCI Plan has been implemented to assist an industrial, commercial, educational or government facility or other large entity, a representative from that entity shall function as agency liaison at the Command Post. 5.7. Incident Expandability The degree and level of implementation of the ICS-MCI module will be determined by the Incident Commander based on the scope of the incident and the availability of staff. 5.8. Establish Command The first arriving unit of any agency having jurisdictional or functional authority shall establish the Incident Command by designating the Incident Commander (IC) until the role can be relinquished to a more qualified individual. 5.9. Medical Operations ALS and BLS providers have responsibility and authority for individual patient management under the authority of the New York State Health Law Article 30. 5.10 Medical Triage All MCI patients shall be initially evaluated using the START method of medical triage. (See Triage Protocols and Procedures) Primary triage needs to be completed as soon as possible so that a more reliable number of total patients and their status categories will be available. 8

5.10. Treatment Areas Once primary triage is completed, patients may be moved by Triage teams to safe, secure and easily accessible treatment areas for secondary triage, treatment and transport. Treatment areas will only be established if the number of patients ready for transport exceeds available transport resources. 5.11. Separate Treatment Areas The EMS Operations shall direct the establishment of separate treatment areas, if required. Separate the Minor Treatment Area from the Immediate and Delayed Treatment Areas and isolate the Morgue to a secure area. Colored tarps, flags or other identifiers should be used to clearly delineate treatment areas. 5.12 Treatment Area Supervisors Treatment Area Supervisors must be assigned by the EMS Operations as soon as treatment areas are established to ensure that secondary and ongoing triage is begun in a timely manner. When available, ALS first responder personnel should be assigned to these positions. All treatment rendered should be recorded on the triage tag. 5.12. Immediate Category Immediate patients (red tag) will be moved as quickly as possible with minimal stabilization to designated areas for secondary triage, further stabilization and preparation for transport. 5.13. Delayed Category Delayed patients (yellow tag) will be moved to the Delayed Treatment Area for secondary triage, treatment and preparation for transport. The move should take place after Immediates and Minors have been relocated. 5.14. Minor Category Minor patients (green tag) will be moved as quickly as possible to the Minor Treatment Area for secondary triage, treatment and relocation from the scene. Note: In some instances "minor" patients may remain to assist with moving seriously injured patients. 5.15. Deceased Category Deceased patients (black tag) will not be moved unless: The Morgue Supervisor so directs It is necessary to facilitate rescue work It is necessary to protect the health and safety of others All other casualties have received care 9

5.16. Medical Direction/Control Certified EMS personnel are to function under New York State and Central New York EMS standing orders. Paramedics responding from outside the region will function under protocols from their home regions. 5.17. Communications On-scene communication between disciplines is critical to the success of the management of a MCI. The Incident Commander or E911 will designate a command channel. The command channel will be used to facilitate communication between the IC and the various group Branch Directors. All ambulance and first responder agencies should have the following frequencies available to them for possible use as the command channel. EMS Dispatch EMS Ops 3 EMS Ops 4 EMS Ops 5 EMS Talk 6 (non-network) EMS Talk 7 (non-network) EMS Incident EMS EWide Unless otherwise specified by the IC, communication within groups should be on the frequencies normally utilized by them. 5.18. Communications Scene to Hospital The EMS Operations must maintain communications with the Resource Hospital. This communication may take place via radio or cell phone. 5.19. Quality Improvement All MCIs shall be reviewed by the responding EMS agencies and Oswego County CQI. 5.20. Medical Supplies Medical supplies will be managed by the EMS Operations or designee. Medical supplies may be augmented by the hospitals, using ambulances to transport supplies on their return to the incident. MCI trailers (Med Trailer North or Med Trailer West) should be requested immediately upon recognition of a major MCI due to the transportation time involved in getting them to the scene. 10

5.21. Reinforced Organizational Principles As additional resources arrive, additional components of the MCI Plan may be put in place. Priorities vary based on the situation unique to each incident. The following principles should be used as guidelines. Ensure that hazards are identified and mitigated. Complete initial "START" (primary) triage with BLS trained personnel. Utilize ALS trained personnel to staff the Treatment Unit, giving priority to Immediate patients. Recognize that ALS providers are critical resources and should primarily function as ALS providers, not Branch Directors. Prioritize extrication needs and sequences and assign Extrication Teams appropriately. Utilize personnel with Branch Directory experience to staff Branch Directory positions within the overall organization. Maintain a reasonable span of control and create Branch Directory positions as needed. When assignment is complete, check with your Branch Director for new assignment. Any responder that is without assignment shall report to the Staging area for assignment. 11

Checklists Checklist 0: Minor Incidents Checklist 1: Incident Command Checklist 2: EMS Operations Checklist 3: Triage Branch Director Checklist 4: Treatment Branch Director Checklist 4A: Red Treatment Supervisor Checklist 4B: Yellow Treatment Supervisor Checklist 4C: Green Treatment Supervisor Checklist 4D: Black Treatment Supervisor Checklist 5: Transportation Branch Director Checklist 5A: Staging Director Checklist 6: E911 Center Checklist 6A: 5-10 patients Checklist 6B: 11-20 patients Checklist 6C:21-50 patients Checklist 6D: 51-150 patients Checklist 7: Oswego Hospital Checklist 8: Law Enforcement Attachments Attachment 1: Organization Chart Attachment 2: Resource and Patient Tracking 13

Checklist 0: ALL Incidents ALL INCIDENTS START HERE 1. First arriving EMS unit (ambulance or rescue): a. Establish Incident Command (always, regardless of the number of patients or call priority) unless this position is already in place. b. Establish EMS Operations (always, regardless of the number of patients or call priority) unless this position is already in place. c. Assess scene and personnel safety and correct issues as much as possible. d. Provide a scene report to Dispatch including Mechanism of Injury, scene or personnel safety issues, number of known patients and request for resources and e. Declare an MCI if there are 5 or more patients requiring transport IF and MCI has been declared, then Obtain the Oswego County MCI Plan Determine how many EMS management personnel will be needed using Attachment 1 Provide the appropriate checklist for each EMS management position assigned If the incident is NOT and MCI, then Perform triage Request additional resources as needed Turn over to Incident Command when appropriate Implement Incident Command Checklist 1 unless that position is filled. Implement EMS Operations Checklist 2 2. Other arriving EMS: Respond to EMS Operations 14

Checklist 1: Incident Command Notes: 1. Radio ID: COMMAND 2. Do NOT begin triage or treatment until incident management is set up. Item Action Establish Incident Command Post (ICP) Inform 911 of the ICP location Establish a radio channel to manage the incident Request a Fireground channel if one has not yet been assigned Don Incident Command vest Rapidly assess the incident AND report approximate number of injured to 911 Declare an MCI if there are 5 or more patients requiring transport Assign personnel positions using Attachment 1 as a guide Assign the following first, as required by the situation: EMS Operations (assign this to the first arriving EMS person (EMT or higher)) Fire Branch Director (may be the Incident Commander) Operations Section Chief Staging Area Supervisor Rescue/Extrication Group Branch Director Inform EMS Operations of Safety issues Assigned radio channel(s) Requested resources Results of any scene assessments to date, including number of patients Consider need for Critical Incident Stress Management of personnel For large incidents or those with a lengthy operational period, consider: Development of an Operational Plan (ICS Form 202) Relief shifts (ICS Form 203) Use of an Activity Log (ICS 214) Announce termination/downgrade of incident as appropriate Check when done 15

Checklist 2: EMS Operations Notes: 1. Do NOT begin triage or treatment until incident management is set up. 2. Radio ID: EMS Operations Item Establish or report to Command Post Action Don EMS Operations or EMS Command vest Check when done CAUTION Prior to dispatching ANY EMS staff to the field, VERIFY: Each person knows their assignment If applicable each person has their checklist(s) from this procedure Each person knows the means by which they will talk to their Branch Director (verbal, radio, phone) Declare an MCI if there are 5 or more patients requiring transport Assign ICS positions as EMS personnel arrive on the scene, by completing Attachment 1 or ICS 207 Note: All positions in Attachment 1 have to have name assigned, even if it the same person. Assign the following first, if the situation requires: Triage Branch Director Treatment Branch Director Transport Branch Director Continued 16

Checklist 2: EMS Operations (continued) Item Action Establish communication with (options: face-to-face, EMS 4 or 5, EMS Talk 6 or 7 or EWide) Incident Commander (should be face-to-face, or use assigned Fire Ground or Talk channel) Incoming ambulances (use EWide) EMS Directors (use EMS 4 or (if that does not work) Talk 6) IF the incident is small enough that only a Triage Branch Director will be assigned then direct the Triage Branch Director to conduct initial triage AND report approximate number of injured to EMS Operations Establish location of Triage, Treatment and Transport areas Inform EMS personnel of the locations of the above areas Verify with 911 What resources are coming to the scene What additional resources are required (consider: ambulances, buses, helicopters, MCI trailers, EMS Coordination, physicians) Check when done Establish contact with Resource Hospital using phone (315-435-1600), Med 10 or MMRS A or B Track resources using Attachment 2 Resource and Patient Tracking or ICS-218 Continuously obtain updates from all Branch Directors Continuously keep the IC informed of changes to scene safety, scene size, numbers of patients and requested Resource Hospitals Continuously reevaluate resources available and required Consider need to rehabilitate EMS personnel Consider the need for Critical Incident Stress Management personnel For extended incidents consider transfer of command and relief for all EMS personnel Develop and utilize a demobilization plan using ICS-221 Announce termination/downgrade of incident as appropriate 17

Checklist 3: Triage Branch Director Notes: 1. Do NOT begin triage or treatment until incident management is set up. 2. Radio ID: Triage Branch Director Item Action Report to Command Post / EMS Operations Request needed support personnel/equipment/supplies from EMS Operations Establish Triage Sector based on scene safety and accessibility to resources Don Triage Officer vest Establish communication with (options: face-to-face, EMS 4 or 5, EMS Talk 6 or 7 or EWide) EMS Operations (use EMS 4 or (if that does not work) Talk 6) Treatment, Transport or Staging Directors (use EMS 4 or (if that does not work) Talk 6) Perform initial Triage of patients Inform EMS Operations of number and type (by color) of patients Request that the EMS Operations appoint Triage support personnel to assist as needed, based on the size and nature of the incident Continuously re-perform triage of patients in or arriving to the treatment area Advise EMS Operations or Treatment Branch Director (if assigned) of number and type (color) of patients Transfer patients by priority to appropriate treatment area (Red, Yellow, Green or Black) Release EMS personnel to Staging Director as they become available. Advise EMS Operations when initial triaging operations are complete. Check when done 18

Checklist 4: Treatment Branch Director Notes: 1. Radio ID: TREATMENT Item Action Report to Command Post / EMS Operations Request equipment and personnel from EMS Operations Establish Primary Treatment Area (s) Don Treatment Officer vest Establish communication with (options: face-to-face, EMS 4 or 5, EMS Talk 6 or 7 or EWide) EMS Operations (use EMS 4 or (if that does not work) Talk 6) Triage, Transport or Staging Directors (use EMS 4 or (if that does not work) Talk 6) Treatment Supervisors (use EMS 5 or (if that does not work) Talk 7) Assign personnel to Treatment Areas: Red Priority 1 - Immediate Yellow Priority 2 - Delayed Green Priority 3 - Minor Black - Dead When informed of the number and acuity of patients from Treatment Supervisors, inform the Transport Director Request additional help from the EMS Operations and/or utilize green patients to assist Consider the sheltering needs of patients and responders during inclement weather. Direct patients to appropriate treatment area Continuously advise Transportation Branch Director when patients are prepared for transport Advise EMS Operations when treatment operations are complete Relieve/reduce staff as necessary Check when done 19

Checklist 4A: Red Treatment Supervisor Notes: 1. Radio ID: RED TREATMENT Item Identify Treatment Area Lay out red tarp Identify needed equipment/supplies Action Establish communication with Treatment Director (options: face-to-face, EMS 4 or 5, EMS Talk 6 or 7 or EWide) Treatment Director (use EMS 5 or (if that does not work) Talk 7) Communicate with Treatment Director and provide an approximate number of patients to expect Identify available transportation Direct patients to appropriate Treatment Area Re-evaluate patients, and re-direct to appropriate Treatment Area, if needed Complete Treatment Log as patients pass through Treatment Area Advise Transportation Branch Director when patients are prepared for transport Continuously re-evaluate resources on hand, required, available. Request additional supplies/personnel, as needed. Advise Treatment Branch Director when treatment operations are complete. Check when done 20

Checklist 4B: Yellow Treatment Supervisor Notes: 1. Radio ID: YELLOW TREATMENT Item Identify Treatment Area Lay out yellow tarp Identify needed equipment/supplies Action Establish communication with Treatment Director (options: face-to-face, EMS 4 or 5, EMS Talk 6 or 7 or EWide) Treatment Director (use EMS 5 or (if that does not work) Talk 7) Communicate with Treatment Director and provide an approximate number of patients to expect Identify available transportation Direct patients to appropriate Treatment Area Re-evaluate patients, and re-direct to appropriate Treatment Area, if needed Complete Treatment Log as patients pass through Treatment Area Advise Transportation Branch Director when patients are prepared for transport Continuously re-evaluate resources on hand, required, available. Request additional supplies/personnel, as needed. Advise Treatment Branch Director when treatment operations are complete. Check when done 21

Checklist 4C: Green Treatment Supervisor Notes: 1. Radio ID: GREEN TREATMENT Item Identify Treatment Area Lay out green tarp Identify needed equipment/supplies Action Establish communication with Treatment Director (options: face-to-face, EMS 4 or 5, EMS Talk 6 or 7 or EWide) Treatment Director (use EMS 5 or (if that does not work) Talk 7) Communicate with Treatment Director and provide an approximate number of patients to expect Identify available transportation Direct patients to appropriate Treatment Area Re-evaluate patients, and re-direct to appropriate Treatment Area, if needed Complete Treatment Log as patients pass through Treatment Area Advise Transportation Branch Director when patients are prepared for transport Continuously re-evaluate resources on hand, required, available. Request additional supplies/personnel, as needed. Advise Treatment Branch Director when treatment operations are complete. Check when done 22

Checklist 4D: Black Treatment Supervisor Notes: 2. Radio ID: BLACK TREATMENT Item Action Identify Treatment Area (keep separate from other treatment areas) Lay out black tarp Identify needed equipment/supplies Establish communication with Treatment Director (options: face-to-face, EMS 4 or 5, EMS Talk 6 or 7 or EWide) Treatment Director (use EMS 5 or (if that does not work) Talk 7) Communicate with Treatment Director and provide an approximate number of dead to be housed or transported Direct patients to appropriate Treatment Area Provide palliative care to patients as appropriate Work with Law and Health officials to establish Morgue Request additional supplies/personnel, as needed. Advise Treatment Branch Director when treatment operations are complete. Check when done 23

Checklist 5: Transportation Branch Director Notes: 1. Radio ID: TRANSPORTATION Item Report to Command Post / EMS Command Establish Transportation Sector Don Transportation Officer vest Action Establish communication with (options: face-to-face, EMS 4 or 5, EMS Talk 6 or 7 or EWide) EMS Operations (use EMS 4 or (if that does not work) Talk 6) Triage, Treatment or Staging Directors (use EMS 4 or (if that does not work) Talk 6) Receive patient number and acuity reports from Treatment Director Request appropriate ambulances/transport vehicles and personnel from Staging Director as needed based on the above information If necessary, coordinate with Incident Commander regarding the appropriate location for a Helispot AND advise EMS Operations of location Determine current capacity of each hospital from EMS Operations Consider specialty services or limitations of each hospital Maintain contact with Resource Hospital, and advise them of patient count Report patient information to Resource Hospital Coordinate routing of patients to proper ambulances Complete Attachment 2 Resource and Patient Tracking as patients are loaded and transported Advise EMS Operations and Resource Hospital when transportation operations are complete Relive/reduce staffing as needed Check when done 24

Checklist 5A: Staging Director Notes: 1. Radio ID: STAGING Item Report to EMS Command Establish Staging Area Don Staging Officer vest Action Establish communication with (options: face-to-face, EMS 4 or 5, EMS Talk 6 or 7 or EWide) EMS Operations (use EMS 4 or (if that does not work) Talk 6) Triage, Transport or Staging Directors (use EMS 4 or (if that does not work) Talk 6) Incoming ambulances (use EWide) Request EMS Operations to request the following as needed: Ambulances Buses Helicopters EMT s Act as the point of contact for incoming ambulances on EWide and direct them to the staging area Communicate with Transportation Branch Director to determine the location of ambulance loading zone, and the best route to the zone Appoint Staging support personnel to assist as needed Send proper number and types of units (with appropriate manpower) to ambulance loading zone when requested by the Transportation Officer Monitor number of EMS units in Staging Area, as number of units decreases, advise EMS Command of possible need to request additional units Consider needs of personnel at long-term incidents AND inform EMS Operations of such (food, shelter, sanitary needs, clothing) Document all available and requested Resource Hospitals Advise EMS Operations when initial Staging operations are complete Relieve / reduce staff as needed Check when done 25

Checklist 6A: E911 Center MCI: 5-10 patients Notes: 1. The E911 Center will receive an assessment of the situation from the first unit arriving on the scene. 2. The E911 Center will receive a patient count from the Incident Commander after the initial triage. 3. Implement this checklist ONLY IF and MCI has been declared by EMS Operations or Incident Command. Item Action Dispatch a total of FIVE ALS ambulances to the scene along with appropriate fire and law enforcement resources. Notify the County EMS Coordinator of the incident Notify University Hospital of the incident. Communicate with the Incident Commander and request if the MCI trailer is required Contact the Clearinghouse and request ONE helicopter to the scene AND dispatch mutual aid engine company to helispot. Put nearest fire departments on standby per request of the Incident Commander. Ask the Incident Commander if a bus is needed for patient transport. Ask the Incident Commander if the Chem Pak is needed Notify the Battalion Deputy Coordinator, Fire Coordinator, and law enforcement. Notify the Oswego County Emergency Management Office Director of the incident. Check when done 26

Checklist 6B E911 Center MCI: 11-20 patients Note: 1. If 11 or more patients have been reported, then implement this checklist. Item Action Dispatch a total of TEN ALS ambulances and THREE BLS ambulances to the scene along with appropriate fire and law enforcement Resource Hospitals. Page the ambulance All Call and request all available personnel to man their station Notify Resource Hospital of the incident Notify the County EMS Coordinator of the incident Communicate with the Incident Commander and dispatch the closest MCI trailer. Contact the Clearinghouse and request TWO helicopters to the scene AND dispatch mutual aid engine company to helispot(s). Ask the Incident Commander if a bus is needed for patient transport. Ask the Incident Commander if the Chem Pak is needed Notify the Battalion Deputy Coordinator, Fire Coordinator, and law enforcement. Notify adjacent Fire Departments to stand by their station for possible move to the scene Notify the Oswego County Emergency Management Office Director of the incident. Consider notification (only) of neighboring counties of the incident. Check when done 27

Checklist 6: E911 Center MCI: 21-50 patients Note: 1. If 21 or more patients have been reported, then implement this checklist. Item Action Dispatch a total of FIFTEEN ALS ambulances and FIVE BLS ambulances to the scene along with appropriate fire and law enforcement Resource Hospitals. Page the ambulance All Call and request all available personnel to man their station Notify Resource Hospital of the incident. Communicate with the Incident Commander and dispatch the closest MCI trailer. Contact the Clearinghouse and request FOUR helicopters to the scene AND dispatch mutual aid engine company to helispot(s). Secure ONE large bus and dispatch to the scene. Ask the Incident Commander if the Chem Pak is needed Notify the Battalion Deputy Coordinator, Fire Coordinator, and law enforcement. Notify adjacent Fire Departments to stand by their station for possible move to the scene Notify the Oswego County Emergency Management Office Director of the incident. Request resources from neighboring counties as required Check when done 28

Checklist 6D: E911 Center MCI: 51-150 patients Note: 1. If 51 or more patients have been reported, then implement this checklist. Item Action Dispatch a total of TWENTY ALS ambulances and TWENTY BLS ambulances to the scene along with appropriate fire and law enforcement resources. Notify Resource Hospital of the incident. Communicate with the Incident Commander and dispatch BOTH MCI trailers. Contact the Clearinghouse and request SIX helicopters to the scene AND dispatch mutual aid engine company to helispot(s). Secure one large bus per 50 patients and dispatch to the scene Ask the Incident Commander if the Chem Pak is needed Notify the Battalion Deputy Coordinator, Fire Coordinator, and law enforcement. Notify ALL Fire Departments to stand by their station for possible move to the scene Notify the Oswego County Emergency Management Office Director of the incident. Alert potentially affected neighboring counties of the incident. Check when done 29

Checklist 7: Oswego Hospital Notes: 1. When a MCI occurs, the E911 Center will notify the Emergency Department. The on-duty charge nurse will immediately notify the hospital administration. Item Action Decide whether to activate the internal disaster plan and the disaster call system. Notify central supply and environmental services for additional supplies. Assess current patients and determine whether they can be discharged or moved to another unit. Assign someone to monitor the EMS radio and communicate with the EMS Transportation Officer. Use the MCI Log Sheet to record information regarding patients received from the scene. Provide updates to the Transportation Officer every 30 minutes as to the hospital s capability to continue to receive patients. After all patients have been treated and stabilized, the MCI operations have been officially terminated. Gather charts from all patients and compare to the MCI Log Sheet to verify that information is accurate and complete. Check when done 30

Checklist 8: Law Enforcement Notes: None Item Coordinate police operations Action Assist Incident Commander at Command Post Assign member of the force to tactical police activities Scene Security and Perimeter Control Check when done Set up and mark incident perimeter lines Supervise security of perimeter Establish appropriate traffic control (road blocks, street closings) Investigations Investigate incident May be patrol division or CID Public Information Officer Gather information Release information approved by Incident Commander Minimize negative impact of the incident Traffic routing information Evacuation and evacuation routes Family reception stations 31

Attachment 1: Organization Chart for EMS Note: This Organization Chart only depicts the EMS management structure. The IC may utilize ICS Form 207 to depict the entire organization for the incident. Incident Commander Operations Chief EMS Operations Staging Director Treatment Director Transport Director Triage Director Green Treatment Supervisor Red Treatment Supervisor Black Treatment Supervisor Yellow Treatment Supervisor 32

Attachment 2: Resource and Patient Tracking Resource McFee 1 Time requested Time at Scene Patient name or Tag #/DOB or Age Destination McFee 2 McFee 3 McFee 4 Menter 1 Menter 2 Menter 3 Menter 4 Menter 5 Menter 6 Menter 7 Menter 8 Menter 9 Menter 10 Menter 11 Menter 12 North Shore 1 North Shore 2 NOCA 1 NOCA 2 NOCA 3 NOCA 4 Oswego 1 Oswego 2 33

Resource Oswego 3 Time requested Time at Scene Patient name or Tag #/DOB or Age Destination Oswego 4 Oswego 5 Oswego 6 SOVAC 1 SOVAC 2 SOVAC 3 SOVAC 4 SAVAC 1 34