Chapter 44 Multiple-Casualty Incidents and Incident Management Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Copyright 2010 by Pearson Education, Inc. All rights reserved. Objectives 1. Define key terms introduced in this chapter (slides 12-13). 2. List situations that might result in multiple trauma casualties and situations that might result in multiple medical casualties (slides 12-13). 3. List aspects important to effective management of an MCI (slide 14). 4. Explain the purposes for establishment of the National Incident Management System (NIMS) (slides 15-16). 5. Describe the purposes and desirable features of the incident command system (ICS) (slides 17-18). Objectives 6. Identify responsibilities that may be assigned to EMS (units that might be established) at a multiple-casualty incident (slides 19-20). 7. Describe the principles of a triage system (slide 21). 8. Describe and contrast primary triage with secondary triage (slides 22-23). 9. Given a scenario with multiple patients, categorize patients according to a color-coded triage system (slide 24). 10. Explain the principles and assessment categories used in START triage (slides 25-26). 1
Objectives 11. Explain why JumpSTART was developed for triage of pediatric patients, contrast JumpSTART with START, and explain how to identify a child for triage purposes at the scene of an MCI (slides 27-29). 12. Explain the important principles of a patient tagging system to be used during triage (slides 30-31). 13. Explain the interrelationship of triage and treatment within the treatment unit at an MCI (slides 32-33). 14. Discuss the logistics of staging and transport at an MCI (slides 34-37). 15. Discuss common issues with communications in MCI and disaster situations (slides 38-39). Objectives 16. List measures that can be taken to reduce rescuer stress during and after an MCI response (slides 42-43). 17. Describe requirements of effective disaster assistance (slides 44-51). 18. Anticipate psychological reactions of disaster victims and describe ways in which EMS providers can assist disaster survivors (slides 52-54). Multimedia Directory Slide 44 Children During Disasters Video 2
Topics Multiple-Casualty Incidents National Incident Management System Triage Disaster Management CASE STUDY Dispatch EMS Unit 105 Respond to the Firebird Raceway, We have reports that two race cars have crashed through a fence into a bleacher full of people. Initial reports indicate as many as ten dead and 40 critical injuries. Time out 1612 3
Upon Arrival Two demolished vehicles on a collapsed bleacher People screaming; bystanders helping the injured You estimate at least 50 injuries Since you re the senior EMT, according to your MCI plan, you re the incident manager for EMS operations How would you proceed with the assessment of these patients? Multiple-Casualty Incidents Back to Topics 4
Multiple-Casualty Incident (MCI) Event that places excessive demands on personnel and equipment ( Rob Crandall/The Image Works) Multiple-Casualty Incident Get help early Too many rescuers is better than too few ( Rob Crandall/The Image Works) National Incident Management System Back to Topics 5
National Incident Management System (NIMS) Standardized approach Provides both flexibility and standardization Agencies required to be NIMS-compliant since 2006 ( AP Photo/Dennis Paquin) Incident Command System ICS ensures: Safety of responders and others Achievement of tactical objectives Efficient use of resources 6
Triage Back to Topics 7
Primary and Secondary Triage Primary triage is performed upon arrival of first EMS unit Secondary triage reevaluates initial triage determination 8
START Triage System JumpSTART Pediatric Triage System 9
( Lou Romig, MD, FAAP, FACEP, 2002) ( Lou Romig, MD, FAAP, FACEP, 2002) Patient Tagging 10
Treatment Treat only salvageable patients Focus on lifethreatening injuries Move to treatment in order of priority 11
Staging and Transport ( Benjamin Benschneider /THE SEATTLE TIMES) A staging unit leader monitors, inventories, and directs available ambulances to the treatment unit at request of transport unit leader. Transport Unit Patient distribution to medical facilities Hospital surge capacity Specialty medical facilities Constant coordination and communication ( Benjamin Benschneider /THE SEATTLE TIMES) 12
Effective Transport Transport high-priority first Use preferred route Transport unit leader should perform report Consider mass transit vehicle for ambulatory patients ( Benjamin Benschneider /THE SEATTLE TIMES) Communications Communications One of the most difficult aspects of incident management Confusion diminishes with ICS establishment Radio communications may be difficult due to gridlock and dead spots Don t become distracted from patient care 13
Follow-Through Follow-Through Following removal of all patients from the scene, assist hospital personnel Seek direction from facility incident manager If your services are not needed, prepare your vehicle for service Reducing Posttraumatic and Cumulative Stress 14
( Tim Fadek/Gamma) Rest regularly Monitor workers for stress Assign tasks appropriate to skills and experience Provide food and beverage Encourage talking to relieve stress Make professional counselors available Children During Disasters Click here to view a video with information about children during disasters. Return to Directory Disaster Management Back to Topics 15
Requirements of Effective Disaster Assistance Communication Quick implementation Adaptability Preplanning Triage Community preparation ( AP Photo/Vincent LaForet/POOL) Warning and Evacuation 16
Evacuation Message Nature of emergency and time of impact Safe route out of area Appropriate destinations where assistance is available Use as many media as possible to send message Disaster Communications System Disaster Communication Establish details of system ahead of time Appoint one person to communicate with those outside of disaster area Maintain area-wide communications Establish central registration station Make travel information available Monitor all health care resources Transport officer at scene should handle hospital report Record communications for later review 17
The Psychological Impact of Disasters Helping Disaster Patients Age Considerations Preschoolers tend to cry, lose control of bodily functions, and suck their thumbs Elementary-age children suffer extreme fears about their safety and show confusion, depression, withdrawal, and the tendency to fight with their peers Preadolescents and adolescents may show the same reaction as elementary-age children, coupled with extreme aggression and stress that is severe enough to disrupt their lives Other Considerations The families of patients need and deserve accurate information Reunite families as soon as possible Group people with families and neighbors Encourage people to do necessary chores Provide structure for emotionally injured Help patients confront reality Do not give false assurances Identify high-risk patients Provide care for rescuers as well 18
CASE STUDY Follow-Up CASE STUDY Scene Size-Up Raceway officials extinguish fires Multiple burn patients Bystanders directed off the bleachers Assume incident command Request 20 ambulances CASE STUDY Scene Size-Up Request ten rescue units with extrication ability Establish extrication, treatment, transport, staging, supply, and triage units 19
CASE STUDY Triage START Triage Ten people walk away when called with bullhorn Classify remaining patients as red or yellow Move red patients to treatment unit first CASE STUDY Supply and Extrication Units Determine amount of medical materials needed Obtain necessary extrication equipment Distribute supplies, equipment, and personnel to area of greatest need CASE STUDY Triage and Treatment Units 40 patients total 10 deaths = 30 patients in the treatment unit Classify five patients as red and treat first Classify remaining 25 yellow Move yellow patients to priority two treatment area 20
CASE STUDY Staging and Transport Request three ambulances for red patients Transport unit contacts hospital Request 13 ambulances for yellow patients CASE STUDY Staging and Transport Request five ambulances for green patients Remaining EMTs assist with clean-up All crews take periodic breaks for rest and nourishment Critical Thinking Scenario Dispatched to a residential neighborhood for a report of a natural gas explosion You re the first EMS unit to arrive on scene You report to the incident commander The IC believes approximately 30 patients have been identified so far He designates you as the EMS branch director 21
Critical Thinking Questions 1. What responsibilities would you have as the EMS branch director? 2. What units would you establish? 3. How should triage be conducted? 4. What patients would be moved into the treatment unit first and moved out of the treatment unit first? 5. How would you manage all of the responding EMS units? Reinforce and Review Please visit www.bradybooks.com and follow the mybradykit links to access content for the text. 22