Town of Brookfield, Connecticut Mass Casualty Incident Plan

Town of Brookfield, Connecticut Mass Casualty Incident Plan 1.0 Definition Of Mass Casualty Incident: A Mass Casualty Incident is an incident having multiple patients that would exceed the amount Brookfield Volunteer Fire Company would be able to transport and/or care for with the number of personnel and ambulances on scene. An example is 7 multi-trauma patients. This number would exceed the number we would be able to transport. 1.1 Early Alert: Any dispatcher, upon learning of the potential for a Mass Casualty event, shall provide an early notice to all responding units. They shall also alert Danbury Hospital for the potential of multiple patients. It is anticipated that the declaration of a Potential Mass Casualty event would occur once the initial arriving Brookfield Volunteer Fire Company personnel (EMT/Firefighter) provide an initial scene size up and assessment. Once an official declaration is made, the dispatcher will then notify all emergency services and agencies listed in the Dispatch Duties. 1.2 Dispatch Center: The Town of Brookfield Police Department is responsible for 911 service and emergency dispatches for the Town of Brookfield. Their local phone number is 203-775-2575. 1.3 Determination of Incident Commander and Scene Size Up: The first arriving Brookfield Volunteer Fire Company personnel shall determine and report the following: A. Extent (number of casualties) B. Nature (mechanisms of injury) C. Severity (number of non-ambulatory patients) D. Spread (geographic area covered) 2.0 Declaration: The first responding Brookfield Volunteer Fire Company personnel may declare a Potential Mass Casualty. The official confirmation will come from Fire or EMS Command or the Paramedic on scene. They shall notify Brookfield Dispatch to Execute the Brookfield Mass

Casualty Plan. Once declared, the dispatcher will follow procedures as defined under Dispatch Duties. 2.1 Mutual Aid Dispatch, Preplans and Protocols: The Dispatch section of this document contains work sheets for the completion of local dispatch from the scene. These are provided as separate documents to allow the completed protocols to be filed at dispatcher consoles for direct consultation. 3.0 Equipment And Supplies: The following BLS (Basic Life Support) equipment items should be stockpiled by each ambulance service and unloaded at the Treatment Area upon arrival at the scene: Backboards, Cravats, Portable Oxygen (non-rebreathers and nasal cannulas), Dressings and bandages (in cases). Specialized rescue equipment will be called for by the Senior Fire Official/Incident commander in charge of the scene, and will be dispatched according to the pre-plan on file in the dispatch center and attached as an appendix to the document. ON SITE ORGANIZATION AND OPERATIONS 4.0 Command Structure: In a declared Mass Casualty situation, the following structure of command organization will apply: A. Incident Commander B. Fire Command Officer C. Police Command Officer D. EMS Scene Control Officer E. Primary Triage Officer F. Secondary Triage Officer G. Treatment Officer H. Communications Officer I. Loading Officer

4.1 Command Post: A Command Post will be established for coordination of all resources on the scene to include the following personnel: A. Fire Command Officer B. Police Command Officer C. EMS Scene Control Officer 4.2 Structure: Tower 100, Candlewood Utility 23, Car 101 or the Police Mobile Command Vehicle will serve as the Command Post due to their high visibility and versatile communications facilities. 4.3 Scene Access and Security: Brookfield Police and Brookfield Volunteer Fire Company s Fire Police will establish a secure perimeter to control access to the scene. When appropriate, Boundary Posts will be manned by Police Vehicles, Red Grass, Civil Defense, Utility 6 or Fire Police with portable radios in private vehicles located on all roads leading to the Mass Casualty Incident. Posts will be named Boundary 1, Boundary 2, ect. Communication will be established between the Command Post and police units via police vehicle or police portable radios, and police units at the Boundary Posts. Fire Police will operate on Firehouse Radios in order to verify the need for and to direct all incoming personnel and equipment. Private vehicles will not be permitted on the scene. All incoming vehicles will be directed as follows: A. Fire apparatus to Fire Command Officer B. Rescue Squads to Fire Command Officer C. Ambulances to Loading Officer once established or the EMS Scene Control Officer early in the operation. All incoming personnel will be directed as follows: A. Firefighters to Fire Command Officer B. EMS Personnel to EMS Scene Control Officer C. Police to Police Command Officer 4.4 Treatment Area: This area is the responsibility of the Treatment Officer

4.5 Equipment: When indicated, incoming ambulances will be asked to unload the following medical supplies at a stockpile adjacent to the Category 1 (RED) treatment area: A. Backboards B. Cravats C. Portable Oxygen and Oxygen supplies D. Dressings and Bandages E. Portable Suction F. Splints G. Airways H. Trauma kits and Supplies 4.6 Triage and Staging: After unloading medical supplies, ambulances will be requested to report to a loading area adjacent to the Category 1 (RED) treatment area and wait for assignment by the Treatment Officer or the Loading Officer. 4.7 Patient Categories: Category 0 (BLACK) Patients: Clinical Death hold for mortuary or transportation after all other category patients have been transported. CPR is not indicated in a declared Mass Casualty Incident. Category 1 (RED) Patients: Require rapid transport by ambulance to a hospital for definitive care or higher levels of medical treatment than available on scene. These are patients with immediate life threatening injuries. They will be carried on long boards to the treatment area for immediate care and stabilization (assigned by the Treatment Officer) and transportation. Category 2 (YELLOW) Patients: Delayed transport to the hospital would not place the patient in jeopardy but transportation by ambulance is indicated. Category 3 (GREEN) Patients: Ambulatory patients not requiring ambulance transport (walking wounded) will be escorted to an area for evaluation. This area will be staffed primarily by non-medical personnel but supervised by at least one EMT. An E.R.

physician or EMS personnel should evaluate everyone involved in the incident, including Category 3 (GREEN) patients. Regional protocols should indicate one of the following: Category 3 (GREEN) patients are those who remain in the field with minor injuries or who may require some minor emotional support. Category 3 (GREEN) patients that require transportation to the hospital that do not require life support (Ambulance) can be transported by other means (ex: Bus). They are transported after all bandaging and stabilization of injuries. An EMT must be on the bus and an ambulance must escort the bus. There will be a portable radio with Fire Repeater Frequency (159.0900) on the bus. 4.8 Transportation: Transportation is the responsibility of the Loading Officer. The E.R. Physician at Danbury Hospital will be the final authority in designating the hospital to which a patient will be transported. The hospital designation will normally be done after consultation with the Treatment Officer. If physician guidance is not available, the Treatment Officer will exercise their authority to distribute patients between Danbury, New Milford and Waterbury hospitals. All trauma patients should go to Danbury Hospital, taking into consideration the distance and stability of the patients. Ambulances will return to the Loading Officer for further instruction. Patients requiring inter-hospital transfer will be transported by an ambulance dispatched from the area of the sending hospital. 4.9 Termination: The EMS Scene Control Officer will assist the Incident Commander to decide when no additional resources are necessary and when the last patient has been transported, including all Category 3 (GREEN) patients. The Incident Commander will terminate the Mass Casualty operation. The EMS Scene Control Officer will decide which units are to remain at the scene during recovery operations when the Incident Commander has requested this. 5.0 Functions of the Incident Command Structure: The following pages contain the duties and job descriptions of the Incident Command Structure. Each of the officers should be trained and thoroughly familiarized not only with their specific duties, but also with duties of the other officers so that there will be smooth interaction throughout the chain of command.

Dispatch 5.1 Dispatch Assignment: This activity is assigned to the Brookfield Police Department Dispatcher. Function: Receive initial information of a possible Mass Casualty Incident, dispatch the appropriate resources to size up and initiate on scene activity and to act on authorized orders to dispatch additional resources required. Reports to: Chiefs of all services who have authorized their units and resources to be dispatched. Supervises: Dispatch Personnel. Operational Comments: Following written protocols, the dispatcher on duty will provide initial responses, and if indicated, additional resources, before a formal declaration of a Mass Casualty Incident is made at the scene. Tasks: 1. Receive initial information on the nature and extent of the situation. 2. Initial dispatching of the responding units. 3. When indicated, notify other public safety dispatchers to coordinate fire, police and area ambulances. 4. When initial information is received from the scene, following the written protocols, request additional resources accordingly. 5. When acting on authorized command from the scene, coordinate the dispatch of the required ambulances and other medical response units to the scene. 6. Following written protocols, provide early notification to area hospitals Radio call sign: Brookfield Dispatch

Incident Commander 5.2 Assignment: This activity is assigned to the Brookfield Volunteer Fire Company s highest ranking fire officer or senior firefighter. Function: Size up and formally declare a Mass Casualty Incident when indicated, serving then as the primary authority to make control decisions affecting coordination of the various agencies and services responding. Reports to: The First Selectman of Brookfield Supervises: A designated officer in each of the following public safety services: Fire, police and ems; and also all other agency and support groups responding to the situation including, but not limited to, civil preparedness, Red Cross, military support groups, CERT, ect. Operational Comments: 1. This person must avoid an extended span of authority limiting the number of personnel reporting and requiring guidance. 2. A command post may be set up to serve any of the following needs: A. To house the Police Command Officer, Fire Command Officer, EMS Scene Control Officer and civil preparedness. To provide direct face-to-face communications and decision making. B. To coordinate inter-agency tactical on-scene decisions. C. To communicate inter-agency strategic communications (scene to dispatch and other centers away from the scene). D. To serve as a focus for the news media to receive up-to-date information. E. A shelter for personnel who need a place to rest or location to store equipment, especially medications and valuable supplies.

Incident Commander (Continued) Tasks: 1. Designates the individuals to report to him, defining their Scope of Responsibilities and authority. 2. Communicates appropriate information and requests for decisions between officials involved 3. Designates emergency equipment staging areas. 4. Designated loading area adjacent to the patient treatment area. 5. Establishes outlying communication points. Radio Call Sign: Command

EMS Scene Control Officer 5.3 Assignment: This duty is assigned to the Brookfield Volunteer Fire Company s highest ranking EMS Officer or Senior EMS Personnel. Function: Directs all medical operations. Reports to: Incident Commander Supervises: 1. Primary Triage Officer 2. Secondary Triage Officer 3. Treatment Officer 4. Communications Officer 5. Loading Officer Operational Comments: This role should be assumed immediately by the Paramedic arriving on scene. This person may be relieved by an EMS Officer, Senior EMS Member or Paramedic Supervisor with concurrence of, or by order of, The Incident Commander. Tasks: 1. Obtain authority from the Incident Commander to enter the scene and establish medical opertations. 2. Communicate an estimate of casualty to Brookfield Dispatch, Incident Command and Danbury Hospital. 3. Designates a Primary triage Officer, Secondary Triage Officer, Treatment Officer, Communications Officer and Loading Officer. 4. Direct incoming EMT s to assist in triage and treatment. 5. Identify problem areas and reassign resources. Radio Call Sign Control

Primary Triage Officer 5.4 Assignment: This duty is assigned to the Brookfield Volunteer Fire Company s EMS Personnel. Function: Views all patients to identify and immediately correct the following life threatening problems: 1. Bleeding 2. Airway 3. Circulation Reports to: EMS Scene Control Officer. Supervises: Personnel assigned to treat immediate life-threatening problems. Operational Comments: Under ideal conditions, this function should be performed by the first arriving AEMT or Paramedic and then be reassigned as more EMS personnel arrive. If a fire or other hazard exists, the Incident Commander will decide on alternatives: 1. Evacuate all patients prior to any triage or care. 2. Control hazard first, followed by triage and care. Tasks: 1. Circulate among all patients. 2. Identify the life threatening problems defined above following the Smart Triage Tag System. 3. Direct others to conduct patient care. 4. After treatment of the immediate life-threatening problems mentioned above, remain in the casualty area and direct patient care of the remaining injured. 5. Assign personnel with EMT level training to bandage and immobilze patients on long boards for transfer to appropriate treatment areas. If needed, non-emt personnel may assist in moving patients as long as they are under the direct supervision of an EMT.

Secondary Triage Officer 5.5 Assignment: This duty is assigned to the Brookfield Volunteer Fire Company s AEMT, EMT or EMR. Function: Determine the order of patient evacuation from the scene to the treatment area. Reports to: EMS Scene Control Officer. Supervises: Other team members assigned with tagging. Operational Comments: Unlike the roles of EMS Scene Control Officer and Primary Triage Officer, this function should not be performed immediately. During the first minutes of the incident, when resources are limited, the focus must be on establishing a command structure and primary triage. It is likely that secondary triage will not occur until 30 minutes into operations. Tasks: 1. View all patients. 2. Classify all patients according to their need for treatment. 3. Tag all patients with Smart Triage Tags as follows: Category Color Indication 0 Black clinical death 1 Red rapid transport 2 Yellow delayed transport 3 Green non-transport or last to be transported 4. After all patients are tagged, remain in the area and assist Primary Triage Officer in directing the treatment removal of patients to the assigned treatment areas.

Treatment Officer 5.6 Assignment: This duty is assigned to the Brookfield Volunteer Fire Company s Paramedic, AEMT, EMT or ERM Function: Establish and supervise the treatment area including the assignment of personnel for patient care. Reports to: EMS Scene Control Officer. Supervises: All personnel moving and treating patients in the treatment area. Operational Comments: This person should be the Paramedic, or the highest level of EMS training and must match the limited treatment resources to patients on a priority basis, and must make appropriate assignment of Paramedic and medical personnel. Tasks: 1. Assume command and control over all personnel within the treatment area; supervise all patient care; and provide for required security arrangements. 2. Identify and mark patient treatment and staging area. 3. Assign personnel with advanced medical training to provide care in the treatment area. 4. Receive and review the condition of all patients as they arrive in the treatment area. 5. Mark Smart Triage Tags of each Category 1 (RED) patient as follows: A more critical B less critical 6. Position A and B patients in separate lines, thus dividing the Category 1 (RED) patients into two distinct priorities for treatment. 7. Maintain communication with the Loading Officer for medical transportation of patients and give periodic reports to the EMS Scene Control Officer. Radio Call Sign TREATMENT

Communications Officer 5.7 Assignment: This duty is assigned to the Brookfield Volunteer Fire Company s EMS Personnel with the highest knowledge of proper radio procedures. This officer will operate out of the command post. Function: Relays communications between Danbury E.R. and the Treatment Officer. Receives communications for the officers at the command post. Reports to: Incident Commander and EMS Scene Control Officer. Tasks: 1. Communicates with the hospital the Smart Tag Number, age and sex of the patient, major characteristics of injury, anticipated departure time. 2. Coordinates with Danbury E.R. patient distribution to area hospitals. 3. Maintains communication with Treatment Officer for medical consultations. Communications: Radio communications will be via C-MED radio in a vehicle with radio capabilities on the assigned radio frequency given by Northwest C- MED to Danbury E.R, from the command post to Danbury E.R. and on radio frequency Fire Repeater (159.0900). Radio Call Sign Communications

Loading Officer 5.8 Assignment: This duty is assigned to the Brookfield Volunteer Fire Company s EMS Personnel or Firefighter Function: Assign ambulance crews to receive patients. Reports to: EMS Scene Control Officer. Supervises: Ambulance crews. Tasks: 1. In the early phase of the event before the patients are ready for transport, assist the Treatment Officer in preparing the treatment area. 2. On requests from the Treatment Officer, assign ambulance crews to patients for the one-on-one patient care in the treatment. 3. Order ambulances to loading area from the holding area and dispatches them to the hospital designated by the Treatment Officer. All Category 1 (RED) patients will be transported first. All Category 2 (YELLOW) patients will be transported second. No Category 3 (GREEN) patients will be transported until all Category 1 (RED) and Category 2 (YELLOW) patients have been transported. Communications: Radio communications will be on Fire Repeater (159.0900) to the command post and to a fire vehicle in the holding area. Radio Call Sign LOADING

Dispatch Duties Any dispatcher, upon learning of the potential for a Mass Casualty Incident, shall provide early notice to Brookfield Emergency Services and Brookfield Police immediately, without waiting for later official confirmation from the scene, with the following message: 1.0 Initial Dispatch to Brookfield Fire Companies: By activating alert tone. Brookfield Fire and Ambulance personnel, a Potential Mass Casualty incident caused by, located at, has been declared by. All personnel are to report with Mass Casualty equipment. 2.0 To Brookfield Police: Inform them the following: A potential Mass Casualty incident caused by, located at, declared by. An initial estimate of casualties is. Brookfield Emergency Services are responding. IF A FIRE IS REPORTED, STANDARD PROCEDURE FOR DISPATCHING A FIRE SHALL BE COMPLETED PRIOR TO THE MASS CASUALTY INCIDENT PROCEDURE. After notifying the emergency services listed above, the dispatcher will immediately notify Danbury Hospital. Danbury Hospital @ 203-797-7100 and give them the following message: Brookfield Fire Company has reported a potential Mass Casualty in Brookfield caused by. An initial estimate of casualties is.

Confirmation of Mass Casualty Confirmation that we have an actual Mass Casualty Incident will be on the order from the Paramedic, Senior EMS/Fire member or Incident Commander to Execute the Brookfield Mass Casualty Plan. Upon receiving this order, the dispatcher will notify the following services in the order listed to give the following message to the individual contacted. 1. Contact VINTECH Management Service at 866-496-8199. Tell them Brookfield has activated their Mass casualty plan and to page the Manager on call. 2. Call Danbury Ambulance and request 2 BLS ambulances to be dispatched to Brookfield for a Mass Casualty Incident. 3. Upon the request by Command, call any services requested. Tell them, Ambulance/Fire/Rescue are requested to respond to a Mass Casualty Incident in Brookfield, caused by. Proceed to LOCATION with all available long boards and Mass Casualty (or special requested equipment). PHONE NUMBERS Newtown Dispatch (FIRE/EMS) 203-270-4296 Danbury Fire Dispatch (FIRE/EMS) 203-796-1550 Danbury Ambulance (EMS/ALS) 203-748-3433 EXT 2 New Milford Dispatch (FIRE/EMS) 860-355-3133 Bethel Dispatch (Bethel/Stony Hill FIRE/EMS) 203-743-5500 Litchfield County Dispatch (Sherman/ Bridgewater) 860-496-0711 New Fairfield Dispatch (Squantz/Company A FIRE/EMS, Ball Pond FIRE) 203-312-5701 Northwest C-MED (Roxbury EMS and REHAB, MED Control) 203-758-0050 Southwest C-MED 203-338-0762 Bus Company 203-775-1545 Note: The Dispatcher will advised the incident commander when all services have been notified.

DANBURY HOSPITAL Once Danbury Hospital has been contacted they will decide by the scope of the incident if they will send an E.R. Physician to Brookfield. Danbury E.R. will decide where patients will be transported. They should also notify other hospitals how many patients will be transported/diverted to each. If larger quantities of supplies are needed, a request may be made from Command to Danbury Hospital for assistance. (IE: Blankets, towels and medical supplies) TRAINING Primary personnel are those responsible for filling the officer roles and managing and MCI. Training requirements include documentation of a triage and Mass Casualty course completion and attendance at field evolution training for all personnel at the scene assigned or assuming a leadership role. Secondary personnel are those taking direction form officers at MCI supporting operations. Training requirements include documentation of a minimum one-hour overview in Mass Casualty scene management for all personnel at the scene assigned a support role. Revised 10/13

Safety Officer? State Mobile hospital? MCI trailer locations? USAR? Med control # NM 860-210-5055 DHER 203-739-6757