TACTICAL-30: Multiple Casualty Incident Response

MULTIPLE CASUALTY INCIDENT (MCI) RESPONSE OVERVIEW

  • Objective: To provide a standardized systematic response for Multiple Casualty Incidents (MCI), designed to expand or contract based on the incident type and total number of patients.

  • S.O.P. Information:

    • S.O.P. #: TACTICAL OPERATIONS MANUAL - 30

    • Division: EMERGENCY OPERATIONS

    • Revised Date: 07/01/16

  • Core Goals:

    • Effective resource utilization.

    • Effective transportation of patients (avoiding "relocating the disaster").

    • Effective use of the Incident Command System (ICS) to maintain organization.

  • Definition of MCI: Any incident involving circumstances that suggest an extraordinary strain could be placed on EMS or healthcare resources.

INCIDENT RESPONSE PROFILES BY ALARM LEVEL

  • First Alarm MCI (10-20 Patients):

    • 1 Battalion Chief

    • 2 EMS District Officers

    • 1 EMS Shift Commander

    • 5 Engines/Trucks/Towers/Squads

    • 5 Transport Units

    • 1 Safety Officer

    • SORT 50 (Chestnut Ridge Vol.)

  • Second Alarm MCI (20-40 Patients):

    • 1 Battalion Chief

    • 2 EMS District Officers

    • 5 Engines/Trucks/Towers/Squads

    • 10 Transport Units

  • Third Alarm MCI (40-60 Patients):

    • 1 Battalion Chief

    • 5 Engines/Trucks/Towers/Squads

    • 10 Transport Units

  • Fourth Alarm MCI (60+ Patients):

    • 1 Battalion Chief

    • 5 Engines/Trucks/Towers/Squads

    • 10 Transport Units

RESOURCE UTILIZATION AND UNIT FUNCTIONS

  • Utilization Triggers:

    • A First Alarm MCI is appropriate when large numbers of porters/litter bearers are required to move patients.

    • Appropriate when more providers are needed to manage and provide care.

    • A Medical Strike Team/Task Force may still be requested as defined in SOP Tact 7 Appendix A.

  • First Arriving Unit Responsibilities:

    • Perform BIR (Brief Initial Report), 360-degree survey, and establish Incident Command per S.O.P. Tactical 7.

    • Execute immediate hazard mitigation.

    • Identify and develop access and egress points for transport units.

    • Establish staging.

  • Other Units Responsibilities:

    • Incident Command and Scene Control.

    • Immediate Hazard Mitigation.

    • Triage of Patients.

    • Patient Movement.

    • Operatative actions as directed by Command.

MEDICAL BRANCH FUNCTIONS

  • Medical Branch Oversight:

    • Responsible for oversight of EMS operations, which must be staffed.

    • Operations include: Triage, Treatment/Morgue, Transportation, and Communications.

    • Must utilize the EMS Officer MCI Worksheet Form or access HC Standard (if FRED - Facility Resource Emergency Database is activated).

    • Activate incident in FRED via Syscom/MIEMSS if Electronic Patient Tracking System (EPTS) is activated.

  • Triage Group:

    • Supervisor: Establish a Triage Group Supervisor.

    • System: Initial triage conducted using START/JumpStart protocols (Maryland Triage System Training Program).

    • Ribbon Categories:

      • "IMMEDIATE/Red"

      • "DELAYED/Yellow"

      • "MINOR/Green"

      • "Expectant/Black"

    • Equipment: Utilize Rapid Deployment Triage Bags.

    • Communication: Communicate the total number of casualties, identified by triage color, to the medical branch director, treatment group supervisor, transportation officer, and Incident Commander.

  • Treatment Group:

    • Divisions: Sections divided into Red, Yellow, and Green zones.

    • Layout: Require adequate spacing based on size, scope, complexity, and location.

    • Flow: Located to ensure patient flow effectively feeds to the transportation area.

    • Security: Sections should be secure and protect providers and patients from environmental factors and the media.

    • Secondary Triage:

      • Triage Tags must be used during secondary triage.

      • Fill out all information on the tag or via the electronic patient tracking device.

    • Equipment: Stage equipment in an area accessible to all treatment groups; consider staging SORT 50 near or in the treatment area.

  • Transportation Group:

    • Coordinate with the Staging Officer for transport units and access/egress.

    • EMRC/Syscom Notification: Notify EMRC that an MCI is declared. Provide:

      • General type of incident and location.

      • Age range of patients.

      • Estimated number of patients by triage status.

      • Approximate number of casualties.

      • Hazardous materials involved.

    • Tracking: Use the transportation tracking form or EPTS.

    • EMRC Channels: EMRC may hold consult channels (224/228224/228) for the duration of the incident.

    • Destination Logic: Determine destinations based on priority, age, and specialty referrals.

    • Final Check: Act as the final checkpoint for patients before transport.

    • Unit Communication: If a central point of contact is unavailable, individual units must communicate patient info (number, illness, age, triage category) to receiving facilities via EMRC, stating they are associated with the MCI.

SUPPORT AND LOGISTICAL FUNCTIONS

  • Porters: Necessary for moving significant numbers of personnel and equipment.

  • Morgue: Identify a location for a large number of deceased patients.

  • Rehab: Consider resources for the rehabilitation of personnel.

  • Staging:

    • Location identified by the first arriving unit.

    • A Staging Officer should be established as soon as practical to coordinate apparatus, equipment, and personnel.

    • Location should be convenient but not hinder access/egress.

    • Consider Law Enforcement for security.

APPENDIX 1: ADDITIONAL RESOURCES

  • Local Resource Considerations:

    • BWI MCI Trailer

    • Baltimore City MCI Trailer

    • Howard County Ambulance Bus

    • Anne Arundel County Ambulance Bus

    • MTA Comfort Bus

    • FRA Bus

    • Volunteer Buses and ATVs

    • Go-Team

    • Associate Medical Directors and Fire Surgeons

    • MSP Aviation

    • MIEMSS

    • Decon 54

    • Rehab Units

  • Region III Health and Medical Task Force:

    • Considered for long-term incidents.

    • Requested through local HSEM (Homeland Security/Emergency Management) by a chief officer.

    • Provides medical equipment, portable structures, and electronic equipment.

    • Requires a logistics truck and personnel.

  • National Disaster Medical System (NDMS):

    • Federal resource for disaster medical, mortuary, and veterinary care.

    • Reserved for long-term response, requested through HSEM to MEMA.

  • Alternate Care Site: Reserved for pandemics and other long-term disasters.

APPENDIX 2: ELECTRONIC PATIENT TRACKING SYSTEM (EPTS)

  • EPTS Kits:

    • Two boxes per kit.

    • Box 1: ERWAP (Mobile Wifi, 3 mile3\,\text{mile} range) in a small Pelican case.

    • Box 2: Includes 5 tracking devices and a laptop for FRED/program access.

    • Deployment: Paramount for large numbers of patients (MCI Alarm 2 or higher).

    • Storage Locations: Offices of EMS 1, 3, and SORT 50.

  • EPTS iPad:

    • Carried on district officer vehicles: EMS 2, 4, 5, 6, 7, and 8.

    • Used in the transportation group for speed/efficiency.

    • Login info on the S drive; FRED Dashboard access limited to EMS 1.

  • Usage Benefits:

    • Reduces radio communication.

    • Improves hospital communication.

    • Assists in patient management and family reunification.

  • Activation Process: Notify Dispatch $\rightarrow$ Dispatch notifies Syscom $\rightarrow$ Syscom notifies MIEMSS.

    • Note: Event creation can take up to 15 minutes15\,\text{minutes}.

  • Data Entry:

    • Scans triage stickers.

    • Required Fields: Triage category, name, gender, age, chief complaint, destination, transporting unit, and destination time.

    • Documentation should not be delayed; patients can be entered and batch uploaded later.

    • Transportation Group Supervisor must scan tags and ensure destination selection prior to transport.