Transcript Document

Hospital Emergency Room Training
Contra Costa County EMS
Tim W. Hennessy
MCI Plan
Tim W. Hennessy
Communications Supervisor
Contra Costa County
Sheriffs Communication
1975-2007
This MCI Plan
is dedicated to Tim.
His expertise and
commitment in developing
this plan was
invaluable.
History
• 1979: First MCI Committee
organized to develop plan following
Yuba City bus crash in Martinez
• 1983: Board of Supervisors
approved the first MCI Plan
• Several revisions to the basic plan
since 1983
Current MCI Working
Group
• Appointed in 2005 to conduct a groundup rewrite of the MCI Plan
• Multidisciplinary
– Fire
– Emergency Ambulance Zone Provider
(public and private)
– Law Enforcement
– Hospitals
– Public Safety Communications
– EMS Agency staff
Why Rewrite the
Plan?
• Improve the usefulness of the
document for first responders
• Compare the Plan to the County’s
current risk profile
• Compare the Plan to the County’s
current public safety and EMS
resources
Why Rewrite the
Plan?
• Attempt to resolve weaknesses in
the Plan experienced during
previous incidents:
– Incident command and control
– Communication flow
– Resource ordering and tracking
• Ensure compliance with NIMS
MCI Plan Objectives
Objective #1:
Establish a common organization,
management, and communications
structure for the coordination of
emergency response to a multicasualty incident.
MCI Plan Objectives
Objective #2:
Establish methods of triage and
transportation that will provide the best
medical outcome possible for the
greatest number of casualties.
MCI Plan Objectives
Objective #3:
Establish pre-defined responsibilities of
all entities with key roles in achieving
successful implementation of the plan.
MCI Plan Objectives
Objective #4:
The Plan will be drilled regularly, and
reviewed annually and following
significant activations of the Plan as
directed by the EMS Director.
Key Concepts
• Use of Incident Command System
– Expansion and contraction of
structure is dynamic and incidentdriven
– Use of single point ordering for
resource requests
– Emphasis on exchanging information
Key Concepts
• Importance of Unified Command
• The “Rule of 2 and 4”
MCI Tiers
• Plan consolidates Expanded
Medical Emergencies, Medical
Advisory Alerts and MCIs into a
single MCI Plan with 4 activation
tiers
• Use of tiered MCI Plan reinforces
the scalability of the Plan
MCI Tiers
• Use of Tiers modeled after
Community Warning System
(CWS) Levels
• Consistent with best practices
Tier Zero
• Notification of incident with
potential to escalate to a higher
tier (Medical Advisory Alert)
• CWS Level II and III Incidents
• Report of Active Shooter incident
• Attempted emergency landing of
passenger aircraft
Tier One
• 6-10 patients with scene
contained, number of patients not
expected to rise
• Multi-vehicle collision
• Multiple gunshot victims at
contained scene and no ongoing
active shooter
Tier Two
• 10 –50 patients or less than 10 patients
with substantial chance of increase in
number of patients
• Transportation resource ordering
switches to EMSOACC
• Petrochemical incident
• Passenger train derailment
• Active shooter with uncontained scene
Tier Three
• More than 50 patients or
reasonable expectations of large
number of casualties
• Actual or suspected WMD incident
• Significant explosion in populated
area
• Emergency evacuation of hospital
or SNF
Plan Components
• Responsibilities matrix/checklists
• Communications flowchart
• Communications overview
• ICS position checklists
• ICS communications forms 205
and 217A
Responsibilities
Matrix
• Multiple agencies
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Fire-EMS: ALS and BLS
Law Enforcement
Hospitals
Helicopter
Communications/EMSOACC
• Defined tier specific responsibilities
• Clear communication pathways
• Resource Coordination
MCI Checklists
• Common Responsibilities
– Back of each checklist
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Get Assignment
Check In
Get briefed
Get work materials
Undertake mission safely
Organize and brief subordinates
Assure communications
Use clear text
Complete forms
Demobilize as required/practical
Hospital
Responsibilities
• Tier Zero
– Make internal notifications and institute
appropriate ED procedures as per facility
protocol
– Respond to ED capacity poll from EMSOACC
(Sheriffs dispatch) if initiated
– Monitor and use Reddinet
Hospital
Responsibilities
• Tier One MCI
– Immediately prepare to accept 2
critical and 4 delayed patients
– Assess ability to handle additional
patients and respond to ED capacity
poll from EMSOACC
– Diversion status does not apply
during Tier 1,2,3 MCI
Hospital
Responsibilities
• Tier Two
– Rule of 2 and 4
– Capacity Poll
• Respond on Reddinet
– No Diversion
• Tier Three
– All of above
– Conduct damage assessment and report
results to EMSOACC/EMS if necessary
– Activate facility disaster plan if necessary
MCI Plan
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Know Reddinet
Know your responsibilities
Utilize HICS as needed
In HICS the certifications and
qualifications determine who does
what…not position
• You might be asked to do things you
normally might not do in MCI Tier III
Transportation
Highlights
• 2/4 Concept
– Continue to disperse casualties as much as
possible
– Use farther hospitals first
• Especially if potential exists for “walk ins”
– Hospital polling whenever possible but
certainly after 2/4 has been maximized
• Coordinate with EMSOACC as much as
possible
Transportation
Highlights (cont)
• Emergency Ambulance Zone Providers still responsible
for normal coverage too
• If limited ambulances, minors can be transported by
other means
• Tier 2 & 3 suspend ambulance to hospital
communications
• PCRs
– Whenever possible PCRs shall be completed
– Tier 3 Branch( or designee) can suspend standard
PCR protocol and replace with triage tag info
– Triage tags are minimum level of documentation
Predetermined
Staging Areas
• East/Central/West
• Rallying point in case of loss of
communications
Example of Tier 1
Scenario
• MVC with 7 patients in 3 vehicles
– Single Medical Group
– Transportation reports to Med Grp Sup
– Triage patients and treat where they were
found
– Do not send all patients to same hospital
– Can use close hospital due to lack of
probability of self transporting patients to
closest facility
Example of Tier 2
Scenario
• Shooting incidents with 21 patients
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Single Medical Group
Transportation reports to Med Grp Sup
Triage patients where they are found
Litter bearers move patients to specific
treatment areas
– Patients re-triaged in treatment areas and
assigned priority for transport
– Avoid close proximity hospitals if possible
due to potential private transport arrivals
Example of Tier 3
Scenario
• Large structural collapse with multiple
victims trapped over a widespread area
– Multiple Medical Groups (probably by Division) report
to Medical Branch
– Transportation reports to Medical Branch
• Still just one transportation staging area
– Triage patients where they are found
– Litter bearers move patients where they are found
– Patient’s re-triaged in Treatment areas and assigned
priority
– Maximize 2/4 concept as needed
Triage Considerations
• START Triage system
– New tags
• Victims will not be re-triaged at
scene
• Victims re-triage in Treatment
Areas
Triage Tags
Contamination
Designation
Will be Standardized
Through-out
County