Transcript Document

FIRE-EMS 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
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
• Review pertinent matrices
– Pp 7 - 16
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 comms
Use clear text
Complete forms
Demobilize as required/practical
Unit Leader
Responsibilities
• Back of each checklist
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Participate in planning as required
Get accurate SitStat/ReSTat of assigned units
Confirm arrival time of resources
Assign duties to subordinates as required
Develop accountability, safety and security
Supervise demobilization
Provide logistics with re-supply needs
Maintain unit log
Packaging of MCI Plan
• Standard Packaging
• Hand out bundles
• “You are the checklist until you
delegate it”
• Morgue Manager-Law enforcement
• Certs/Quals determine who does
what…not rank or position
Personnel Options
• Branch Director
– Chief Officer(Fire)/Lieutenant/Captain (Law)
• EMS/Pt Transport Group Supervisors
– Captain (Fire)/Sergeant (Law)/Supervisor(EMS)
• Triage/Treatment/Transport Unit Leaders
– Captain(Fire)/Sergeant(Law)/Supervisor(EMS)
Transportation Group
Supervisor/Unit Leader
• Only one per incident
• If a Single EMS Group Supervisor
– Reports to the EMS group supervisor
• If multiple EMS Group Supervisors
– Reports to the EMS Branch Director/Ops
• Single Staging area for ground
transport units
• Single Helispot for air transport units
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 comms
• 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
• MVA 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
– BLS personnel perfect for this
– Utilize teams whenever possible
– Good mission for an Engine Company
– Minimal Treatment
• Do not re-triage at scene
• Can re-triage in Treatment Areas
Triage Considerations
(cont)
• Patients can be upgraded or downgraded
– New tag if not written on
– Fold old tag and give new one if started writing
patient info on it
• ?Who providers litter bearers
– PT TX Unit Leader
• DOA’s stay where found unless need for movement
necessitates taking them to a morgue location
• Patients may not be moved to a Tx Area
– MVA’s with limited number of victims
START and
Tag Review
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