Transcript Zone 4 Mass Casualty Training

ZONE 4 MASS CASUALTY TRAINING
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To assure all crews within Central Zone
understand the roles and responsibilities of
operating in the framework of a MCI incident.
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FIRESCOPE
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COUNTY SAN DIEGO
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CENTRAL ZONE POLICY
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ZONE TRAINING OFFICERS
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Review MCI vs MPI
Review ICS Positions and Responsibilities
Review DMS “New” Triage Tag
Review START Guidelines
Table Top Exercise
Debrief
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MPI - Multi-Patient Incident
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MPI is any number greater than one patient.
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Agency has sufficient resources to handle
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Patients often numbered in sequence
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Most common system used each day
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MCI – MASS CASUALTY INCIDENT
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MCI is an incident with multiple patients
which will overwhelm the resources of the
responding agencies or the area hospitals.
This can and will differ from agency to agency
depending upon the size and scope of their
respective resources.
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Often confusion between the two modes.
The difference between MPI and MCI is
“AGENCY” driven.
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Resource driven
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Different Radio Formats
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Example
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A six patient accident place in San Diego City
may be determined by the IC to be a MPI.
While the same six patient incident in a rural
setting would most likely be deemed a MCI
due to lack of relative resources.
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Med Com must supply clear and concise
report.
Requires a more comprehensive radio report
than an MCI per policy S-140
PAMSCATE format (Pt. Number, Age,
Mechanism, Sex, Chief Complaint, Abnormal
Findings, Transporting Unit and ETA)
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Patient Triage Tag Number (Last 4 digits)
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Patient Status (WW, Immediate, Delayed)
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Transporting Unit
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ETA
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Specialty patients, such as Burn or Pediatric
should be communicated to the base in an
effort to get those patients to the best location
for those types of patients.
Med Com must be disciplined and avoid
extraneous radio information.
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Size up (Scope of the incident)
Safety
Determine and order Resources
Establish Traffic Flow (early) for incident
Declare MCI (Annex D)
Make Assignments
Establish Staging
Clear Direction
ICS Vests (if possible)
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Goal of triage is to sort patients rapidly
Use START Guidelines
ID Walking Wounded
Begin with closest patient
Consider Recon to get better understanding of
scope.
Tag patients
Relay number of patients in each category to
Transportation and Med Com
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Provide extrication and patient movement to
either Transport Area or Treatment Area
Consider using Triage Team after they have
completed Triage assignment.
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Responsible for communication between incident
and the CLOSEST BASE HOSPITAL
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(not necessarily the trauma center unless they are closest)
Initial contact with hospital uses unit number
Additional contacts use ICS terminology
IE: “Greenfield Med Com”
Must be able to relay scope and size of incident to
hospital.
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The Med Com and the Transportation Unit
leader or Group Supervisor should be colocated near the patient loading zone for
effective communications.
Scribe is highly recommended
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Med Com can quickly get overwhelmed
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Highly recommend a scribe
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Scribe works as a buffer
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Information should be funneled through scribe
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Med Com and Scribe should work side by side
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Scribe fields information
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Scribe maintains accurate records ( bed counts,
Patient acuity, Unit ID with destinations
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Establish early
Ambulance Staging Manager reports to the
Transportation Group Supervisor
Responsible for organizing the staging area,
resource accountability, briefing units on the
situational awareness and maintains unit
documentation.
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Staging should organize the available supplies
from waiting ambulances in the staging area
Load up one ambulance with supplies collected
in staging and send to scene
When organizing the staging area, the staging
manager should separate the transportation
resources by patient care capabilities when
possible
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The Staging Manager should monitor the
number of units in staging and advise
Operations or the IC when resources fall below
minimum levels
The Staging Manager should also coordinate
resource levels with the Transportation Unit
Leader
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Assign early
This role requires leadership and organization
skills to perform the critical tasks required for this
position
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ID best location (ingress/egress)
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Communicates with Med Com
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Transportation Group supervisor use natural
barriers, cones or banner tape to identify and
create a funnel where patients move though.
Transportation Group supervisor should
request a scribe early to assist with the
documentation.
In a coordinated process the Transportation
Group supervisor will request an ambulance
from the ambulance staging manager
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Transportation Group supervisor will request a
destination from Med Com and assign the
patients to the transporting ambulance
The County’s Annex D policy requires that
every receiving hospital will accept a minimum
of 1 Immediate and 1 Delayed patient and
every Trauma Center to accept a minimum of 2
Immediate patients
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An important but not always necessary
position
Set up areas, (WW, Immediate, Delayed)
Assure Treatment Areas have sufficient
supplies
Communicates with Triage, Med Com and
Transport
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Triage
Transport
Pt. Is triaged
as immediate
Contact Base Hospital
-Declare MCI
-establish Med Com
Staging
Litter
Bearers
-Extricates
-carry to
treatment
area
Sends
AMB upon
request
from
Transport
Gets AMB
from staging
Assigns
patient to
ambulance
Ambulance
is assigned
destination
Treatment
(if activated)
-Stabilizes
-Treats
-Documents
Med Com
Ambulance
leaves
Reports number of patients
by category to Hospital
(info from Triage)
Receive list of destination
hospitals and bed count
from Base Hospital
– advises Transport
Advises hospital when AMB
departs:
-Pt Numbers
-AMB number
-Destination
--Patient Flow --Comm Flow
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If you don’t
plan ahead
early enough,
All routes may
get blocked
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Establish
Staging and
traffic flow
EARLY
For success
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A simple approach
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Where to START
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One patient at a time
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START Triage Algorithm
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Patient scenarios
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Simple
Triage
And
Rapid
Treatment
In the early 1980’s the START method was
developed in California by Hoag hospital
and Newport Beach Fire and Marine.
It provided rescuers with an easy, simple
step-by-step approach to assessing and
treating a large number of patients with
varying degrees of injuries.
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Simple
Triage
And
Rapid
Treatment
The Initial assessment and treatment
of each patient is accomplished within
30 seconds.
Initial treatment is limited to
correcting immediate life-threatening
conditions (i.e. opening an airway and
controlling severe bleeding)
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The Triage Tag
Simple
Triage
And
Rapid
Treatment
A Tag is placed on each patient
once they have been assessed.
The tag displays the patient’s
current status and advises those
providing treatment with one of
the four possible treatment
priorities:
Minor
Delayed
Immediate
Deceased
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The Triage Tag
Simple
Triage
And
Rapid
Treatment
Each tab is distinctly color-coded allowing
fast patient priority identification from a
distance
DECEASED
IMMEDIATE
DELAYED
MINOR
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Simple
Triage
And
Rapid
Treatment
Triage Tags are
designed with tear-off
tabs. There is two tabs
per category.
One tag gets torn off
by Triage Team and
one tab is left with the
patient.
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Start where you stand - begin the triage process
with the patient closest to you. Solicit the help
of bystanders and/or uninjured victims. They
can be utilized to control bleeding, help
maintain an open airway or hold c-spine
traction.
Do not spend too much time on any one patient.
Move quickly from one patient to the next.
Assess each patient’s RPMs
Respirations
Perfusion
Mental Status
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Upon your arrival, first make sure
the scene is safe. Then begin by
directing the walking wounded
away from the immediate scene to
a pre-determined evaluation and
treatment area.
Tag them as MINOR (GREEN)
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R PM
ASSESS RESPIRATIONS
If the patient is not breathing then
Open the Airway
If the patient is still not breathing
then tag them as DECEASED
(BLACK)
Move on to the next patient...
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R PM
ASSESS RESPIRATIONS
If breathing is present then Assess the
Rate
If the rate is greater than >30
then tag them as IMMEDIATE (RED)
Move on to the next patient…
If the rate is less than <30
then assess PERFUSION
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RPM
ASSESS PERFUSION
If a radial pulse is absent (or)
the capillary refill is greater than > 2 seconds
then tag them as IMMEDIATE (RED)
Move on to the next patient…
If a radial pulse is present (or)
the capillary refill is less than < 2 seconds
then assess MENTAL STATUS
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RP M
ASSESS MENTAL STATUS
If the patient cannot follow simple commands
(or)
has an altered mental status (or)
is unconscious
then tag them as IMMEDIATE (RED)
Move on to the next patient…
If patient is able to follow simple commands
then tag them as DELAYED (YELLOW)
Move on to the next patient…
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Simple
Triage
And
Rapid
Treatment
This patient states he cannot move or feel his
legs
His respirations are 24
He has a radial pulse of 100
He is awake are oriented
How would you triage this patient?
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Simple
Triage
And
Rapid
Treatment
This patient states he cannot move or feel his
legs
His respirations are 24
He has a radial pulse of 100
He is awake are oriented
DELAYED (YELLOW)
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Simple
Triage
And
Rapid
Treatment
This patient has a blood soaked shirt on
His respirations are 36
His capillary refill is less than 2 seconds
He is awake are oriented
How would you triage this patient?
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Simple
Triage
And
Rapid
Treatment
This patient has a blood soaked shirt on
His respirations are 36
His capillary refill is less than 2 seconds
He is awake are oriented
IMMEDIATE (RED)
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Simple
Triage
And
Rapid
Treatment
This patient has some minor abrasions on his
forehead
His respirations are 16
His capillary refill is less than 2 seconds
He is very slow in recalling his name and
whereabouts
How would you triage this patient?
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Simple
Triage
And
Rapid
Treatment
This patient has some minor abrasions on his
forehead
His respirations are 16
His capillary refill is less than 2 seconds
He is very slow in recalling his name and
whereabouts
IMMEDIATE (RED)
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Simple
Triage
And
Rapid
Treatment
This patient appears to have no injuries
Her respirations are 20
Her capillary refill is less than 2 seconds
She is unconscious
How would you triage this patient?
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Simple
Triage
And
Rapid
Treatment
This patient appears to have no injuries
Her respirations are 20
Her capillary refill is less than 2 seconds
She is unconscious
IMMEDIATE (RED)
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Simple
Triage
And
Rapid
Treatment
This patient is lying quietly on the floor
He is not breathing
His capillary refill is more than 2 seconds
He is unconscious
What is the first thing you would do?
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Simple
Triage
And
Rapid
Treatment
This patient is lying quietly on the floor
He is not breathing
His capillary refill is more than 2 seconds
He is unconscious
REPOSITION THE AIRWAY!
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Simple
Triage
And
Rapid
Treatment
He gurgles a couple of times as you attempt to
open his airway but does not resume
breathing on his own
His capillary refill is still more than 2 seconds
He is still unconscious
How would you triage this patient?
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Simple
Triage
And
Rapid
Treatment
He gurgles a couple of times as you attempt to
open
his airway but does not resume breathing on
his own
His capillary refill is still more than 2 seconds
He is still unconscious
DECEASED (BLACK)
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DVD 8 MINUTES in length
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First Tuesday of the month, start date not yet set
Why?: Most field mis-classify patients as “acute” or
“delayed” and aren’t comfortable or familiar with
triage tags
To make Pre-Hospital and Hospital personnel more
familiar with triage tags and terminology
Will report patient tag number and provide a triage
report on every call (including medical calls)
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Exercise our understanding of a MCI scene
management
Exercise our communication skills as it relate to
MCI.
Review large scale MCI ICS management.
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Engage as a role player.
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Communicate as you would in a real incident.
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Obtain a ICS Vest
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Track patients
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IC
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Determines other positions
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Facilitator
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Dispatcher
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Companies
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1830 hours
Wednesday July 14th
El Cajon Car Show
Report Auto v. Ped
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Was objectives met?
Were communications and orders clear?
Were proper lines of communications used?
Were sufficient resources ordered?
Was START guidelines used?
Was patient transport effective?
Was patient tracking done?
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