Mass Casualty Incidents

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Mass Casualty Incidents

• Joseph Donoghue, CPP, EMT-B
• Fidelity Investments Corporate Security

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What constitutes an MCI?

• More than one patient and system resources are
  taxed at the time
• Anytime there are more Patients than Rescuers

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The Goal of all Responders Should be to Save
as Many Lives as Possible
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The Basics

• Your first 5 minutes will determine how the
  incident will go Emotions are Contagious
• Think Incident Command
• Think Triage
• Pre-plan and train or you will fail

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Incident Command

• First person on scene sends an Initial On Scene
  Report
• See as much as the scene as you can in 30
  seconds
• Process what you see and hear
• THINK - Dont Panic
• Paint an accurate picture of the scene with your
  brief report
• Declare yourself the IC, Where the IC Post will
  be and where responding units should report to

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Triage - To sort by priority

• Hard to do for the inexperienced, but it is
  really very easy
• All responders must know what the goal is..
• Sometimes most severely injured patient does not
  get treated and dies

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How to Triage using the Tags

• Conduct an Initial Walkthrough
• Tag Patients as Red, Yellow, Green or Black
• Remember - Triage is constantly conducted so
  dont panic with your first tag

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RED - IMMEDIATE

• Severely injured but able to be saved with
  relatively quick treatment and transport
• Examples
• Severe bleeding,
• Severe Shock,
• Open Chest or Abdominal Wounds,
• Unconscious but has pulse and is breathing,
• Several Major Fractures

• Emotionally Out Of Control - (Emotions are
  Contagious)
• Injured Rescuers - For Morale of other Rescuers

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Yellow - Delayed

• Injured but unable to walk on their own
• These people will be treated!
• Dont over tag people because of bystanders or
  age (children)
• Examples
• severe burns but no respiratory distress,
• spinal injuries
• moderate blood loss
• conscious with head injuries

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Green - Walking Wounded or Mortal Wounds

• Minor injures that need to be assessed or treated
  but not right away.
• Ex Minor fractures, minor bleeding
• Some systems use the green tag for obviously
  mortal wounds where death appears reasonably
  certain
• (these patients can be retriaged later if
  personnel and/or resources become available)
• Have a Refusal Log handy and use it

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Black - Obviously Dead

• Some systems include Dead or Obviously Dying
• Depends on local protocols
• Examples
• cardiac arrest
• respiratory arrest but has pulse
• etc.

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Treatment

• Once Triage is done, move patients to the proper
  treatment area
• Use tarps, cones, flags, to mark areas
• Control access to areas
• Constantly re-triage

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Transportation

• Ambulances report to staging area
• Transportation Officer assigns patients to
  ambulances
• Broadcast the All Immediates Transported

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Management of the Deceased

• If it is a crime scene, leave the bodies where
  they are
• Cover the victim with a white sheet if possible
• If the bodies can be seen by the surviving
  patients, consider moving them

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Designate a Temporary Morgue Area

• Should be out of site from bystanders and victims
• Maintain Access Control
• loved ones
• media
• thieves

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Handling the Dead

• Show respect and dignity
• Reduce the pain that witnesses may feel (they
  will watch)
• Package them as if they were still alive

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Body Bags

• Always choose white instead of black if possible
• white is pure and is associated with patients
• black resembles a trash bag
• Inner plastic lining that can stay intact for
  viewing

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Carrying the Dead

• It is virtually impossible to carry the bag
  without support
• Always use a backboard or better yet,a scoop
  stretcher

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Emotional Distancing Techniques

• Double Glove and Tape Wrists of Personnel
• Use shovels and not hands to pick up body parts
• Cover the body or at least the head before
  picking it up

• Use Vicks VapoRub under a mask when necessary
• Scoop Stretchers when possible
• Secure the body to the backboard well so that it
  does not move
• Volunteers only !

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Summary - Top Ten

• 1. First On Scene Report
• 2. Escalated Response
• 3. Think Incident Command
• 4. Triage
• 5. Treat by Priority

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Summary - Top Ten

• 6. Separate victims by priority
• 7. Transport by priority
• 8. Re-Triage Constantly
• 9. Only move the dead when it is effecting
  patient care
• 10. Train, Train, Train and Practice

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Thank You All