Incident Command and Multiple-Casualty Incidents

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Incident Command andMultiple-Casualty Incidents
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You Are the Emergency Medical Responder
Lesson 45 Incident Command and Multiple-Casualty
Incidents

• A school bus carrying 30 students is involved in
  a collision and is severely damaged near the
  front of the bus. The students are scared and
  some are injured. People are starting to crowd
  around the area, and the local fire department
  already is on scene. You arrive as an EMR on
  scene.

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Incident Management Systems

• National Incident Management System (NIMS)
• Systematic, proactive approach to guide
  organizations responding to incidents
• Provides a template for the management of
  incidents
• National Response Framework (NRF)
• Guide to how an all-hazards response is conducted
• Incident Command System (ICS)
• Organizes who is responsible for overall direction

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Incident Command System

• Management system originally developed to help
  manage fighting forest fires
• All-hazards management system
• Incident commander
• Establishes incident objectives
• Scene safety, identify the MCI, patients
• Manages resources
• Fire, ambulances, HZMAT
• Supervises use of resources

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Common Roles in the ICS

• Triage officer
• Initial triage of patients
• Treatment officer
• Sets up area/medical care
• Transportation officer
• Transport vehicles
• Staging officer
• Distributes resources
• Safety officer
• Maintains scene safety

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Multiple-Casualty Incidents

• Motor-vehicle crashes
• Transportation accidents
• Flood
• Fire
• Explosion
• Structure collapse

• Train derailment
• Airliner crash
• HAZMAT incidents
• Earthquake
• Tornado
• Hurricane

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Triage

• French for separate, sift or select
• The process for identifying which patients
  require urgent care in a multiple-casualty
  incident
• Triage officer performs triage on all patients
• Primary and secondary triage
• Each patient is tagged and identified by a
  tag/tape
• Green, yellow, red, and black

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Types of Triage

• Primary
• Used on scene to rapidly categorize the condition
  of the patients, including the number and
  location of the patients and what transportation
  is needed
• Secondary
• Often performed after patients are moved to the
  treatment area or before entering the treatment
  area

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The START System

• Simple
• Triage
• And
• Rapid
• Treatment
• START is a triage system used only in situation
  in which your assessment and care-giving skills
  are modified
• The system requires you to assess and base you
  treatment level on three factors
• Breathing
• Radial pulse (Circulation)
• Level of consciousness

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Triage Categories

• Ambulatory (walking wounded) Green
• Immediate care Red
• Delayed care Yellow
• Deceased/non-salvageable/expectant Black
• Hold White

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Other Methods for Triage

• SALT Mass Casualty Triage
• Priority 1 Still/obvious life threat
• Priority 2 Waving/purposeful movement
• Priority 3 Walking
• JumpSTART
• Used with children
• Not for use with infants younger than 12 months

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Activity

• You are assisting with triage at the scene of a
  multi-vehicle collision involving several
  automobiles and a tractor trailer. One of the
  patients, a 35-year-old woman, is alert and
  responsive with a small cut on her forehead and
  forearm and is complaining of a headache. An
  8-year-old child has a fractured leg with the
  bone protruding through the skin with significant
  bleeding. A third victim, a 65-year-old male is
  not breathing, even after attempting to open and
  clear his airway.

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Stress at a Multiple-Casualty Incident

• Patient
• More then just visible injuries
• Cognitive, emotional, physical and behavioral
• Children and elderly with increased risk for
  severe stress reactions
• EMRs and the need for debriefing
• Adequate rest/down time
• Talking with colleagues about their experience

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You Are the Emergency Medical Responder

• A number of students from the bus are yelling at
  you to help them, and one of the firefighters
  asks you to come over and check the coach, whose
  pain in his abdomen and chest seems to be getting
  worse.