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TRANSCRIPT
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Chapter 44
Multiple-Casualty Incidents and
Incident Management
Copyright ©2010 by Pearson Education, Inc.
All rights reserved.
Prehospital Emergency Care, Ninth Edition
Joseph J. Mistovich • Keith J. Karren
Objectives
1. Define key terms introduced in this chapter (slides 12-
13).
2. List situations that might result in multiple trauma
casualties and situations that might result in multiple
medical casualties (slides 12-13).
3. List aspects important to effective management of an
MCI (slide 14).
4. Explain the purposes for establishment of the National
Incident Management System (NIMS) (slides 15-16).
5. Describe the purposes and desirable features of the
incident command system (ICS) (slides 17-18).
Objectives
6. Identify responsibilities that may be assigned to EMS
(units that might be established) at a multiple-casualty
incident (slides 19-20).
7. Describe the principles of a triage system (slide 21).
8. Describe and contrast primary triage with secondary
triage (slides 22-23).
9. Given a scenario with multiple patients, categorize
patients according to a color-coded triage system (slide
24).
10. Explain the principles and assessment categories used
in START triage (slides 25-26).
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Objectives
11. Explain why JumpSTART was developed for triage of
pediatric patients, contrast JumpSTART with START,
and explain how to identify a “child” for triage purposes
at the scene of an MCI (slides 27-29).
12. Explain the important principles of a patient tagging
system to be used during triage (slides 30-31).
13. Explain the interrelationship of triage and treatment
within the treatment unit at an MCI (slides 32-33).
14. Discuss the logistics of staging and transport at an MCI
(slides 34-37).
15. Discuss common issues with communications in MCI
and disaster situations (slides 38-39).
Objectives
16. List measures that can be taken to reduce rescuer
stress during and after an MCI response (slides 42-43).
17. Describe requirements of effective disaster assistance
(slides 44-51).
18. Anticipate psychological reactions of disaster victims
and describe ways in which EMS providers can assist
disaster survivors (slides 52-54).
Multimedia Directory
Slide 44 Children During Disasters Video
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Topics
Multiple-Casualty Incidents
National Incident Management System
Triage
Disaster Management
CASE STUDY
Dispatch
Respond to the Firebird Raceway, We have
reports that two race cars have crashed through
a fence into a bleacher full of people. Initial
reports indicate as many as ten dead and 40
critical injuries.
EMS Unit 105
Time out 1612
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• Two demolished vehicles on a collapsed bleacher
• People screaming; bystanders helping the injured
• You estimate at least 50 injuries
• Since you’re the senior EMT, according to your
MCI plan, you’re the incident manager for EMS
operations
Upon Arrival
How would you proceed with the assessment of these patients?
Back to Topics
Multiple-Casualty
Incidents
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Multiple-Casualty Incident (MCI)
Event that places excessive
demands on personnel and
equipment
(© Rob Crandall/The Image Works) Back to Objectives
Multiple-Casualty Incident
• Get help early
• Too many rescuers is
better than too few
(© Rob Crandall/The Image Works) Back to Objectives
National Incident
Management System
Back to Topics
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National Incident Management
System (NIMS)
• Standardized approach
• Provides both flexibility and
standardization
• Agencies required to be
NIMS-compliant since 2006
(© AP Photo/Dennis Paquin) Back to Objectives
Incident Command System
Back to Objectives
• Safety of responders and
others
• Achievement of tactical
objectives
• Efficient use of resources
ICS
ensures:
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Back to Objectives
Triage
Back to Topics
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Primary and Secondary
Triage
Back to Objectives
• Primary triage is performed
upon arrival of first EMS unit
• Secondary triage
reevaluates initial triage
determination
Back to Objectives
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START Triage System
Back to Objectives
JumpSTART Pediatric
Triage System
Back to Objectives
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(© Lou Romig, MD, FAAP, FACEP, 2002)
(© Lou Romig, MD, FAAP, FACEP, 2002)
Patient Tagging
Back to Objectives
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Treatment
Back to Objectives
• Treat only salvageable
patients
• Focus on life-
threatening injuries
• Move to treatment in
order of priority
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Staging and Transport
Back to Objectives
A staging unit leader
monitors, inventories,
and directs available
ambulances to the
treatment unit at request
of transport unit leader.
(© Benjamin Benschneider /THE SEATTLE TIMES)
• Patient distribution to
medical facilities
• Hospital surge capacity
• Specialty medical
facilities
• Constant coordination
and communication
Transport Unit
(© Benjamin Benschneider /THE SEATTLE TIMES)
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• Transport high-priority first
• Use preferred route
• Transport unit leader should
perform report
• Consider mass transit vehicle
for ambulatory patients
Effective Transport
(© Benjamin Benschneider /THE SEATTLE TIMES)
Communications
Back to Objectives
Communications
• One of the most difficult aspects of incident
management
• Confusion diminishes with ICS establishment
• Radio communications may be difficult due to
gridlock and “dead spots”
• Don’t become distracted from patient care
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Follow-Through
Follow-Through
• Following removal of all patients from the
scene, assist hospital personnel
• Seek direction from facility incident manager
• If your services are not needed, prepare your
vehicle for service
Reducing Posttraumatic and
Cumulative Stress
Back to Objectives
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• Rest regularly
• Monitor workers for stress
• Assign tasks appropriate to
skills and experience
• Provide food and beverage
• Encourage talking to relieve
stress
• Make professional counselors
available
(© Tim Fadek/Gamma)
Children During Disasters
Return to Directory
Click here to view a video with information about children during disasters.
Disaster Management
Back to Topics
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Requirements of Effective
Disaster Assistance
Back to Objectives
• Communication
• Quick implementation
• Adaptability
• Preplanning
• Triage
• Community preparation (© AP Photo/Vincent LaForet/POOL)
Warning and Evacuation
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Evacuation Message
• Nature of emergency and time of impact
• Safe route out of area
• Appropriate destinations where assistance is
available
• Use as many media as possible to send
message
Disaster Communications
System
Disaster Communication
• Establish details of system ahead of time
• Appoint one person to communicate with
those outside of disaster area
• Maintain area-wide communications
• Establish central registration station
• Make travel information available
• Monitor all health care resources
• Transport officer at scene should handle
hospital report
• Record communications for later review
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The Psychological Impact
of Disasters
Helping Disaster
Patients
Back to Objectives
Age Considerations
• Preschoolers tend to cry, lose control of bodily
functions, and suck their thumbs
• Elementary-age children suffer extreme fears
about their safety and show confusion,
depression, withdrawal, and the tendency to
fight with their peers
• Preadolescents and adolescents may show
the same reaction as elementary-age children,
coupled with extreme aggression and stress
that is severe enough to disrupt their lives
Other Considerations
• The families of patients need and deserve
accurate information
• Reunite families as soon as possible
• Group people with families and neighbors
• Encourage people to do necessary chores
• Provide structure for emotionally injured
• Help patients confront reality
• Do not give false assurances
• Identify high-risk patients
• Provide care for rescuers as well
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CASE STUDY
Follow-Up
Scene Size-Up
• Raceway officials extinguish fires
• Multiple burn patients
• Bystanders directed off the bleachers
• Assume incident command
• Request 20 ambulances
CASE STUDY
Scene Size-Up
• Request ten rescue units with
extrication ability
• Establish extrication, treatment,
transport, staging, supply, and triage
units
CASE STUDY
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Triage
• START Triage
• Ten people walk away when called with bullhorn
• Classify remaining patients as red or yellow
• Move red patients to treatment unit first
CASE STUDY
Supply and Extrication Units
• Determine amount of medical materials needed
• Obtain necessary extrication equipment
• Distribute supplies, equipment, and personnel to area of greatest need
CASE STUDY
Triage and Treatment Units
• 40 patients total – 10 deaths = 30 patients in the treatment unit
• Classify five patients as red and treat first
• Classify remaining 25 yellow
• Move yellow patients to priority two treatment area
CASE STUDY
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Staging and Transport
• Request three ambulances for red patients
• Transport unit contacts hospital
• Request 13 ambulances for yellow patients
CASE STUDY
Staging and Transport
• Request five ambulances for green patients
• Remaining EMTs assist with clean-up
• All crews take periodic breaks for rest and nourishment
CASE STUDY
• Dispatched to a residential neighborhood
for a report of a natural gas explosion
• You’re the first EMS unit to arrive on scene
• You report to the incident commander
• The IC believes approximately 30 patients
have been identified so far
• He designates you as the EMS branch
director
Critical Thinking Scenario
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1. What responsibilities would you have as
the EMS branch director?
2. What units would you establish?
3. How should triage be conducted?
4. What patients would be moved into the
treatment unit first and moved out of the
treatment unit first?
5. How would you manage all of the
responding EMS units?
Critical Thinking Questions
Reinforce and Review
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