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Palm Beach County Fire Rescue
MCI Dispatch Protocol Revisions
The following packet contains the changes to the MCI Dispatch Protocol along
with a brief review of Scene Size Up involving an MCI, Declaration of an MCI and
Scene Management Priorities.
The first section in this packet contains the New MCI Dispatch Protocol showing
the number of units that will be paged for Level (1-3) MCI. Included in this section
is a Note page for pertinent clarification, Wire Diagrams/Command Flow Charts
for Level 1-3 and a Blank Template Wire Diagram/Command Flow Chart to be
utilized by Command Units. This change in number of units responding for Levels
1-3 was created by utilizing a Wire Diagram/Command Flow Chart format for each
Level 1-3. They were created by simulating the number of units it would take to
efficiently manage and process the given number of victims per each Level 1-3. It
must be noted that these diagrams are examples only of where units can be
assigned to efficiently manage an MCI. The Incident Commander is responsible for
assigning units as needed based on incident priorities.
The second section contains a brief review of Scene Size Up involving an MCI,
Declaration of an MCI and Scene Management Priorities. Although there are
many considerations in the management of an MCI, this document reviews some
coaching points for the First In units with respect to initial assignments, scene
safety (hazards) and scene security, Triage, Treatment and Transport. The last
part in this section lists some plans for Future Changes to the Management of the
MCI being developed and tested by the MCI committee.
Effective date for this MCI Dispatch Protocol change is February 1 2011, in the
CAD system.
Purpose- Enhance the Number of Emergency Vehicles responding to MCI’s, Engines,
Rescues, Command Units and Support Units - (Support 81, TCU, DRU1, etc…), Include Wire
Diagrams for Levels of MCI to show the utilization of units that will be responding. (Wire
Diagrams are Examples Only- Incident Commander to assign units as needed). Review MCI
Scene Size-Up, MCI Scene Declaration and Scene Management Priorities
Revisions- Increased number of units responding to the Declared Level of MCI
Level 1(5-10 patients) Level 2(11-20 Patients) Level 3(21-100 Patients)
4- Engines
7- Engines
8- Engines
6- Rescues
11- Rescues
19- Rescues
2- EMS Captains
3- District Chiefs (1- Sp/Ops D/C)
4- District Chief (1- Sp/Ops D/C)
1- District Chief
3- District Captains
4- District Captains
1- Battalion Chief
2- Battalion Chiefs
3- Battalion Chiefs
1- Helicopter-Standby
1- Division Chief
1- Division Chief
2- Helicopters- Standby
2- Helicopters – Standby
1- Special Operation Team
1- PIO
2- Special Operations Team
1-PIO
Special Deployment Units
1- Support 81
1- TCU (Tactical Command Unit)
1- DRU2 and DRU3
1-Tactical 34
*Note – The number of units responding for each Level MCI is based on the
maximum number of Victims / Patients for that Level MCI
*Note - Incident Commander can downsize level of response per numbers of
victims/patients based on the severity of injuries/illnesses
*Note: When an MCI is upgraded to the next Level MCI the Incident Commander
will receive the balance from the previous Level MCI to supplement the
requested Level MCI
*Note: For MCI Level 4 (101-1000patients) and Level 5(OVER 1000 patients)
refer to Level 3 Wire Diagram (command flow chart) repeat Level 3 MCI for
every 100 patients –Below Operations
*Note: Wire Diagrams are Examples Only- Incident Commander to assign units
as needed
* Wire Diagrams are Examples Only- Incident Commander to assign units as
needed
Wire Diagram/ Command Flow Chart Level 1
The dashed lines illustrate the movement of units from their initial assignment
to possible additional assignments.
* Wire Diagrams are Examples Only- Incident Commander to assign units as
needed
Wire Diagram/ Command Flow Chart Level 2
The dashed lines illustrate the movement of units from their initial assignment
to possible additional assignments.
* Wire Diagrams are Examples Only- Incident Commander to assign units as
needed
Wire Diagram/ Command Flow Chart Level 3
The dashed lines illustrate the movement of units from their initial assignment
to possible additional assignments.
Blank Template
Will be on Division Chief, Battalion Chief, District Chief, and District Captain
Vehicles on a 12x18 board
Scene Size- up involving an MCI, Declaration of an MCI
and Scene Management Priorities and Plans for Future
Changes
This section contains a brief review of Scene Size- Up involving
an MCI, Declaration of an MCI and Scene Management
Priorities. Although there are many considerations in the
management of an MCI, this document reviews some coaching
points for the First In units with respect to initial assignments,
scene safety and security, Triage, Treatment and Transport.
The last part in this section lists some plans for Future Changes
to the Management of the MCI being developed and tested by
the MCI committee.
There are many SOG’s that can apply to an MCI but here a few
that we should review with our crews.
Incident Command SOG # 1105
Staging SOG# 1310
Disaster Response Units SOG # 1322
Personal Protective SOG # 1510
Traffic Operations SOG # 1740
Vehicle Accident SOG # 2310
MCI SOG # 2315
Response to Violent Incidents SOG # 2320
Response to HAZ MAT/WMD Incidents SOG # 2401
Emergency/ Gross Decontamination SOG # 2407
Review MCI Scene Size-Up/MCI Declaration/ Scene Management Priorities
MCI may have been declared prior to First in Unit arrival based on caller/dispatch
information
• Important that First in Units stage other responding units for assignment to allow for
proper scene size-up
Perform Outer and Inner Circle/Scene Survey for Potential Hazards- Address Immediate
Safety Concerns – Not Limited To -
• Wind Direction, Product Clouds, Placards, Unstable Vehicles, Leaking Fuels, Number
of Vehicles, Hybrid logos, Number of Distressed Civilians Visualized, Electrical
Hazards etc…
Determine number involved versus number of victims/patients
• Persons with No Injury/Illness should not be counted to Declare Level of MCI
• Proper scene size up is important in declaring the correct level of MCI Begin Triage using S.T.A.R.T. and Jump S.T.A.R.T. process
• Refer to MCI Triage F.O.G. including the S.T.A.R.T. / Jump S.T.A.R.T. algorithm
Declare Level of MCI with Type
• Level 1 (5-10 patients)
• Level 2 (11-20 patients)
• Level 3 (21-100 patients)
• Level 4 (101-1000 patients)
• Level 5 (over 1000 patients)
• Type- Traumatic, Chemical, Medical, Pediatric etc… Law Enforcement to secure area/establish perimeter
• Control scene to eliminate the potential of anybody involved leaving the scene
• Important they keep road clear for Entry and Exit of Transport Vehicles
Assignment Priorities
• Hazards, Triage, Treatment, Transport, Staging area, etc…
• Special Resources Available – Support 81, TCU, DRU Trailers Triage Leader/Supervisor priorities
• Follow MCI F.O.G. #3
• Ensure entire scene is checked for victims/patients
• Assign enough personnel(litter bearers) to efficiently move patients to
Treatment Area
• Initially, Coordinate with Law Enforcement per Command to secure
scene/preserve potential crime scene until liaison is assigned
• Backboards should be staged for easy access of liter bearers Treatment Area Leader/Supervisor priorities
• Follow MCI F.O.G.# 4
• Indentify Entry and Exit points within treatment area
• Treatment area leader/supervisor should secure entry point to direct the
movement of patients to the proper location within the treatment area based on
color categories for secondary triage/treatment/transport
• Refer to PBCFR ALS/BLS Protocols 2009 and Trauma Transport Criteria
Treatment and Transport area established close as safety will allow to Initial Triage
area
• Reduce patient movement distances Transport Area leader/supervisor priorities
• Follow MCI F.O.G.# 5
• Communication with hospitals
• Communication with Air Transport
• Transportation of patients by priority
• Needs documentation aid for patient tracking
• Assigned Transport Units need to leave extra Backboards and any extra supplies
requested
Future Enhancements to Manage MCI Responses
New Documentation procedures
• Possible use of hospital type wristbands with barcode stickers in initial triage
• Eliminate the use of ribbons in the initial triage
• New tag/report with bar code in conjunction with EPCR(tablet)
• New MCI bag/pouch in a safety vest style with updated MCI F.O.G.’s Enhancements to the process of color coding (Green, Yellow and Red)
• Green category to indicate Involved with no obvious injury/Illness
• Victims with any Injury/Illness will be either a Red or Yellow
• Pilot program in Bat 7
• Train the Trainer for future MCI Drills
Revised 01/01/2011
FIRST ARRIVING _ MCI FIELD OPERATIONS GUIDE 1
Perform Initial Size –Up and Establish Command
Begin “Triage”- Using START/ JUMP START process
Scene Declaration of MCI with TYPE of MCI - Traumatic, Chemical
Exposure, Medical, etc…
Level of MCI- Approximate number of victims/patients
Level 1 (5-10 victims/patients) Level
2 (11-20 victims/patients) Level 3
(21-100 victims/patients) Level 4
(101-1000 victims/patients) Level 5
(over 1000 victims/patients)
Involved/Minor Injury/Illness- relocate to safe area (Green Tagged) for
Secondary triage
Assign Incoming Units- Hazards, Triage, Treatment, Transport
Consider additional resource needs- Special Deployment Units
(DRU’s, TCU, Support 81, Tactical 34)
Establish Staging Area to accommodate the number of units responding
Revised 01/01/2011
COMMAND _ MCI FIELD OPERATIONS GUIDE 2
Establish Command in a Fixed and Visible Location
Radio designation “COMMAND”
Confirm/Declare Level of MCI- Approximate number of victims
Level 1 (5-10 victims/patients) Level
2 (11-20 victims/patients) Level 3
(21-100 victims/patients) Level 4
(101-1000 victims/patients) Level 5
(over 1000 victims/patients)
Set up Command Board/MCI work board
Assign Units to perform following functions
Immediate Hazards
Triage (Should be OIC of First Arriving Unit)
Treatment
Transport
Assign Staging Area Manager
Advise dispatch of the number of victims and their categories
Have a liaison from each involved agency at the command post
Large scale or complex MCI’s, designate a “MEDICAL BRANCH”
Revised 01/01/2011
TRIAGE_ _
MCI FIELD OPERATIONS GUIDE 3
Radio designation “TRIAGE”
Organize triage personnel to begin initial Triaging of Victims using
S.T.A.R.T and Jump S.T.A.R.T. System
Ensure all involved with no Injury/Illness stay on scene for incident
documentation
Ensure that all areas of the incident have been checked for victims and
all victims have been triaged
Ensure enough triage personnel are assigned for Litter Bearers for victim
movement to treatment area
Advise Command of the number of victims, their categories and need for
additional resources
Coordinate with Treatment the movement of victims based on priority
Request Law Enforcement to maintain security of Triage Area
When Triage is completed contact Command or Medical Branch for
further assignment of personnel
02/01/2011
Dece ased
(Black)
Involved minor injury/illness
(Needs secondary triage)
START TRIAGE
Minor
(Green)
Respirations
NO YES
Position Airway
NO YES (RED)
Immediate
(RED)
Radical Pulse ABSENT
or
Capillary Refill
Greater than 2 seconds
Radical Pulse PRESENT
or
Capillary Refill
Less than 2 seconds
Control Bleeding Mental Status
Immediate
(RED)
CANNOT
Follow Simple
Commands
CAN
Follow Simple
Commands
Immediate
(RED)
Delayed
(Yellow)
02/01/2011
Respirations
JUMP START TRIAGE
Involved minor injury/illness
(Needs secondary triage)
Minor
(Green)
Respirations
NO YES
Position Airway Over 15/min
Under 45/min
Under 15/min
Over 45/min
NO YES (RED)
Palpate
Peripheral Pulse
Immediate
(RED)
Peripheral Pulse
ABSENT
Peripheral Pulse
PRESENT
YES PULSE
Give 5
Ventilations
(15 seconds)
Via barrier
NO PULSE NO
Spontaneous
Respirations
Immediate
(RED)
Control Bleeding
Mental Status
Spontaneous
Respirations
YES NO
Deceased
(Black)
Unconscious or
Responds only
to Painful
Stimuli
Alert
or Alert to
Verbal Stimuli
Immediate
(RED)
Deceased
(Black)
Immediate
(RED)
Delayed
(Yellow)
Revised 01/01/2011
TREATMENT
MCI FIELD OPERATIONS GUIDE 4
Radio designation “TREATMENT”
Establish a centralized TREATMENT area with access to TRANSPORT area
capable of accommodating the number of victims encountered
Supervise on- site medical care, utilizing PBCFR ALS/BLS Protocols 2009
and Trauma Transport Criteria
Ensure enough personnel and equipment is available to effectively
treat all victims
Ensure contaminated patients have moved through the Decon Area
Coordinate with TRIAGE (Litter Bearers) for victim movement to
TREATMENT area
Red tagged victims should be transported immediately when transport
units are available
Establish communication with TRANSPORT to coordinate transport of
victims by priority
Update COMMAND or MEDICAL BRANCH of any changes in the victim
count or category
Revised 01/01/2011
TRANSPORT
MCI FIELD OPERATIONS GUIDE 5
Radio designation “TRANSPORT”
Assign a Documentation and Medical Communication Aide early
Ensure TRANSPORT area has efficient Entry and Exit for Transport Units
with easy access to TREATMENT area
Request Law Enforcement to secure TRANSPORT area
Establish early contact with Hospitals. Request designated Med Channel
for all Hospitals
Establish contact with Landing Zone for Air Transport needs
Coordinate the Transport of Victims by Priority and Hospital Capabilities
Record on TRANSPORT LOG victim ID number, destination Hospital
and transport unit number prior to victims leaving the scene
Advise destination Hospitals of number of victims, their Triage status
and mode of transportation to that facility
Request additional Units from COMMAND or MEDICAL BRANCH
Revised 01/01/2011
STAGING
MCI FIELD OPERATIONS GUIDE 6
Radio designation “STAGING”
Establish a safe location for the STAGING area and advise COMMAND
Organize units by type to allow for easy deployment when requested
Ensure personnel stay with their vehicle unless otherwise directed and
keep keys with the vehicle
Maintain a Unit Staging Log. Assign a Documentation Aide if available
Maintain a reserve of at least 2 Transport Units
Have knowledge of Incident location to advise best route to scene as
units are assigned
Contact COMMAND or OPERATIONS for additional resource needs