Week 6 Assignment – MCI/Incident

Command
Scenario Details
You and your partner are just leaving Bowmanville Hospital and returning to your base in South Oshawa
when you get a call to respond to a multiple vehicle collision on the 401. You are currently westbound on
Baseline Rd west of Liberty St, turning left to access the westbound 401 on-ramp. It is a sunny cold afternoon
in February.

“3117 call Oshawa…Respond Code 4 to the westbound lanes of the 401, there have been several reports of a
multiple vehicle collision between the 418 and Courtice Rd. Two tractor trailers and several cars are
involved”. You flip on your lights and siren, get on the 401 and a minute later notice the vehicles slowing
down in all 3 lanes as you approach Holt Rd. You decide to take the left shoulder lane and book 10-7 at the
scene at 1430h, 3 minutes after receiving the call. Vehicles are trying to pass the accident scene ahead of
you. You maneuver your vehicle and end up parking on the east side of the accident protecting the scene as
best as you can. You leave your emergency lights flashing. From where you have parked you notice a couple
of jackknifed tractor trailers ahead, with several vehicles crashed into them. It is hard to determine the
number of vehicles that are involved at this point. You and your partner determine this to be an MCI, and
decide that you as the most senior paramedic, will establish command, and your partner will act as triage
officer. You are grateful to hear sirens approaching the scene as you pick up the mike and call CACC with a
quick update. ①

Your partner fished out the MCI kit and donned his PPE and Triage Officer vest, and hands you the Incident
Command vest. Together you decide that any green patients will be staged to the back of your ambulance.
You both decide to take a quick perimeter to survey the scene, observe for any hazards and get an idea of
how many vehicles and patients are involved. You suspect at least one or two patients will need extrication
from the extent of the damage to their vehicles. You notice there are a few bystanders attending to patients
in their cars and advise them that help is on the way. Your partner begins triaging patients as you head back
to the vehicle wishing you had taken the day off. Two police cruisers have arrived and have begun to control
traffic around the scene. The first 2 fire vehicles have also arrived positioning their trucks to protect the
scene, and a fire captain comes to ask what you need. You tell them you may need help with extrication and
ask that a couple of FFs find and help your partner who is triaging. Your mind takes you back to that MCI day
in paramedic school as you estimate at least a dozen patients involved, start to think of access and egress,
and wonder from which direction the responding vehicles will come from. You are not terribly familiar with
the area, so you get out your phone and Google map your location to help determine the best access and
egress. You are also considering whether the surrounding hospitals can accommodate all the patients, and
how far away the hospitals are. Will I need a helicopter, what other resources might I need, how does that
FTT standard go again? CACC had switched you to a tactical channel after your first transmission, and now
you hear, “3117 call Oshawa, do you have an update?” ②

CACC tells you your first vehicle is enroute from the Courtice Station and they have an ETA of 5 minutes.
They are trying to clear a vehicle from Ajax Hospital, one from Oshawa and one from Bowmanville. They will
see if the helicopter is available, try to mobilize other resources and call the surrounding hospitals to see how
many patients they can handle. In the meantime, your very efficient partner has completed his triage and
comes back to you with a report. Here is an overview of the scene, with the locations of the vehicles and
each patient:

Below is a summary of the patients that your partner has triaged:

Patients Triage Transport

Tag Order
Patient #1: 45 yo male driver of brown tractor trailer. He is
conscious and alert, was getting out of his truck when your partner
Green 7
arrived. He is complaining of stiffness in his neck and chest from
hitting the steering wheel when his vehicle was struck
Patient #2: middle aged male driver of black tractor trailer.
Unresponsive, VSA. Sustained significant head and neck trauma. No Black
breathing after attempts to open airway.
Patient #3: elderly male driver of red mid-sized sedan.
Grey
Unresponsive, stertorous breathing, bleeding from head, trapped 5
Red
behind steering wheel.
Patient #4 : elderly female passenger of red mid-sized sedan,
semiconscious, shallow respirations, weak peripheral pulses, obvious
Red 3  LHO
extremity trauma to right wrist and legs, which appear trapped
under the dash
Patient #5 : 30 yo male driver of small purple car with significant
damage to passenger side of car. Conscious but slightly confused,
1  St.
having difficulty breathing and complaining of severe right sided Red
Michael’s
chest pain. A piece of window trim is impaled in his right shoulder.
Bleeding is controlled. Peripheral pulses present
Patient #6: 18 yo female driver of light blue car, hyperventilating, Yellow
crying, but conscious and alert, swerved into ditch to avoid accident. → 10
Friend in car was instructed to coach breathing Green
Patient #7: 18 yo female passenger in light blue car, conscious,
alert, uninjured but scared. Green 12

Patient #8: 44 yo female driver of green sedan, bruising to forehead,

conscious and confused, but obeys commands, obvious open fracture
Yellow 6
of right lower leg, bleed is controlled with pressure. Peripheral
pulses present.
Patient #9: 32 yo female driver of yellow sedan, conscious and alert,
complaining of soreness both wrists, and in the centre of her chest. Green 11
No difficulty breathing, strong peripheral pulses.
Patient #10: 29 year old male driver of blue van, conscious and
alert, complaining of soreness in his neck. No difficulty breathing, Green 9
good peripheral pulses. Anxious about his son.
Patient #11: 29 year old female passenger of blue van, conscious
and alert, complaining of headache, with hematoma to right side of Green 8
head. No difficulty breathing, strong peripheral pulses.
Patient #12: 5 yo male back seat passenger in blue van.
2
Unresponsive with head and chest injuries. Slow respirations, Red
Sunnybrook
peripheral pulses present.
Patient #13: 58 yo male driver of grey sedan, conscious and alert
with strong peripheral pulses, states he is uninjured, but is Red 4  LHO
complaining of chest pains and feeling short of breath.
#14 & 15: middle aged male driver of orange vehicle and his wife,
uninjured and not involved in accident. Pulled over as they were
witness to the accident.
#16 & #17: Bystanders from pink cars stopped on the shoulder to
help with first aid.
Considerations:
 Patient #7 refuses transport, coaching friend with breathing.
 20 minutes later upon reassessment, patient #6 has calmed her breathing and
refuses treatment.
  Patient #10 refuses treatment but wants to go to hospital with his son #12 and
wife #11.
 Patient #1 refuses transport.

After looking over the list of patients that your partner has triaged you realize you have to make some
decisions on where to send your patients, and who should be transported out first (your partner thought
Patient #12 and Patient #5 should be transported first but is leaving the rest up to you). You are also trying to
determine which would be the most appropriate hospital for each patient and consider FTT as well. So
much to think about! As you hear the siren sound of your first responding vehicle, you hear CACC calling you
again. “3117 call Oshawa…. The helicopter (799) is available, and they would like an update on their patient
③.

Dispatch continues, “10-4, 3117. Once 799 accepts the call, they can be at your location in 12 minutes…
There are also 3 more vehicles enroute… LHO can take 3 patients, LHAP 2, LHB - minor injuries only… Vehicle
3500 is just going 10-7 at your location. Can you pass along some information regarding access and egress?
They are approaching from the east. By the way, 799 has accepted your call and is in the air…” ④

Shortly afterward you hear the siren from Courtice vehicle 3500, and you notice they park exactly where you
indicated. One of the crew members approaches you and asks which patient you would like them to take,
and which hospital to take them to. You tell them… ⑤.

Your partner calls you on the radio to tell you the FD is working on extricating patient #4, and they expect to
have her free within the next 10 minutes. Your partner says he needs a stretcher and backboard for
extrication so he is sending a FF to come and get the one from your vehicle. Fire has their O2 on that patient.
Your partner says he has placed his O2 on patient #12 and asks when the next vehicles are arriving. You
respond to your partner…⑥

As you hear sirens approaching, CACC calls with the message that Oshawa 3123 and Ajax 3103 are pulling up
to the scene. They would like direction as to where to park and which patient to attend to. In your next
transmission to CACC, you say…⑦

Air ambulance is in the air with an ETA of 8 minutes and is requesting a landing area be identified, and an
update on their patient. After consulting with the police on traffic duty and your partner, you tell 799…⑧

Courtice vehicle 3500 has packaged their patient and is ready to depart to the receiving hospital. You are
happy to cross the first patient off your list.

“3117 call Oshawa”. Dispatch is calling you and says they would like to give the hospitals a heads up on how
many patients they can expect. You take a quick look at your triage sheet and give an update…⑨

You hear and see the helicopter approaching and as you watch it land, you marvel at how cool that thing
looks. When it is safe to approach, your partner greets the crew and directs them to the patient. Yay, now
the second patient will be soon ready to leave the scene.

Your partner radios you again and says he has reassessed the grey patient #6, and found that he is still
breathing. Now that there are more resources, he would like to re-triage this patient up to a red. Your
partner has place O2 on this patient. The FD is working on extricating him.

Dispatch calls you and advises that Bowmanville 3152 is pulling up to the scene, then you hear them go 10-7.
You call 3152 on the tac channel to advise them of their patient…. “3152 call 3117…⑩

You can see that the 799 crew has their patient on a stretcher and is loading into the chopper. Vehicles 3123
and 3103 are both packaging their patients and are preparing to leave the scene. They come to you to check
out and depart as soon as 799 has cleared. Yes! Three more patients have left the scene, and you check
them off your triage sheet. You take a quick look and see who you have left to transport off the scene.

Whitby vehicle 3164 arrives at the scene, approaches you and asks where you need them to go. You respond
with ⑪.

Dispatch advises that vehicle 3500 has cleared the hospital and is returning to the scene. They should be
arriving in 5 minutes. Your partner comes to check in with you and says 4 of the green patients are refusing
transport and there are 2 green patients remaining. Your partner has moved the green patients to the back of
the vehicle. 3500 arrives, and you direct them to take the 2 remaining patients to LHB.

Taking a big sigh of relief, you and your partner decide to tie up the loose ends of the call. You have been on
the scene for over an hour and a half. Your partner grabs the computer and begins to sign of the refusals
while you go to assess patient #2 for a termination of resuscitation. You notice the patient is unresponsive,
pulseless, not breathing, cyanotic and cool to the touch. He has head, face and neck trauma, his chest is
pinned by the steering wheel. You are able to get pads on and determine him to be asystolic. At this point
you call CACC for a patch to the BHP to request TOR. ⑫

Just when you think this party is over, Patient #1 who initially refused transport tells you he is getting really
stiff and tight in his neck and chest and would like to get checked out at the hospital. The patient jumps in
the back of your truck with your partner. You make one more sweep of the scene and let police and fire
know you will be on your way. As you are leaving the scene with the last patient you make one last
transmission to dispatch⑬ before arriving at the hospital. You then look forward to spending the rest of
your shift doing paperwork. 😊

Considerations:
 Who are the most critical patients, and what is the most appropriate destination
for each of them?
 Do any of your patients meet FTT standard? You figure from where you are it
is about a 30 minute drive to Sunnybrook.
 On reassessment, the triage status of patients may change