Mass Casualty

Incident
Preparation for
EMS

Mass Casualty Incident (MCI)

Definition
An incident which produces
multiple casualties such
that emergency services,
medical personnel and
referral systems within the
normal catchment area
cannot provide adequate
and timely response and
care without unacceptable
mortality and/or morbidity.

Chronology of a Disaster
Incident with multiple casualties reported to CCE
Central Dispatch

Police/Fire/EMS are dispatched by CCE.

Incident Command is established on scene
Size up identifies mass casualty event.
Incident Commander notifies Central Dispatch to activate the
Mass Casualty Plan
Incident Commander establishes staging area and requests
additional resources.

Flow Chart
Law
Law

911
911
Call
Call

Fire
Fire

EMS
EMS

Incident
Incident
Command
Command

Size-up
Size-up

Activate
Activate
Mass
Mass
Casualty
Casualty
Plan
Plan

Establish
Establish
Command
Command
Post
Post

Central
Central
Dispatch
Dispatch

Chronology (continued)

Central Dispatch Activates

Mass Casualty Plan
Central Dispatch notifies
area hospitals of plan
activation
Central Dispatch obtains
available EMS units from
adjacent locations and
directs them to staging
Central Dispatch notifies
County Coordinator of plan
activation
Central Dispatch requests
channel priority

Ambulance
Ambulance

Staging
Staging

EMS Ground
155.295 VHF

Helicopter
Helicopter
EMS
Ground
Establish
Establish
Command
Command
Post
Post

EMS
EMS
Command
Command

Central
Central
Dispatch
Dispatch

Transport
Transport

Alternate
Alternate

Activate
Activate
Hospital
Hospital
Emergency
Emergency
Plan
Plan

Alert
Alert
Nearest
Nearest
Hospital
Hospital

Victim
Victim
Collection
Collection
Area
Area

Triage
Triage

On-scene
On-scene
Treatment
Treatment

K
K

Medical
Medical
Control
Control

155.340 VHF
HERN
TX or 800Mghz

Notify
Notify
Area
Area
Hospitals
Hospitals

Notify
Notify
EMC
EMC

Activate
Activate
Hospital
Hospital
Emergency
Emergency
Plan
Plan

Activate
Activate
EOC
EOC

Determine
Determine
Capacity
Capacity
PIO
PIO
Emergency
Emergency
Declaration
Declaration

State
State
EOC
EOC

Tracking
Tracking

Additional
Resources

EMS RESPONSE
First arriving unit:
Senior EMS responder
assumes Command role

Put on EMS Command vest

Assist IC in locating staging
Establish victim collection area
Deploy Mass Casualty Kit
Strip rig for use at triage

EMS RESPONSE
First arriving Unit:
Second EMS responder
assigned role of Triage
Officer
- Put on Triage Officer Vest
- Triage and tag victims
- Use MFR or medically trained
volunteers

EMS RESPONSE
Second Arriving Unit:
Third EMS person assigned role of
transportation officer
- Put on Transportation Officer
vest
- Establish communications with
Medical Control Hospital via
HERN on 155.340
- Establish communications with
staging on EMS Ground 155.295
- Strip rig of gear for use at victim
collection point

EMS Response
Second arriving Unit:
Fourth EMS responder
assigned role of Treatment
Officer
- Put on Treatment Officer vest
- Supervise establishment of
victim collection area
- Supervise treatment of
victims in collection area

Victim Collection Point

Select secure area with
protection from further injury
Accessibility for transporting
ambulances
Use ground sheets from
mass casualty kit
Identify each Priority area
with colored flag

Ambulance
Ambulance

Staging
Staging

EMS Ground
155.295 VHF

Helicopter
Helicopter
EMS
Ground
Establish
Establish
Command
Command
Post
Post

EMS
EMS
Command
Command

Central
Central
Dispatch
Dispatch

Transport
Transport

Alternate
Alternate

Activate
Activate
Hospital
Hospital
Emergency
Emergency
Plan
Plan

Alert
Alert
Nearest
Nearest
Hospital
Hospital

Victim
Victim
Collection
Collection
Area
Area

Triage
Triage

On-scene
On-scene
Treatment
Treatment

K
K

Medical
Medical
Control
Control

155.340 VHF
HERN
TX or 800Mghz

Notify
Notify
Area
Area
Hospitals
Hospitals

Notify
Notify
EMC
EMC

Activate
Activate
Hospital
Hospital
Emergency
Emergency
Plan
Plan

Activate
Activate
EOC
EOC

Determine
Determine
Capacity
Capacity
PIO
PIO
Emergency
Emergency
Declaration
Declaration

State
State
EOC
EOC

Tracking
Tracking

Additional
Resources

Coordination
Treatment Officer advises
Transportation Officer when
victim ready for transport.
Staging sends ambulance and
load patient
Treatment Officer advises
Medical Control of patients
Priority
Chief complaint
Gender and age

Medical Control assigns

hospital destination

Coordination (continued)
Transportation Officer
verbally advises ambulance
of destination
Ambulance transports patient
observing radio silence
unless en-route emergency
Ambulance monitors HERN
on 155.340
Once patient delivered,
ambulance returns to Staging
for re-assignment

Flow Chart continued

Release
Release

NMH
NMH
Treatment
Treatment

Transfer
Transfer
To Other
To Other
Facility
Facility

CAH
CAH
Morgue
Morgue

CMH
CMH

Otsego
Otsego

Munson
Munson

Straits
Straits

Staff & Equipment

Mass Casualty Kit
- Request from nearest EMS
agency

Fire and first responders

Move patients to established
Collection Points

Arriving EMS units

Report to staging
Move up when directed by
Transportation Officer

Staging
Staging area established by
IC with advice from Medical
Command
CCE notified of Staging
Location
Staging and Transportation
communicate on freg.155.295
Assets and Resources are
dispersed

General Considerations
Agency Responses
Police
Fire
EMS

Command Responsibility
Initial Agency on Scene

Multiple Disciplines
Unified Command

Communication
Obstacles
Terrain
Different Frequencies
Overloaded channels

Hospital

Medical Control
Patient Routing
Transportation Officer
Staging Officer

Things to Remember
Maintain strict radio procedures
Enroute communications must
be limited to urgent matters only
Transport patients in adequate
vehicles
Transport patients with
adequate escort staff
Maintain a log of all Patients
(PCR)

IN REVIEW

Flow Chart
Law
Law

911
911
Call
Call

Fire
Fire

EMS
EMS

Incident
Incident
Command
Command

Size-up
Size-up

Activate
Activate
Mass
Mass
Casualty
Casualty
Plan
Plan

Establish
Establish
Command
Command
Post
Post

Central
Central
Dispatch
Dispatch

Ambulance
Ambulance

Staging
Staging

EMS Ground
155.295 VHF

Helicopter
Helicopter
EMS
Ground
Establish
Establish
Command
Command
Post
Post

EMS
EMS
Command
Command

Central
Central
Dispatch
Dispatch

Transport
Transport

Alternate
Alternate

Activate
Activate
Hospital
Hospital
Emergency
Emergency
Plan
Plan

Alert
Alert
Nearest
Nearest
Hospital
Hospital

Victim
Victim
Collection
Collection
Area
Area

Triage
Triage

On-scene
On-scene
Treatment
Treatment

K
K

Medical
Medical
Control
Control

155.340 VHF
HERN
TX or 800Mghz

Notify
Notify
Area
Area
Hospitals
Hospitals

Notify
Notify
EMC
EMC

Activate
Activate
Hospital
Hospital
Emergency
Emergency
Plan
Plan

Activate
Activate
EOC
EOC

Determine
Determine
Capacity
Capacity
PIO
PIO
Emergency
Emergency
Declaration
Declaration

State
State
EOC
EOC

Tracking
Tracking

Additional
Resources

Flow Chart continued

Release
Release

NMH
NMH
Treatment
Treatment

Transfer
Transfer
To Other
To Other
Facility
Facility

CAH
CAH
Morgue
Morgue

CMH
CMH

Otsego
Otsego

Munson
Munson

Straits
Straits

QUESTIONS?