MULTI-

CASUALTY
INCIDENTS
GLENDALE FIRE DEPARTMENT
ANNUAL TRAINING
MARIANNE NEWBY
COURSE OBJECTIVES
• Review overall ICS for MCI
• Back to basics
• Some new things from DHS
• Lessons learned from past incidents
• Multiple jurisdictions
• Separate triage / treatment / transportation areas
• MCI Task Force
• Reference:
• FOG Manual: ICS 420-1
ROLE OF THE FIRST-
IN UNIT
On scene size up:
•What do I have ?
•What do I need ?
•What am I doing ?
•Who is in command ?
Assign crew to triage
 Incident Commander
Safety
P a s a d e n a F ir e D e p a r t me n t
Air Operations
Mu l t i-c a s u a l t y In c id e n t Operations
Branch Director
O r g a n iz a t io n a l C h a r t
Multi-Casualty Branch Director Air Ambulance
Staging

Number of Patients
Immediate Delayed Minor Morgue Patient Transportation Group
Medical Group Supervisor
Supervisor
Recorder
Triage Criterion (keys)
Minor 1. Walking wounded Medical Comm.
Coordinator
Delayed 1. Resps under 30/min Medical Supply
2. Cap. Refill under 2 secs. or radial pulse Coordinator
3. Conscious and coherent

Immediate 1. Resps. Over 30/min Air Ambulance Coordinator

2. Cap. Refill over 2 secs. or no radial pulse
3. Altered LOC
Priorities Triage Unit
1. Incident Commander
Initial Medical Communications Leader Treatment Unit Ground Ambulance
Triage Personnel Coordinator
Leader
2. Triage Unit Leader
3. Treatment Unit Leader
4. Patient Trans. Group Supervisor
Ground Ambulance Coordinator Triage Personnel Treatment Dispatch
Staging Area Manager Manager
Recorder
5. Medical Supply Coordinator
6. Treatment Dispatch Manager
Immediate Treatment Manager Morgue Manager Immediate Treatment
Delayed Treatment Manager Manager
Minor Treatment Manager
7. Medical Group Supervisor
8. Med Comm. Coordinator (former I.C.)
Delayed Treatment
Resource Guide Manager
Victims PM Units Eng / Trk Amb.
5-10 2-3 2-4 3-5
11-15 3 5 5-7
15-20 3 6 7-10
Minor Treatment
21-30 4 6-8 10-12 Manager
31-50 5-6 8 12-15
51+ 6+ 8+ 15+
 I.C.
P a s a d e n a F ir e D e p a r t me n t – M.C .I. C o mma n d W o r k s h e e t
Safety
Air Ops. Branch
In c id e n t In f o r ma t io n Operations Director
Incident Name:
Air Ambulance
Location: Multi-Casualty Staging
Branch Director
Cross Street:
Base Loc:
Helispot: Patient
Time: Medical Transportation
Group Group
Thom. Bro. Map: Supervisor
Supervisor Recorder

F ir e R e s o u r c e s Medical
Unit O/S Assignment Communications
Medical Coordinator
Supply
Coordinator
Air
Ambulance
Coordinator

Triage
Unit Ground
Leader Treatment
Unit Ambulance
Leader Coordinator

Size Up Situation
Report on Conditions
Triage Treatment Make Assignments
Personnel Dispatch Location and Objectives
Manager
Staging Location
Ambulances
Alert MAC / HEAR
Morgue Immediate H.E.R.T. Teams
Manager Treatment Medical Caches
Manager
Staff Activation
Air Squads
Organizational Special Equipment
Lines Delayed Mutual Aid
Treatment
Lighting
Manager
Communication Separate Tacs
Lines Evacuation Center
Buses
Minor P.I.O. / Code 20
Communication Treatment
Traffic Control
Triangle Manager
Utility Companies
Red Cross Notification
INITIAL RESPONSE
RADIO FREQUENCIES
REQUIRED
Tactical channel
Command channel

Direct channel- Ask for an additional tactical channel

•Communication triangle
• Treatment dispatch manager
• Medical communications coordinator
• Ground ambulance coordinator
INITIAL RESPONSE
Prioritize your needs and assign resources:
• First priority
• Incident Commander (officer)
• Triage personnel
• Second priority
• Triage Unit Leader (officer)
• next priority
• Med Com
• Treatment Unit Leader (officer)
• next priority
• Transportation Group Supervisor ( officer)
REINFORCED
RESPONSE
Priorities (continued)
• Next priority
• Medical Supply Coordinator
• Treatment Dispatch Manager ( PM or Captain)
• Treatment Area Managers ( PM’s)
• Medical Group Supervisor (Chief or Captain that was previous
IC)
INCIDENT
COMMANDER
Who becomes I.C.?
• First in company officer
• First in battalion chief
The incident commander remains in charge until relieved
TRIAGE UNIT LEADER
Responsibilities
• Develop organization large enough to handle assignment
• Implement triage process
• Coordinate movement of patients from triage to treatment
areas
• Maintain security of triage area
• Establish morgue
TRIAGE PERSONNEL
Supervised by triage unit leader
• Triage and tag injured patients
• Direct movement of patients to proper treatment area
• Provide appropriate medical treatment to patients prior to
movement as incident indicates
TRIAGE PROCESS
FIRST
Verbalize Reassurance and ask: “Whoever can walk please
do so now. Help has arrived” Direct them to a specific
location.

(By asking this you’ve immediately triaged a group of MINOR

patients)
NEXT…. Move from Patient to Patient
Beginning with the person closest to you
(to perform a < 1-minute triage)

Is the person Breathing?

(they’re either breathing or Not)

Yes? No?
How Fast? Re-position Airway
R= RESPIRATIONS

Airway Repositioned

Spontaneous
Still Apneic
Breathing

This Person is This Person is

IMMEDIATE DECEASED

Move on to
Other Victims
P= PERFUSION

You have a BREATHING patient

With respirations UNDER 30 / min

Is the Radial Pulse Is the Radial Pulse

PRESENT? ABSENT?

OR is CAP REFILL
AND CAP REFILL > 2 SEC
< 2 SEC

Control Bleeding Now

Now Eval
MENTAL STATUS

This Patient is
IMMEDIATE
M= MENTAL STATUS

Your Patient is
Breathing, Has a Pulse
Cap refill is < 2 sec

What is their
MENTAL STATUS?

Can’t Follow Follows

SIMPLE COMMANDS? SIMPLE COMMANDS!

This Patient is This patient is

IMMEDIATE! DELAYED!
TRIAGE
TREATMENT UNIT
LEADER
Responsibilities
• Manage all activities within area
• Develop organization large enough to handle
assignment
• Plan layout
• Coordinate patient transportation needs
• Assign H.E.R.T. Teams as needed
• Provide guidance to subordinates
• Immediate, delayed, minor area managers
TRANSPORT PRIORITY
GUIDELINES
TRANSPORTATION
GROUP SUPERVISOR (1
OF 3)
Responsibilities: This may be same as ground ambulance
coordinator depending on size of incident ( officer)
• Establish the following positions:
• Ground ambulance coordinator
• Staging officer
• Recorder
• Only priority that splits the crew
• Establish ambulance staging area
• Request additional ambulances as needed
TRANSPORTATION
GROUP SUPERVISOR (2
OF 3)
Responsibilities (continued):
• Establish a loading zone
• Control all ambulance loading activities and movement
• Establish communications with ground ambulance
coordinator and medical communication coordinator
TRANSPORTATION
GROUP SUPERVISOR (3
OF 3)
Direct the transportation of patients as
indicated by medical Group supervisior
Assure all patient information and
destinations are recorded
GROUND AMBULANCE
COORDINATOR
 Responsibilities:
◦ Establish ambulance
staging area
◦ Determine route of
travel
◦ Communicate with
med. Comm. And
treatment dispatch
manager
◦ Maintain records as
required
PRIVATE
AMBULANCE
RESOURCES

Some terms you need to know:

• Exclusive Operating Area (EOA)
• Private ambulance companies contracting with DHS to
provide emergency patient transport within seven
established areas
• Where this transport is not provided by the jurisdictional
911 provider
• Fire Operational Area Coordinator (FOAC)
• LA County Fire Department
STAGING OFFICER
Establish appropriate staging area for
resources
Maintain communications with I.C. Or
operations section chief
Maintain records as required
Request additional resources if
appropriate
RECORDER

Responsibilities
• Document all patient
information and
destination
• Complete multi-
casualty recorder
worksheet (pt. Info)
CHIEF OFFICER
ARRIVAL
Face to face briefing
Transfer of command
Establish command post
Name incident (if not established)
Former incident commander becomes medical
group supervisor or remains with IC through the
remainder of incident.
MED COM
Establish communication with MAC via the Hear Radio
This should be a medic from the initial response.
First in Medic should contact MAC .
MED COM
Size-up
• Advise of working multi-casualty incident
• Location of incident
• State “this is not a drill”
• Approximate number of patients
• Request
• Hospital availability
• Standing orders ( 806)
• HERT teams if necessary
• 1:1 staffing
May break contact with MAC and recontact
Large incidents may require additional personnel for recording
COMMUNICATION
TRIANGLE
Used to streamline patient movement only
Separate frequency
Key players:
• Medical communication coordinator
• Treatment dispatch manager
• Ground ambulance coordinator

Back to MedCom
Back to ICS Chart
MEDICAL SUPPLY
COORDINATOR
Acquire, distribute and maintain medical equipment
Request additional supplies if required (medical cache)
Distribute supplies to treatment and triage
Maintain documentation
TREATMENT
DISPATCH MANAGER
Establish communications with:
• Immediate, delayed and minor area managers
• Medical communications coordinator
• Ground ambulance coordinator
Verify patient priority
Coordinate transportation of patients to loading zone
AREA TREATMENT
MANAGERS

Immediate, delayed
and minor
• Request medical
teams as necessary
• Treatment of patients
in areas
• Prioritize transportation
• Notify treatment
dispatch manager of
patient readiness
Managing Large Scale Incidents
 Medical Comm.
Coordinator
(1 Officer - Former I.C.)

Deputy Med Comm. Deputy Med Comm. Deputy Med Comm. Deputy Med Comm.
(Division A) (Division B) (Division C) (Division D)

Treatment Unit Leader Treatment Unit Leader Treatment Unit Leader Treatment Unit Leader
(1 Officer) (1 Officer) (1 Officer) (1 Officer)

Treatment Dispatch Treatment Dispatch Treatment Dispatch Treatment Dispatch

Manager Manager Manager Manager
(1 Officer) (1 Officer) (1 Officer) (1 Officer)

Immediate Treatment Immediate Treatment Immediate Treatment Immediate Treatment

Manager Manager Manager Manager
Imm. Tx Area Imm. Tx Area Imm. Tx Area Imm. Tx Area
(1 EMT/Officer) (2 PM, 1 Company) (1 EMT/Officer) (2 PM, 1 Company) (1 EMT/Officer) (2 PM, 1 Company) (1 EMT/Officer) (2 PM, 1 Company)

Delayed Treatment Delayed Treatment Delayed Treatment Delayed Treatment

Manager Manager Manager Manager
Delayed Tx Area Delayed Tx Area Delayed Tx Area Delayed Tx Area
(1 EMT/Officer) (2 PM, 1 Company) (1 EMT/Officer) (2 PM, 1 Company) (1 EMT/Officer) (2 PM, 1 Company) (1 EMT/Officer) (2 PM, 1 Company)

Minor Treatment Minor Treatment Minor Treatment Minor Treatment

Manager Manager Manager Manager
Minor Tx Area Minor Tx Area Minor Tx Area Minor Tx Area
(1 EMT/Officer) (2 PM, 1 Company) (1 EMT/Officer) (2 PM, 1 Company) (1 EMT/Officer) (2 PM, 1 Company) (1 EMT/Officer) (2 PM, 1 Company)
 Treatment Unit Leader
(1 Officer)

Treatment Dispatch
Manager
(1 Officer) Deputy Med Comm.
(Division C)
Immediate Treatment
Manager
Imm. Tx Area
Deputy Med Comm.
(1 EMT/Officer) (2 PM, 1 Company)
(Division D)
Delayed Treatment
Manager
(1 EMT/Officer)
Delayed Tx Area
(2 PM, 1 Company)
Treatment Unit Leader
(1 Officer)
Minor Treatment
Manager Treatment Dispatch
(1 EMT/Officer)
Minor Tx Area
(2 PM, 1 Company)
Manager
(1 Officer)

Immediate Treatment
Manager
Imm. Tx Area
(1 EMT/Officer) (2 PM, 1 Company)

Delayed Treatment
Manager
Treatment Unit Leader (1 EMT/Officer)
Delayed Tx Area
(2 PM, 1 Company)
(1 Officer)
Minor Treatment
Treatment Dispatch Manager
Manager (1 EMT/Officer)
Minor Tx Area
(2 PM, 1 Company)
(1 Officer)
Deputy Med Comm.
Immediate Treatment (Division B)
Manager
Imm. Tx Area
(1 EMT/Officer) (2 PM, 1 Company)

Delayed Treatment
Manager
Delayed Tx Area
(1 EMT/Officer) (2 PM, 1 Company)

Minor Treatment
Manager
Minor Tx Area
(1 EMT/Officer) (2 PM, 1 Company)

Treatment Unit Leader

(1 Officer)

Treatment Dispatch
Manager Deputy Med Comm.
(1 Officer)
(Division A)
Immediate Treatment
Manager
Imm. Tx Area
(1 EMT/Officer) (2 PM, 1 Company)

Delayed Treatment
Manager
Delayed Tx Area
(1 EMT/Officer) (2 PM, 1 Company)

Minor Treatment
Manager
Minor Tx Area
(1 EMT/Officer) (2 PM, 1 Company)