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Objective

This plan is intended to outline the response of ������ɫ resources in the event of a mass casualty incident (MCI).  This plan will be implemented in conjunction with all Broome County emergency response plans.  The purpose of this plan is to:

• • Provide a methodology by which emergency medical care and transportation can be provided to the victims of a natural or man-made (whether intentional or unintentional) incident. 
  • To provide a method to identify those patients most in need of emergency medical care at an MCI, and to assure that those patients are the first to receive care and transportation. 
  • The coordinate manpower, equipment, vehicles, and other resources in response to an MCI. 
  • To describe the lines of command and information flow (communications), so that essential information is quickly obtained and disseminated as needed for effective incident management. 
  • To minimize confusion and error. 
  • To provide a uniform response to an MCI
  • To serve as a guide for organization and training of EMS personnel for response to future MCIs. 

Definitions

Closed Incident

An incident at which victims are confined in an enclosed area, and thus are or may not be readily accessible to rescuers. 

Contained Incident

An incident in which the injury-causing mechanism or factors have ceased, thus rendering additional casualties unlikely. 

Continuing Incident

An incident in which the injury-causing mechanism or factors continue or may be continuing in effect, thus making additional casualties likely, or at least possible. 

Event

Any planned, non-emergency activity for which Medical Incident Management/NIMS will be utilized (e.g.: parades, concerts, sporting events) 

Emergency

Any unplanned occurrence, natural or human-caused, that requires an emergency response to protect life or property. 

First-In Report (or Size-Up)

The initial report on the situation and conditions assessed and observed by the first-arriving EMS unit, which must be transmitted to the Communications Center via the Incident Command Post. 

Incident

An occurrence or event, natural or human-caused that requires and emergency response to protect life or property. Incidents can, for example, include major disasters, emergencies, terrorist attacks, terrorist threats, wild land and urban fires, floods, hazardous materials spills, nuclear accidents, aircraft accidents, earthquakes, hurricanes, tornadoes, public health and medical emergencies, and other occurrences requiring an emergency response. 

Incident Command

The entity in overall command of all personnel, functions, and resources at an incident scene, and responsible for overall incident management.

Major Disaster

As defined under the Robert T. Stafford Disaster Relief and Emergency Assistance Act (42 U.S.C. 5122), a major disaster is any natural catastrophe (including any hurricane, water, tidal wave, tsunami, earthquake, volcanic eruption, landslide, mudslide, snowstorm, or drought) or, regardless of cause, any fire, flood, or explosion in any part of the United States, which in the determination of the President causes damage of sufficient severity and magnitude to warrant major disaster assistance under this Act to supplement the efforts and available resources of States, tribes, local governments, and disaster relief organizations in alleviating the damage, loss, hardship, or suffering caused thereby. 

Mass Casualty Incident (MCI)

A mass casualty incident (MCI) is any event / incident in which emergency medical services resources, such as personnel and/or equipment, are overwhelmed by the number and/or severity of casualties.

Open Incident

An incident at which victims are spread out over an open area, and thus are readily-accessible to rescuers. 

Primary (or Initial) Triage

The act of quickly sorting victims into categories of severity of injury, using the START Triage System, in order to facilitate their treatment and transport from the scene in the order indicated by medical necessity. 

Secondary Triage

The act of re-evaluating the triage category given to patients during Primary Triage, commonly done after the patient has been removed to the Treatment Area, where conditions are more conducive to an accurate evaluation, and/or the patient’s condition may have changed. 

Single Command

A single individual acting as the Incident Commander.

START Triage

Simple Triage and Rapid Treatment system used in MCIs (see attached) 

Unified Command

Responding agencies and/or jurisdictions with responsibility for the incident share the incident command role. 

Rationale

Early Implementation and utilization of the Incident Command System (ICS), specifically the “MEDICAL BRANCH”, improves a patient’s chances for recovery and survival through the establishment of a well-organized, clearly defined unified incident management structure that insures timely and optimal clinical care decision making and utilization of emergency resources. Early, patient-specific clinical notification to hospitals Emergency Department Physicians/Charge Nurse by certified EMS providers will optimize the hospitals opportunity to prepare for each inbound patient. The goal is to minimize out-of-hospital time while optimizing pre-hospital care and hospital preparedness. 

Authority

This plan mirrors the Broome County Emergency Medical Services System Mass Casualty Incident Response Plan, a REMAC-approved protocol that is considered a ‘physician order’ and will be followed by all EMS providers and agencies operating within Broome County.

Procedure

Upon arrival of the “First-due” EMS Unit, the EMS provider in charge will report to or establish an incident command post (if not already established) and implement this protocol by establishing a unified Command Post or the “Medical Branch” as soon as it is determined that this protocol applies. This EMS provider shall assume the radio designation of “[Incident Name] Command Post or “Medical Branch Director” (an orderly transition of Medical Location Branch Leadership may occur as additional EMS units, agencies, leadership, and/or personnel arrive). 

Actions: “First Due EMS Unit”

1. The “first-due EMS unit” due to arrive on-scene will utilize all available information (e.g. dispatch, law enforcement, bystanders, etc.) to request the “Stand-by” or RESPONSE OF ADDITIONAL SPECIFIC EMS RESOURCES at the earliest indication of need (e.g. helicopter stand-by or launch, additional EMS personnel, ambulances, ALS response, fire/rescue, EMS Coordinator, agency management/ leadership, law enforcement, dive team, search and rescue, etc.). If a Command Post has already been established, the “first due” EMS unit will request these resources through the Command Post. 
2. Assure or establish scene safety in conjunction with the on-scene command post (Fire and/or Law Command Post Leaders) (reassessment of scene safety should be an ongoing effort by all public safety personnel and leaders). If the Command Post does not communicate “Scene Safe” to all responders, then a good deal of duplication of scene safety surveys may occur. 
3. As the First-Due EMS unit arrives, broadcast a size-up if no command post has been established to include what you can see or what you are told (e.g. number of vehicles, actual or potential hazards, number of possible patients visible, description of structure or scene, nature/severity of injuries, etc.) Establish a Command Post if one does not exist. 

Requesting Resources

Request for additional resources shall be made through the Incident Command Post.  The Broome County Office of Emergency Services shall be the lead agency for identifying and assigning all non-SUNY related resources.

Hospital Contact

The Medical Branch Director or designee shall:

• Establish and maintain early and frequent contact with destination hospitals. He/she shall develop a specific single contact at each hospital (Command Physician or Charge RN) in order to maintain consistency and accuracy of information 
• Make consideration for a continuous, open-line of communication with hospital(s). This may be accomplished through the Broome County 911 Center. 
• Provide the Hospital Medical Command Physician with event details, number of suspected patients, nature of injuries/illness, contamination, special needs, etc. 
• Ascertain Emergency Department capacity for each hospital utilizing the START Triage system – see attached (# red, # yellow, # green they can/will accept). (i.e.( “We have ___ red, ___ yellow, ___ green, and ___ black patients on scene at __________________and given the scope of this incident, how many ___ red, ___ yellow, green patients will you accept? Our likely ETA(s) will be ________.” 
• Provide updates as they become available. 
• Consider appointment of a dedicated “Hospital Communications” EMS provider to maintain contact with hospitals and provide updates as the situation progresses. 
• Consider notification to out of area hospitals for larger incidents (Consult with EMS Coordinator Staff to assist you). 
• Consider direct helicopter MedEvac of major burn injuries in an MCI situation directly to regional burn center. Consult with Medical Command Physician at trauma center. 

Leadership Positions within Medical Branch

Working and communicating effectively within the Unified Incident Command Post Structure, assign additional EMS responders to appropriate roles and establish EMS organizational units as necessary. 

• Medical Branch Director (consider “Medical Communications Coordinator”) 
• Triage Unit/Triage Unit Leader 
• Treatment Unit/Treatment Unit Leader 
• Medical/Ambulance Transportation Unit/Transportation Unit Leader 
• Medical Supply Coordinator 
• Medical Group Supervisor (if needed) (What’s he do?) 
• IMAT (Incident Management Assistance Team) 
• County EMS Coordinator Roles: County EMS Coordinators will support the “Medical Branch Director” and Command Post as directed. They may perform the following functions as assigned: 
  • May be delegated a position within the Command Post or Leadership Staff 
  • Poll hospitals for capacity and/or establish regular or continuous communications with hospitals 
  • Record incident /command post data for command post 
  • Issue radios or assist with medical communication functions 
  • Support/Consultant to Medical Branch Director 
  • Arrange for Physician response to scene. 
  • Other duties as assigned by Medical Branch Director or Command post (within scope of practice) 

MCI Medical Branch Unit Structure

START Triage Algorithm

• Green = Walking Wounded
• Yellow = Delayed Transportation
• Red = Immediate Transportation
• Black = Dead / No Ambulance Transportation