EMS COMMAND

What we imagine is order is merely the prevailing form of

chaos.

Kerry Thornley, Principia Discordia, 5th edition

PROCEDURE At all medical incidents where Command has been

established, the Incident Commander will implement the necessary components of the EMS Command structure to ensure firefighter and public safety.

Additionally, he/she will effectively mitigate the incident while maintaining strict accountability for all patients and their personal belongings.

EMS COMMAND IMPLEMENTATION

Implement EMS Command early. Develop the system in a logical order. Provide tactical objectives to subordinate

positions when you assign them. Determine if your incident requires the

expanded EMS ICS structure to manage it. Think about geography (Scene set-up). Use visual indicators to assist responders and

the public.

TERMINOLOGY Mass-Casualty Incident – Any incident with

multiple patients that will significantly impact local resources including area hospitals.

1st Alarm Medical – Through our established Automatic Aid Agreement, a 1st Alarm Medical will result in the response of 2 Engines, 2 Rescues, and 1 Command Officer. (No such thing as a 2nd Alarm Medical)

EM’s System – The Medical Communications Officer will activate the EM’s system through Summit Regional. This system will indicate the availability and status of all regional facilities. (Flagstaff, Phoenix, Tucson, etc….)

ROLES AND RESPONSIBILITIES

COMMAND

Command : Establishes an effective command structure. Manages Communications. Utilize EMS Command tools to assist in this

process. EMS Tactical Worksheet Command Checklist

MEDICAL

Medical : Reports to Command . Organizes incoming resources to mitigate large

EMS incidents.

Medical Branch Director Checklist

TRIAGE Triage :

Reports to Medical/Command. Recon incident area. Is responsible for sorting and prioritizing all

casualties.

Triage Unit Leader Checklist

EXAMPLE:“Medical , Triage Team 1 triaged 15

patients, 7-Immediate, 7-Delayed, and 1-Dead or Dying”

Triage Team

Medical Branch

Incident Command

Triage Team, reports findings up the Chain of Command

TREATMENTTREATMENT

TreatmentTreatment : : Reports to Medical/CommandReports to Medical/Command

Responsible for prioritizing casualties and Responsible for prioritizing casualties and treating the injured.treating the injured.

Treatment Unit Leader Checklist

TREATMENT OFFICER

• SUPERVISES TREATMENT AREA.

• REPORTS TO MEDICAL /

COMMAND

• TEAM SETS UP TREATMENT

AREA

• UTILIZE VISUAL CUES TO

DESIGNATE THE AREAS

Min

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Tre

at

Are

a

Del a

yed T

reat

Are

a

Imm

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reat

Are

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Treatment Entry Point

•Treatment Teams are responsible for re-evaluating and stabilizing patients brought by each assigned “litter bearers.”

TREATMENT OFFICER / TEAMS

TRANSPORTATION

Transportation

Organizes and coordinates the transportation of all casualties.

Transportation Unit Leader Checklist Transportation Record

TRANSPORTATION OFFICER

• Remains around the designated treatment area and works with the Treatment Officer on transport priorities.

• Assigns patients to transport units.

• Removes last tag and puts it into the “Hospital Can”

• Reports to Medical / Command.

RESCUE Rescue/Extrication:

Reports to Medical/Command Removes trapped victims and provides for their

movement to triage/treatment area(s) (whichever is most appropriate.)

Rescue Group Checklist

MEDS COMM

Medical Communications (MEDS COMM)

Reports to Medical/Command Maintains communications with area hospitals

(EMSCOM) and dispatch to facilitate transportation of victims to the appropriate facilities.

MEDS COMM Checklist

MEDICAL COMMUNICATIONS Medical Communications Officer maintains

communication with area hospitals via EMSCOM.

Receiving hospitals availability in terms of #’s of Immediate/Delayed/Minor pt’s they can take.

Report to receiving facilities the pt. triage level, transport unit #, and ETA.

If requested by Medical Branch, implement the EM’s system .

MEDICAL STAGING Medical Staging :

Reports to Transportation/Medical Establishes, organizes and maintains an area for

incoming medical resources.

Medical Staging Checklist

MORGUE Morgue:

Report to Medical/Command. Collect, protect, and identify deceased victims.

Morgue Manager Checklist

MORGUE MANAGER Mission-Collect,

Protect, and Identify bodies

Establish morgue area

Utilize Law Enforcement/Coroner for assistance

Use litter bearers for moving of dead

Morgue

MEDICAL SUPPLY Not included in the EMS Command Kits. Treatment Officer assigns team to rob

equipment off of every truck. Or, have trucks bring all equipment to

treatment area prior to being assigned to a task.

As the MCI develops, other actions may need to be taken to facilitate equipment. (Department Stock).

EXAMPLE

The following is an example of a typical MCI and the associated command structure.

The ICS StructureIC

MEDS COM

Triage Group Treatment Group Transportation Group

Triage Teams

Litter bearers

Immediate Manager

Delayed Manager

Minor Manager

Medical Staging

Medical Supply

Rescue Group

Morgue

Extrication Teams

Ground Ambulance Manager

Air Ambulance Manager

The ICS StructureIC

Medical Branch

PIO Safety

Divisions GroupsMEDS COM

Triage Group Treatment Group Transportation Group

Triage Teams

Litter bearers

Immediate Manager

Delayed Manager

Minor Manager

Medical Staging

Medical Supply

Rescue Group

Morgue

Extrication Teams

Hazmat Branch Fire Branch

Ground AmbulanceManager

Air Ambulance Manager

The ICS StructureIC

Operations

Medical Branch

PIO Safety

Divisions GroupsMEDS COM

Triage Group Treatment Group Transportation Group

Triage Teams

Litter bearers

Immediate Manager

Delayed Manager

Minor Manager

Medical Staging

Medical Supply

Rescue Group

Morgue

Extrication Teams

Fire BranchHazmat Branch

Planning Logistics Admin/Finance

Ground Ambulance Manager

Air AmbulanceManager

Min

or

Tre

at

Del a

yed T

reat

Imm

edia

te

Tre

at

Treatment Entry Point

Medical StagingTriage Area