Hospital Emergency Room TrainingHospital Emergency Room Training

Contra Costa County EMSContra Costa County EMS

Tim W. HennessyMCI Plan

Tim W. Hennessy Communications Supervisor

Contra Costa County Sheriffs Communication

1975-2007

This MCI Plan is dedicated to Tim.

His expertise and commitment in

developing this plan was invaluable.

History

• 1979: First MCI Committee organized to develop plan following Yuba City bus crash in Martinez

• 1983: Board of Supervisors approved the first MCI Plan

• Several revisions to the basic plan since 1983

Current MCI Working Group

• Appointed in 2005 to conduct a ground-up rewrite of the MCI Plan

• Multidisciplinary– Fire – Emergency Ambulance Zone Provider (public

and private)– Law Enforcement– Hospitals– Public Safety Communications– EMS Agency staff

Why Rewrite the Plan?

• Improve the usefulness of the document for first responders

• Compare the Plan to the County’s current risk profile

• Compare the Plan to the County’s current public safety and EMS resources

Why Rewrite the Plan?

• Attempt to resolve weaknesses in the Plan experienced during previous incidents:– Incident command and control– Communication flow– Resource ordering and tracking

• Ensure compliance with NIMS

MCI Plan Objectives

Objective #1:

Establish a common organization, management, and communications

structure for the coordination of emergency response to a multi-

casualty incident.

MCI Plan Objectives

Objective #2:

Establish methods of triage and transportation that will provide the best

medical outcome possible for the greatest number of casualties.

MCI Plan Objectives

Objective #3:

Establish pre-defined responsibilities of all entities with key roles in achieving

successful implementation of the plan.

MCI Plan Objectives

Objective #4:

The Plan will be drilled regularly, and reviewed annually and following

significant activations of the Plan as directed by the EMS Director.

Key Concepts

• Use of Incident Command System– Expansion and contraction of

structure is dynamic and incident-driven

– Use of single point ordering for resource requests

– Emphasis on exchanging information

Key Concepts

• Importance of Unified Command• The “Rule of 2 and 4”

MCI Tiers

• Plan consolidates Expanded Medical Emergencies, Medical Advisory Alerts and MCIs into a single MCI Plan with 4 activation tiers

• Use of tiered MCI Plan reinforces the scalability of the Plan

MCI Tiers

• Use of Tiers modeled after Community Warning System (CWS) Levels

• Consistent with best practices

Tier Zero

• Notification of incident with potential to escalate to a higher tier (Medical Advisory Alert)

• CWS Level II and III Incidents• Report of Active Shooter incident• Attempted emergency landing of

passenger aircraft

Tier One

• 6-10 patients with scene contained, number of patients not expected to rise

• Multi-vehicle collision• Multiple gunshot victims at

contained scene and no ongoing active shooter

Tier Two

• 10 –50 patients or less than 10 patients with substantial chance of increase in number of patients

• Transportation resource ordering switches to EMSOACC

• Petrochemical incident• Passenger train derailment• Active shooter with uncontained scene

Tier Three

• More than 50 patients or reasonable expectations of large number of casualties

• Actual or suspected WMD incident• Significant explosion in populated

area• Emergency evacuation of hospital

or SNF

Plan Components

• Responsibilities matrix/checklists• Communications flowchart• Communications overview• ICS position checklists• ICS communications forms 205 and

217A

Responsibilities Matrix

• Multiple agencies– Fire-EMS: ALS and BLS– Law Enforcement– Hospitals– Helicopter– Communications/EMSOACC

• Defined tier specific responsibilities• Clear communication pathways• Resource Coordination

MCI Checklists

• Common Responsibilities– Back of each checklist

• Get Assignment• Check In• Get briefed• Get work materials• Undertake mission safely• Organize and brief subordinates• Assure communications• Use clear text• Complete forms• Demobilize as required/practical

Hospital Responsibilities

• Tier Zero– Make internal notifications and institute

appropriate ED procedures as per facility protocol

– Respond to ED capacity poll from EMSOACC (Sheriffs dispatch) if initiated

– Monitor and use Reddinet

Hospital Responsibilities

• Tier One MCI– Immediately prepare to accept 2

critical and 4 delayed patients– Assess ability to handle additional

patients and respond to ED capacity poll from EMSOACC

– Diversion status does not apply during Tier 1,2,3 MCI

Hospital Responsibilities

• Tier Two– Rule of 2 and 4– Capacity Poll

• Respond on Reddinet– No Diversion

• Tier Three– All of above– Conduct damage assessment and report

results to EMSOACC/EMS if necessary– Activate facility disaster plan if necessary

MCI Plan

• Know Reddinet• Know your responsibilities• Utilize HICS as needed• In HICS the certifications and

qualifications determine who does what…not position

• You might be asked to do things you normally might not do in MCI Tier III

Transportation Highlights

• 2/4 Concept– Continue to disperse casualties as much as

possible– Use farther hospitals first

• Especially if potential exists for “walk ins”

– Hospital polling whenever possible but certainly after 2/4 has been maximized

• Coordinate with EMSOACC as much as possible

Transportation Highlights (cont)

• Emergency Ambulance Zone Providers still responsible for normal coverage too

• If limited ambulances, minors can be transported by other means

• Tier 2 & 3 suspend ambulance to hospital communications

• PCRs– Whenever possible PCRs shall be completed– Tier 3 Branch( or designee) can suspend standard

PCR protocol and replace with triage tag info– Triage tags are minimum level of documentation

Predetermined Staging Areas

• East/Central/West• Rallying point in case of loss of

communications

Example of Tier 1 Scenario

• MVC with 7 patients in 3 vehicles– Single Medical Group– Transportation reports to Med Grp Sup– Triage patients and treat where they were

found– Do not send all patients to same hospital– Can use close hospital due to lack of

probability of self transporting patients to closest facility

Example of Tier 2 Scenario

• Shooting incidents with 21 patients– Single Medical Group– Transportation reports to Med Grp Sup– Triage patients where they are found– Litter bearers move patients to specific

treatment areas– Patients re-triaged in treatment areas and

assigned priority for transport– Avoid close proximity hospitals if possible

due to potential private transport arrivals

Example of Tier 3 Scenario

• Large structural collapse with multiple victims trapped over a widespread area– Multiple Medical Groups (probably by Division) report

to Medical Branch– Transportation reports to Medical Branch

• Still just one transportation staging area– Triage patients where they are found– Litter bearers move patients where they are found– Patient’s re-triaged in Treatment areas and assigned

priority – Maximize 2/4 concept as needed

Triage Considerations

• START Triage system– New tags

• Victims will not be re-triaged at scene

• Victims re-triage in Treatment Areas

Triage Tags

Contamination Designation

Will be StandardizedThrough-out

County