Managing The Mass-Casualty Incident
A Quick Reference
Compiled by Captain Barry C. Reid, Montgomery County, MD, Department of Fire and Rescue Services
Command Action Guidelines
Effective management of a mass-casualty incident (MCI) requires rapid triage and strong command early in the incident.
- Quickly scan the scene for hazards to fire/rescue personnel and civilians.
- Determine the level of PPE (personal protective equipment) needed and inform all personnel through an emergency communications center (ECC). (Do not overlook command and staff.)
- Rapidly estimate the number of patients: Priority 1 (red), Priority 2 (yellow), Priority 3/4 (green), DOA (black)
- Quickly establish COMMAND, placing the command post upwind and upgrade. Use a mobile command center or fixed facility, away from direct involvement with casualties and operational personnel. Wear command vest and assign other vests.
- Request additional resources based on need. :
- additional EMS units
- command support
- manpower units
- medevac helicopters
- extrication units
- hospital teams
- public information officer (PIO)
- buses (for ambulatory patients)
- mobile crisis team
- EMS task force (2 medic units, 1 ambulance, 1 rescue squad, 1 command officer)
- Fire task force (2 engines, 1 truck/tower, 1 command officer)
- scene control/access
- other law
- enforcement agencies
- scene security (possible crime scene)
- Quickly conduct primary triage and apply ribbons (red, yellow, green, black).
- Have bystanders and Good Samaritans assist in moving patients/walking wounded.
- Establish treatment areas/secondary triage based on priority. Assign treatment teams.
- Consult with base hospital only. Limit communications.
- Request regional standing orders.
- Check/triage walking wounded and others involved in incident when time and resources permit.
- Account for all persons involved in the incident.
Review this reference periodically to improve recall.