A Quick Reference: Managing The Mass-Casualty Incident

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 ANTICIPATED need. Order Big And Order Early:

1. additional EMS units
2. command support
3. police
4. manpower units
5. medevac helicopters
6. extrication units
7. hospital teams
8. public information officer (PIO)
9. buses (for ambulatory patients)
10. mobile crisis team
11. EMS task force (2 medic units, 1 ambulance, 1 rescue squad, 1 command officer)
12. Fire task force (2 engines, 1 truck/tower, 1 command officer)

Direct walking wounded and those that do not appear injured to an assigned area. Assign a company to them ASAP. Quickly establish sectors/EMS Control. Do not allow yourself to be overwhelmed by the incident. Delegate functions early. (Sample command structure on reverse.) Alert hospitals of imminent casualties (who may be arriving by other means). Assign separate channel for sectors to improve control and efficiency. Request a collapse rescue team to set-up portable tents to serve as field hospitals and to set-up field communication systems. Request the senior ranking law enforcement officer to report to and remain at the command post to coordinate:

1. scene control/access
2. evacuation
3. other law
4. enforcement agencies
5. scene security (possible crime scene)

Consider using a task force for a specific function (e.g., command support, safety, triage, extrication, treatment, etc.) Take steps to request mobilization of local, state, and federal assets. Assign a resource sector to mobilize apparatus using a one-way flow through the incident. Shelter those affected in high schools. Utilize a church or warehouse as a temporary morgue. Consider nature of incident and need for DECON. Establish REHAB and crisis management for rescuers. Establish a human services sector to help meet the needs of those affected by the incident.

EMS Considerations

• 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.