Medical incident command powerpoint

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Powerpoint presentation on the correct way to set up Incident Command and Medical Incident Command at a Disaster.

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Medical incident command powerpoint

  1. 1. MEDICAL INCIDENTCOMMAND
  2. 2.  Disasters and MCI’s are challenging situations Why? Large number of patients Lack of specialized equipment or help
  3. 3.  Systemic approach to manage incident efficiently
  4. 4.  Incident Command System (ICS) Try to do the greatest good for the greatest number!
  5. 5.  National Incident Management System (NIMS) Created to promote efficient coordination
  6. 6.  Critical Infrastructure can be damageda) Electrical power gridb) Communication systemc) Fuel for vehiclesd) Watere) Sewage Removalf) Foodg) Hospitalsh) Transportation systems
  7. 7.  Disaster Management Requires planners to take a broad look at:1) Preparedness2) Planning3) Training4) Response5) After-action review
  8. 8. 1. Number of patients exceeds resources available to the initial responders2. ICS will help Paramedics work efficiently and effectively
  9. 9.  Number of casualties not yet located Rescuers may have to search for patients Ongoing situation that produces more patients
  10. 10.  Situation that is not expected to produce more patients than initially presenta) Triaged and treated as they are removedb) May suddenly become an open incident
  11. 11. OVERVIEW
  12. 12.  Terminology Common terminology and “clear text” communications
  13. 13.  Modular Organization Structurea) Built on size and complexity of incidentb) Designed to control duplication of effort and freelancing
  14. 14.  SPAN OF CONTROLa) Limited by ICSb) Keeps supervisor/worker ratio at: One(1) Supervisor for three(3) to seven(7) workers
  15. 15.  Organizational Division May Include:1) Sections2) Branches3) Divisions4) GroupsSee Figure 47-3) Page 47.6
  16. 16.  Emergency Operations Center1) In some regions2) Usually operated by city, state or Federal3) Only activated in large catastrophic event that may go on for days
  17. 17.  General Staff includes:1. Command Incident Command2. Finance3. Logistics4. Operations5. Planning Operations Finance Logistics Planning
  18. 18.  Person in charge of overall incident Assesses incident Establishes strategic objectives and priorities Develops a plan to manage incident Number of Command duties varies by the size of the incident such as Public information, Safety and Liaison
  19. 19.  Required in large MCI’s Multiagency or multijurisdiction response Plans drawn up in advance by all cooperating agencies that have shared responsibility for decision making and cooperation Designate lead and support agencies in several kinds of MCIs
  20. 20.  One person in charge Generally used with incidents in which one agency has majority of responsibility for incident management Short duration, limited incidents
  21. 21.  IC may turn over command to someone with more experience in a critical area Orderly, face to face Termination of command Demobilization procedures—workers relieved as incident is mitigated
  22. 22.  The Finance Section Chief is1. Responsible for documenting all expenditures at an incident for reimbursement2. Responding agencies and organizations may be eligible for some types of reimbursement3. Trained in process of assessing expenditures with eye to reimbursement long before an actual event
  23. 23.  The Logistics Section Chief isa) Responsible fori. Communications equipmentii. Facilitiesiii. Food and wateriv. Fuelv. Lightingvi. Medical equipment and supplies
  24. 24.  Local standard operating procedures will list medical equipment needed for incident See Table 47-1 MCI Equipment and Supplies Trained to find food, shelter and health care for responders at the scene of MCI
  25. 25.  The Operations section Chief1. Responsible for managing the tactical operations job at a large incident2. Supervises the people working at the scene of the incident
  26. 26.  The Planning Section chief1. Solves problems as they arise during the MCI2. Obtains data, analyzes the previous incident plan, and predicts what or who is needed to make the new plan work3. Responsible for demobilization when needed
  27. 27.  Monitors scene for conditions or operations that may present a hazard to responders and patients May need to work with environmental health and hazardous materials specialists Authority to stop an emergency operation whenever a rescuer is in danger
  28. 28.  Provides public and media with clear and understandable information Positioned well away from incident command post Must keep media safe and prevent them from becoming part of the incident May work in cooperation with PIO’s from other agencies in a joint information center(JIC)
  29. 29.  Disseminates messages aimed at helping a situation, preventing panic, and /or providing evacuation directions
  30. 30.  Relays information and concerns among command, the general staff, and other agencies If any agency is not represented in the command structure, questions and input should be given through the LNO
  31. 31. NATIONAL INCIDENT MANAGEMENT SYSTEM
  32. 32. 1) President directed Secretary of Homeland Security to implement in March 20042) Provides consistent nationwide template to enable Federal, state and local governments as well as private-sector and nongovernmental organizations to work together effectively and efficiently
  33. 33. 3) Prepare for, prevent, respond to and recover from domestic incidents, regardless of cause, size or complexity, including acts of catastrophic terrorism4) Underlying principles Flexibility: rapid adaptation Standardization Interoperability: agencies of different types can communicate with one another
  34. 34.  Command and Managementa) Incident management is standardized for all hazards and across all levels of governmentb) ICS, mulitagency coordination systems and public information systems are the three key constructs
  35. 35.  Preparednessa) Establishes measures for all responders to incorporate into their systems in preparation to respond to all incidents at any time
  36. 36.  Resource Managementa) Mechanisms to describe, inventory, track and dispatch resources before, during and after an incidentb) Defines standard procedures to recover equipment used during the inciden
  37. 37.  Communications and Information managementa) Critical aspect of domestic incident managementb) Enable essential functions needed to provide interoperability
  38. 38.  Supporting Technologiesa) Promotes national standards and interoperability for supporting technologies to successfully implement NIMSb) Provides structure for the science and technology used in incident management
  39. 39.  Ongoing Management and Maintenancea) U.S. Department of Homeland Security will establish a multijurisdictional, multidisciplinary NIMS integration centerb) This will provide strategic direction for and oversight of NIMS, supporting routine maintenance and continuous improvement of the system in the long term
  40. 40. 1) Decision making and basic planning are done before an incident occurs2) EMS agency should have written disaster plans3) Disaster supplies for at least 72-hour period of self-sufficiency4) Mutual Aid agreements with surrounding organizations5) Assistance program for families of EMS
  41. 41. 1) Unsafe scene a. Stay away b. Get close enough only to make an assessment2) Three Basic Questions a. What do I have? b. What do I need to do? c. What resources do I need?
  42. 42. 1) After scene size-up, establish command2) Command system ensures resources are effectively and efficiently coordinated3) Establish early
  43. 43. 1) Often key problem at an MCI or disaster2) Problems should be worked out before a disaster happensa) Designate channels strictly for commandb) Ensure equipment is reliable, durable and field-tested, and that there are backups in place
  44. 44.  Known also as Medical (EMS) branch of ICS Medical group leader a. supervises primary roles of medical group (triage, treatment and transport of injured) b. Ensures EMS units are working within ICS c. See Figures 47-7 and 47-8
  45. 45.  Triage Officer  TASKSa) Counts and prioritizes  Triage and tag all pts. patients  Ensure adequate staff tob) Makes sure every pt. accomplish tasks receives initial  Ensure safety of all assessment and moved members to appropriate  Communicate with EMS treatment sector branch on progress ofc) Don’t begin treatment operations until all patients are  Establish initial morgue triaged  Document activities of triage area.
  46. 46. 1) Locates and sets up  TASKS treatment area 1) Separate patients by a. tier for each priority of priority patient 2) Responsible for safety b. secondary triage of of all members working patients in area c. assist with moving 3) Ensure sufficient patients to supplies and personnel transportation area 4) Maintain security of2) Communicates with area medical group leaders 5) Document activities 6) Provide updates to EMS Branch Director
  47. 47. 1) Coordinates transportation and distribution of patients to appropriate receiving hospitals2) Communicates with area hospitals3) Documents and tracks number of vehicles transporting, patients transported, and the facility destination of each vehicle and patient
  48. 48. 1) Scenes requiring numerous emergency vehicles or agencies a. vehicles cannot and should not drive into the scene without direction from the staging officer.2) Area established away from the scene3) Locates area to stage equipment and responders, track unit arrivals, and send out vehicles as needed
  49. 49. 1) Some area plans are in place for physicians on scene a. Enormity of situation may require physicians sent to scene b. Ability to make difficult triage decisions c. Secondary triage decisions in the treatment sector (priority for transport) d. On-scene medical direction
  50. 50. 1) Extended Periods2) Establishes a Rehabilitation Section a. area providing protection for responders from the elements and the situation b. Located away from exhaust fumes and crowds and out of view of scene c. Responder’s needs for rest, fluids, food and protection from elements are met d. monitor for signs of stress e. Defuses and debriefs team
  51. 51. Extrication Officer (rescue officer)a) Determines type of equipment and resources needed for situationb) Victims may need to be extricated or rescued before triage and treatmentc) Functions under EMS branced) Crew safety is of utmost importance
  52. 52. 1) Dead patients2) Works with medical examiners, coroners, disaster mortuary assistance teams and law enforcement agencies to coordinate removal of bodies and body parts3) Attempts to leave dead victims in location found until removal and storage plan determined4) If morgue area necessary
  53. 53. 1) Triage means “to sort” based on severity of injuries2) Primary triage---done in field3) Secondary triage---done in treatment area4) Rapid and accurate triage will help bring order to the chaos of the MCI scene5) After primary triage report a. total number patients b. number of patients in each category c. recommendation for extrication and movement of patients to treatment area d. resources needed to complete triage and begin movement
  54. 54.  Four common triage categories1. Immediate (red tag)—First priority2. Delayed (yellow tag)—Second priority3. Minimal (green tag)—Third priority4. Expectant(black tag)—Last Priority
  55. 55.  Usually have problems with ABC’s, head trauma, or signs and symptoms of shock
  56. 56.  Usually have multiple injuries to bones or joints, including back injuries with or without spinal cord injury
  57. 57.  They may require no field treatment, “walking wounded” or soft-tissue injuries (contusions, abrasions and lacerations)
  58. 58.  These are patients who are dead or whose injuries are so severe they have a minimal chance of survival (cardiac arrest, open head injury, or respiratory arrest)
  59. 59.  Tagging patients assist in tracking them Helps keep accurate record of condition Tag will become part of patient’s medical record
  60. 60. 1) Simple triage and rapid treatment2) Limited assessment of patient’s ability to walk, respiratory status, hemodynamic status, and neurologic status
  61. 61.  Steps1) Call out “If you can hear my voice and are able to walk…”(identifies walking wounded)2) Assess respiratory status and open airway is needed(black if not breathing, red if breathing)3) Assess the hemodynamic status by checking for a radial pulse (if no pulse, red tag)4) Assess neurologic status by ability to follow simple commands (red tag if unconscious, yellow tag if conscious)
  62. 62. 1) Children younger than 8 or who appear to weigh less than 100 pounds2) Respiratory status assessment 1. If child not breathing and has no pulse, label as expectant 2. If patient is not breathing but has pulse, open airway, give five rescue breaths; if child does no begin to breathe label as expectant 3. Approximate rate of respirations: less than 15 breaths/min or more than 45 tagged as immediate
  63. 63. 3) Hemodynamic status—no distal pulse, immediate priority4) Neurologic status a. responses will vary based on development b. unresponsive or responding to pain by posturing or with incomprehensible sounds or unable to localize pain in an immediate priority c. alert or able to localize pain is a delayed priority
  64. 64. 1) Hysterical and disruptive patients a. immediate priority to be transported out of the disaster site b. Panic breeds panic2) A sick or injured rescuer a. immediate priority to be transported3) Hazardous materials and weapons of mass destruction incidents
  65. 65. 1) Immediate (red) or delayed (yellow) should be transported by ambulance2) With extreme situations, “walking wounded” are transported by bus3) Immediate priority patients are transported two at a time until they are all transported4) Delayed are transported two or three at a time5) Slightly injured are transported6) Expectant patients who are still alive would receive transport and treatment
  66. 66. 1) Responders may become overwhelmed2) Stress management should be available but not imposed
  67. 67.  All agencies involved in response should participate in effort to improve future reactions to disasters Discourage finger pointing
  68. 68. 1) Disasters and mass-casualty incidents2) Incident command3) Emergency Response within the ICS4) Triage
  69. 69.  Read Assessment in Action and then answer questions to discuss in class Answer Challenging Question Read Points to Ponder. Answer questions and be prepared to discuss in class Fill out Organization chart for ICS

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