Mass
Casualty
Incidents
Forward Movement
of Patients
MCI: Forward Movement
MCI: Forward Movement
Where we are right now.
Problem
Goal
Challenge
MCI: Forward Movement
How are we going to get there?
 Case Studies
 Identify the MCI
 Forward Movement of Patients
① Co...
MCI: Forward Movement
Hurricane Andrew – 8/1992
 Brand new EMT.
 Let’s go.
 Widespread damage.
 Rules are rules.
MCI: Forward Movement
New Fairfield, CT School Buses -1996
 Three School Buses > 200 patients
 Paramedic and Volunteer F...
MCI: Forward Movement
WTC – September 11th, 2001
MCI: Forward Movement
MCI: Forward Movement
MCI: Forward Movement
MCI: Forward Movement
WTC Building 7 Collapses
MCI: Forward Movement
Liberty Plaza
MCI: Forward Movement
 Broken CoC
 Freelancing
 Self-Dispatching
 No Credentialing
 Improper PPE
 Resource Leeching
...
MCI: Forward Movement
 WTC Tower #2
Ambulance Staging
RehabFood
Triage / Transport
Critical
Care
Supplies
Primary
Care
MCI: Forward Movement
MCI: Forward Movement
MCI: Forward Movement
Identifying the MCI
 Definition
 Needs outstrip resources
 Threshold
 More than initial response...
MCI: Forward Movement
MCI Management
 Why Not Declare an MCI?
 Bystanders – Expectations
 Peers - Can’t handle it?
 Ho...
MCI: Forward Movement
Identifying the MCI
 Why?
 Low Impact MCI
 Increased Efficiency
 Coordination
 Communication
 ...
MCI: Forward Movement
MCI Management
 Types of MCI
 Mass Transit Crash
 Personal MVA
 Structural Collapse
 Fire / Exp...
MCI: Forward Movement
Initial Hazards
 Examples
 Physical Hazards
 Haz Mat
 WMD
 Crowds
 Active Shooter
 Weather
 ...
MCI: Forward Movement
Initial Hazards
What can you SAFELY MAKE SAFE?
Call 4 Race Horses
Protect Yourself, Your Crew, Yo...
MCI: Forward Movement
MCI Management
MCI: Forward Movement
MCI: Forward Movement
First Due
Triage
Treatment
Transport
Staging
MCI: Forward Movement
①Size Up
②Set Up
③Move Forward
MCI: Forward Movement
First Due!
MCI: Forward Movement
Unit
Conditions
Actions
Needs
MCI: Forward Movement
First Due
① Size Up
 Incident Area
 Hazards
 Ingress
 Egress
 Command Post
 Initiate MCI
② Set...
MCI: Forward Movement
Triage
① Size Up
 Patients
 Patient Generator(s)
 Ingress
 Egress
 Treatment Area
② Set Up
 Tr...
MCI: Forward Movement
Triage
Victim #1
66 y/o Male
CC:
Facial Lacerations
R:
22
P:
< 2 sec.
M:
Follows Commands
MCI: Forward Movement
Triage
Victim #2
22 y/o Female
CC:
L Ankle Fracture
R:
28
P:
< 2 sec.
M:
Follows Commands
MCI: Forward Movement
Triage
Victim #3
18 y/o Male
CC:
None Verbalized
R:
32
P:
> 2 sec.
M:
Unresponsive
MCI: Forward Movement
MCI: Forward Movement
MCI: Forward Movement
MCI: Forward Movement
Treatment
① Size Up
 Ingress
 Egress
 Holding Areas
② Set Up
 Resources
 Structure
 Staff
 St...
MCI: Forward Movement
Transport
① Size Up
 Patients
 Ambulances
 Destinations
② Set Up
 Ingress
 Egress
 Staging
 C...
MCI: Forward Movement
Staging
① Size Up
 Needs
 Resources
② Set Up
 Ingress
 Egress
 Incoming Resources
 Open Channe...
MCI: Forward Movement
Danbury, CT Anthrax – 9/2007
MCI: Forward Movement
Sandy Hook, CT – 12/2012
MCI: Forward Movement
What to do BEFORE the MCI
 Hazard Assessment
 Pre-Plan
 Pre-Stock
 Mutual Aid
 Dispatch Protoco...
MCI: Forward Movement
First Due
Triage
Treatment
Transport
Staging
MCI: Forward Movement
①Size Up
②Set Up
③Move Forward
MCI: Forward Movement
• What this was not…
• What this was…
• Who I am…
• Who you are…
• Because we’re EMS,
and we’re here...
MCI: Forward Movement
MCI: Forward Movement
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MCI First Due First Five

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Using the instructor’s personal experiences from Hurricane Andrew and 9/11 along with lessons from MCI management around the world to make core skills of MCI management both concrete and tangible, students will learn “first due” command and control for large and small-scale mass casualty incidents and apply these principles through role-play and scenarios. This dynamic program covers fundamental aspects of Command, Triage, Treatment and Transportation.

Teaching Formats:
-Lecture
-Demonstration
-Interactive Role Play
-Question and Answer

Learning Objectives: Students will learn:
-The importance of the role of each first responder at any multi casualty incident.
-The differences and similarities between large and small impact MCIs.
-The roles and responsibilities of the four key MCI management positions.
-The importance of maintaining the functions of Incident Command and MCI management in the face of chaos and freelancing.

As seen at EMS World Expo 2011

Published in: Health & Medicine, Business
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  • Graphic descriptions of emotionally intense events.
  • MCI First Due First Five

    1. 1. Mass Casualty Incidents Forward Movement of Patients
    2. 2. MCI: Forward Movement
    3. 3. MCI: Forward Movement Where we are right now. Problem Goal Challenge
    4. 4. MCI: Forward Movement How are we going to get there?  Case Studies  Identify the MCI  Forward Movement of Patients ① Command ② Triage ③ Treatment ④ Transport ⑤ Staging
    5. 5. MCI: Forward Movement Hurricane Andrew – 8/1992  Brand new EMT.  Let’s go.  Widespread damage.  Rules are rules.
    6. 6. MCI: Forward Movement New Fairfield, CT School Buses -1996  Three School Buses > 200 patients  Paramedic and Volunteer Fire Officer  Treatment Officer  Establishment of Command and Coordination  No Freelancing!  Scene Controls.
    7. 7. MCI: Forward Movement WTC – September 11th, 2001
    8. 8. MCI: Forward Movement
    9. 9. MCI: Forward Movement
    10. 10. MCI: Forward Movement
    11. 11. MCI: Forward Movement WTC Building 7 Collapses
    12. 12. MCI: Forward Movement Liberty Plaza
    13. 13. MCI: Forward Movement  Broken CoC  Freelancing  Self-Dispatching  No Credentialing  Improper PPE  Resource Leeching  Taxed Rescuers
    14. 14. MCI: Forward Movement  WTC Tower #2 Ambulance Staging RehabFood Triage / Transport Critical Care Supplies Primary Care
    15. 15. MCI: Forward Movement
    16. 16. MCI: Forward Movement
    17. 17. MCI: Forward Movement Identifying the MCI  Definition  Needs outstrip resources  Threshold  More than initial response can treat / transport  Varies
    18. 18. MCI: Forward Movement MCI Management  Why Not Declare an MCI?  Bystanders – Expectations  Peers - Can’t handle it?  Hospitals – Treatment / Golden Hour  Supervisors – Cost  Self – Unfamiliarity
    19. 19. MCI: Forward Movement Identifying the MCI  Why?  Low Impact MCI  Increased Efficiency  Coordination  Communication  Culture  High Impact MCI  Increased Manageability  Increased Survivability
    20. 20. MCI: Forward Movement MCI Management  Types of MCI  Mass Transit Crash  Personal MVA  Structural Collapse  Fire / Explosion  Crime Scenes  Terrorist Events / Haz Mat  Mass Gatherings / Events  Others  Train for what you get.
    21. 21. MCI: Forward Movement Initial Hazards  Examples  Physical Hazards  Haz Mat  WMD  Crowds  Active Shooter  Weather  Area Access  Traffic  Angry Bees  Other?
    22. 22. MCI: Forward Movement Initial Hazards What can you SAFELY MAKE SAFE? Call 4 Race Horses Protect Yourself, Your Crew, Your Public  Time  Distance  Shielding Secondary Events  Accidental  Targeted
    23. 23. MCI: Forward Movement MCI Management
    24. 24. MCI: Forward Movement
    25. 25. MCI: Forward Movement First Due Triage Treatment Transport Staging
    26. 26. MCI: Forward Movement ①Size Up ②Set Up ③Move Forward
    27. 27. MCI: Forward Movement First Due!
    28. 28. MCI: Forward Movement Unit Conditions Actions Needs
    29. 29. MCI: Forward Movement First Due ① Size Up  Incident Area  Hazards  Ingress  Egress  Command Post  Initiate MCI ② Set Up  Assign  Triage  Treatment  Transport  Staging ③ Move Forward  Monitor  Conditions  Actions  Needs
    30. 30. MCI: Forward Movement Triage ① Size Up  Patients  Patient Generator(s)  Ingress  Egress  Treatment Area ② Set Up  Triage Kits  Delegate Assistants  Aim for Treatment Area ③ Move Forward  Global Triage  Non-Injured HERE -  Injured HERE -  Raise You’re Hand –  Not Moving–  Individual Triage  Breathing Y/N?-> B  Obeys, Pulse, Breathing OK, Bleeding OK->  Might Survive? ->  Portage to Treatment  Continuous Triage
    31. 31. MCI: Forward Movement Triage Victim #1 66 y/o Male CC: Facial Lacerations R: 22 P: < 2 sec. M: Follows Commands
    32. 32. MCI: Forward Movement Triage Victim #2 22 y/o Female CC: L Ankle Fracture R: 28 P: < 2 sec. M: Follows Commands
    33. 33. MCI: Forward Movement Triage Victim #3 18 y/o Male CC: None Verbalized R: 32 P: > 2 sec. M: Unresponsive
    34. 34. MCI: Forward Movement
    35. 35. MCI: Forward Movement
    36. 36. MCI: Forward Movement
    37. 37. MCI: Forward Movement Treatment ① Size Up  Ingress  Egress  Holding Areas ② Set Up  Resources  Structure  Staff  Stuff  Think BIG  Have a backup  Checkpoints  Tarps / Flags / Designators ③ Move Forward  Treatment  Assist? –  First In, Last Out-  Delayed–  Immediate –  Morgue / Dependant – B  Batter Up  Double Up
    38. 38. MCI: Forward Movement Transport ① Size Up  Patients  Ambulances  Destinations ② Set Up  Ingress  Egress  Staging  Communications  Local Dispatch  Regional Dispatch  Hospitals  Patient Tracking ③ Move Forward  Open Channels  Local Dispatch  Regional Dispatch  Hospitals  Designate  Patient(s)  Ambulance  Crew  Destination  Track Patients  Priority  ID  Ambulance  Destination
    39. 39. MCI: Forward Movement Staging ① Size Up  Needs  Resources ② Set Up  Ingress  Egress  Incoming Resources  Open Channel with Transport ③ Move Forward  Track Resources  Drivers Stay  Crew Goes  Take Gear
    40. 40. MCI: Forward Movement Danbury, CT Anthrax – 9/2007
    41. 41. MCI: Forward Movement Sandy Hook, CT – 12/2012
    42. 42. MCI: Forward Movement What to do BEFORE the MCI  Hazard Assessment  Pre-Plan  Pre-Stock  Mutual Aid  Dispatch Protocols  Education  Training  Culture Change
    43. 43. MCI: Forward Movement First Due Triage Treatment Transport Staging
    44. 44. MCI: Forward Movement ①Size Up ②Set Up ③Move Forward
    45. 45. MCI: Forward Movement • What this was not… • What this was… • Who I am… • Who you are… • Because we’re EMS, and we’re here to help.
    46. 46. MCI: Forward Movement
    47. 47. MCI: Forward Movement

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