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MCI First Due First Five
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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,......

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

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  • Graphic descriptions of emotionally intense events.

Transcript

  • 1. Mass Casualty Incidents
    First Due / First Five
  • 2. Las Vegas Conv. Ctr 8/2011
  • 3. Las Vegas Conv. Ctr8/2011
  • 4. WARNING
  • 5. Indiana State Fair – 8/2011
  • 6. Indiana State Fair – 8/2011
    What did they do right?
    JOC.
    Immediate Triage.
    Quick treatment.
    Rapid movement from the patient generator.
    Ready Resources.
    What did they do right?
    COMMAND.
    TRIAGE
    TREATMENT
    TRANSPORT
    STAGING
    First Due
    First Five
  • 7. Objectives
    Case Studies
    Identifying the MCI
    MCI Management
    Command
    Triage
    Treatment
    Transport
    Staging
  • 8. Hurricane Andrew – 8/1992
    Brand new EMT.
    Let’s go.
    Widespread damage.
    Rules are rules.
  • 9. 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.
  • 10. WTC – September 11th, 2001
  • 11.
  • 12.
  • 13.
  • 14. WTC Building 7 Collapses
  • 15. Liberty Plaza
  • 16.
  • 17. Broken CoC
    Freelancing
    Self-Dispatching
    No Credentialing
    Improper PPE
    Resource Leeching
    Taxed Rescuers
  • 18.  WTC Tower #2
    Rehab
    Food
    Primary
    Care
    Critical
    Care
    Triage / Transport
    Supplies
    Ambulance Staging
  • 19.
  • 20.
  • 21. Identifying the MCI
    Definition
    Needs outstrip resources
    Threshold
    More than initial response can treat / transport
    Varies
  • 22. Identifying the MCI
    MCI Mode vs Standard Response
    At an M.C.I.priority becomes Incident Management rather than patient care
    When needs outstrip resources, YOU CANNOT PROVIDE EFFECTIVE PATIENT CARE UNTIL YOU FIRST MANAGE THE INCIDENT.
  • 23. Identifying the MCI
    Why?
    Low Impact MCI
    Increased Efficiency
    Coordination
    Communication
    Culture
    High Impact MCI
    Increased Manageability
    Increased Survivability
  • 24. MCI Management
    Why Not Declare an MCI?
    Bystanders – Expectations
    Peers - Can’t handle it?
    Hospitals – Treatment / Golden Hour
    Supervisors – Cost
    Self – Unfamiliarity
  • 25. MCI Management
    How?
    I must break you…
    Of the habit of treating, not triaging.
    “Providers will do only what they have been trained to do, or not do, if not trained ”
    Disaster Management Pitfalls, (Ramzy & Warren, JEMS 1983)
    “Now is the time to inventory lessons learned from previous disasters and use them to plan together.”
    Preparing for terrorism, an emergency services guide, (Buck, G. 2002)
  • 26. 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.
  • 27. MCI Management
    When do we pull the trigger on this?
    You want to know…
    Where to go?
    Who to talk to?
    What is wrong with MY patient?
    The Vests and Triage Tags answer these questions from a distance and without radio traffic
    He may look funny in those tights but everybody know he’s in charge
  • 28. Initial Hazards
    Examples
    Physical Hazards
    Haz Mat
    WMD
    Crowds
    Active Shooter
    Weather
    Area Access
    Traffic
    Angry Bees
    Other?
  • 29. 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
  • 30. The First Five
  • 31. Command
    What to do BEFORE the MCI
    Hazard Assessment
    Pre-Plan
    Pre-Stock
    Mutual Aid
    Dispatch Protocols
    Education
    Training
    Culture Change
  • 32. Command
    ICS / NIMS
    Must have 100, 700
    Should have 200, 800
    May have 300, 400
    I have NIMS 1,000,001
  • 33. Command
    ICS / NIMS Features
    Standard Structure
    Expandable
    Contractable
    Modular
    Chain of command
    Unity of command
    Span of control
    Communication
    Accountability
  • 34. Command
  • 35. Command
    Incident
    Commander
    Public Information
    Officer
    Command Staff
    Liaison
    Officer
    Safety
    Officer
    General Staff
    Operations
    Section Chief
    Planning
    Section Chief
    Logistics
    Section Chief
    Finance/Admin
    Section Chief
    Branch / Division / Sector
    EMS Branch
    Director
    Rescue Branch Director
    Haz Mat Branch Director
    BLS Unit
    ALS Unit
    Unit / Strike Team / Task Force
  • 36. Congratulations, You’re Hired!
    Take the job
    Job description
    Dress for Success
    Gather your tools
    Set Up Your Workspace
    Clear your desk
    Go To Work
    Empty your In-Box
    Communicate
    Upstream and Downstream
  • 37. Congratulations, You’re Hired!
  • 38. First Due!
    Through the windshield
    Size UP!
    Location
    Rough Number of patients
    MCI Area
    Command location
    Hazards
    Access
    Immediate
    Additional Resources
  • 39. First Due!
    Size Up
  • 40. First In Unit / EMS Officer
  • 41. EMS Officer
    Take the job
    Initiate MCI
    Take / Coordinate Command
    Get Briefing
    Grab Help
    Dress for Success
    Vest
    Radio
    Command Board
    Set Up Your Workspace
    Incident Area
    Command Post
    Ingress
    Egress
    T, T, T, S Areas
    Go To Work
    Assign T, T, T, S
    Call 4 Racehorses
    Structure
    Staff
    Stuff
    Communicate
    Upstream
    IC
    Downstream
    Triage
    Treatment
    Transport
    Staging
  • 42. EMS Officer
    Watching out for personnel and other citizens
    Watching traffic and its approach to the scene
    Assigned to a single resource or to a company
    Lookouts
    Protect tactical channels from chatter.
    Establish traffic control on a separate channel.
    Communications
    Established early on in the incident
    Communicated to all personnel
    Escape routes
    Established early in the incident
    Second area of refuge established as a back-up
    Safety zones
  • 43. EMS Officer
    One patient pinned under dash
    Difficulty with lower extremities
    Stable vital signs
    Planning to roll up dash
    Removing glass from windshield
    Establishing I.V. on patient
    Manpower
    Send FD to assist
    Dispatch helicopter
    Conditions
    Actions
    Needs
  • 44. Triage
    Take the job
    Get Briefing
    Grab Help
    Dress for Success
    Vest
    Radio
    Triage Kits
    Set Up Your Workspace
    Patient Generator
    Ingress
    Egress
    Go To Work
    Primary Triage
    Non-Injured HERE - W
    Injured HERE - G
    Raise You’re Hand – Y
    Breathing – R
    Not Breathing - B
    Secondary Triage
    Tag
    Treat
    Portage
    Communicate
    Upstream
    IC
    Downstream
    Treatment
  • 45. START TRIAGE
  • 46. Triage
    Victim #1
    66 y/o Male
    CC:
    Facial Lacerations
    R:
    22
    P:
    < 2 sec.
    M:
    Follows Commands
  • 47. Triage
    Victim #2
    22 y/o Female
    CC:
    L Ankle Pain
    R:
    28
    P:
    < 2 sec.
    M:
    Follows Commands
  • 48. Triage
    Victim #3
    18 y/o Male
    CC:
    None Verbalized
    R:
    32
    P:
    > 2 sec.
    M:
    Unresponsive
  • 49. Treatment
    Take the job
    Get Briefing
    Grab Help
    Dress for Success
    Vest
    Radio
    Supplies
    Staff
    Structure
    Stuff
    Set Up Your Workspace
    Think BIG
    Have a backup
    Ingress
    Egress
    Tape
    Checkpoints
    Tarps / Flags / Designators
    Go To Work
    Treatment
    Assist? – W
    First In, Last Out- G
    Delayed– Y
    Immediate – R
    Dependent / Morgue – B
    Re-Triage
    Communicate
    Upstream
    Triage
    Downstream
    Transport
  • 50. Treatment
  • 51. Transport
    Take the job
    Get Briefing
    Grab Help
    Dress for Success
    Vest
    Radios, Many Radios
    Patient Tracking Sheets
    Set Up Your Workspace
    Ingress
    Egress
    Go To Work
    Notify Comms
    Notify Hospitals
    Track Patients
    ID
    Ambulance
    Destination
    Coordinate Specialties
    Communicate
    Upstream
    Treatment
    Downstream
    Hospitals
    Staging
  • 52. Staging
    Take the job
    Get Briefing
    Grab Help
    Dress for Success
    Vest
    Radio
    Set Up Your Workspace
    Ingress
    Egress
    Go To Work
    Track Resources
    Drivers Stay
    Crew Goes
    Take Equipment
    Communicate
    Upstream
    IC
    Transport
    Downstream
    Ambulances
  • 53. Danbury, CT Anthrax – 9/2007
  • 54. The Next Step
    Conferences
    EMS World Expo
    MCI Management Systems
    Tabletop Exercises
    Local Training
    Triage Tuesdays
    Regional Exercises
    Full Scale Drills
    National Fire Academy
    Ongoing and Pilot Programs
  • 55. SUMMARY
    Objectives
    Case Studies
    Identifying the MCI
    MCI Management
    Command
    Triage
    Treatment
    Transport
    Staging
  • 56. SUMMARY
    Take the job
    Job description
    Dress for Success
    Gather your tools
    Set Up Your Workspace
    Clear your desk
    Go To Work
    Empty your In-Box
    Communicate
    Upstream and Downstream
  • 57.
    • What this was not…
    • 58. What this was…
    • 59. Who I am…
    • 60. Who you are…
    • 61. Because we’re EMS,
    and we’re here to help.
  • 62. For More Information
    For questions, comments, feedback
    and to find additional resources on this and other lecture topics find me at…
    Twitter: @romduck
    Linked In: romduck
    email: romduck@snet.net
    www.romduckworth.com