Service Profile outlines what our service is ie location/ service/ equipment/ staff Contingency Plan outlines if any of the above are interrupted Based on CIMS 4 x r’s MCP is what we are looking at today and how the ED responds Pending but additional plans to be added are Pandemic and Hazardous Substance Exposure Plans
Plan is reference tool best read before any event, ie in orientation. Be familiar. The MCP is one section of the Emergency Plan. On the day information is best accessed from the mass casualty box. Talk Stage 123
The stage chosen reflects the resources at that moment – what may be able to be managed M-F 8-4 may overwhelm resources on Sunday 0300 hours.
A collective response with clinical and non-clinical services working in unison. Each area has its own Stage 123 instructions and they have further developed these within each unit to best fulfil their responsibilities. Personnel and services are activated automatically as per the plan.
Solve bed block – BUT gives strategies to utilise areas not used under normal conditions. Those areas are aware and have their own Stage 123 plan to manage overflow. Solve staff shortages – BUT authorises call in of staff to adequately manage influx of patients.
Info received from variety of sources. Police/ ambulance/ patients arriving/ bush telegraph. Decision to activate is jointly made between ED nurse in charge and DNM.
Reduces the need to spend time calling in so can focus on preparing ED to receive patients. Stage 1 quite reflective of a normal day with its peaks in volume. Can be activated for ‘slow leak’ of ED becoming overwhelmed without a single incident cause.
The box and vest holder are on wheels and easy to move.
Located outside of the staff station to allow this area for clinical functioning. Co-ord to take a phone for their use. Info Point to be set at middle window of ED Reception to take details of those seeking family. Initially ED closed to visitors to ensure all patients are assessed promptly, therefore important people aware and are able to be informed.
The tx and orderly points can be used to write up jobs pending in whiteboard on the glass. This cuts down the phone traffic and staff can return to this list for their next job.
Staff who do not normally work in ED are allocated to an ED staff member. This creates small teams with staff unfamiliar with ED supported and aware who they go to.
Non ED staff report only to their team leader. Prevents Coord from being overwhelmed and focuses the resources with everyone knowing their role.
ED staff have assistance they can oversee with their patient load. ED staff remain accountable for their patient load but delegate and direct the staff in their team.
ED doctors/nurses, triage front and back, HCA/Recep and Non ED doctors/nurses/HCA/admin and orderly, transport nurse, cleaner Security. These give a set of instructions on how to carry out their role.
Those being called should resist urge to ask questions and this will delay staff. Keep the calling brief.
Clear trauma beds. Label corridor beds. Consider double up in rooms. Consider lazyboys and chair area in AAU to increase ED capacity until surge areas ready to receive.
Don’t change for a new system! A patient log is in the Coord Pack. Important for tracking patients. Will be kept at Coord point and referred to by Info Point.
A list of contents is in the coord pack showing what will be delivered. Focus on trauma related medications and consumables.
Based on 3 rd Floor Lambie. Coordinate overall response. Receive status reports and act to place resources where most needed. Inform them early of problems.
Mass cas & haz chem 2013
Mass Casualty +
Dr Chris Cresswell
Still learning and
Key points for docs
Consider “Lock down”
Get more staff including SMOs
Consider early transfer
Clear ED as much as possible
Do what you would normally do (but skip some
of the finer details like Family Hx and CRP,
BNP). Documentation. Emergency ID
Write ID on the patient
Reverse triage is controversial
ED teams with outside assistance
Senior docs: logistics, overview, consultation
Surge out to PACU, Day unit, Outpatients
Emergency Management Plan
Red Folder located in ED Drug Room
Mass Casualty Plan
Hazardous Substance Exposure Plan
Mass Casualty Plan
One section of Emergency Plan
Response staged into 3 tiers dependent on
magnitude of event
Stage 1 = ED only
Stage 2 = ED + Hospital
Stage 3 = ED + WDHB wide + EOC +/-
local, regional or national support
Mass Casualty Plan
To establish which stage is required refer to
the MCP Flowchart
Located ED Drug Room with explanation of
Stage 1, 2 & 3
Flowchart allows for MCP to be escalated
as event unfolds
Activating Mass Casualty Plan
Information of event
D/W DNM / ED Team
Decide on Stage of
DNM is the only one
who can activate MCP
Operator of activation
of Stage 1,2 or 3 of
What Happens Then?
Switchboard Operator follows a list of
instructions and calls in and notifies the
Staff and services activated at Stage 1,2,3
can be seen on the wall of the ED Drug
Room and also in the Coord Pack of the
Mass Casualty Box
Open Mass Casualty Box
Mass Casualty Box & Vests
Mass Casualty Box
and vests are stored in
the ambulance store
Open the Box
Elect a Coord
Follow the instructions
in the Coord Pack
Coord point by Rm3
ED outside of staff
outside Resus 2
Orderly & Transport
Nurse @ Coord point
Info point at reception
Allocating Roles & Areas
Vests are for ED staff
Each role comes with
a job card
areas/rooms to ED
staff and further
dividing as more staff
ED Staff with Vests and Job Cards
ED staff manage their
area and helper staff
that are allocated to
Creation of small
teams allows ED staff
to focus on their area
and helper staff to be
Non ED Staff
Non ED staff who
come to help are also
given a job card,
allocated to a ED staff
member and given a
ED and non ED staff
All staff receive a job
card when they check
Gives a guide of what
their role is and who to
Many titles – take a
look and familiarize
Calling in ED Staff
Coord decides how
many of each
Call in or delegate
task to colleague
Call in until required
number on way and
record on Staff Log
Liase with DNM and clear ED as much as
Consider Pts for discharge / TX to WR / TX
to WAM / TX to Ward
Possible surge capacity SDU / PACU /
OPD / ATR (All require DNM to arrange)
Clear trauma beds
Do what you normally
ID pts ASAP
Use Unknown ID if
delays in registering
All pts need to go on
This is basis for
tracking pts in system
Pre ordered supply
of pharmacy items,
arrive within the
first hour of a Stage
2 or 3 of MCP
List in Coord Pack
Emergency Operations Centre
EOC manage the
overall response to
Send Status Report
to EOC hourly PRN
Can request staff,
equipment via EOC
2 people to
Everyone from scene goes thru shower by ambulance
Keep faces out of pools of water!
CPR etc could continue in shower
Then patient goes through to triage etc and is
Thanks for those staff who kindly ‘volunteered’ as models for the
photos of this presentation
Coordinated Incident Management Systems, 26/08/11.
Thanks to Midcentral DHB, Hawkes Bay DHB, Capital & Coast
DHB sharing their Emergency Management Plans, 2010.
Thanks to RN Michelle Battarbee and Katie Edmonds for
developing the plan and Michelle for writing the first version of this