The document outlines the framework for managing medical incidents and disasters through the Incident Command System (ICS) and the National Incident Management System (NIMS). It highlights the need for a systematic approach to effectively coordinate resources, triage patients, and ensure safety and communication among responders during large-scale emergencies. Key components discussed include organization structure, roles of different command sections, and the critical importance of preparedness and training.

1. MEDICAL INCIDENT
COMMAND

2.  Disasters and MCI’s are challenging situations
 Why?
 Large number of patients
 Lack of specialized equipment or help

3.  Systemic approach to manage
incident efficiently

4.  Incident Command System (ICS)
 Try to do the greatest good for the greatest
number!

5.  National Incident Management System
(NIMS)
 Created to promote efficient coordination

6.  Critical Infrastructure can be damaged
a) Electrical power grid
b) Communication system
c) Fuel for vehicles
d) Water
e) Sewage Removal
f) Food
g) Hospitals
h) Transportation systems

7.  Disaster Management
 Requires planners to take a broad look at:
1) Preparedness
2) Planning
3) Training
4) Response
5) After-action review

8. 1. Number of patients exceeds resources
available to the initial responders
2. ICS will help Paramedics work efficiently and
effectively

9.  Number of casualties not yet located
 Rescuers may have to search for patients
 Ongoing situation that produces more
patients

10.  Situation that is not expected to produce
more patients than initially present
a) Triaged and treated as they are removed
b) May suddenly become an open incident

11. OVERVIEW

12.  Terminology
 Common terminology and “clear text”
communications

13.  Modular Organization Structure
a) Built on size and complexity of incident
b) Designed to control duplication of effort and
freelancing

14.  SPAN OF CONTROL
a) Limited by ICS
b) Keeps supervisor/worker ratio at:
One(1) Supervisor for three(3) to seven(7)
workers

15.  Organizational Division
 May Include:
1) Sections
2) Branches
3) Divisions
4) Groups
See Figure 47-3) Page 47.6

16.  Emergency Operations Center
1) In some regions
2) Usually operated by city, state or Federal
3) Only activated in large catastrophic event
that may go on for days

17.  General Staff includes:
1. Command Incident Command
2. Finance
3. Logistics
4. Operations
5. Planning
Operations Finance Logistics Planning

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.  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.  One person in charge
 Generally used with incidents in which one
agency has majority of responsibility for
incident management
 Short duration, limited incidents

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.  The Finance Section Chief is
1. Responsible for documenting all
expenditures at an incident for
reimbursement
2. Responding agencies and organizations may
be eligible for some types of reimbursement
3. Trained in process of assessing expenditures
with eye to reimbursement long before an
actual event

23.  The Logistics Section Chief is
a) Responsible for
i. Communications equipment
ii. Facilities
iii. Food and water
iv. Fuel
v. Lighting
vi. Medical equipment and supplies

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.  The Operations section Chief
1. Responsible for managing the tactical
operations job at a large incident
2. Supervises the people working at the scene
of the incident

26.  The Planning Section chief
1. Solves problems as they arise during the
MCI
2. Obtains data, analyzes the previous incident
plan, and predicts what or who is needed to
make the new plan work
3. Responsible for demobilization when
needed

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.  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.  Disseminates messages aimed at helping a
situation, preventing panic, and /or providing
evacuation directions

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. NATIONAL INCIDENT MANAGEMENT SYSTEM

32. 1) President directed Secretary of Homeland
Security to implement in March 2004
2) 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. 3) Prepare for, prevent, respond to and recover
from domestic incidents, regardless of
cause, size or complexity, including acts of
catastrophic terrorism
4) Underlying principles
Flexibility: rapid adaptation
Standardization
Interoperability: agencies of different types
can communicate with one another

34.  Command and Management
a) Incident management is standardized for all
hazards and across all levels of government
b) ICS, mulitagency coordination systems and
public information systems are the three key
constructs

35.  Preparedness
a) Establishes measures for all responders to
incorporate into their systems in
preparation to respond to all incidents at
any time

36.  Resource Management
a) Mechanisms to describe, inventory, track
and dispatch resources before, during and
after an incident
b) Defines standard procedures to recover
equipment used during the inciden

37.  Communications and Information
management
a) Critical aspect of domestic incident
management
b) Enable essential functions needed to
provide interoperability

38.  Supporting Technologies
a) Promotes national standards and
interoperability for supporting technologies
to successfully implement NIMS
b) Provides structure for the science and
technology used in incident management

39.  Ongoing Management and Maintenance
a) U.S. Department of Homeland Security will
establish a
multijurisdictional, multidisciplinary NIMS
integration center
b) This will provide strategic direction for and
oversight of NIMS, supporting routine
maintenance and continuous improvement
of the system in the long term

41. 1) Decision making and basic planning are
done before an incident occurs
2) EMS agency should have written disaster
plans
3) Disaster supplies for at least 72-hour period
of self-sufficiency
4) Mutual Aid agreements with surrounding
organizations
5) Assistance program for families of EMS

42. 1) Unsafe scene
a. Stay away
b. Get close enough only to make an
assessment
2) Three Basic Questions
a. What do I have?
b. What do I need to do?
c. What resources do I need?

43. 1) After scene size-up, establish command
2) Command system ensures resources are
effectively and efficiently coordinated
3) Establish early

44. 1) Often key problem at an MCI or disaster
2) Problems should be worked out before a
disaster happens
a) Designate channels strictly for command
b) Ensure equipment is reliable, durable and
field-tested, and that there are backups in
place

46.  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

47.  Triage Officer  TASKS
a) Counts and prioritizes  Triage and tag all pts.
patients  Ensure adequate staff to
b) 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 of
c) Don’t begin treatment operations
until all patients are  Establish initial morgue
triaged  Document activities of
triage area.

48. 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 of
2) Communicates with area
medical group leaders 5) Document activities
6) Provide updates to
EMS Branch Director

49. 1) Coordinates transportation and distribution
of patients to appropriate receiving
hospitals
2) Communicates with area hospitals
3) Documents and tracks number of vehicles
transporting, patients transported, and the
facility destination of each vehicle and
patient

50. 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 scene
3) Locates area to stage equipment and
responders, track unit arrivals, and send out
vehicles as needed

51. 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

52. 1) Extended Periods
2) 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

53. Extrication Officer (rescue officer)
a) Determines type of equipment and
resources needed for situation
b) Victims may need to be extricated or
rescued before triage and treatment
c) Functions under EMS brance
d) Crew safety is of utmost importance

54. 1) Dead patients
2) Works with medical examiners, coroners,
disaster mortuary assistance teams and law
enforcement agencies to coordinate
removal of bodies and body parts
3) Attempts to leave dead victims in location
found until removal and storage plan
determined
4) If morgue area necessary

56. 1) Triage means “to sort” based on severity of injuries
2) Primary triage---done in field
3) Secondary triage---done in treatment area
4) Rapid and accurate triage will help bring order to the
chaos of the MCI scene
5) 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

57.  Four common triage categories
1. Immediate (red tag)—First priority
2. Delayed (yellow tag)—Second priority
3. Minimal (green tag)—Third priority
4. Expectant(black tag)—Last Priority

58.  Usually have problems with ABC’s, head
trauma, or signs and symptoms of shock

59.  Usually have multiple injuries to bones or
joints, including back injuries with or without
spinal cord injury

60.  They may require no field
treatment, “walking wounded” or soft-tissue
injuries (contusions, abrasions and
lacerations)

61.  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)

62.  Tagging patients assist in tracking them
 Helps keep accurate record of condition
 Tag will become part of patient’s medical
record

63. 1) Simple triage and rapid treatment
2) Limited assessment of patient’s ability to
walk, respiratory status, hemodynamic
status, and neurologic status

64.  Steps
1) 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)

65. 1) Children younger than 8 or who appear to
weigh less than 100 pounds
2) 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

66. 3) Hemodynamic status—no distal
pulse, immediate priority
4) 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

67. 1) Hysterical and disruptive patients
a. immediate priority to be transported out
of the disaster site
b. Panic breeds panic
2) A sick or injured rescuer
a. immediate priority to be transported
3) Hazardous materials and weapons of mass
destruction incidents

68. 1) Immediate (red) or delayed (yellow) should be
transported by ambulance
2) With extreme situations, “walking wounded”
are transported by bus
3) Immediate priority patients are transported
two at a time until they are all transported
4) Delayed are transported two or three at a time
5) Slightly injured are transported
6) Expectant patients who are still alive would
receive transport and treatment

69. 1) Responders may become overwhelmed
2) Stress management should be available but
not imposed

70.  All agencies involved in response should
participate in effort to improve future
reactions to disasters
 Discourage finger pointing

71. 1) Disasters and mass-casualty incidents
2) Incident command
3) Emergency Response within the ICS
4) Triage

72.  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