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DMACC EMT Chapter 45

The document discusses multiple casualty incidents and incident management. It describes the National Incident Management System (NIMS) which provides a standardized approach for managing disasters through an incident command system. NIMS involves specialized training and establishes common terminology, organization and procedures. The document also discusses triage protocols for sorting patients by priority at mass casualty scenes, including the START and JumpSTART systems. EMS units have designated roles within the incident command structure to effectively treat and transport patients.

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PREHOSPITALPREHOSPITAL EMERGENCY CAREEMERGENCY CARE CHAPTER Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Prehospital Emergency Care, 10th edition Mistovich | Karren TENTH EDITION Multiple-Casualty Incidents and Incident Management 45
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Learning ReadinessLearning Readiness • EMS Education Standards, text p. 1215
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Learning ReadinessLearning Readiness ObjectivesObjectives • Please refer to page 1215 of your text to view the objectives for this chapter.
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Learning ReadinessLearning Readiness Key TermsKey Terms • Please refer to page 1215 of your text to view the key terms for this chapter.
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Setting the StageSetting the Stage • Overview of Lesson Topics  Multiple-Casualty Incidents  National Incident Management System  Triage  Disaster Management
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Case Study IntroductionCase Study Introduction EMTs Tom Hurley and Joe Meyer are the first EMS unit to arrive on the scene of a tour bus collision, in which the bus hit a bridge abutment. A half dozen patients with various injuries have made their way out of the bus. "Help us," says one man. "There are people dying in the bus."
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Case StudyCase Study • What steps do Joe and Tom need to carry out to establish an organized response? • How should the EMTs decide which patients should be treated first?
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved IntroductionIntroduction • The number of patients needed to declare a multiple-casualty incident varies according to the resources available. • Incident management, triage, and disaster response plans are needed to effectively respond to multiple-casualty incidents.
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Multiple-Casualty IncidentsMultiple-Casualty Incidents • An MCI is any event that places excessive demands on personnel and equipment, and typically involves three or more patients. • A variety of events can lead to multiple casualties.
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved National Incident ManagementNational Incident Management SystemSystem • NIMS provides for a consistent approach to managing disasters. • The incident command system (ICS) is part of NIMS. • NIMS provides for flexibility and standardization. continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved National Incident ManagementNational Incident Management SystemSystem • NIMS involves specialized training and preparedness. • Relationships built during preparedness are key to effective response. continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Relationships developed during the preparedness phase of NIMS worked to the advantage of responders and agencies in the aftermath of Hurricane Katrina in 2005 as shown in this disaster triage and treatment sector. (© AP Photo/Dennis Paquin)
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved National Incident ManagementNational Incident Management SystemSystem • An incident command system provides a standardized approach to on-scene management. continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved The incident commander directs the response and coordinates resources at a multiple-casualty incident. continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved National Incident ManagementNational Incident Management SystemSystem • The purpose of NIMS is to ensure:  Safety of emergency responders and others  Achievement of tactical objectives  Efficient use of resources continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved National Incident ManagementNational Incident Management SystemSystem • Features of ICS  Use of common terminology and plain English  Common designations for all organizational resources  Manageable spans of control  Identification of incident facilities by common terminology continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved National Incident ManagementNational Incident Management SystemSystem • Features of ICS  Distinct titles are used  Incident action plans identify the objectives to be accomplished  Integrated communications approach  Accountability at all levels continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved National Incident ManagementNational Incident Management SystemSystem • Designated ICS sections  Command  Finance/administration  Logistics  Operations  Planning continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved EMS branch organization for a major incident. continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved National Incident ManagementNational Incident Management SystemSystem • Incident command is initially assumed by the most experienced and senior person of the first arriving service. • Incident command can then be transferred to the most qualified person in an orderly manner. continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved National Incident ManagementNational Incident Management SystemSystem • Responsibilities of EMS units may include:  Triage unit  Treatment unit  Transport unit  Staging unit  Morgue unit
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Basic ICS organization for a small- to medium-sized incident. continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved TriageTriage • Triage is a system used to sort patients to determine the order in which they receive medical care or transportation. continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Triage sector at the Houston Astrodome where up to 16,000 evacuees from Hurricane Katrina stayed. (© Carlos Barria/Reuters/Corbis) continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved TriageTriage • Primary triage occurs immediately upon arrival of the first EMS crew. • Patients are tagged with a color-coded system to allow organization of their removal from the incident site. • Patients are moved to the triage unit, where secondary triage is performed. continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved TriageTriage • START is a triage system that uses universal colors to identify priority. • It is used for patients older than 8 years of age and greater than 100 lbs. • Each patient is triaged in less than 30 seconds. • Patients are assessed for respiratory, perfusion, and mental status. continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved TriageTriage • JumpSTART pediatric triage system  Accounts for pediatric differences in physiology  Used on any patient who appears to be a child continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved The JumpSTART system. (© Lou Romig, MD, FAAP, FACEP, 2002) continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved TriageTriage • Patients are moved from the triage area to the treatment area. • Only salvageable patients are treated. • Provide only necessary care. continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Triage summary. continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved TriageTriage • The treatment, staging and transport unit leaders make decisions about priority of transport. • The transport unit ensures that transportation is coordinated. continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Figure 45-10a EMS personnel must have a universally understood triage identification tag system as shown in photos (a), (b), and (c).
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Figure 45-10b EMS personnel must have a universally understood triage identification tag system as shown in photos (a), (b), and (c).
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Figure 45-10c EMS personnel must have a universally understood triage identification tag system as shown in photos (a), (b), and (c).
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved TriageTriage • The transport unit leader must consider:  Distribution of patients to each medical facility  Surge capacity of each hospital or facility continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved TriageTriage • The transport unit leader must consider:  Need for transport to a specialty medical facility  Need for constant coordination and communication continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved TriageTriage • Follow-through  When all patients have been transported, EMS personnel may be needed to assist at hospitals. continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved TriageTriage • Reducing posttraumatic and cumulative stress  Try not to become overwhelmed by the incident, care for patients one by one.  Rest periods should be provided. continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved TriageTriage • Reducing posttraumatic and cumulative stress  Each worker must be fully aware of his assignment.  Someone should circulate among personnel, looking for signs of exhaustion or stress. continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Firefighters and rescue workers take a break in a rehab unit near “Ground Zero,” New York City, September 12, 2001. (© Tim Fadek/Gamma) continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved TriageTriage • Reducing posttraumatic and cumulative stress  Rescuers should be assigned tasks appropriate to their skill levels.  Food and drink should be provided. continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved TriageTriage • Reducing posttraumatic and cumulative stress  Rescuers should be encouraged to talk amongst themselves.  Rescuers should have the opportunity to talk with trained counselors following the incident.
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Click on the triage category most suitable for a 30-year-oldClick on the triage category most suitable for a 30-year-old patient with a leg amputated below the knee, who is awake,patient with a leg amputated below the knee, who is awake, able to follow commands, has respirations of 24 per minute,able to follow commands, has respirations of 24 per minute, and a weak, rapid radial pulse.and a weak, rapid radial pulse. A. Green B. Yellow C. Red D. Black
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Case StudyCase Study Joe establishes initial incident command, and advises dispatch that there are 30 to 40 patients. Tom begins triage by asking anyone who is able to leave the bus on his own to do so. Left with nine patients on the bus, the first patient Tom comes to is a man in his 50s who is confused and having difficulty breathing. continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Case StudyCase Study • What additional information does Tom need in order to categorize this first patient? • Once additional help arrives, what incident command sections will be established? • How will EMS be organized within the ICS?
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Disaster ManagementDisaster Management • A disaster is a sudden catastrophic event that overwhelms natural order and causes great loss of property or life. • There is a great disparity between casualties and resources. • Disasters may be natural or man-made. continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Disaster ManagementDisaster Management • Requirements of effective disaster assistance  Preparation of the entire community  Careful preplanning  Ability to quickly implement a plan  Effective communication among responders continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Disaster ManagementDisaster Management • Requirements of effective disaster assistance  Application of triage skills  Ability to organize quickly and utilize all emergency personnel  Ability to adapt the plan to meet special conditions continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Disaster ManagementDisaster Management • Requirements of effective disaster assistance  A contingency plan for shelter and transportation for the community  Doing the greatest good for the greatest number  A plan that avoids relocating the disaster from the scene to the hospital continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Disaster ManagementDisaster Management • An evacuation and warning message should communicate the following:  The nature of the disaster, its estimated time of impact, and estimated severity  Safe routes out of the area  Destinations for those who evacuate continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Disaster ManagementDisaster Management • Disaster communications systems  An effective system includes a backup system.  Establish details of the system ahead of time.  Appoint only one person who communicates with those outside the disaster area. continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Disaster ManagementDisaster Management • Disaster communications systems  The designated communication person should stay in contact with hospitals and rescue units.  Area-wide communications are vital.  Provide an area where people can register concerning whereabouts and health status. continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Disaster ManagementDisaster Management • Disaster communications systems  Make sure information about road conditions and alternative routes is constantly monitored and updated.  Monitor hospital status.  Do not allow vehicles en route to hospitals to communicate with hospitals except if an emergency occurs en route. continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Disaster ManagementDisaster Management • Disaster communications systems  Individual rescuers should have individual portable radios to communicate with their command.  Include a mechanism of recording communications for later review. continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Disaster ManagementDisaster Management • Psychological impact of disasters  Survivors suffer many negative emotions and physical effects.  Reactions depend on age, physical health, and emotional health. continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Disaster ManagementDisaster Management • Guidelines for managing the psychological impact of disasters  Families of patients need and deserve accurate information.  Reunite families as soon as possible.  Group people with their families and neighbors.  Encourage people to do necessary chores. continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Disaster ManagementDisaster Management • Guidelines for managing the psychological impact of disasters  Provide emotional structure and expectations for the emotionally injured.  Help patients confront the reality of the disaster.  Don't give false assurances. continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Disaster ManagementDisaster Management • Guidelines for managing the psychological impact of disasters  If patients refuse help, assure them that accepting help is in no way a sign of weakness.  Identify high-risk patients, including those with no support, and target them for immediate crisis intervention. continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Disaster ManagementDisaster Management • Guidelines for managing the psychological impact of disasters  Identify people who are in a unique position to help and recruit them for psychological emergency care.  Arrange for all those involved in the disaster to get follow-up care and support.
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Case Study ConclusionCase Study Conclusion The first arriving fire personnel assume incident command, as Joe joins Tom in completing primary triage. An EMS supervisor is designated the EMS branch supervisor, as two arriving paramedics assume triage and treatment unit positions. Joe is then reassigned to the transport unit. continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Case Study ConclusionCase Study Conclusion There are seven immediate, 18 delayed, and ten minor patients. The patients are transported to three local hospitals.
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Lesson SummaryLesson Summary • Response to MCIs requires standardized preplanning and training. • NIMS was established to provide standardization of MCI response. • The ICS identifies the authority and responsibilities of responders at an MCI. continued on next slide
Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Lesson SummaryLesson Summary • Triage is a mechanism for sorting and prioritizing patients according to their injuries. • Triage systems rely on color-coded tags. • MCIs and disasters have profound psychological effects on survivors and responders.

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DMACC EMT Chapter 45

  • 1.
    PREHOSPITALPREHOSPITAL EMERGENCY CAREEMERGENCY CARE CHAPTER Copyright© 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Prehospital Emergency Care, 10th edition Mistovich | Karren TENTH EDITION Multiple-Casualty Incidents and Incident Management 45
  • 2.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Learning ReadinessLearning Readiness • EMS Education Standards, text p. 1215
  • 3.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Learning ReadinessLearning Readiness ObjectivesObjectives • Please refer to page 1215 of your text to view the objectives for this chapter.
  • 4.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Learning ReadinessLearning Readiness Key TermsKey Terms • Please refer to page 1215 of your text to view the key terms for this chapter.
  • 5.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Setting the StageSetting the Stage • Overview of Lesson Topics  Multiple-Casualty Incidents  National Incident Management System  Triage  Disaster Management
  • 6.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Case Study IntroductionCase Study Introduction EMTs Tom Hurley and Joe Meyer are the first EMS unit to arrive on the scene of a tour bus collision, in which the bus hit a bridge abutment. A half dozen patients with various injuries have made their way out of the bus. "Help us," says one man. "There are people dying in the bus."
  • 7.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Case StudyCase Study • What steps do Joe and Tom need to carry out to establish an organized response? • How should the EMTs decide which patients should be treated first?
  • 8.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved IntroductionIntroduction • The number of patients needed to declare a multiple-casualty incident varies according to the resources available. • Incident management, triage, and disaster response plans are needed to effectively respond to multiple-casualty incidents.
  • 9.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Multiple-Casualty IncidentsMultiple-Casualty Incidents • An MCI is any event that places excessive demands on personnel and equipment, and typically involves three or more patients. • A variety of events can lead to multiple casualties.
  • 10.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved National Incident ManagementNational Incident Management SystemSystem • NIMS provides for a consistent approach to managing disasters. • The incident command system (ICS) is part of NIMS. • NIMS provides for flexibility and standardization. continued on next slide
  • 11.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved National Incident ManagementNational Incident Management SystemSystem • NIMS involves specialized training and preparedness. • Relationships built during preparedness are key to effective response. continued on next slide
  • 12.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Relationships developed during the preparedness phase of NIMS worked to the advantage of responders and agencies in the aftermath of Hurricane Katrina in 2005 as shown in this disaster triage and treatment sector. (© AP Photo/Dennis Paquin)
  • 13.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved National Incident ManagementNational Incident Management SystemSystem • An incident command system provides a standardized approach to on-scene management. continued on next slide
  • 14.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved The incident commander directs the response and coordinates resources at a multiple-casualty incident. continued on next slide
  • 15.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved National Incident ManagementNational Incident Management SystemSystem • The purpose of NIMS is to ensure:  Safety of emergency responders and others  Achievement of tactical objectives  Efficient use of resources continued on next slide
  • 16.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved National Incident ManagementNational Incident Management SystemSystem • Features of ICS  Use of common terminology and plain English  Common designations for all organizational resources  Manageable spans of control  Identification of incident facilities by common terminology continued on next slide
  • 17.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved National Incident ManagementNational Incident Management SystemSystem • Features of ICS  Distinct titles are used  Incident action plans identify the objectives to be accomplished  Integrated communications approach  Accountability at all levels continued on next slide
  • 18.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved National Incident ManagementNational Incident Management SystemSystem • Designated ICS sections  Command  Finance/administration  Logistics  Operations  Planning continued on next slide
  • 19.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved EMS branch organization for a major incident. continued on next slide
  • 20.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved National Incident ManagementNational Incident Management SystemSystem • Incident command is initially assumed by the most experienced and senior person of the first arriving service. • Incident command can then be transferred to the most qualified person in an orderly manner. continued on next slide
  • 21.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved National Incident ManagementNational Incident Management SystemSystem • Responsibilities of EMS units may include:  Triage unit  Treatment unit  Transport unit  Staging unit  Morgue unit
  • 22.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Basic ICS organization for a small- to medium-sized incident. continued on next slide
  • 23.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved TriageTriage • Triage is a system used to sort patients to determine the order in which they receive medical care or transportation. continued on next slide
  • 24.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Triage sector at the Houston Astrodome where up to 16,000 evacuees from Hurricane Katrina stayed. (© Carlos Barria/Reuters/Corbis) continued on next slide
  • 25.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved TriageTriage • Primary triage occurs immediately upon arrival of the first EMS crew. • Patients are tagged with a color-coded system to allow organization of their removal from the incident site. • Patients are moved to the triage unit, where secondary triage is performed. continued on next slide
  • 26.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved TriageTriage • START is a triage system that uses universal colors to identify priority. • It is used for patients older than 8 years of age and greater than 100 lbs. • Each patient is triaged in less than 30 seconds. • Patients are assessed for respiratory, perfusion, and mental status. continued on next slide
  • 27.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved TriageTriage • JumpSTART pediatric triage system  Accounts for pediatric differences in physiology  Used on any patient who appears to be a child continued on next slide
  • 28.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved The JumpSTART system. (© Lou Romig, MD, FAAP, FACEP, 2002) continued on next slide
  • 29.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved TriageTriage • Patients are moved from the triage area to the treatment area. • Only salvageable patients are treated. • Provide only necessary care. continued on next slide
  • 30.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Triage summary. continued on next slide
  • 31.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved TriageTriage • The treatment, staging and transport unit leaders make decisions about priority of transport. • The transport unit ensures that transportation is coordinated. continued on next slide
  • 32.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Figure 45-10a EMS personnel must have a universally understood triage identification tag system as shown in photos (a), (b), and (c).
  • 33.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Figure 45-10b EMS personnel must have a universally understood triage identification tag system as shown in photos (a), (b), and (c).
  • 34.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Figure 45-10c EMS personnel must have a universally understood triage identification tag system as shown in photos (a), (b), and (c).
  • 35.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved TriageTriage • The transport unit leader must consider:  Distribution of patients to each medical facility  Surge capacity of each hospital or facility continued on next slide
  • 36.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved TriageTriage • The transport unit leader must consider:  Need for transport to a specialty medical facility  Need for constant coordination and communication continued on next slide
  • 37.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved TriageTriage • Follow-through  When all patients have been transported, EMS personnel may be needed to assist at hospitals. continued on next slide
  • 38.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved TriageTriage • Reducing posttraumatic and cumulative stress  Try not to become overwhelmed by the incident, care for patients one by one.  Rest periods should be provided. continued on next slide
  • 39.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved TriageTriage • Reducing posttraumatic and cumulative stress  Each worker must be fully aware of his assignment.  Someone should circulate among personnel, looking for signs of exhaustion or stress. continued on next slide
  • 40.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Firefighters and rescue workers take a break in a rehab unit near “Ground Zero,” New York City, September 12, 2001. (© Tim Fadek/Gamma) continued on next slide
  • 41.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved TriageTriage • Reducing posttraumatic and cumulative stress  Rescuers should be assigned tasks appropriate to their skill levels.  Food and drink should be provided. continued on next slide
  • 42.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved TriageTriage • Reducing posttraumatic and cumulative stress  Rescuers should be encouraged to talk amongst themselves.  Rescuers should have the opportunity to talk with trained counselors following the incident.
  • 43.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Click on the triage category most suitable for a 30-year-oldClick on the triage category most suitable for a 30-year-old patient with a leg amputated below the knee, who is awake,patient with a leg amputated below the knee, who is awake, able to follow commands, has respirations of 24 per minute,able to follow commands, has respirations of 24 per minute, and a weak, rapid radial pulse.and a weak, rapid radial pulse. A. Green B. Yellow C. Red D. Black
  • 44.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Case StudyCase Study Joe establishes initial incident command, and advises dispatch that there are 30 to 40 patients. Tom begins triage by asking anyone who is able to leave the bus on his own to do so. Left with nine patients on the bus, the first patient Tom comes to is a man in his 50s who is confused and having difficulty breathing. continued on next slide
  • 45.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Case StudyCase Study • What additional information does Tom need in order to categorize this first patient? • Once additional help arrives, what incident command sections will be established? • How will EMS be organized within the ICS?
  • 46.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Disaster ManagementDisaster Management • A disaster is a sudden catastrophic event that overwhelms natural order and causes great loss of property or life. • There is a great disparity between casualties and resources. • Disasters may be natural or man-made. continued on next slide
  • 47.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Disaster ManagementDisaster Management • Requirements of effective disaster assistance  Preparation of the entire community  Careful preplanning  Ability to quickly implement a plan  Effective communication among responders continued on next slide
  • 48.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Disaster ManagementDisaster Management • Requirements of effective disaster assistance  Application of triage skills  Ability to organize quickly and utilize all emergency personnel  Ability to adapt the plan to meet special conditions continued on next slide
  • 49.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Disaster ManagementDisaster Management • Requirements of effective disaster assistance  A contingency plan for shelter and transportation for the community  Doing the greatest good for the greatest number  A plan that avoids relocating the disaster from the scene to the hospital continued on next slide
  • 50.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Disaster ManagementDisaster Management • An evacuation and warning message should communicate the following:  The nature of the disaster, its estimated time of impact, and estimated severity  Safe routes out of the area  Destinations for those who evacuate continued on next slide
  • 51.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Disaster ManagementDisaster Management • Disaster communications systems  An effective system includes a backup system.  Establish details of the system ahead of time.  Appoint only one person who communicates with those outside the disaster area. continued on next slide
  • 52.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Disaster ManagementDisaster Management • Disaster communications systems  The designated communication person should stay in contact with hospitals and rescue units.  Area-wide communications are vital.  Provide an area where people can register concerning whereabouts and health status. continued on next slide
  • 53.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Disaster ManagementDisaster Management • Disaster communications systems  Make sure information about road conditions and alternative routes is constantly monitored and updated.  Monitor hospital status.  Do not allow vehicles en route to hospitals to communicate with hospitals except if an emergency occurs en route. continued on next slide
  • 54.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Disaster ManagementDisaster Management • Disaster communications systems  Individual rescuers should have individual portable radios to communicate with their command.  Include a mechanism of recording communications for later review. continued on next slide
  • 55.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Disaster ManagementDisaster Management • Psychological impact of disasters  Survivors suffer many negative emotions and physical effects.  Reactions depend on age, physical health, and emotional health. continued on next slide
  • 56.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Disaster ManagementDisaster Management • Guidelines for managing the psychological impact of disasters  Families of patients need and deserve accurate information.  Reunite families as soon as possible.  Group people with their families and neighbors.  Encourage people to do necessary chores. continued on next slide
  • 57.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Disaster ManagementDisaster Management • Guidelines for managing the psychological impact of disasters  Provide emotional structure and expectations for the emotionally injured.  Help patients confront the reality of the disaster.  Don't give false assurances. continued on next slide
  • 58.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Disaster ManagementDisaster Management • Guidelines for managing the psychological impact of disasters  If patients refuse help, assure them that accepting help is in no way a sign of weakness.  Identify high-risk patients, including those with no support, and target them for immediate crisis intervention. continued on next slide
  • 59.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Disaster ManagementDisaster Management • Guidelines for managing the psychological impact of disasters  Identify people who are in a unique position to help and recruit them for psychological emergency care.  Arrange for all those involved in the disaster to get follow-up care and support.
  • 60.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Case Study ConclusionCase Study Conclusion The first arriving fire personnel assume incident command, as Joe joins Tom in completing primary triage. An EMS supervisor is designated the EMS branch supervisor, as two arriving paramedics assume triage and treatment unit positions. Joe is then reassigned to the transport unit. continued on next slide
  • 61.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Case Study ConclusionCase Study Conclusion There are seven immediate, 18 delayed, and ten minor patients. The patients are transported to three local hospitals.
  • 62.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Lesson SummaryLesson Summary • Response to MCIs requires standardized preplanning and training. • NIMS was established to provide standardization of MCI response. • The ICS identifies the authority and responsibilities of responders at an MCI. continued on next slide
  • 63.
    Prehospital Emergency Care,10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Lesson SummaryLesson Summary • Triage is a mechanism for sorting and prioritizing patients according to their injuries. • Triage systems rely on color-coded tags. • MCIs and disasters have profound psychological effects on survivors and responders.

Editor's Notes

  • #2 Advance Preparation Student Readiness Assign the associated section of MyBRADYLab and review student scores. Review the chapter material in the Instructor Resources, which includes Student Handouts, PowerPoint slides, and the MyTest Program. Prepare Review local protocols and operating procedures for multiple casualty incidents, triage, and incident command. Consider inviting someone with incident command expertise to guest lecture. Bring examples of triage tags used in your EMS system. Arrange for mock patients and assistant instructors to conduct a mock MCI for your students. Pre-determine the injuries for each patient and make sure each is well-informed about his or her role. Moulage is an important aspect of this exercise. If the above exercise is not feasible, prepare a tabletop disaster exercise by writing patient descriptions on index cards. Plan 100 to 120 minutes for this class as follows: Multiple Casualty Incidents: 5 minutes Defines the characteristics of multiple casualty incidents. National Incident Management System: 20 minutes Describes each of the components of the National Incident Management System (NIMS) Triage: 60 minutes Explains the principles and implementation of triage systems used in mass casualty incidents Disaster Management: 15 minutes Describes components of effective disaster management, and the role of EMS in disaster management The total teaching time recommended is only a guideline. Take into consideration factors such as the pace at which students learn, the size of the class, breaks, and classroom activities. The actual time devoted to teaching objectives is the responsibility of the instructor.
  • #3 Explain to students what the National EMS Education Standards are. The National EMS Education Standards communicate the expectations of entry-level EMS providers. As EMTs, students will be expected to be competent in these areas. Acknowledge that the Standards are broad, general statements. Although this lesson addresses the listed competencies, the competencies are often complex and require completion of more than one lesson to accomplish.
  • #4 Objectives are more specific statements of what students should be able to do after completing all reading and activities related to a specific chapter. Remind students they are responsible for the learning objectives and key terms for this chapter.
  • #5 Assess and reinforce the objectives and key terms using quizzes, handouts from the electronic instructor resources, and workbook pages.
  • #7 Case Study Present the Case Study Introduction provided in the PowerPoint slide set. Lead a discussion using the case study questions provided on the subsequent slide(s). The Case Study with discussion questions continues throughout the PowerPoint presentation. Case Study Discussion Use the case study content and questions to foreshadow the upcoming lesson content
  • #9 During this lesson, students will learn about the roles and responsibilities of an EMT during a multiple-casualty incident.
  • #10 Teaching Tips Discuss events that have led to MCIs in your community and the events that your community includes in its disaster plan.   Discussion Questions What events (local, state, or national) can you recall that would be classified as MCIs? Why is the number of patients that define an MCI different in different locations?   Critical Thinking Discussion What should you include in a personal disaster preparedness plan for yourself and your family?  
  • #11 Teaching Tips Discuss local ICS configurations.   Discussion Questions What is the purpose of NIMS? What is the purpose of ICS? What features are designed to make ICS effective?   Knowledge Application Student should be able to apply the principles in this section in order to operate within an ICS.   Critical Thinking Discussion What is the best way to be prepared to function well in an MCI?
  • #12 Discussion Question What responsibilities does each of the typical EMS units in an ICS system carry out?
  • #24 Teaching Tips Discuss local triage practices. Discuss the capabilities of local hospitals. Discuss mutual aid agreements in place for cooperation among jurisdictions.   Discussion Question How do responders use primary and secondary triage?   Knowledge Application Students should be able to apply the principles of triage while working within an ICS.   Class Activity Hold an MCI drill or, if this is not feasible, do a tabletop triage exercise with students.
  • #26 Teaching Tips Show students the triage tags used in your system.   Discussion Question How can you classify patients according to the red, yellow, green, and black color triage system?
  • #27 Discussion Question How do you perform START triage?  
  • #28 Discussion Question How is JumpSTART different from START?
  • #39 Discussion Question What mechanisms should be in place to monitor for, minimize, and manage rescuer stress reactions?   Critical Thinking Discussion What should you do if you feel overwhelmed when working at the scene of an MCI?  
  • #40 Discussion Question What mechanisms should be in place to monitor for, minimize, and manage rescuer stress reactions?   Critical Thinking Discussion What should you do if you feel overwhelmed when working at the scene of an MCI?  
  • #48 Teaching Tips Discuss the response to any disasters that have occurred in your area.   Critical Thinking Discussion How can you promote disaster preparedness in your community? What type of disasters should you anticipate in your community?
  • #51 Discussion Question What types of events can be considered disasters?
  • #52 Discussion Question What principles of communications should you apply in disaster situations?
  • #56 Discussion Questions What is the psychological impact of disasters? What can the EMT do to minimize the psychological impact of disasters? Knowledge Application Students should be able to apply the information in this chapter to the psychological care of disaster patients.  
  • #63 Follow-Up Answer student questions. Follow-Up Assignments Review Chapter 45 Summary. Complete Chapter 45 In Review questions. Complete Chapter 45 Critical Thinking questions. Assessments Handouts Chapter 45 quiz
  • #64 Class Activity As an alternative to assigning the follow-up exercises in the lesson plan as homework, assign each question to a small group of students for in-class discussion.   Teaching Tips Answers to In Review questions are in the appendix of the text. Advise students to review the questions again as they study the chapter.