This document discusses mass casualty incidents and the role of emergency medical responders. It describes what constitutes a mass casualty incident, the sectors that should be established at the scene including triage, treatment and transportation. It outlines the START triage plan involving assessing airways, breathing, circulation and mental status to assign patients priority levels of red, yellow, green or black to determine treatment. The emergency responder's role is to begin triaging patients and provide initial care until additional EMS support arrives.

1. Barry Kidd 2010 1
Mass Casualty
Incidents

2. Barry Kidd 2010 2
Overview
 Mass Casualty Incidents
 Role of an Emergency Medical
Responder at a MCI
 Mass casualty sectors
 Triage
 Priority levels
 START Plan

3. Barry Kidd 2010 3
Mass Casualty Incident
 Any event that places excessive
demands on EMS personnel, and/or
equipment
 A disaster is defined as a sudden
catastrophic event that overwhelms
natural order, and causes great loss of
life and property

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Mass Casualty Incidents
 Any typical MCI involves three or more
patient’s
 The following are examples of a MCI:
o Single and/or multiple MVC’s
o Large structure fires
o Natural disasters
o Collapsed buildings
o Carbon Monoxide poisoning
o Radio active spills
 Not all MCI’s are trauma related accidents

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Mass Casualty Incident
During each MCI,
there must be only
one person in
charge; this is
determined upon
initial arrival on the
scene
This person is called
the “Incident
Commander”

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Mass Casualty Incidents
The Emergency Medical Responder will
most likely be the first rescuer on scene
The Emergency Medical Responder
must be able to start triaging the
wounded patient’s and when
appropriate, initiate medical care. Once
other EMS personnel arrive on scene,
the Emergency Medical Responder must
be able to pass the required information
on to the other appropriate personnel

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Mass Casualty Sectors
After an “Incident Commander” is determined,
he/she should begin to establish the following
MCI sectors:
 Mobile Command Sector
 Supply Sector
 Extrication Sector
 Triage Sector
 Treatment Sector
 Staging Sector
 Transportation Sector

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Mass Casualty Sectors
These sectors are
only to be
established if the
resources are
available

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Triage
Triage is a process of sorting a number of
patient’s into categories and ordering
their treatment and transport based on
the severity of their injuries or medical
conditions
The purpose of triage is to assess the
patient’s condition, determine severity of
injuries, and determine treatment priority

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Triage

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Priority Levels
Once each
patient has been
assessed, they
must get a triage
tag put on to their
extremity, with the
appropriate level
of priority on it

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Priority Levels
Priority # 1 – Red
All patient’s with life threatening injuries that
can be treatable:
 Airway and breathing difficulties
 Uncontrolled or severe bleeding
 Altered mental status
 Severe medical problems
 Severe burns
 Showing signs and symptoms of shock

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Priority Levels
Priority # 2 – Yellow
 All patient’s with serious injuries, but not
life threatening:
 Burns without airway problems
 Major or multiple bone/joint fractures
 Back injuries without spinal cord
damage

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Priority Levels
Priority # 3 – Green
All patient’s who are walking wounded:
 Minor musculoskeletal injuries , but able
to move and function properly
 Minor soft tissue injuries

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Priority Levels
Priority # 4 – Black
All patient’s who appear to have no life signs:
 Cardiac arrest with no pulse greater than 20
minutes
 Exposed brain matter
 Severed torso
 Decapitation
 Incineration
These are the FOUR Priority Levels in which
every patient needs to be assessed under

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Triage

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The START Plan
A four stage
Simple Triage And
Rapid Treatment
program,
designed for use
during a MCI

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The START Plan
Step 1 includes all of the following:
 Directing walking wounded patient’s to a
designated area
 Appoint another Emergency Medical
Responder to stay and monitor these
patient’s

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The Start Plan
Step 2 includes all of the following:
 Check patient’s airway and breathing for
a maximum of one minute
 Each patient who now cannot walk, must
be assessed for airway and breathing
 If the patient is unconscious, instruct
someone to secure the airway, then
proceed to check respirations
 All respiratory rates are only an
estimation

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The Start Plan
Step 3 includes all of the following:
 Check patient’s circulation, and determine if
patient has a radial pulse. A radial pulse
indicates a systolic blood pressure of at lease
80mmHg
 Any patient without a radial pulse will be
classed as Priority # 1 (Red Tag)
 Quickly assess and control any major bleeding
with direct pressure. If showing signs of shock,
treat for shock and classed as Priority # 1 (Red
Tag)

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The Start Plan
Step 4 includes all of the following:
 Check to see if the patient has adequate
ABC’s, check the patient’s mental status
 If the patient has an altered mental
status, this patient is classed as Priority
# 1 (Red Tag) even if the ABC’s are
intact

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Summary
 Mass Casualty Incidents
 Role of a First Responder at a MCI
 Mass casualty sectors
 Triage
 Priority levels
 START Plan

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ANY QUESTIONS?