BLOCK 3: MASS-CASUALTY Flashcards
multiple-casualty incident
any situation with more than one patient that will NOT overwhelm available resources
mass casualty incident
number of patients and severity of injuries that can overwhelm available community resources, requiring mutual aid response
leading authority agency over mass-casualty response in US
FEMA (federal emergency management agency)
National Incident Management System (NIMS)
designed to improve efficiency in managing incidents regardless of size or complexity and improve coordination
when did NIMS become required for all first responders
after 9/11
who implemented the NIMS system
president of US directed Secretary of Homeland Security
three important features of NIMS
standardization, flexibility, interoperability
the 4 major NIMS components
fundamentals and concepts
resource management
command and coordination
communications and info management
where does EMS provider’s role fall within the NIMS components
command and coordination
general staff of the incident command system (ICS)
FLOP
finance
logistics
operations
planning
who has overall command responsibility for the ICS
incident commander (IC)
the command functions
PIO (public information officer)
safety officer
liaison officer
what type of command system does multiagency responses use
unified
single command system
one person in charge, used for small incidents involving only one agency or jurisdiction
small-scale vs large-scale incidents where is the incident commander
small-scale: on fringes of a scene
large-scale: short distance from the scene
each transfer of command should occur as a ____
face-to-face exchange
operations section role
tactical operations including triage, patient treatment/transport
finance section role
documenting all expenditures at an incident for reimbursement
4 units of the finance section
time unit: recording of personnel/equipment time
procurement unit: vendor contracts
compensation/claims unit: claims and injury compensation
cost unit: collecting and reporting costs
logistics section role
for equipment (comms, facilities, food/water, fuel, lighting, medical)
planning section role
solves problems as they arise during the MCI
4 units in planning section
resources, situation, demobilization, documentation
which section develops the incident action plan
planning section
safety officer role
monitors scenes for hazards
public information officer role
provides public and media with information
what is a joint information center
PIO’s from different agencies working together
liaison officer role
relays info and concerns among everyone
what has historically been the weak point at most major incidents
communications
who do you check in with upon arrival at a large-scale incident
resource unit (subsection of planning section)
two basic questions responder sizing up scene asks themselves
what do i have? what do i need?
what is the rescue task force
EMS with ballistic vest and helmets
can enter building of active shooter under law enforcement’s guidance after an area is cleared
EMS/medical branch’s roles
triage, treatment, transport
triage unit leader role
in charge of counting and prioritizing patients
treatment unit leader role
locate and set up treatment area with tiers for priority
ensure secondary triage is performed
adequate patient care
assisting moving patients to transport area
request supplies
transportation unit leader role
coordinates transportation and distribution of patients to hospitals (call to establish how many patients they can accommodate)
documents transports and destinations
staging area manager role
locates area away from scene to stage equipment, track arrivals, and send out vehicles as needed
rehabilitation group leader role
establish area protecting responders from elements and situation to rest
monitor responders for signs of stress
defusing/debriefing team
extrication/rescue task force leader role
determine type of equipment and resources needed for extrication
morgue unit leader role
coordinate with med examiners, coroners to coordinate removal of bodies
may need to create morgue area
open vs. closed incident
open: several casualties not yet located, search/rescue, may produce more patients
closed: contained incident, all patients in one location, not expected to produce more patients than already found
primary vs. secondary triage
primary: rapid categorization of patients with tags
secondary: sorting within treatment group and to reassess for changes
a complete triage assessment should take no more than ___
30 seconds
4 triage categories
IDME
immediate (red)
delayed (yellow)
minimal (green)
expectant (black: likely to die or dead)
red tag patients
immediate
ABCs, head trauma, signs of shock
any injured responder regardless of medical status
yellow tag patients
delayed
multiple injuries to bones or joints including back injuries
green tag patients
minimal
“walking wounded” contusions, abrasions, lacerations
black tag patients
dead or likely to die
cardiac arrest or open head injury
may also include patients in respiratory arrest
what tag is included in modified triage systems
a fifth triage category
orange-tag between red and yellow (patients with prior conditions that arise)
4 steps in the START
- call out for “walking wounded” - greens
- check for breathing - if not breathing, open airway - if they don’t breathe: black, if they breathe: red and place in recovery position (if over 30RR, red. if under 30RR move on)
- check for hemodynamic status (if radial pulse is absent: red, if radial pulse present: move on)
- check for neurologic status (if they can’t follow commands: red, if they can: yellow)
who is the jumpSTART system for
children under 8 years old or appear to be under 100lbs
steps of jumpSTART triage
- identify walking wounded (children who can’t walk or follow commands taken to treatment)
- breathing: if not breathing, check pulse. if no pulse: black, if pulse: open airway, then give 5 rescue breaths and recheck, if nothing: black
- respirations - under 15RR or over 45RR: red, within 15-45, move on with assessment
- distal pulse - absent: red, present: move on with assessment
- neurological AVPU - unresponsive or incomprehensible: red, normal response: yellow
SALT triage acronym
sort, assess, lifesaving interventions, treatment/transport
SALT triage system
- identify walking wounded to assess last
- identify those who can’t walk but have purposeful movement/follow verbal commands - second to last
- obvious life-threatening injuries -first
rapid interventions: bleeding control, opening airway (2 rescue breaths for kids), needle decompression, auto-injectors
then assess airway, mental status, perfusion, respiratory status, assess if bleeding controlled
SALT triage different tags
black: dead and should not be moved
gray: patients who are not expected to survive but may be revisited after all reds are taken care of
what classification must occur for triage at hazardous materials/weapons of mass destruction incident
contaminated and decontaminated patients before normal triage begins
hospital surge capacity
hospital plan for MCIs to accommodate overload of patients using mobile units (tents)
coping mechanisms for after MCIs
EAPs
mental health professions
peer counselors trained in CISM
fundamental goal of MCIs
“doing the most good for the most patients”
triage numbers responding to color tags
zero: black
one: red
two: yellow
three: green
