Incident Management Flashcards
Any call that involves three or more patients, any situation that places such a great demand on available equipment or personnel that the system would require a mutual aid response, or any incident that has the potential to create one of the previously mentioned situations
Mass-casualty incident
An agreement between neighboring EMS systems to respond when local resources are insufficient to handle the response
Mutual aid response
Two important underlying principles of the NIMS
- Flexibility
- Standardization
Allows various agencies to achieve common objectives by supporting each other while maintaining individual authorities
Unity of effort
The ability of agencies of different types or from different jurisdictions to communicate with each other
Interoperability
Three major NIMS components
- Communication and information management
- Resource management
- Command and coordination
NIMS standard incident command structures are based on three key constructs:
- ICS
- Multiagency coordination systems
- Public information systems
Purpose of ICS
Ensure responder and public safety, achieve incident management goals, and ensure the efficient use of resources
Individual units or different organizations make independent and often inefficient decisions about the next appropriate action
Freelancing
Span of control ideal ratio
1 supervisor for 5 subordinates
Responsible for a major functional area such as finance/administration, logistics, planning, or operations
Sections
In charge of activity directly related to the section
Branches
Branches are managed by the ___
Branch director
Branches may be ___
Functional or geographic
Branches tend to be established when ___
Span of control is a problem
Serve to align resources and/or crews under one supervisor
Divisions or groups
___ usually refer to crews working in the same geographic area
Divisions
___ usually refer to crews working in the same functional area
Groups
ICS General staff
- Command
- Finance/administration
- Logistics
- Operations
- Planning
Command staff include ___
Public information officer, safety officer, and liaison officer
Person in charge of the overall incident
Incident commander (IC)
Assesses the incident, establishes the strategic objectives and priorities, and develop a plan to manage the incident
Incident commander
A command system used in larger incidents in which there is a multiagency response or multiple jurisdictions are involved
Unified command system
A command system in which one person is in charge; generally used with small incidents that involve only one responding agency or jurisdiction
Single command system
___ is particularly important if a transfer of command takes place
Communication
Responsible for documenting all expenditures at an incident for reimbursement
Finance/administration section chief
Functions within the finance/administration section
- Time unit
- Procurement unit
- Compensation and claims unit
- Cost unit
Responsible for ensuring the daily recording of personnel time and equipment use
Time unit
Deals with all matters concerning vendor contracts
Procurement unit
Deals with claims as a result of the incident, and injury compensation
Compensation and claims unit
Responsible for collecting, analyzing, and reporting the costs related to an incident
Cost unit
Responsible for communications equipment, facilities, food and water, fuel, lighting, and medical equipment and supplies for patients and emergency responders
Logistics section
Responsible for managing the tactical operations usually handled by the IC on routine EMS calls
Operations section chief
Solves problems as they arise during the incident
Planning section
The central tool for planning during a response to a disaster emergency
Incident action plan
Three important positions that help the general staff and the IC
- Safety officer
- PIO
- Liaison officer
Monitors the scene for conditions or operations that may present a hazard to responders and patients
Safery officer
The safety officer has the authority to ___ whenever a rescuer is in danger
Stop an emergency operation
Provides the public and media with clear and understandable information
PIO
The designated PIO may cooperate with PIOs from other agencies in a ___
Joint information center (JIC)
Relays information and concerns among command, the general staff, and other agencies
Liaison officer
Size-up will be driven by three basic questions
- What do I have?
- What resources do I need?
- What do I need to do?
Incident that is not yet contained
Open incident
Incident that is contained and all casualties are accounted for
Closed incident
Priorities to keep in mind during size-up
- Safety
- Incident stabilization
- Preservation of property and the environment
Preferred communication method at an MCI
Face-to-face
Chief of the medical branch reports to the ___
Operations section
Primary roles of the medical branch
Triage, treatment, and transport of injured people
Ultimately in charge of counting and prioritizing patients
Triage supervisor
Will locate and set up the treatment area with a tier for each priority of patient
Treatment supervisor
Assists with moving patients to the transportation area
Treatment supervisor
Coordinates the transportation and distribution of patients to appropriate receiving hospitals and helps to ensure that hospitals do not become overwhelmed by a patient surge
Transportation supervisor
Assigned when an MCI or disaster requires a multivehicle or multiagency response
Staging supervisor
Establishes an area that provides protection for responders from the elements and the situation
Rehabilitation supervisor
Where should the rehabilitation area be located?
Away from exhaust fumes and crowds and out of view of the scene itself
Signs of stress the rehabilitation supervisor must monitor for
- Fatigue
- Altered thinking patterns
- Complete collapse
Determine the type of equipment and resources needed for the situation
Extrication supervisor or rescue supervisor
Will work with area medical examiners, coroners, disaster mortuary assistance teams, and LE agencies to coordinate removal of the bodies and even, possible, body parts
Morgue supervisor
To sort patients based on the severity of their injuries
Triage
Goal of triage
Greatest good for the greatest number
Triage groups patients based on their ___
Acuity
Initial triage done in the field
Primary triage
Done as the patient’s are brought to the treatment area
Secondary triage
The main info needed on the triage tag
Unique number and triage category
After the primary triage, the triage supervisor should report what to the medical branch director?
- Total number of patients
- Number of patients in each triage category
- Recommendations for extrication and movement of patients to the treatment area
- Resources needed to complete triage and begin movement of patients
Mnemonic to remember triage categories
IDME
IDME
Immediate (red)
Delayed (yellow)
Minor or minimal (green; hold)
Expectant (black; likely to die or dead)
Immediate patients usually have problems with ___
The ABCs, head trauma, or signs and symptoms of shock
Delayed patients usually have ___
Multiple injuries to bones or joints, including back injuries with or without spinal cord injury
START
Simple Triage And Rapid Treatment
One of the easiest methods of triage
START triage
START triage uses a limited assessment of the patient’s ___
Respiratory status, hemodynamic status (pulse), and neurologic status
1st step of the START triage
Call out and direct those who can walk to a landmark (green tag)
Second step of the START triage
Assess respiratory status of non-ambulatory patients. If not breathing, open the airway with a simple maneuver. If they breath (red), if not (black). If breathing without opening airway over 30/min or slower than 10/min (red). If 10 - 29 /min, check bilateral pulses. Absent radial pulse (red). If present assess neurologic status. If able to understand and follow commands (yellow), if unconscious or unable to follow commands (red)
SALT triage system
Sort, Assess, Lifesaving interventions, and treatment and/or transport
JumpSTART triage system is intended for ___
Children younger than 8 or who weigh less than 100 lbs
JumpSTART triage process
- Direct walking wounded and get infants and children with special needs to the treatment area
- Assess breathing, if not breathing check pulse. No pulse (black). Pulse present, open the airway, 5 rescue breaths. Still not breathing (black).
- Respirations less than 15/min or greater than 45/min (red)
- Respirations 15 to 45 /min, beck distal pulse. Absent pulse (red)
- Distal pulse present, check AVPU. Localizes or withdraws from pain (yellow), if worse (red)
Preferable transport for red or yellow patients
Ground or air ambulance
Immediate-priority patients should be transported ___ at a time until all are transported from the site
2
Patients in the delayed category can be transported ___ at a time
2 to 3
Widespread event that disrupts functions and resources of a community and threatens lives and property
Disaster
Two good indicators of the possible presence of a hazardous material
Location and type of building
Senses you can safely use to detect hazardous material
Sight and sound
Any vessel or receptacle that holds a material
Container
What about a container can provide important clues about the nature of the substance inside?
Type, size, and material of construction
Two categories of containers based on capacity
- Bulk
- Nonbulk
Include fixed tanks, highway cargo tanks, rail cars, totes, and intermodal tanks
Bulk storage containers
In general, bulk storage containers are found in ___
Buildings that rely on and need to store large quantities of a particular chemical
Often bulk storage containers at a manufacturing facility are surrounded by ___
A secondary containment system
An engineered method to control spilled or released product if the main containment vessel fails
Secondary containment
Large-volume horizontal tanks are also called ___
Aboveground or underground storage tanks
The tote is also called an ___
Intermediate bulk container
Most common tote sizes
275 and 330 gallons
Portable plastic tank surrounded by a stainless steel web
Tote
A tote can contain ___
Any type of chemical, including flammable liquids, corrosives, food-grade liquids, or oxidizers
Intermodal tank size
4000 to 6000 gallons
All types of containers other than bulk containers
Nonbulk storage vessels
Nonbulk storage vessel capacity
A few ounces to 119 gallons
Easily recognizable, barrellike containers
Drums
Commonly used to store solids and powders
Bags
A glass, plastic, or steel container that holds 1 to 15 gallons of product
Carboy
Glass carboys are often placed in ___
A protective wood, foam, fiberglass, or steel box to prevent breakage
Can often enable you to ID a released chemical
Presence of labels, placards, and other markings
Diamond-shaped indicators that are placed on all four side of highway transport vehicles, railroad tank cars, and other forms of transportation carrying hazardous materials
Placards
Placard size
At least 9.8” per side
Smaller versions of placards that are place on the four sides of individual boxes and smaller packages being transported
Labels
Label size
3.9” per side
A placard IDs ___
The broad hazard class to which the material inside belongs
This number on a placard IDs the specific material being shipped
Four-digit UN number
Offers a certain amount of guidance for responders operating at a hazmat incident
Emergency Response Guidebook (ERG)
How often is the ERG updated?
Every 3 to 4 years
Common source of info about a particular chemical that is specific to that substance
Material safety data sheet
Shipping papers for road and highway transportation are called ___
Bills of lading or freight bills
Where are the bills of lading or freight bills located?
In the cab of the vehicle or on the driver’s person
An agency that provides technical info for first responders who are called to respond to chemical incidents
Chemical Transportation Emergency Center (CHEMTREC)
Number for CHEMTREC
1-800-262-8200
How to pass chemical names to CHEMTREC
Spell them
___ helps reduce the number of civilians and responders who may be exposed to the released substance
Setting control zones and limiting access
Established at a hazmat incident based on the chemical and physical properties of the released material, the environmental factors at the time of the release, and the general layout of the scene
Control zones
If the incident takes place inside a structure, the best place to control access is ___
At the normal points of ingress and egress
Control zones at a hazmat incident
- Exclusionary zone (hot zone)
- Contamination reduction zone (warm zone)
- Outer perimeter (cold zone)
An area immediately surrounding the release, which is also the most contaminated area
Hot zone
Where personnel and equipment transition into and out of the hot zone
Warm zone
The warm zone contains ___
Control points for access as well as the decontamination area
The process of removing or neutralizing and properly disposing of hazardous materials from equipment, patients, and rescue personnel
Decontamination
The water used for decontamination must be ___
Captured and delivered into special sealable containers
The safe zone where personnel do not need to wear any special protective clothing for safer operation
Cold zone
A system for the ID of hazardous materials according to health hazard or toxicity levels, fire hazard, chemical reactive hazard, and special hazards
NFPA 704
Measures of the health risk that a substance poses to someone who comes in contact with it
Toxicity levels
Toxicity levels
1 - 5
PPE levels
A - D
Level A PPE
Most hazardous, require fully encapsulated, chemical-resistant clothing that provides full-body protection, with SCBA
Level B PPE
Nonencapsulated clothing that is designed to protect against a particular hazard
Level C PPE
Like level B, requires nonpermeable clothing and eye protection. Face masks that filter all outside air must be used
Level D PPE
Work uniform
All levels of PPE require ___
Gloves, including two pairs of rubber gloves
Health hazard 0
Little or no hazard (no protection)
Health hazard 1
Slightly hazardous (SCBA level C suit)
Health hazard 2
Slightly hazardous (SCBA level C suit)
Health hazard 3
Extremely hazardous (full protection, with no exposed skin, level A or B suit)
Health hazard 4
Minimal exposure causes death (Special hazmat gear, level A suit)
Most serious injures and deaths from hazmat result from ___
Airway and breathing problems
