MCI & Triage Flashcards by Alicia Daum

What does a MCI do?

Overwhelms resources (equipment, rescuers, facilities) available in a system or area

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Types of Mass Casualty Incidents

Natural disasters
Technical hazards
Civil-Political

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Examples of Natural Disaster MCIs

Extreme heat/cold
Fires
Floods
Earthquakes
Tropical storms and hurricanes
Tornados
Epidemics

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Examples of Technical Hazard MCIs

Building collapse
High rise incidents
Hazardous materials incidents
Transportation accidents
Major industrial accidents

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Examples of Ciliv-Political MCIs

Civil disobedience: demonstrations, strikes, riots
Criminal or terrorist incidents: mass shootings, hostage situation, explosive, chemical, biological, nuclear
Military attack on the US

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What does an incident management system allow?

Effective control, direction, and coordination of response resources

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Influencing Factos of an Incident Management System

Magnitude of event

Available resources

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Components of Magnitude of Event

Number of patients
Area
Boundaries: open or closed

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Components of Available Resources

Response and support personnel
Vehicles and equipment
Facilities

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Categories of Mass Casualty Incidents

Expanded medical incident
Major medical incident
Disaster
Catastrophe

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Define Expanded Medical Incident

Prehospital resources adequate

Hospital capacity adequate

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Define Major Medical Incident

Multi-jurisdictional and regional EMS response

Regional allocation of patients to hospitals

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Define Disaster

Overwhelms local, multi-jurisdictional, and regional mutual aid
Requires assistance from state, interstate, or federal resources

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Define Catastrophe

Overwhelms local, multi-jurisdictional, regional and state resources
Interstate and federal resources needed
Local resources concentrate on own survival

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Goals of MCI Management

Greatest good for greatest number
Scarce resource management
Don’t relocate disaster

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Components of Doing the Greatest Good

Make the best of possible use of available resources
Salvage the most patients as possible
NO heroic resuscitation
Concentrate on those we can save

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Components of Resource Management

Call for extra resources early
Prepare for delays
Use command hospitals to coordinate with other hospitals and transportation decisions

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5 S’s of MCI

Safety assessment
Scene safety
Send information
Setup
START

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Safety Assessment of MCI’s

Fire
Electrical hazard
Flammable liquids
Hazardous materials
Other life threats and hazards to rescuers

Scene Safety of MCI’s

Type of incident
Approximate number of patients
Severity of injuries
Area involved and access

Send Information of MCI’s

Contact dispatch with survey information
Request resources and mutual aid
Notify command hospital

Setup of MCIs

Medical group supervision
Triage
Treatment
Transportation
Extrication
Staging
Medical supply
Medical communications

First EMS Provider Setup

Establishes medical group
Directs triage of all patients
Assigns resources as available
Key functions running

Transport Decisions in Setup

Patient prioritization
Destination facilities
Transportation resources

What does START stand for in MCIs?

``` S: simple T: triage A: and R: rapid T: treatment ```

Define Triage

To sort | Separates patients needing rapid care

Problems with Triage

Reliance on specific diagnosis to put patients in categories | Too slow

Ideal Triage System

``` Simple No advanced skills No specific diagnosis Easy to do Rapid and simple life-threatening intervention Easy to teach and learn ```

What is the START system based on?

RPM R: respirations P: perfusion M: mental status

Virginia Triage Tag System

Red: immediate Yellow: delayed Green: minor Black: dead

Conditions for a Red Tag

Poor respiration, perfusion, mental status | Severe burns

Conditions for a Yellow Tag

Burns | Major or multiple bone or back injuries

Conditions for a Green Tag

Minor painful, swollen deformities Minor soft tissue injuries "Walking wounded"

Conditions for a Black Tag

Deceased | Non-salveable

START First Steps

``` Begin where you stand Move all who can walk Move in a pattern Assess using START and place tags Keep count of casualties Provide MINIMAL treatment Keep moving ```

Respiration Assessment: Open Airway

Black: doesn't breath Red: starts to breath

Respiration Assessment: Breathing

Red: RR >30 Next: RR less than 30 Maintain airway

Perfusion Assessment: Radial Pulse

Red: absent Next: present Stop gross hemorrhage

Mental Status Assessment: Commands

Red: doesn't follow commands Yellow: follows commands

Purpose of Treatment

Identify specific injury Categorize patients Prioritize for transport

Treatment: Reassessment and Tagging Complete

On way to treatment In treatment area In ambulance

Secondary Triage Within Initial Triage Groups

More subjective | Based on specific condition and experience

Secondary Triage of Red Tagged Patients

Life threatening injury Risk of asphyxiation or shock High probability of survival Can be stabilized

Secondary Triage of Yellow Tagged Patients

Potentially life threatening Severely debilitating injury Can stand a delay in treatment and transport

Secondary Triage of Green Tagged Patients

Non life threatening injuries | Minimal care with minimal risk

Secondary Triage of Black Tagged Patients

Deceased at site, en route to treatment area, or in treatment area Unresponsive with no circulation

Reverse Triage

Lightening injuries Dead treated first High potential for respiratory arrest