Vol.5-Ch.11 "MCIs and Incident Management"

Question 1

What is the definition of a MCI?

Answer 1

Some systems call it any scene with 3+ casualties while other set the bar at 5, 7 or more.

In general though an MCI is considered any incident that depletes the available on scene resources at any given time.

Question 2

What are the 3 classifications of MCIs?

Answer 2

• Low Impact Incident: One that can be managed by a local emergency service, it may tax the service but not overwhelm it. Large MVCs, shootings, ect.
• High Impact Incident: One that stresses local emergency systems including fire, police, EMS, and hospitals. Tornadoes, structural collapse, floods, ect.
• Disaster: One that overwhelms regional emergency response systems. Hurricanes, earthquakes, major floods, terrorist acts, ect.

Question 3

How did MCI management come about and how did it get to where it is today?

Answer 3

It started with a series of small fires in the 1970s when fire services created the Fire Scope system to handle a massive or series of fires.

Later the Fire Scope system became used wide spread and was refined into the Incident Command System used to take the basic tenets of good, sound management and apply them to the needs of an emergency scene.

While ICS was originally meant for fires it was adopted by law enforcement, EMS, and hospitals and then refined into the Incident Management System (IMS)

After 911 IMS was taken to a national level and created into National Incident Management System (NIMS) in which it stays today, and slowly the Department of Homeland Security (DHS) is creating new minimum requirements for EMS systems to follow on an MCI scene.

Question 4

What legislation was created that demanded the use of NIMS by emergency services?

Answer 4

The Homeland Security Presidential Directive #5 (HSPD5) and the DHS still update and require training for use of a NIMS.

Question 5

What law mandates authority to a person on a scene of an incident?

Answer 5

Scene-Authority Law

Question 6

Why is NIMS better than other forms of IMS that may be used?

Answer 6

1. It recognized that a incident can cross jurisdictional lines and the use of standardized and compatible management system will permit a well organized response to routine and large scale emergencies.
2. Has the flexibility to respond to emergencies in both the public and private sectors and incorporates concepts of business continuity and crisis management employed by the private sector to ensure the necessary continuity and continuance of critical operations

Question 7

What is the Mutual Aid Coordination Center (MACC)?

Answer 7

It is a key element in the management of an incident that spans across more than one jurisdiction and is a site from which civil government officials exercise direction and control an emergency scene. From this site management and support personnel carry out coordinated emergency response activities. This should be set up in a secure and protected location.

Question 8

What is the pneumonic to help remember the functional areas of NIMS?

Answer 8

C-FLOP (FLOP is more of a support to C)

Command
Finance/Administration
Logistics
Operations
Planning

Question 9

What is the most important functional area in the IMS and whos responsibility is it?

Answer 9

COMMAND

The duty of this falls onto the Incident Commander (IC)
“The ultimate authority for decision making rests with the IC. The IC is responsible for coordinating the many activities that occur on the emergency scene. Because it would be too confusing or impossible for all on-scene personnel to report directly to the IC, the person charged with command delegates certain functions and responsibilities to others.”

Being able to delegate allows the IC to have a SPAN OF CONTROL or number of people or tasks that a single individual can monitor. The ideal number of people controlled at one time is 5.

(also note that if anything bad happens at an MCI scene it falls on the ICs head)

Question 10

When should you implement IMS at a scene? And who establishes command?

Answer 10

Generally when 2 or more units respond, when there are 2 or more casualties, or if multiple agencies are involved you should implement IMS.

The first arriving public safety unit should establish command.

Question 11

What is the first thing an IC will do when arriving to a scene?

Answer 11

A Windshield Survey, meaning that FROM THE VEHICLE they will assess the safety of the scene before getting out.

Question 12

What are the 3 main priorities of all Emergency Service Operations?

Answer 12

1. Life Safety (of you, then partner, then other rescuers, then patients)
2. Incident Stabilization: there are 2 types: 1. Open Incidents in which there is potential for the creation of new patients at any time such as in a house fire, remember in these cases that calling too many additional resources is better than too few. 2. Closed Incidents in which the injuries have already occurred by the time you arrive on scene such as in a MVA.
3. Property Conservation (never damage property needlessly)

Question 13

If the first vehicle to arrive to a MCI is you and your partner which roles should you two take up first?

Answer 13

Once should become the IC and the other should be the triage officer until more help arrives

Question 14

Singular Command Vs Unified Command

Answer 14

Singular Command is when there is just one IC with ultimate authority such as in cases where there are not multiple jurisdictions being used. As in if there was fire, law enforcement, and EMS on scene within one jurisdiction either the first safety officer on scene or the department best suited for the nature of the call can take over with their own official.

Unified command is when the incident is so big that multiple jurisdictions, multiple types of response systems at various levels (local, state, federal) are all there, there may be a need to have high officials of each separate entity to coordinate together while maintaining their own agencies.

Question 15

Who decides if there is need for an information officer and liaison officer and what would their roles be?

Answer 15

If the incident is so big the IC can determine the need for an information officer to interact with the media or the need for a liaison officer to deal with all the agencies and organizations that will undoubtedly respond to an large incident.

Question 16

When might an IC request an Incident Command Post (ICP) and what is it for?

Answer 16

IF the incident is of such a large magnitude that the IC deems it necessary he can have a ICP set up on or near the scene to provide a place where representatives and officers from the various agencies involved in the incident can meet with one another and make relevant decisions. Since an ICP may be set up for days or weeks it must be close by the incident and may need telephones, internet, and bathrooms. Persons operating on the scene, members of the media, and bystanders should NOT have routine access to the ICP.

Question 17

Where should a staging area be placed?

Answer 17

A staging area should be placed close enough to the incident that resources can be quickly deployed throughout the scene but far enough away it is out of harms way. If needed a second staging area can be placed as a contingency plan in case the first staging area becomes compromised.

Question 18

Once a IC has been appointed and a scene survey has been conducted what is the first thing the IC should do?

Answer 18

They should transmit a preliminary report to dispatch that states the type of incident, appox # of casualties, request for more units if needed, staging instructions, plan of action, and if a staging area or incident command post site has been chosen the location should be relayed as well.

Question 19

Once an MCI has been declared how does this effect radio communications?

Answer 19

Comms with the IC should be switched to a secondary or tactical channel. This will allow the regular ems channel to not be over flooded with talk as well as will help keep other jurisdiction radio frequencies from being over used. Also, at this point you should NOT use radio codes and should just use plain english.

Question 20

What is the primary role of the IC?

Answer 20

The strategic deployment of all necessary resources at an incident. They must have goals, tactics, and resources delegated as needed. These things should be reported to dispatch via radio approx every 10 minutes to keep them updated

Question 21

What is a useful tool for an IC to help keep track of what is going on and can be especially helpful when transferring the role of IC to someone else?

Answer 21

Worksheets or clip boards that have basic information of what is going on at the incident, a small area to draw the scene, and a checklist to remember important items that need to be done or checked on

Question 22

Once a MCI is reduced to the point there is no longer the need for an IC, and enough units are Demobilized, who should receive the report going over all that happened created by the IC?

Answer 22

The communications center

Question 23

Who is in charge of the FLOP of C-FLOP?

Answer 23

Each section of Finance/Admin, Logistics, Operations, and Planning are headed by a SECTION CHEIF. Each section chief has COMMAND STAFF that may report directly to the IC and who may be in charge of information, safety, outside liaisons, and mental health support. The combination of the Section Chief and their Command Staff comprise and carry out the STAFF FUNCTIONS.

Question 24

What are the different roles of a Command Staff position and what are their perspective responsibilities? (remember Command Staff are under the Section Chiefs of FLOP but can also report directly to the IC if needed.)

Answer 24

SAFETY OFFICER: is in charge of monitoring all the actions and environment on scene and can stop any action or correct any environmental condition (with the ability to be controlled such as lighting) with his authority alone.

LIAISON OFFICER: is in charge of coordinating all incident operations that involve outside agencies.

INFORMATION OFFICER: is in charge of collecting data about the incident and releasing it to the press or other agencies on a need to know and appropriate basis.

MENTAL HEALTH SUPPORT OFFICER: is in charge of rotating personnel in and out of working so as not to over tax a persons mental or physical well being. Also they must be on the look out for any individuals that look like they are over stressed or presenting with abnormal stress reactions and take them out of service. This officer does not give therapy to those people but ensures that they get the rescuers immediate needs such as rest, water, and food.

Question 25

Finance/ Administration Role (of C-FLOP)

Answer 25

This is usually run by the jurisdictional government and rarely are used in a small-scale incident. They are in charge of keeping track and recording all accounting and administrative activities, personnel and time records, estimates costs, pays claims, and handles procurement of items required at the incident.

Question 26

Logistics Role (of C-FLOP)

Answer 26

Supports incident operations, such as operating the Medical Supply Unit from which supplies and equipment are distributed as needed. They may also run a facilities unit that is in charge of maintaining areas used for command and rehab such as ensuring there is adequate food, water, restrooms, lighting, power, etc.

Question 27

Operations Role (of C-FLOP)

Answer 27

This is the branch that gets things done. They carry out tactical objectives, direct front-end activates, participates in planning, modifies action plans, maintains discipline, and accounts for personnel. This section may have many Branches and what that means will be discussed in another card.

Question 28

Planning/Intelligence Role (of C-FLOP)

Answer 28

Provides past, present, and future information about an incident. They are the ones who create the overall incident action plan (IAP) and collect data such as weather, incident action reports, and possible contingency plans to do this. They will ensure that written standard operating procedures (SOPs) for Mutual Aid Agreements that govern sharing of departmental resources are activated or fulfilled.

This role operates under the assumption of “anything that can go wrong, will go wrong”

Question 29

As mentioned on the Operations note card the operations of C-FLOP can be divided down into branches, what are branches, Groups/Divisions, units, and sectors?

Answer 29

These are smaller groups divided within themselves to create specific groups with particular goals.

Branches are sections of people that the IC can dedicate to a task and appoint a Branch Director to report back to the IC as needed.

Branches may be broken down further into Groups or Divisions

Groups or Divisions may be broken down into Units

Sectors is an interchangeable term with a Branch, Group, or Division.

Question 30

Under what theory does IMS operate?

Answer 30

The “Tool-Box Theory” which states that you do NOT remove a tool from the tool box unless you actually need to use it. In other words you only use parts of the C-FLOP or branches/divisions on a need bases

Question 31

What are the 2 phases of triage?

Answer 31

PRIMARY TRIAGE is the triage you do at first contact on scene with the patients that are there at first contact.

SECONDAY TRIAGE is ongoing and takes place throughout the incident as pts are collected

Question 32

What are the different categories pts can be triaged into?

Answer 32

Immediate = Red = Priority 1 (P-1)
Pt needs immediate treatment for survival

Delayed = Yellow = Priority 2 (P-2)
Pt can wait for treatment without risk of death

Minimal = Green = Priority 3 (P-3)
Pt needs minimal treatment

Expectant = Black = Priority 0 (P-0)
Pt is expected to die or is deceased

Question 33

What are the 3 Triage systems used?

Answer 33

START (Simple Triage and Rapid Transport)
is the most widely used.

SALT created by the CDC based off other systems stand for Sort - Assess - Lifesaving interventions - Treatment/Transport. It can be used with all ages.

JumpSTART is a specific triage tool used for children

Question 34

The SALT Triage System

Answer 34

SALT created by the CDC based off other systems stand for Sort - Assess - Lifesaving interventions - Treatment/Transport. It can be used with all ages. As pt status’ change, pt triage categories can change as needed based on improvement by life saving interventions or deterioration from delayed care.

This has 5 different triage categories instead of 4:

• Immediate (Red): Pts who require immediate lifesaving interventions such as, don’t follow command, no peripheral pulses, respiratory distress, uncontrolled hemorrhage.
• Delayed (Yellow): Pts who have injuries but do not require immediate life saving interventions but have a condition that is likely to deteriorate without medical care
• Minimal (Green): Pts with minor injuries that can tolerate a delay in care without increasing risk of death
• Expectant (Gray):
• Dead (Black):

Transport should go in this order 1. Immediate, 2. Delayed, 3. Minimal, 4. Expectant

STEP 1: Global Sorting:
Walk = Assess 3rd ;
Wave/Purposeful Movements = Assess 2nd ;
Still/Obvious Life Threat = Assess 1st

STEP 2: Assess: Individual Assessment:
BEFORE ASSESSMENT IN STEP 2 YOU SHOULD PERFORM THE NEEDED LIFE SAVING INTERVENTIONS!
- Breathing? if no then dead, if yes then move down
- Obeys commands, Has peripheral pulse, Not in resp distress, major hemorrhage? If all yes then move down 1. If no then move down 2.
- Minor injuries only? if yes then minimal (green), if no then delayed (yellow)
- If any are no to 2 above then likely to survive given current resources? if yes then immediate (red) if no then grey (expectant)

Question 35

The START Triage System

Answer 35

START (Simple Triage and Rapid Transport)
is the most widely used. It consists of triaging based on:

• ability to walk (if YES then green)
• respiratory effort (if NO then reposition/open airway, if resp start then red if not then black; if YES then if over 30bpm gets red, if under then move to pulse/perfusion)
• Pulse/perfusion (if radial pulse absent or cap refill over 2 sec then red; if radial pulse present or cap refill under 2 sec then move to neuro)
• Neuro Status (if cannot follow commands then red, if can follow commands then yellow)

Question 36

What is the JumpSTART triage system and what demographic is it used for?

Answer 36

It is used for the triage of pediatric pts, by taking into account the differences in pediatric physiology.

Main differences:
- you should try giving 5 rescue breaths after repositioning the airway before giving them either a black or red tag.

• Breathing rates are less than 15 or more than 45 for a red (instead of over 30
• and after pulse being present of not, if P or U in AVPU (P being inappropriate) gets red

Question 37

Advantages and disadvantages of using tags vs tape for triaging.

What 2 criteria must tagging meet to be used?

Answer 37

Tags:

• Advantages: Its easier to track pts, record treatment info, and indicate pt’s location
• Disadvantages: can be damaged in wet weather and tearing off the strips can make it difficult to change pt statuses

Tape:

• Advantages: cost less
• Disadvantages: does not allow you to count pts

Two minimum required criteria:

• Be easy to use
• Provide rapid visual identification of priorities

Question 38

What should triaging officers carry in order to give quick treatments that may be needed?

Answer 38

• infection control supplies
• oral airways
• trauma dressings

Other material may be: tags/tape, portable radio, command vest, and flashlight.

Question 39

How long should it take you to triage each pt ideally?

Answer 39

30 seconds

Question 40

What should you do with the black tag pts?

Answer 40

Stage a “Morgue” area that is away from the treatment area, keep bystanders and media out of the area, once established you should assign a morgue officer control the area.

Question 41

How should treatment groups be split up and who is in charge of the Treatment area?

Answer 41

Teams of 4 should be assigned to prevent lifting injuries

The Treatment Group Supervisor is in charge of the treatment area but there is also a Treatment Unit Leader for each group of 4 that reports to the Group Supervisor

Question 42

What should you do with ambulances at an MCI?

Answer 42

They should be staged in a staging area controlled by the Staging officer and wait for deployment if needed. Often the crew manning those ambulances will be asked to stay by their ambulance until called upon.