Multiple Casualty Incident Manual, 3rdEdition, July 2017

Question 1

The Virginia Office of Emergency Management (VOEMS) defines multiple casualty incident as :

Answer 1

Any incident that injures enough people to overwhelm resources usually available in a particular system or area

Page 3

Question 2

This provides the resources to manage incidents with approximately 10 patients. Patients are assigned directly to the EMS units and the incident should not require establishment of a Treatment area.

What units come with this dispatch complement?

Answer 2

EMS Task Force

5 EMS transport pieces
1 Battalion Chief
1 EMS Supervisor / Command Staff
2 Suppression Units

Page 4

Question 3

This provides the resources to manage incidents with approximately 25 patients.

The initial assignment is designed to complete the structure of what?

What units come with this dispatch complement?

Answer 3

MCI Alarm

Designed to complete the structure of the EMS Branch

Includes:

10 EMS Transport units
10 Suppression units
1 Battalion Chief
3 EMS Supervisors / Command Staff
1 Mobile Command Unit
1 Green (Civilian) Transport Bus
1 Medical Care Support Unit (MCSU)
1 Medical Ambulance Bus (MAB)

Page 5

Question 4

What does each subsequent MCI Alarm after the first one bring?

Answer 4

10 EMS Transport units
5 Suppression Units
1 Medical Care Support Unit (MCSU)
1 Medical Ambulance Bus (MAB)
1 Green (Civilian) Transport Bus

Page 5

Question 5

The first arriving unit on an MCI is to establish the five S’s and shall establish command per the NOVA Command Officer Operations Manual Guidelines. What are the 5 S’s?

Answer 5

Safety - Identify the IDLH / High-threat situations and warn incoming units of hazards

Size-up - Determine the need for additional resources based on the type of incident. Approximate the number and severity of victims.

Send - Transmit a situation report. Request the appropriate alarm based on the number of patients, activate the Regional Healthcare Coordination Center (RHCC)

Set-up - Identify a staging area. Identify and announce scene access and egress.

Start - Initiate triage

Page 6

Question 6

When should an EMS task force or MCI Alarm be requested?

Answer 6

An EMS Task Force should be requested to treat approximately 10 patients and an MCI alarm for approximately 25 patients.

Page 7

Question 7

If no staging manager is assigned by the IC or operations chief, who assumes the position?

Answer 7

The first suppression unit officer to arrive at the staging area.

Page 7

Question 8

During an MCI alarm response, which units are designated to report to staging?

Answer 8

The eighth, ninth and tenth arriving suppression units.

Page 7

Question 9

What are the critical responsibilities of the staging manager?

Answer 9

1. Establish staging area
2. Use the staging manager form
3. Respond to request for resource assignments from IC, Operations, or the Transportation Group Supervisor
4. In the even of multiple Transportation Areas, direct transport units to the appropriate transportation area as directed by the Transportation Group Supervisor.
5. Ensure units leaving staging area switch to the appropriate channel.
6. Advise the Operations Section when apparatus reserves reach minimum levels as established by Incident Command

Pages 7 and 8

Question 10

What channel should staging be on?

Answer 10

The command Channel

Page 8

Question 11

The EMS Branch director is established by whom?

To whom does s/he report?

Answer 11

First arriving battalion chief on the initial MCI alarm.

S/he reports to the operations section chief or to the IC.

Page 9

Question 12

What are the critical responsibilities of the EMS Branch Director?

Answer 12

1. Obtain EMS Branch command board
2. Ensure dedicated Transportation Group and Medical Group tactical channels have been assigned
3. Assign units to MCI positions as designated in the MCI Quick Reference Guide.
4. Coordinate actions of the Transportation and Medical Groups
5. Request resources from Operations Section Chief or Incident Commander to meet current and anticipated Transport Unit and personnel needs.

Page 9

Question 13

What initial resources on an MCI become part of the Transportation group?

Answer 13

The First arriving transport piece

The First arriving EMS Supervisor

The second and seventh arriving suppression units

Page 9

Question 14

Who is the transportation group supervisor?

Answer 14

Transportation group supervisor is established by the first arriving transport units AIC / OIC and will be assumed by the first arriving EMS supervisor.

Page 9

Question 15

What does the transportation group supervisor do and to whom do they report?

Answer 15

They supervise the Medical Communications Supervisor, the transport recorder and the ambulance coordinator.

They report to the EMS Branch Director

Page 9 and 10

Question 16

What are the critical responsibilities of the Transportation Group Supervisor?

Answer 16

1. Obtain Transportation Group Supervisor Command Board.
2. Request a dedicated Transportation Group radio channel via chain of command.
3. Ensure designation of the PEP and Transportation Corridor.
4. Once established, direct incoming transport units to the transportation corridor
5. Establish communications with RHCC.
6. Acquire patient counts from the medical group supervisor and request sufficient transport units from staging.
7. Coordinate with EMS Branch to ensure that the appropriate Patient Tracking incident event has been announced.

Page 10

Question 17

Who fills the roll of medical communications coordinator (MCC)?

Answer 17

The MCC is established by the AIC / OIC from the first arriving transport piece once relieved of the role of Transportation Group Supervisor.

Page 10

Question 18

What are the critical responsibilities of the Medical Communications Coordinator (MMC)?

Answer 18

1. Establish and maintain communications with RHCC. RHCC will provide bed availability for the five hospitals and two trauma centers closest to the incident.
2. Advise RHCC if additional beds or hospitals will be required. Use the Medical Communications Coordinator Forms to maintain current status of receiving facility availability and capability.
3. Assign patient destinations to transport units.

Page 10 and 11

Question 19

Who becomes the transport recorder? Who do they report to?

Answer 19

Driver of the first arriving transport unit.

They report to the transportation group supervisor or Transportation Unit Leader if multiple transportation areas exist.

Page 11

Question 20

Some priority patients may bypass the Treatment Area and arrive at the Patient Exit Point (PEP), without having a disaster tag applied. In this case, what should be done by the Transport recorder?

Answer 20

They must ensure a disaster tag is applied and completed.

Page 11

Question 21

What are the critical responsibilities of the Transport Recorder?

Answer 21

1. Ensure a disaster tag is attached to each patient
2. At a minimum, the transport record must have the following fields completed: Patient Sex, Destination, Transportation Agency / Unit, Departure time / Time Out, Triage Status.
3. Use a separate Transportation Recorder Form, for each destination hospital.
4. Affix the disaster tag Transport Record stub to the appropriate Transport Recorder Form.
5. Enter the Transport Record Stub information into the Patient Tracking System.

Page 11

Question 22

Who becomes the Ambulance coordinator? What is their job and to whom do they report?

Answer 22

The Ambulance Coordinator is established by the OIC of the second arriving suppression unit.

They report to the Transportation Group Supervisor or Transportation Unit Leader (if multiple transportation areas exist).

They supervise the Transport Loaders and manage the access, egress, positioning, and loading of transport units.

Pages 11 and 12

Question 23

What are the critical responsibilities of the ambulance coordinator?

Answer 23

1. Designate and clearly mark transportation corridor points of entry, exit, and transport unit loading area.
2. Direct transport units where to park to receive patients.
3. Ensure efficient traffic flow in the transport corridor.
4. Direct loaders to report to the Treatment Unit Leader to obtain a patient and exit through the Patient Exist Point (PEP).

Page 12

Question 24

Who becomes the Air Ambulance coordinator if helicopter(s) are requested? What is their job?

Answer 24

The Air Ambulance Coordinator will be a member of the suppression unit assigned to the landing zone and reports to the Transportation Group Supervisor.

The Air Ambulance Coordinator is the liaison between air medical crews and the Transportation Group Supervisor.

Page 12

Question 25

What units become the transport loaders? To whom do they report?

Answer 25

Personnel from the second and seventh arriving suppression pieces. They report to the ambulance coordinator. Page 13

Question 26

What are the critical responsibilities of the Transport loaders?

Answer 26

1. Retrieve patient movement device(s) 2. On direction from the Ambulance Coordinator, report to the Treatment Unit Leader who will direct Loaders to a treatment area manager. 3. Bring the patient through the PEP and assist transport unit crew with patient loading. Page 13

Question 27

Who fills the role of Medical Group Supervisor? To whom do they report and who do they supervise?

Answer 27

The second arriving EMS supervisor. Reports to the EMS branch Director. S/he supervisors the Triage Unit Leader, Treatment Unit Leader, Morgue Manager, and Medical Supply Coordinator. Page 13

Question 28

What are the critical responsibilities of the Medical Group Supervisor?

Answer 28

1. Obtain Medical Group Supervisor Command Board. 2. Request a dedicated tactical channel for the Medical Group. 3. Receive patient counts from triage and treatment unit leaders. 4. Provide updated patient counts to Transportation Group Supervisor. Page 14

Question 29

What is the job of the triage unit leader? Who holds this job, to whom do they report and who do they supervise?

Answer 29

The triage unit leader is responsible for triaging patients within the impact area or Casualty Collection Point (CCP) using START / Jump Start triage. The job is held by the OIC of the first arriving suppression unit. S/he supervise the Triage Crews and porters. Page 14

Question 30

What are the critical responsibilities of triage unit leader?

Answer 30

1. Obtain the Triage Unit Leader Command Board 2. Designate the Casualty Collection Point (CCP) if needed. 3. Direct walking wounded patients to a defined location. 4. If transport units are available, direct porters, to move red tag patients directly to the transport area through the PEP. 5. Obtain and frequently communicate patient counts to the medical group supervisor. Page 14

Question 31

Triage groups are most efficient when comprised of how many people?

Answer 31

Two or Three Page 14

Question 32

What are the critical responsibilities of triage crews?

Answer 32

1. Direct walking wounded to a defined location 2. Perform Start / Jump Start Triage and attach a colored ribbon to all injured patients. 3. Initial treatment should be limited to appropriate lifesaving interventions (position airway, deliver five rescue breaths for Jump Start Triage, Control Sever bleeding with tourniquet or pressure, apply chest seals if available). 4. Communicate accurate counts, triage status, and locations, of patients to the Triage Unit Leader. Pages 14 and 15

Question 33

Who assigns porters and to whom do the porters report?

Answer 33

Porters are assigned by and report to the Triage Unit Leader. Page 15

Question 34

What are the critical responsibilities of porters?

Answer 34

1. Coordinate with Triage Unit Leader to determine location of triaged patients. 2. Obtain necessary equipment to port patients. 3. Port patients, as directed by the Triage Unit Leader, to PEP or treatment area(s). Page 15

Question 35

What is the Treatment Unit Leader responsible for? Who is the treatment unit leader?

Answer 35

The Treatment Unit Leader is responsible for the location, set-up, and operation of the treatment areas. It is established by the OIC of the fourth arriving engine and assumed by the third arriving EMS supervisor. Page 15

Question 36

What are the critical responsibilities of the Treatment Unit Leader?

Answer 36

1. Obtain Treatment Unit Leader Command Board 2. Identify and announce the location of all treatment areas. 3. Maintain communications and coordinate patient movement with the Medical Group Supervisor 4. Maintain a real-time count of all patients within the treatment areas. 5. Direct loaders and ambulance crews to appropriate treatment area manager. Pages 15 and 16

Question 37

There should be a treatment area manager for each triaged group; immediate (red), delayed (yellow) and Minor (green). What are the critical responsibilities for all three managers? What additional responsibility do all three have? What other responsibilities does the minor treatment area manager have?

Answer 37

1. Use Treatment Area Management Worksheets. 2. Ensure patients undergo secondary triage, are appropriately treated, and relocated as necessary. 3. Frequently communicate patient counts to the treatment unit leader. 4. Ensure every patient receives a disaster tag and that the transport record stub has been completed as much as possible. 5. Direct loaders or ambulance crews to the patient they will transport. Additional responsibility for all three: As time permits, scan and enter patient information into PTS. Other responsibilities for the minor treatment area manager include: 1. Distribute self-care kits 2. Anticipate needs for prolonged on-site care and management. 3. As time permits, scan and enter patient information into PTS. 4. Report needs of uninjured to the Treatment Unit Leader. Pages 16 and 17

Question 38

Who is the medical supply coordinator and to whom do they report? What are the critical responsibilities?

Answer 38

Established by the OIC of the first arriving MCSU on scene and reports to the Medical Group Supervisor. Critical responsibilities include: 1. Set up the MSCU in proximity to the Red and Yellow treatment area(s) 2. Distribute supplies to the Triage and Treatment Area(s) 3. Request and secure additional medical supplies as necessary Pages 17 and 18

Question 39

Who becomes the morgue manager and to whom do they report?

Answer 39

No morgue manager is preassigned. The morgue manager is assigned by and reports to the Medical Group Supervisor. Page 18

Question 40

What are the critical responsibilities of the morgue manager? What additional responsibilities do they have?

Answer 40

1. Establish a temporary morgue away from viable patients. 2. Perform re-triage and ensure those in the morgue are pulseless and apneic. 3. Deny access to unauthorized personnel. 4. Maintain decedent confidentiality. Additional responsibilities: 1. Ensure a disaster tag has been applied. 2. Scan the disaster tag and update decedents triage status and information 3. Obtain a picture of the patient's face and identifying marks if possible and enter it into the Patient Tracking System. Page 18

Question 41

If multiple transportation areas are required, who is in charge of each transport area?

Answer 41

The transportation group supervisor shall assume responsibility for overall management of Transport Group to include all subsequent Transport Areas. A Transportation Unit Leader will then be assigned to each designated transport area. Page 20

Question 42

If there are multiple transportation areas, who becomes transport unit leaders? Who does a transport unit leader supervise?

Answer 42

The transport unit leader is assigned by the Transportation Group Supervisor and can be filled by any available resource. They supervise their respective Ambulance Coordinator, Medical Communications liaison, transport recorder, and loaders as needed. Page 21

Question 43

What are the critical responsibilities of the transport unit leader?

Answer 43

1. Ensure designation of Division Patient Exit Point (PEP) and transportation coordinator. 2. Obtain transportation group supervisor command board. 3. Establish and maintain communications with Transportation Group Supervisor and the corresponding medical group supervisor. 4. Acquire patient counts from their corresponding medical division supervisor 5. Request resources from the transportation group supervisor. 6. Coordinate the air and ground transportation of patients in that area. Page 21

Question 44

Who assigns the medical communications liaison and what do they do? How many are there? What are their critical responsibilities?

Answer 44

The medical communications liaison (MCL) is appointed by the Transport Unit Leader and coordinates with the medical communications coordinator (MCC) to assign patient transport destinations. A MCL will be assigned for each transport area. Critical responsibilities are: 1. Establish and maintain communications with the MCC 2. Assign patient destination to transport units. Page 21

Question 45

Who does the Medical Group Supervisor report to and who do they supervise? What are their critical responsibilities?

Answer 45

They report to the EMS Branch and supervise their respective Triage and Treatment Unit Leaders. Critical responsibilities include: 1. Obtain medical group supervisor command board 2. Monitor actions of the triage and treatment groups. 3. Receives patient count from Triage and Treatment unit leaders and request transport assets from the transportation unit leader. Page 21

Question 46

What are the priority of unit assignments for the initial MCI alarm?

Answer 46

1st Suppression Unit - Triage Unit Leader 2nd Suppression Unit - Ambulance Coordinator 3rd Suppression Unit - Report to Triage (porters or triage crew) 4th Suppression Unit - Treatment Unit Leader 5th Suppression Unit - Report to Triage (porters or triage crew) 6th Suppression Unit - Report to Treatment 7th Suppression Unit - Report to Ambulance Coordinator (loaders) 8th - 10th Suppression Unit - Report to staging, establish if not done already. 1st EMS Transport Unit - Establish Transportation Group (Med Comm and transport recorder). Remaining Transport Units - Report to transportation corridor or Staging as directed by Transportation Group Supervisor. 1st EMS Supervisor - Assume Transportation Group Supervisor 2nd EMS Supervisor - Establish Medical Group Supervisor 3rd EMS Supervisor - Establish Treatment Unit Leader 1st Battalion Chief - Establish EMS Branch Page 26