WIXLIB

Multiple Casualty Incidents (MCI)EMResource

Learning Objectives1) Understand the layout of Region III2) Understand hospital and Field operations in anMCI.3) Understand the Control Facility’s role in and MCI4) Know the communications layout5) How to use EMResource during and after the MCIevent.

California OES Mutual AidRegions California is dividedinto 6 OES mutual aidregions OES Region IIIincludes Butte, Colusa,Glenn, Lassen, Modoc,Plumas, Shasta,Sierra, Siskiyou,Sutter, Tehama,Trinity and YubaCounties

Regional MCI Plan Region III MCI Plan Developed/implemented in 2013, updated in2020 Manual 1 – Field Operations Manual 2 – Control Facility (CF) Operations

Control Facility (CF)Definition Entity responsible for coordination &dispersal of patients during MultiCasualty Incidents (MCIs) Hospital, dispatch center, or local warningcenter

CF Purpose &Responsibilities Single point of contactfor the field MedicalCommunicationsCoordinator(MCC)/patient dispersalduring an MCI Supports otherOperational Areas (OAs)involved in patientdispersal (CF to CF)

OES Region III DesignatedCFs Enloe Medical Centero Butte, Colusa, Glenn, Lassen County (east),Plumas & Sierra Counties Mercy Medical Center Reddingo Lassen County (west), Modoc, Shasta, Siskiyou,Tehama & Trinity Counties Rideout Regional Medical Centero Sutter & Yuba Counties

CF Personnel Positions CF Supervisor: Provides hospital CF programoversight and direction Responsible for training of CF staff Schedules and runs drills/exercises Liaison with administration/otherfacilities Evaluates/keeps records of MCIs Attends/helps organize critiques

CF Personnel Positions Patient DispersalOfficer: Activated/assigned duringMCI Assumes patient dispersaldecisions Communicates directly withfield Medical CommunicationsCoordinator (MCC) Provides destination to otherEMS units during an MCI

CF Personnel Positions Facility Status Officer: Activated/assigned during MCI Provides patient destination notification andother relevant incident information to receivingfacilities Role may be assumed/maintained by thePatient Dispersal Officer depending on theincident

Receiving Facility Positions Receiving Facility Officer: Determines/reports patient treatment capabilities Communicates with the CF as needed Advises facility staff of pertinent incidentinformation and number/type of patients they arereceiving

MCI Communications Med Net radios VHF/800 MHz radios Amateur Radio (ham radio) EMResource Blast phone/landline Cellular telephone

MCI Types Trauma Physical injuries and/or burns (traffic collision,plane crash, earthquake, explosion, mass shootings,etc.) Hazmat Release of toxic materials, radioactive matter, orradioactive energy from a radiation emission device Medical Non-trauma, non-hazmat incidents (biological orclandestine radiological incidents, environmental,medical resource depletion, medical evacuations,etc.)

MCI Activation MCI Criteria (any of the following) 5 or more IMMEDIATE (Red)/DELAYED(Yellow) patients 10 or more MINOR (Green) patients Prehospital and/or hospital provider discretion

MCI Activation The CF may be activated by any ofthe following entities: EMS dispatch center Field EMS personnel (responding or at scene) Neighboring CFs for incidents exceeding theircapacity to disburse patients within their area Medical Health Operational Area Coordinator(MHOAC)

MCI Pre-Alert by EMSResponders The CF should obtain the followinginformation from dispatch/fieldpersonnel when possible: Incident location Incident typeo Traumao Mass Violenceo Hazmato Medical Possible number of patients

Initial CF ResponseWhen notified of a possible orconfirmed MCI, the CF should: Assign appropriate staff to manage the incident Create an MCI Event in EMResourceo Identify the incident location on facility maps anddetermine the receiving facilities within 30minutes travel time Maintain communications with the field MedicalCommunications Coordinator (MCC)

Initial CF ResponseThe following information should beprovided by field personnel upon MCIconfirmation: Incident location (if unclear – CF staff must clarify) Incident name Type of incident Approximate number of patients Type of transport resources available (ground/airambulances, buses) Estimated time triage is expected to be completed

EMResource MCI EventCreation Select‘Event’ Tab Select‘EventManagement’

EMResource MCI EventCreation Select ‘Create’ for the eventlocation (OA)

EMResource MCI EventCreation Enter the appropriate eventinformation

EMResource MCI EventCreation UtilizeEMResourcetools to lookupevent locationif necessary

EMResource MCI EventCreation Select theappropriate receivingfacilitiesyou wantto poll Select‘Save’ toinitiate theEvent

EMResource MCI EventCreation Return to the ‘View’ screen andselect your event on the colored barto monitor receiving facilityreporting capability status

EMResource MCI EventCreation Receiving facility capacities areupdated as reported & totaled at thebottom of the screen

Receiving Facility Response Receiving facilitiesnotified of an MCI(polled) arerequired todetermine andreport theirpatient receivingcapabilities onEMResource

Receiving Facility Response Receiving capabilities are based onavailable patient teams and beds: Immediate Patient Team (1 patient perteam)o 1 ED Bedo ED physiciano Surgeon (if Trauma MCI)o 2 nurses

Receiving Facility Response Delayed Patient Team (2 patients per team)o 2 ED Bedso ED physiciano 2 nurseso Patients in spinal immobilization or unaccompaniedminors are minimally triaged as Delayed regardless ofcondition Minor Patient Team (10 patients per team)o 1 nurseo Minor patients can often be directed to ED waitingroom for re-triage or possible alternate treatment areas

ReceivingFacilityResponse The receiving facilitydocuments their capabilitieson the Receiving FacilityCapacity Worksheet andenters their patientcapacity in EMResourcewithin 5 minutes

Receiving Facility Response The receivingcapabilities screen,accompanied by anaudible alert, willautomatically showon the EMResourcescreen for eachhospital polled

Receiving Facility Response Enter theappropriatecapabilities for yourfacility, or leavedefault value at “0”if correct Enter surgeoninformation ifapplicable Select ‘Save’ tosubmit yourcapabilities

Receiving Facility Response If the screen does not automatically show, oryou need to update your capabilities at anytime, the following process may be utilized: Select the applicable event on the colored bar

Receiving Facility Response Select the ‘keys’ icon for your facility

Receiving Facility Response Select each category to expand and enter yourcapabilitiesNor-Cal EMS Agency MICN

Field Operations S.T.A.R.T. triage isutilized byprehospital personnelon any declared MCI Approved triage tagsare applied to eachpatient prior totransport

Field Operations The Medical CommunicationsCoordinator (MCC) communicatesdirectly with the CF The MCC may alsoassume/maintain theMedical Group Supervisorand/or Patient TransportUnit Leader role dependingon the incident

Field Operations When the MCI is in progress: All EMS patient communication should be routedthrough the CF (even for non-MCI patients) Individual EMS units should not provide patientreports to receiving facilities unless they do notinterfere with MCI operations/communications

Patient Destinations Additional information relayed to the CF byMCC: Total number of patients by triage categoryo Immediate (classified as ‘Head’, ‘Chest’, or ‘Abdomen’ ifapplicable)o Delayedo Minoro Special patient circumstances (pediatric/pregnancy/families)should also be reported Number and category of patients ready for transport Number and type of transport resources available

Patient Destinations When patients are ready for transport,the MCC contacts the CF to obtainpatient destination and mode oftransport

PatientDestinations When notified bythe MCC thatpatient triage iscomplete, the CFdocumentspatientinformation onthe PatientDestinationWorksheet

Patient Destinations The CF assigns destinations using thefollowing Patient Destination Guidelines: Immediate Patientso Send to Immediate Teams at facilities within 30 minutestransport time, whenever possibleo Send Immediate trauma patients to designated traumacenters (following Nor-Cal EMS policies/protocols)o Send other specialty patients (burns, pregnancy, pediatrictrauma, etc.) to designated specialty receiving centers(following Nor-Cal EMS policies/protocols)

Patient Destinations Delayed Patientso Send to Delayed or Immediate Teams within 60 minutestransport time from the incident whenever possible Minor Patientso Transport of minor patients can be delayedo Send to Minor or Delayed Teams within 30 minutestransport time from the incident whenever possibleo If there are a large number of minor patients to distribute,local receiving facilities should consider opening atemporary minor treatment area at their facility to triageand treat these patientso Transporting minor patient by bus is permitted

Patient Destinations Austere Careo If there are more patients within any triage categorythan available teams to accept those patients,consider: Requesting local receiving facilities to increase patientcapacity Sending more patients to local teams than standardguidelines Sending patients beyond the standard transport timeradius

Patient Destinations CF directs where to transport eachpatient in coordination with the MCC CF must be advised by the MCC wheneach unit departs the scene and theirETA to the receiving facility CF notifies receiving facility of transportunit ID/ETA and pertinent patientinformation

Receiving Facility PatientTransport Notification The CF notifies the receiving facility ofincoming patients utilizing any of thefollowing methods: Telephone Radio EMResource Incoming Patient Notification(IPN) Form

EMResource IPN Form Select ‘Add Incoming Patient Notification’under the ‘Form’ tab, or the Ambulancequick link icon at the top of the page

EMResource IPN Form Complete theappropriatepatientinformation Select thereceiving hospitalfrom the dropdown box Select “Save” tonotify thereceiving hospital

EMResource IPN Form System will display a confirmation box thatthe IPN form has been sent to the receivinghosp.

EMResource IPN Form Receiving hospital will receive a visual/audiblealert The form can be reviewed (opens in anotherbrowser window), or printed if desired

EMResource IPN Form‘Review’ Browser Window‘Print’ Version

EMResource IPN Form To review a list of all your IPN formssent/received within the last 24 hours, select‘Incoming Patient Notifications’ under the‘Form’ tabNor-Cal EMS Agency MICN

Patient Tracking A Prehospital Patient TrackingWorksheet is utilized by field personnelon any MCI: All patients arelogged prior to EMStransport Completedworksheets aresubmitted to NorCalEMS Agency as soonas possible

Patient Tracking The patients assigned triage tag numbershould be entered into the patient’shospital chart

Updating the MCI Event The CF should update event informationas appropriate: MCI is cancelled New pertinent event information is received Updated patient counts Need to expand the receiving facility capabilitiespolling request to additional hospitals When all patients have been transported

Updating the MCI Event Select the‘Event’ tab Select the‘Edit’ link inthe ‘Action’column next toyour eventNor-Cal EMS Agency MICN

Updating the MCI Event Enter theappropriate updatesin the ‘Title’ and/or‘Information boxes Select anyadditional receivingfacilities you wish topoll Select ‘Save’ ateither the top orbottom of the screen

Ending the MCI Event The event shouldbe ended when allpatients aretransported Select the ‘Event’tab Select the ‘End’link in the ‘Action’column next toyour event