Mass Casualty Incidents

Joseph Donoghue, CPP, EMT-B Fidelity Investments Corporate Security

What constitutes an MCI?

More than one patient and system resources are taxed at the time Anytime there are more Patients than Rescuers

The Goal of all Responders Should be to Save as Many Lives as Possible

The Basics
Your first 5 minutes will determine how the incident will go: Emotions are Contagious Think Incident Command Think Triage Pre-plan and train or you will fail

Incident Command
First person on scene sends an Initial On Scene Report
See as much as the scene as you can in 30 seconds Process what you see and hear THINK - Dont Panic Paint an accurate picture of the scene with your brief report Declare yourself the IC, Where the IC Post will be and where responding units should report to 5

Triage - To sort by priority

Hard to do for the inexperienced, but it is really very easy All responders must know what the goal is.. Sometimes most severely injured patient does not get treated and dies

How to Triage using the Tags

Conduct an Initial Walkthrough Tag Patients as Red, Yellow, Green or Black Remember - Triage is constantly conducted so dont panic with your first tag

RED - IMMEDIATE
Severely injured but able to be saved with relatively quick treatment and transport Examples:
Severe bleeding, Severe Shock, Open Chest or Abdominal Wounds, Unconscious but has pulse and is breathing, Several Major Fractures

Emotionally Out Of Control (Emotions are Contagious) Injured Rescuers - For Morale of other Rescuers

Yellow - Delayed
Injured but unable to walk on their own These people will be treated!
Dont over tag people because of bystanders or age (children)

Examples:
severe burns but no respiratory distress, spinal injuries moderate blood loss conscious with head injuries
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Green - Walking Wounded or Mortal Wounds

Minor injures that need to be assessed or treated but not right away. Ex: Minor fractures, minor bleeding Some systems use the green tag for obviously mortal wounds where death appears reasonably certain
(these patients can be retriaged later if personnel and/or resources become available)

Have a Refusal Log handy and use it

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Black - Obviously Dead

Some systems include Dead or Obviously Dying Depends on local protocols Examples:
cardiac arrest respiratory arrest but has pulse etc.
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Treatment
Once Triage is done, move patients to the proper treatment area Use tarps, cones, flags, to mark areas Control access to areas Constantly re-triage

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Transportation
Ambulances report to staging area Transportation Officer assigns patients to ambulances Broadcast the All Immediates Transported

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Management of the Deceased

If it is a crime scene, leave the bodies where they are Cover the victim with a white sheet if possible If the bodies can be seen by the surviving patients, consider moving them

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Designate a Temporary Morgue Area

Should be out of site from bystanders and victims Maintain Access Control
loved ones media thieves

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Handling the Dead

Show respect and dignity Reduce the pain that witnesses may feel (they will watch) Package them as if they were still alive

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Body Bags
Always choose white instead of black if possible
white is pure and is associated with patients black resembles a trash bag

Inner plastic lining that can stay intact for viewing

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Carrying the Dead

It is virtually impossible to carry the bag without support Always use a backboard or better yet, a scoop stretcher

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Emotional Distancing Techniques

Double Glove and Tape Wrists of Personnel Use shovels and not hands to pick up body parts Cover the body or at least the head before picking it up Use Vicks VapoRub under a mask when necessary Scoop Stretchers when possible Secure the body to the backboard well so that it does not move Volunteers only !
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Summary - Top Ten

1. 2. 3. 4. 5. First On Scene Report Escalated Response Think Incident Command Triage Treat by Priority

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Summary - Top Ten

Separate victims by priority Transport by priority Re-Triage Constantly Only move the dead when it is effecting patient care 10. Train, Train, Train and Practice 6. 7. 8. 9.
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Thank You All