SSV EMS MICN Course Module 7 Multiple Casualty

S-SV EMS MICN Course Module 7 Multiple Casualty Incidents (MCI) S-SV EMS Agency MICN Training (Updated 12 -2019) 1

California OES Mutual Aid Regions • California is divided into 6 OES mutual aid regions • OES Region III includes Butte, Colusa, Glenn Shasta, Siskiyou, Sutter, Tehama and Yuba Counties • OES Region IV includes Nevada & Placer Counties S-SV EMS Agency MICN Training (Updated 12 -2019) 2

Regional MCI Plan • Utilized by all S-SV EMS Counties (also referred to as ‘operational areas’ or ‘OAs’) • Regularly updated to reflect current technology and MCI procedures § Manual 1 – ‘Field Operations’ § Manual 2 – ‘Patient Distribution’ Control Facility (CF) and receiving facility operations S-SV EMS Agency MICN Training (Updated 12 -2019) 3

Control Facility (CF) Definition • Entity responsible for coordination & dispersal of patients during Multi Casualty Incidents (MCIs) • Can be a hospital, dispatch center, or local warning center S-SV EMS Agency MICN Training (Updated 12 -2019) 4

CF Purpose & Responsibilities • Single point of contact for the field Patient Transportation Unit Leader/Medical Communications Coordinator to direct patient dispersal during an MCI S-SV EMS Agency MICN Training (Updated 12 -2019) 5

S-SV EMS Designated CFs • OES Region III: § Enloe Medical Center o Butte, Colusa and Glenn Counties § Mercy Medical Center Redding o Shasta, Siskiyou & Tehama Counties § Adventist Health Rideout o Sutter & Yuba Counties S-SV EMS Agency MICN Training (Updated 12 -2019) 6

S-SV EMS Designated CFs • OES Region IV: § Sutter Roseville Medical Center o Western Slope of Nevada & Placer Counties § Tahoe Forest Hospital o Tahoe Basin & Eastern Slope of Nevada & Placer Counties o Note: REMSA dispatch may act as a backup CF in this area upon request from Tahoe Forest Hospital S-SV EMS Agency MICN Training (Updated 12 -2019) 7

CF Personnel Positions • CF Supervisor: § Provides CF oversight and direction § Responsible for training of CF staff § Schedules and runs drills/exercises § Liaison with administration & receiving facilities § Evaluates & keeps records of MCIs § Organizes & attends MCI reviews S-SV EMS Agency MICN Training (Updated 12 -2019) 8

CF Personnel Positions • Patient Dispersal Officer: § Assigned during an MCI § Responsible for patient dispersal decisions § Communicates directly with field Patient Transportation Unit Leader/ Medical Communications Coordinator S-SV EMS Agency MICN Training (Updated 12 -2019) 9

CF Personnel Positions • Facility Status Officer: § Assigned during an MCI § Provides patient destination notifications and other relevant incident information to receiving facilities § Role may be assumed/maintained by the Patient Dispersal Officer depending on incident size S-SV EMS Agency MICN Training (Updated 12 -2019) 10

Receiving Facility Positions • Receiving Facility Officer: § Determines & reports patient receiving capabilities § Communicates directly with the CF as needed § Advises receiving facility staff of pertinent incident information and number/type of patients they are receiving S-SV EMS Agency MICN Training (Updated 12 -2019) 11

MCI Communications • Med Net radios • VHF/800 MHz radios • Amateur Radio (ham radio) • EMResource • Blast phone/landline • Cellular telephone S-SV EMS Agency MICN Training (Updated 12 -2019) 12

MCI Types • Trauma § Physical injuries and/or burns (traffic collision, plane crash, earthquake, explosion, mass shootings, etc. ) • Hazmat § Release of toxic materials, radioactive matter, or radioactive energy from a radiation emission device • Medical § Non-trauma, non-hazmat incidents (biological or clandestine radiological incidents, environmental, medical resource depletion, medical evacuations, etc. ) S-SV EMS Agency MICN Training (Updated 12 -2019) 13

MCI Activation • MCI Criteria (any of the following) § 5 or more IMMEDIATE/DELAYED patients § 10 or more MINOR patients § Prehospital and/or hospital provider discretion S-SV EMS Agency MICN Training (Updated 12 -2019) 14

MCI Activation • The CF may be activated by any of the following: § EMS dispatch center § Field EMS personnel (responding or at scene) § Neighboring CFs for incidents exceeding their capacity to disburse patients within their area § Medical Health Operational Area Coordinator (MHOAC) S-SV EMS Agency MICN Training (Updated 12 -2019) 15

MCI Pre-Alert by EMS Responders • The CF should obtain the following information from the activating entity when possible: § Incident location § Incident type o Trauma o Hazmat o Medical § Potential patient count S-SV EMS Agency MICN Training (Updated 12 -2019) 16

Initial CF Response • When notified of a possible or confirmed MCI, the CF should: § Assign appropriate staff to manage the incident § Create an MCI Event in EMResource (including polling appropriate surrounding hospitals) § Maintain communications with the field Patient Transportation Unit Leader/Medical Communications Coordinator o Communication should be clear, concise and include only information necessary for appropriate patient dispersal S-SV EMS Agency MICN Training (Updated 12 -2019) 17

Initial CF Response • The following information should be provided by field personnel upon MCI confirmation: § Incident location (if unclear – CF staff must clarify) § Incident name § Type of incident § Approximate number of patients § Type of transport resources available (ground/air ambulances, buses, etc. ) § Estimated time triage is expected to be completed S-SV EMS Agency MICN Training (Updated 12 -2019) 18

EMResource MCI Event Creation • Select ‘Event’ Tab • Select ‘Event Management’ *Note: There additional procedures for creating an MCI event to also poll Sacramento County Hospitals which are not included in these instructions S-SV EMS Agency MICN Training (Updated 12 -2019) 19

EMResource MCI Event Creation • Select ‘Create’ for the event location (OA) S-SV EMS Agency MICN Training (Updated 12 -2019) 20

EMResource MCI Event Creation • Enter the appropriate event information S-SV EMS Agency MICN Training (Updated 12 -2019) 21

EMResource MCI Event Creation • Select the appropriate receiving facilities you want to poll • Select ‘Save’ to initiate the Event S-SV EMS Agency MICN Training (Updated 12 -2019) 22

EMResource MCI Event Creation • Return to the ‘View’ screen and select your event on the colored bar to monitor receiving facility reported capability status S-SV EMS Agency MICN Training (Updated 12 -2019) 23

EMResource MCI Event Creation • Receiving facility capabilities are updated as reported & totaled at the bottom of the screen S-SV EMS Agency MICN Training (Updated 12 -2019) 24

Receiving Facility Response • Receiving facilities notified of a MCI are required to report their patient capabilities on EMResource within 5 minutes of notification S-SV EMS Agency MICN Training (Updated 12 -2019) 25

Receiving Facility Response • Receiving capabilities are based on available patient teams and beds: § IMMEDIATE Patient Team (1 patient per team) o 1 ED Bed o ED physician o Surgeon (if Trauma MCI) o 2 nurses S-SV EMS Agency MICN Training (Updated 12 -2019) 26

Receiving Facility Response § DELAYED Patient Team (2 patients per team) o 2 ED Beds o ED physician o 2 nurses § MINOR Patient Team (10 patients per team) o 1 nurse o Minor patients can often be directed to ED waiting room for re-triage or possible alternate treatment areas S-SV EMS Agency MICN Training (Updated 12 -2019) 27

Receiving Facility Patient Capacity Worksheet S-SV EMS Agency MICN Training (Updated 12 -2019) 28

Receiving Facility Response • The receiving capabilities screen, accompanied by an audible alert, will automatically show on the EMResource screen for each hospital polled S-SV EMS Agency MICN Training (Updated 12 -2019) 29

Receiving Facility Response § Enter the appropriate capabilities for your facility, or leave default value at “ 0” if correct § Enter surgeon information if applicable § Select ‘Save’ to submit your capabilities S-SV EMS Agency MICN Training (Updated 12 -2019) 30

Receiving Facility Response • If the screen does not automatically show, or you need to update your capabilities at any time: § Select the applicable event on the colored bar S-SV EMS Agency MICN Training (Updated 12 -2019) 31

Receiving Facility Response § Select the ‘keys’ icon for your facility S-SV EMS Agency MICN Training (Updated 12 -2019) 32

Receiving Facility Response § Select each category to expand & enter your capabilities S-SV EMS Agency MICN Training (Updated 12 -2019) 33

Field Operations • S. T. A. R. T. triage is utilized by prehospital personnel on any declared MCI • Approved triage tags are applied to each patient prior to transport S-SV EMS Agency MICN Training (Updated 12 -2019) 34

Field Operations • Special patient triage circumstances § Pts placed in spinal motion restriction or unaccompanied children must be triaged as a DELAYED or higher § Pts with a tourniquet or hemostatic dressing applied must be triaged as an IMMEDIATE S-SV EMS Agency MICN Training (Updated 12 -2019) 35

Field Operations • The Patient Transportation Unit Leader/ Medical Communications Coordinator communicates directly with the CF S-SV EMS Agency MICN Training (Updated 12 -2019) 36

Field Operations • When the MCI is in progress: § All EMS patient communication should be routed through the CF (even for non-MCI patients) § Individual EMS units should not provide patient reports to receiving facilities unless they do not interfere with MCI operations/communications S-SV EMS Agency MICN Training (Updated 12 -2019) 37

Patient Destinations • Additional information relayed to the CF: § Total number of patients by triage category o IMMEDIATE (classified as ‘Head’, ‘Chest’, or ‘Abdomen’ if applicable) o DELAYED o MINOR o Special patient circumstances (pediatric, pregnancy, families, etc. ) § Routine patient information (vital signs, assessment, specific injury types not indicated above) is not necessary for patient distribution and should not be requested by the CF S-SV EMS Agency MICN Training (Updated 12 -2019) 38

Patient Destinations • When patients are ready for transport, the field Patient Transportation Unit Leader/Medical Communications Coordinator contacts the CF to obtain/confirm destination and mode of transport S-SV EMS Agency MICN Training (Updated 12 -2019) 39

CF Patient Destination Worksheet S-SV EMS Agency MICN Training (Updated 12 -2019) 40

Patient Destinations • The CF assigns destinations using the following patient destination guidelines: § Send trauma patients who meet trauma triage criteria to designated trauma centers when possible § Send other specialty patients (burns, pregnancy, pediatric trauma, etc. ) to designated specialty receiving centers when possible § Transport of MINOR patients by bus is permitted S-SV EMS Agency MICN Training (Updated 12 -2019) 41

Patient Destinations § Austere Care o If there are more patients within any triage category than available teams to accept those patients, consider: Ø Requesting local receiving facilities to increase patient capacity Ø Sending patients to further receiving facilities S-SV EMS Agency MICN Training (Updated 12 -2019) 42

Patient Destinations • The CF directs where to transport patients in coordination with the field Patient Transportation Unit Leader/Medical Communications Coordinator • The CF is responsible for notifying receiving facilities of patients being transported to their facility S-SV EMS Agency MICN Training (Updated 12 -2019) 43

Patient Tracking • A Prehospital Patient Tracking Worksheet is utilized by field personnel on any MCI: § All patients are logged prior to EMS transport § Completed worksheets are submitted to S-SV EMS Agency MICN Training (Updated 12 -2019) 44

Patient Tracking • Patient triage tag numbers should be entered into the patient’s hospital chart at the receiving facility S-SV EMS Agency MICN Training (Updated 12 -2019) 45

Updating the MCI Event • The CF should update EMResource event information as appropriate: § MCI is cancelled § New pertinent event information is received § Updated patient counts § Need to expand the receiving facility capabilities polling request to additional hospitals § When all patients have been transported S-SV EMS Agency MICN Training (Updated 12 -2019) 46

Updating the MCI Event • Select the ‘Event’ tab • Select the ‘Edit’ link in the ‘Action’ column next to your event S-SV EMS Agency MICN Training (Updated 12 -2019) 47

Updating the MCI Event • Enter the appropriate updates in the ‘Title’ and/or ‘Information boxes • Select any additional receiving facilities to poll/notify • Select ‘Save’ at either the top or bottom of the screen S-SV EMS Agency MICN Training (Updated 12 -2019) 48

Ending the MCI Event • The event should be ended when all patients are transported • Select the ‘Event’ tab • Select the ‘End’ link in the ‘Action’ column next to your event S-SV EMS Agency MICN Training (Updated 12 -2019) 49

MCI Critique & AAR Process • S-SV EMS conducts AAR’s of all MCIs to recognize areas that went well and identify opportunities for improvement, education &/or policy revisions • Participating CF, receiving facility and prehospital providers are required to complete/submit an MCI review form within 7 days of the event S-SV EMS Agency MICN Training (Updated 12 -2019) 50

MHOAC Program • The Medical Health Operational Area Coordinator (MHOAC) Program is based on the activities described in Health and Safety Code § 1797. 153 • Within each OA (County), the Health and Safety Code authorizes the County Health Officer and Local Emergency Medical Services Agency (LEMSA) administrator to jointly act as the MHOAC or appoint another individual S-SV EMS Agency MICN Training (Updated 12 -2019) 51

MHOAC Program • The MHOAC Program is notified by the CF in the following circumstances: § Incidents involving hospital evacuation § Incidents requiring implementation of altered levels of care in the field, hospitals, or system-wide § Inability of the CF to conduct patient distribution activities during an MCI § Other unusual events S-SV EMS Agency MICN Training (Updated 12 -2019) 52

MHOAC Program • The MHOAC Program can be contacted through the public safety dispatch center by requesting the MHOAC or Public Health Duty Officer • The S-SV EMS Duty Officer can be contacted utilizing the S-SV EMS contact procedures provided S-SV EMS Agency MICN Training (Updated 12 -2019) 53

Special Circumstances • Crisis Standard of Care § A level of medical care delivered to individuals under conditions of duress, such as a disaster, or when medical resources are insufficient for demand of emergency care § S-SV EMS has developed policies to allow for altering the EMS system under the direction of the S-SV EMS Medical Director in consultation with the applicable County Health Officer(s) S-SV EMS Agency MICN Training (Updated 12 -2019) 54

Special Circumstances • Crisis Standard of Care (cont. ) § CFs may be requested to perform the following functions in these extreme instances (under specific direction of the S-SV EMS Medical Director and County Health Officer): o Direct EMS patients to alternate destinations (alternate care sites, field treatment sites, etc. ) o Direct field personnel not to transport certain types of patients and/or refer certain types of patients to nonemergency numbers to arrange transportation S-SV EMS Agency MICN Training (Updated 12 -2019) 55