Medical Incident Command

Medical Incident Command : 

Medical Incident Command

Major Incident : 

Major Incident Cannot be managed with local resources Multiple patients Special hazards Chemical Radiological Biological Difficult rescue

Emergency Management Cycle : 

Emergency Management Cycle Mitigation Preparedness Response Recovery

Major Incident : 

Major Incident Do the most good for the most people Control response Control treatment Control transport LIMITED RESOURCE SITUATION

Success depends on: : 

Success depends on: Knowing what is needed Knowing what is available Matching needs/resources

Slide 6: 

Communications Control Command A PLAN

A good plan. . . : 

A good plan. . . Simple, concise, realistic Designed by people who will use it Defines responsibilities, areas of authority Provides unified command Defines initial actions thoroughly, precisely

A good plan. . . : 

A good plan. . . Keeps people doing what they do best Provides for smooth interaction Provides common terminology, communications interface Provides for training, practice, evaluation, revision

A good plan. . . : 

A good plan. . . Describes what needs to be done, but… Leaves how to do it up to people using plan

Incident Management Systems : 

Incident Management Systems A Framework for Planning

IMS History : 

IMS History Developed in 1970s following series of major wild-land fires in Southern California FIRESCOPE Problems identified Nonstandard terminology Lack of flexibility in organizational structure Non-integrated communications Lack of consolidated action plans Lack of designated facilities

Incident Management System : 

Incident Management System Model tool for command, control, coordination of resources during incidents Overcomes jurisdictional, geographic boundaries Expands, contracts with incident Works for all incidents Used by public, private sectors

Incident Management System : 

Incident Management System Required by federal law (OSHA, EPA) for HAZMAT incidents National standardization occurring Local variations still exist

Basic IMS Elements : 

Basic IMS Elements C-FLOP

Command : 

Command Established at every incident Responsible for all functions unless delegated

Command : 

Command Oversees incident needs Sets incident priorities, strategies, objectives Identifies appropriate command structure Develops incident action plan Coordinates with other agencies Approves, orders, deploys, releases resources Authorizes public information releases Determines when to transfer/terminate command

Command Structures : 

Command Structures Single Command One commander for entire incident Works well for: Short duration incidents Limited jurisdictions Limited responsibilities Does not work well for: Overlapping responsibilities Overlapping jurisdictions Incidents that evolve over time Unified Command Agency command personnel unify Right agency at right time Stimulates cooperation Provides for balanced decision-making Maintains Adequate span of control Unity of command

Single vs Unified Command? : 

Single vs Unified Command? An major fire has occurred in a high-rise office building in City A. The building has been evacuated with no casualties. Fire suppression units from City A have responded along with pre-designated police, EMS, and public works units from City A Mutual aid fire suppression units have been requested from City B and City C.

Single vs Unified Command? : 

Single vs Unified Command? An major fire has occurred in a large apartment complex in City A. At least 50 persons have suffered burns and inhalation injury. At least 500 persons have been displaced from their homes. Fire, EMS, and police elements from City A have responded. Mutual aid EMS and fire suppression units have been requested from City B and City C.

Single vs Unified Command? : 

Single vs Unified Command? A train derailment with a hazardous chemical spill has occurred in City A. A nearby residential neighborhood is exposed. Product is draining into the storm sewer system and into a nearby creek. Units from the police, fire, and public works departments have responded.

Single vs Unified Command? : 

Single vs Unified Command? A grass fire that started in County A has extended into County B and County C. The fire now covers 100,000 acres. Elements from 8 municipal fire departments and the State Forest Service are involved.

Single vs Unified Command? : 

Single vs Unified Command? A mass shooting incident has occurred at a school in City A. The suspect is still on scene. Police and EMS elements from City A and EMS mutual aid elements from Cities B and C have responded.

Command Special Staff : 

Command Special Staff Incident Commander Liaison Officer Safety Officer Information Officer CISM Officer

Information Officer : 

Information Officer Expedites effective, accurate dissemination of media information When appropriate, escorts media representatives through scene Only one per incident

Safety Officer : 

Safety Officer Assesses hazardous and unsafe situations Develops measures to assure personnel safety Investigates accidents in incident area Has emergency authority to bypass chain of command to prevent or stop unsafe acts

Liaison Officer : 

Liaison Officer Point of contact for agencies: Other than command agency in single command structures Not participating in unified command in unified command structures

CISM Officer : 

CISM Officer Monitors emotional status of all on-scene personnel Coordinates defusings, debriefings as needed

Command General Staff : 

Command General Staff

Finance-Administration : 

Finance-Administration Not part of routine daily incidents Seldom used on small scale incidents Essential as incident grows in magnitude, costs Responsibilities Time accounting Procurement Estimating costs Paying claims

Logistics : 

Logistics Seldom used at routine daily incidents Expands as incident size, duration increase Responsible for: Supplies, equipment Facilities Food Communications support Incident personnel medical support

Operations : 

Operations Major functional area in all incidents Responsible for all activities directly applicable to primary mission Responsibilities Develops operations portion of incident action plan Supervises operations to meet tactical objectives Determines need for additional resources

Planning : 

Planning Command’s “intelligence” function Past, present, future information about incident Information on alternative strategies Real-time information on resource, situation status

Where will EMS usually fall in the IMS Structure? : 

Where will EMS usually fall in the IMS Structure?

IMS Terminology : 

IMS Terminology Division = A geographical subdivision of an incident (North Division, Interior Division) Group = A functional subdivision of an incident (Suppression Group, Rescue Group, Ventilation Group) Division vs. Group

IMS Terminology : 

IMS Terminology Single Resource = One of anything (fire engine, ambulance, etc.) plus people needed to use it Task Force = Combination of single resources assembled for specific mission (battalion chief, engine, truck, heavy rescue, ambulance) Strike Team = Set number of single resources of same kind plus leader in separate vehicle (a police sergeant and 3 two-officer elements)

IMS Terminology : 

IMS Terminology

IMS Terminology : 

IMS Terminology Command post Located in field near incident Representatives from all responding agencies Allows for C3 interface during incident Strategic/operational focus during smaller, short duration incidents Operational focus in incidents when EOC is activated Emergency Operations Center (EOC) Located at fixed facility away from incident Activated during complex, widespread, or prolonged incidents Focus for strategic decision-making, planning, logistics Liaison with state, federal authorities

Command Post vs EOC : 

Command Post vs EOC The EOC determines: What? When? Where? The Command Post determines: How?

EMS In Major Incidents : 

EMS In Major Incidents Effective C3 begins with first unit Establish command Do NOT treat patients

EMS Branch Director (EMS Command) : 

EMS Branch Director (EMS Command) Perform size-up Priorities Life Safety Incident Stabilization (stable vs. unstable) Property Conservation

EMS Branch Director (EMS Command) : 

EMS Branch Director (EMS Command) Declare major incident Request appropriate assistance Designate staging area Designate treatment area(s) Coordinate with other agencies as part of unified command Direct EMS activities until relieved

Triage : 

Triage Coordinate patient removal from danger with rescue/extrication personnel Provide Command with updates Identify/correct life-threats without slowing triage Assess, categorize, tag Coordinate “hazard zone” activities Continuously retriage

Staging : 

Staging Identify safe location for vehicle staging Assure access routes Assure orderly parking, traffic flow Categorize units, capabilities Assign units as requested Inform Command of status

Treatment : 

Treatment Locate treatment areas, advise Command and Triage Evaluate resources needed for treatment Assign, coordinate treatment personnel Maintain Morgue, Rehab units as needed Inform Command of status Inform Command of available manpower

Transport : 

Transport Establish transport area(s) Request ambulances from staging Coordinate transport of patients with dispatch or command hospital Direct transport to appropriate facilities Inform Command of status Maintain records of patient destinations

Rapid Intervention Team : 

Rapid Intervention Team Dedicated ambulance/personnel Stands by in event of rescuer illness/injury

Incident Management System : 

Incident Management System

Incident Command System : 

Incident Command System Positions are functions, not persons One person can fill more than one position Until delegated, Command performs all functions Address communications to functions, not persons

Incident Management System : 

Incident Management System South Central North

Incident Command System : 

Incident Command System

Incident Command System : 

Incident Command System EMS Branch Director Staging Officer Transport Officer Treatment Officer Triage Officer Hospitals Dispatch

On-Scene Physicians : 

On-Scene Physicians Triage Comfort with difficult decisions Emergency surgery to facilitate extrication Treatment On-scene medical direction Secondary triage decisions in treatment area Specialized invasive procedures

Common Problems : 

Common Problems Lack of proper community assessment and planning Lack of adequate training Lack of identifiable command personnel

Common Problems : 

Common Problems Delayed notification of event Failure to conduct proper triage Lack of “initial” patient stabilization Failure to move patients to treatment area

Common Problems : 

Common Problems Time-consuming patient care Premature patient transport Improper or inefficient personnel use Lack of proper patient distribution to medical facilities Failure to track patient destinations

Triage : 

Triage “To sort” Prioritizing patients based on severity Dynamic process Occurs at multiple points during incident Hazard zone by triage officer Treatment area by treatment officer Transport area by transport officer

Primary Triage : 

Primary Triage Focus on speed to quickly sort patients Document locations Categorize condition for treatment Identify transport needs Triage tape or labels used

Secondary Triage : 

Secondary Triage Used at treatment areas Retriage of patients Not always necessary at small incidents Paper tags used

START : 

START Hoag Memorial Hospital, Newport Beach, CA Allows rapid sorting Essentially the PHTLS Rapid Initial Assessment Simple Triage & Rapid Treatment

START : 

START Able to walk? Yes = MINOR No = Assess Ventilation

START : 

START Ventilation present? Yes = Greater than 30 per minute? Yes = Immediate No = Assess perfusion No = Position airway. Breathing present? Yes = Immediate No = Dead

START : 

START Radial pulse present or capillary refill < 2 seconds? Yes = Assess mental status No = Immediate, Control Bleeding

START : 

START Follows commands Yes = Delayed No = Immediate

Four Category System : 

Four Category System

Rules of Triage : 

Rules of Triage Greatest good for greatest number Save lives, then limbs One Chief, many Indians Squeaky wheels don’t need grease You can’t save everyone! So don’t try!

CISM : 

CISM Critical incident = Powerful emotional response to catastrophic event Can be immediate or delayed Can be physical, emotional, or behavioral

CISM : 

CISM Large or prolonged incidents: Include CISM officer in command staff Smaller incidents: Personnel must monitor one another, be prepared to respond appropriately