Each MCI/Disaster scene presents its own unique hazards and difficulties. This plan is a general guide to the management of MCIs. It should be understood that modifications may need to be made by command personnel on scene as such changes are needed.
A multiple casualty incident (MCI ) is any situation where the number of sick or injured patients exceeds the available local, regional or state EMS system resources to provide adequate care in a timely manner to minimize injury and death. An MCI may be the result of a man made disaster or a natural event. Successful management of an MCI will require preplanning and organization of local, regional and state EMS, fire, law enforcement and civil defense resources. Hospital resources and specialized care services must also be included in preparing your MCI plan.
MCI management process is defined in the Incident Command System (ICS) . In general, the Fire Department establishes the overall command and designates the incident commander (IC ). NOTE: Other agencies may function as the IC, for example, Law Enforcement agencies at a crime scene or hostage situation. Other agencies may assist the IC. Clear precise inter-agency communication networks must be established for successful MCI management.
Levels of response to an MCI can be developed and will dictate which personnel and resources will be required at the scene. These levels include:
Level I Response: A localized MCI that can be managed by local EMS and Rescue personnel without the need for mutual aid from outside organizations.
Level II Response: An MCI that overwhelms or severely taxes local EMS and Rescue personnel that requires the need for mutual aid and interagency coordination. Typically a large number of patients are involved.
Level III Response: An MCI that overwhelms both local and regional EMS and rescue resources. Multiple patients spread over multiple sites are often involved. Significant inter-agency coordination is required.
TRIAGE
Triage is a special process of sorting patients by the severity of injury or illness to determine the need of emergency care and transportation. This needs to be a continuous process throughout the management of an MCI. The initial triage process should be performed by the first crew to arrive on scene and needs to be continuously reevaluated since the patient's triage status may change. Presently there are no national standard guidelines established for triage. Therefore, a suggested method of triage may be performed by either the METTAG (triage tagging system) or the START Field Guide (Simple Triage And Rapid Transportation) triage systems.
MULTIPLE CASUALTY INCIDENTS / TRIAGE
A suggested approach to treatment prioritization of victims is that found in the METTAG system. The treatment priorities are defined as:
Zero priority (BLACK): Deceased or live patients with obvious fatal and
non-resuscitatable injuries
First priority (RED) : Severely injured patients requiring immediate care and
transport. (e.g., respiratory distress, thoracoabdominal injury, severe
head or maxillofacial injuries, shock/severe bleeding, severe burns)
Second priority (YELLOW) : Patients with injuries that are determined not to be
immediately life threatening. (e.g., abdominal injury without
shock, thoracic injury without respiratory compromise, major fractures
without shock, head injury/cervical spine injury, and minor burns)
Third priority (GREEN): Patients with minor injuries that do not require immediate
stabilization. (e.g., soft tissue injuries, extremity fractures and
dislocations, maxillofacial injuries without airway compromise and
psychological emergencies)
The START Field Guide consists of a sixty (60) second patient assessment that evaluates ventilation, perfusion, and mental status to classify the victims as needing immediate or delayed transport or are non-salvageable or dead. This allows rescuers to quickly identify victims that are at greatest risk of early death or if they may require delayed transport. The METTAG or similar color coded tagging systems may be used as part of the START Field Guide.
MULTIPLE CASUALTY INCIDENTS / TRIAGE
SCENE ASSESSMENT AND TRIAGE PRIORITIES
1. Maintain universal blood and body fluid precautions.
2. The initial response team should assess the scene for potential hazards, safety and number of
victims to determine the appropriate level of response.
3. Notify central dispatch to declare an MCI and need for interagency support as defined by incident level.
4. Identify and designate the following positions as qualified personnel become available:
5. Identify and designate sector areas of MCI
6. Post incident MCI Plan
BASIC, INTERMEDIATE AND PARAMEDIC MCI PROCEDURE SUMMARY
All EMT level personnel will eventually be involved in the management of an MCI. It is imperative that all EMTs implement the above incident command system (ICS) in all MCI situations. Every EMT must be aware and have a thorough knowledge of their particular role and responsibilities in the rescue effort.
Due to the many complexities of MCI/Disaster situations, it is recommended that all EMTs should participate and receive additional training in MCI/Disaster management.