Principles of Major
Incident Response
Temple College EMS Professions
Major Incident
Cannot be managed with local resources
Multiple patients
Special hazards
Chemical
Radiological
Biological
Difficult rescue
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Major Incident
LIMITED RESOURCE SITUATION
Do the most good for the most people
Control response
Control treatment
Control transport
Temple College EMS Professions
Success depends on:
Knowing what is needed
Knowing what is available
Matching needs/resources
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Command
A PLAN
Control
Communications
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A good plan. . .
Is simple, concise, realistic
Is designed by the people who will use it
Defines responsibilities, areas of authority
Provides for unified command
Defines initial actions thoroughly, precisely
Temple College EMS Professions
A good plan. . .
Keeps people doing what they do best
Provides for smooth interaction
Provides common terminology and a
communications interface
Provides for training, practice, evaluation,
revision
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A good plan. . .
Describes what needs to be done, but…
Leaves how to do it up to the people
using the plan
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Incident Command System
Effective C3 begins with first unit
Establish command
Do NOT treat patients
Temple College EMS Professions
EMS Command
Perform size-up
Declare major incident
Request appropriate assistance
Designate staging area
Designate treatment area(s)
Coordinate with other agencies
Command until relieved
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Triage Officer
Coordinate patient removal from danger
Provide Command with updates
Identify/correct life-threats without
slowing triage
Assess, categorize, tag
Coordinate “hazard zone” activities
Continuously retriage
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Staging Officer
Assure access routes
Assure orderly parking, traffic flow
Categorize units, capabilities
Assign units as requested
Inform Command of status
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Treatment Officer
Locate treatment areas, advise Command
and Triage
Evaluate resources needed for treatment
Assign, coordinate treatment personnel
Inform Command of status
Inform Command of available manpower
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Transport Officer
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
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Support Officer
Determine equipment, supply needs
Coordinate procurement
Maintain inventory
Allocate equipment, supplies
Inform command of status
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Incident Command System
Incident Command
Law Enforcement Command
EMS Command
Staging
Fire/Rescue Command
Support
Air Ops
Triage
Treatment
Transport
Temple College EMS Professions
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
Temple College EMS Professions
Incident Command System
Incident Command
EMS Command
Staging
Deputy I
Support
Deputy II
Deputy III
Triage I
Triage II
Triage III
Treatment I
Treatment II
Treatment III
Transport I
Transport II
Transport III
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Incident Command System
Dispatch
EMS
Command
Staging
Officer
Hospitals
Triage
Officer
Treatment
Officer
Transport
Officer
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Triage
“To sort”
Prioritizing patients based on severity
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START
Simple Triage & Rapid
Treatment
 Able to walk?
Yes = Delayed
No = Assess Ventilation
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START
Ventilation present?
Yes = Greater than 30 per minute?
Yes = Immediate
No = Assess perfusion
No = Position airway. Breathing present?
Yes = Immediate
No = Dead
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START
Perfusion adequate? (radial pulse)
Yes = Assess mental status
No = Immediate
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START
Mental status adequate (follows commands)
Yes = Delayed
No = Immediate
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Four Category System
 Green:
Red:
Immediate life threat
Yellow:
Significant morbidity
Delayed life threat
 Minimal life threat
 Black:
 Dead or will die
Temple College EMS Professions
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!
Temple College EMS Professions