Mass Casualty Incidents
What is an MCI ?
It is any incident where the number of
patients and/or the severity of their
injuries prohibits immediate patient
care provided to all at that moment.
Multiple Casualty Incident
It will never happen to me right ?
High Risk/Low Frequency events
MCI Events in King County:
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Highland Ice Arena, Shoreline: 76 patients
from a CO leak .
 Chlorine leak at a County Pool, 26 Patients
 School bus accident in Redmond 60 patients
 Several MVA’s ranging from 5 to 10
Patients
 Seattle Aurora Bridge Bus Incident. 33
Patients.
Common Problems at an MCI
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Personnel not fully understanding their roles
in an MCI setting.
 Failure to identify the incident as an MCI
 Failure to triage properly
 Improper numbering of treatment tags /Pt’s
 Inappropriate, time consuming treatment
 Clogging at the transportation site.
Problems…
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Scene access problems
 Ineffective response plan for the size of
incident.
 Lack of a large equipment cache on hand
 Congested treatment areas
 Transport vehicles left unattended
Misconceptions of MCI:
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Every MCI requires a Medical Group to be set up.
I.C. does not need an “Medical Group Supervisor”
in a large event.
You cannot down grade a patient once they have
been triaged.
All Immediate or red patients must be transported
first.
Patients have to go the the closest Hospital.
Yellow patients equal BLS patients always.
Multiple Casualty Definitions:
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Ambulance Staging
Staging Manager
Colored flagging Tape
Funnel Point
Hospital Control
Medical group
Supervisor or Branch
director
Medical Support Unit
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Morgue area
Plan C
Triage
Tracking Boards
Treatment Area
Transport Area
Treatment Tags
Triage Belt
Incident Management System
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MCI plan is based on the same principles of
the IMS system.
 Allows for creation of an organizational
structure for the most effectiveness of
resources, personnel and equipment.
 Span of control 3 to 7 with optimal being 5
 Is a “Medical Group” or “Medical Branch”
needed to effectively manage the incident ?
Activation of an MCI
Incident Commander’s responsibility to
declare an MCI and provide a verbal size up
of the incident.
 Additional resources should be requested
early on by the I.C.
 The I.C. or designee is responsible for
initial “Hospital Control” contact and plan
activation.
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Activation of Hospital Control
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Request “Activation of the MCI Hospital Control
Plan” done by the I.C.
Transportation Team Leader communicates with
Hospital Control
PRIMARY: Harborview Medical Center
Ask for the “Charge Nurse”
This will result in notification of HMC E.R. staff,
HMC Physician portable 55, and area Hospitals if
necessary.
Is a “Lock Down” needed at local Hospitals ?
Secondary Hospital Control
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Overlake Medical Center
 Request Charge Nurse and provide the same
information as you would to HMC.
Incident Commander
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Develop a “Incident action plan” necessary to
control the incident.
Establish a Medical Group or branch if needed.
Ensure that adequate resources are requested for
both incident manpower and transport capabilities.
Direct incoming resources
Establish Command post/location and necessary
staging /base areas
Incident Management
Considerations:
Is “Gross Decon” and “Lock Down”
notification for hospitals needed ?
 Buses for shelter and patient transport.
 Crowd control, separating injured from non.
 Separate walking wounded from non
ambulatory patients.
 Separate tactical channel for medical
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Gross Decon Procedure
I.C. establishes “gross decon group”
 Location: prior to funnel point.
 Once clean, patient is given a Tyvek suit.
 Disposable blanket if Back Boarded.
 Attach white flagging tape to wrist.
 Proceed to funnel point or green holding
area.
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Medical Group/Branch
Supervisor
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Filled by a “Medical Services Officer”or first in
Medic Unit officer.
Responsible for the over all coordination of the
medical group and Hospital control
Recommend early activation of Hospital control
Ensure proper resources and manpower for the
medical group.
Responsible for accountability
Medical Group
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Medical Branch vs.
Medical Group
 Medical group
supervisor
 Triage Team Leader
 Treatment Team
Leader
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Transportation Team
Leader / ambulance
staging manager
 Morgue Team Leader
Triage Team Leader
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Filled by a Company Officer
Accountable for litter barriers and equipment for
back boarding.
Responsible for setting up a funnel point
Responsible for proper triage including
numbering/flagging of patients
Responsible for clearing Patients after gross
deacon needs are complete prior to treatment area.
Funnel Point Procedure
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V shape set up with saw horses, and a white flag
to identify the funnel point.
Pre number treatment tags prior to Patients
arriving.
Use division numbers for multiple funnel points.
Re-triage “ Safety Net”
Mark the treatment card, and patients forehead,
cheek or arm.
Attach the tag to the colored tape
Treatment Team leader
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Filled by driver of first in medic Unit
Sets up Treatment area using supplies from Medic
Units and MSU vehicles.
Responsible for the over all treatment in all areas.
Appoints treatment area leaders.
Ensure adequate resources and proper
documentation is complete on each tag.
Coordinates Pt. Loading with Transport.
Transport Team Leader
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Filled by experienced EMT, Medic or MSO
Responsible for the loading, transporting and
accountability of all patients.
Coordinates the destination with Hospital Control.
Ensures proper transport resources.
Documents all information on a tracking form
using an aid.
Consider using an ambulance supervisor
Hospital Control
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Utilize cell phones or 800 radios
 Make contact with HMC Charge nurse.
 Transport Team leader advises them of the
condition of the patient. Hospital control
advises to which hospital to transport to.
 Hospital controls calls ahead, not the unit
transporting.
Communication Problems
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If no phone access, use the following
guidelines.
 First 10 patients go directly to HMC
 1 or 2 red patients may be sent to other
regional level 3and 4 trauma centers.
 Use caution transporting to local hospitals.
They may be inundated with self-directed
patients.
Ambulance staging
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Separate from manpower staging.
 Assign a Staging manager. Consider using
the Ambulance supervisor for that.
 All personnel stay with their vehicles
 Position units in staging to allow easy
access to the transport post.
Morgue Team Leader
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Filled by an EMT, P.D. or KC M.E.
 Responsible for scene security of the
deceased. i.e.. personal effects
 Coordinates duties with Police and the
Medical Examiner.
 Documents Morgue activities
 If body is moved, mark the spot with a flag.
First Arriving Unit
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Size-up the incident. MCI Yes or No?
Announce you have an MCI to incoming
resources
Call for additional resources. Consider the need
for specialty equipment such as an MSU vehicle.
Establish command. BE Command
Make assignments for incoming companies.
Base units. Secure ingress and egress routes.
Initiate triage
Triage Equipment
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Triage Belt with triage tape with red,
yellow, green, black/white rolls.
 First Aid Bag attached to belt to provide 5
pressure dressings.
 Two inch Tape
 Marker “water resistant”
Triage Criteria
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30 seconds per patient
 Using the ABC or RPM approach.
 Awake / Airway
 Breathing
 Circulation, “presence of a radial pulse”
 Attach the proper triage colored tape to the
wrist. Document onto a piece of 2” tape.
Harvesting Patients:
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Recommended four litter barriers per back board
for an adult patient.
Recommended two litter barriers per back board
for a pediatric patient
Three straps per board for an MCI
Duct Tape may be used in place of cloth straps.
Large resources needed for litter barriers. Labor
intensive.
Remember…
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The Key to the success of an MCI is early
recognition that you have an MCI and to
respond the appropriate resources early on.
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Be Familiar with your own Departments
polices/procedures. Know your equipment.
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Train on MCI.
BE PREPARED !!