City of Toronto Emergency Plan
OPERATIONAL SUPPORT FUNCTION
MASS CASUALTY
TORONTO EMERGENCY MEDICAL SERVICES
Version 1.0
April 2013
Mass Casualty OSF – Approved April 2013
1
Revision History
Revision Name of Contributor
Number
1.0
I. Attard (EMS), M. Phair
(TPS), J. Smysnuik
(OEM), and M.
Noormahamud (TFS)
2.0
Summary Of Changes
Revision Date

April 2013
3.0

4.0

5.0

6.0

7.0

Complete update of the
document with input from
OEM, TPS, and TFS

Mass Casualty OSF – Approved April 2013
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Table of Contents
1.0
Introduction .................................................................................................................... 3
1.1
Purpose ............................................................................................................................ 3
1.2
Scope ............................................................................................................................... 3
2.0
Concept of Operations ................................................................................................... 5
2.1
General............................................................................................................................. 5
3.0
Roles and Responsibilities ............................................................................................ 7
3.1
Primary / Lead Agency / Division – Toronto Emergency Medical Services ................... 7
3.1.1 Initial Actions .................................................................................................................... 7
3.1.2 TEMS Incident Site ........................................................................................................... 7
3.1.3 Joint Area Command ...................................................................................................... 10
3.1.4 TEMS Division Operations Centre (DOC) ...................................................................... 11
3.1.5 TEMS Basic Response Organizational Chart ................................................................. 12
4.0
Supporting Agencies / Divisions ................................................................................ 13
4.1
Toronto Police Service ................................................................................................... 13
4.2
Toronto Fire Services ..................................................................................................... 13
4.3
Office of Emergency Management ................................................................................. 14
Mass Casualty OSF – Approved April 2013
3
Operational Support Function
Mass Casualty
Primary / Lead Agency / Division:
Toronto Emergency Medical Services
Supporting Agencies / Divisions:
(ABCD's)
Toronto Police Service
Toronto Fire Service
Office of Emergency Management
1.0
1.1
Introduction
Purpose
Toronto Emergency Medical Services (TEMS), Toronto Police Service (TPS), and
Toronto Fire Services (TFS) provide coordinated city assistance and resources to
respond to mass casualty needs during an emergency.
A Mass Casualty Incident (MCI) is any event or emergency of varying duration where
the number of victims and / or patients exceeds the immediately available resources,
equipment or facilities.
Assistance provided under this Operational Support Function is directed by TEMS and
is supported by several City divisions and external organizations.
1.2
Scope
This document provides a general overview of the coordinated medical response to an
MCI that impedes routine health and medical services within the City of Toronto. TEMS
support includes:
People:
 TEMS personnel including:
o Paramedics
o Emergency Medical Dispatchers
o Administrative and support staff including occupational health and safety
and crisis intervention specialists
o Management staff
Mass Casualty OSF – Approved April 2013
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
Special Operations Team response participation, consultation, and technical
assistance
o Joint CBRNE (Chemical, Biological, Radiological, Nuclear, Explosive)
Team
o HUSAR (Heavy Urban Search and Rescue) Team
o ETF (Emergency Task Force)
o EMS ESU (Emergency Support Unit)
o Marine Unit
Processes:
 Incident Management System (IMS) model of response
o IMS is a comprehensive, flexible and adaptable approach to emergency
management for unplanned and planned incidents encompassing
personnel, facilities, equipment, procedures, and communications
operating within a common organizational structure
o Is predicated on the understanding that in any and every incident there are
certain management functions that must be carried out regardless of the
number of persons who are available or involved in the emergency
o Management of any incident begins at the site level

Incident response including all required command and general staff functions at
multiple levels, if necessary:
o TEMS Incident Site
 Including Reception Centre Liaison
o Joint Area Command
o TEMS Division Operations Centre (DOC)
o Toronto Emergency Operations Centre (EOC)
Places:
 TEMS facilities including EMS Stations, Toronto Central Ambulance
Communication Centre (CACC), DOC, etc.
Tools:
 Health/medical equipment and supplies
 TEMS Fleet -EMS Ambulances, Support vehicles, MCI, CBRNE, and/or Special
Event Pods, etc.
Mass Casualty OSF – Approved April 2013
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2.0
2.1
Concept of Operations
General
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6
City of Toronto – Emergency Plan
Operational Support Functions and Risk Specific Plans
Identification of Lead Agencies
Toronto Emergency Plan
Operational Support Functions
(OSF’s)
Emergency Level
Notifications
Risk Specific Plans
(RSP’s)
Emergency
Information
Nuclear
OEM
OEM
Strategic
Communications
EOC Operations
Evacuation
OEM
Police Service
Incident
Management
System
Mass Casualty
Floods
Emergency Medical
Services
Toronto & Region
Conservation Authority
Toronto Public Health
Power Disruption
(Electricity)
OEM
Toronto Hydro
OEM
Animal Care &
Relief
Municipal Licensing &
Standards
Damage
Assessment
Toronto Building
Debris
Management
Solid Waste
Management
Donations
Management
Mass Fatality
Police Service
Psychosocial
Response &
Recovery
Toronto Public Health
Shared Fleet
Management
Fleet Services
Traffic
Management
Office of Partnerships
Transportation
Services
Emergency
Human Services
Volunteer
Management
OEM
Human Resources
Toronto Public
Health Plan for an
Influenza Pandemic
Figure 1
Mass Casualty OSF – Approved April 2013
Fuel Distribution
Fleet Services
7
3.0
3.1
Roles and Responsibilities
Primary / Lead Agency / Division – Toronto Emergency Medical Services
3.1.1 Initial Actions


Implementation of the Incident Management System (IMS)
Notification of incident to allied agency partners, if not already completed
The following describes the basic organization of EMS response at the Incident Site,
Joint Area Command, and DOC levels.
3.1.2 TEMS Incident Site
TEMS will establish Incident Site response in conjunction with allied emergency
services and other partners.
General response priorities:
 Life safety
 Incident stabilization
 Maintain critical infrastructure
 Protect property and environment
Incident Site response takes into account:
 The severity of the incident
 The availability of resources
 The amount of site management required
An MCI may require, but is not limited to:
 Ambulance Units
 Emergency Support Units (includes EMS Bus)
 EMS Superintendents
 EMS Operations Commanders
 Tactical EMDs and dedicated radio channels
 DOC Activation
 Hospital notification
 Other resources as required
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Pre- hospital response operates in two areas of the incident site:
1. Inner perimeter – Hot and Warm Zones
2. Outer perimeter – Cold Zone
Figure 2
Inner Perimeter-Hot and Warm Zones
The Hot Zone is the controlled danger or contaminated area that requires all medical
responders working in this zone to be appropriately qualified. These qualifications are
not limited to:
 CBRNE, HUSAR, etc. trained
 Part of a joint special team
 Have appropriate personal protective equipment (PPE)
o PPE is absolutely required in this zone.
The Warm Zone is the control area surrounding the controlled danger or contamination
zone where life saving emergency care and decontamination are conducted. All medical
responders working in this zone must be appropriately qualified. These qualifications
are not limited to:
 CBRNE, HUSAR, etc. trained
 Part of a joint special team
 Have appropriate personal protective equipment (PPE)
o PPE is absolutely required in this zone.
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Outer perimeter – Cold Zone
The Cold Zone is the area where normal medical triage and continuing medical
treatment is provided. Normal medical triage prioritizes patients into minor, delayed,
immediate, and deceased categories. Based on the acuity of the patient, they would be
transferred to a staged EMS crew for continuing care and transport to the most
appropriate hospital. In this area, rescuers do not require the same level of training or
PPE as personnel in the Hot and Warm Zones unless it is specified.
Some or all of the following IMS functions may be activated, but are not limited to:
 Command and Command Staff
o Responsible for managing all responses to an incident
o May consist of a single person or team
o The title of “Command” is exclusive - only one per incident at each
response level
o First and primary organizational component of IMS - all other functions
report to Command

Operations – including Joint Special Teams, Tactical Incident Site
Communications support, etc.
o Directs and coordinates all incident tactical operations
o Is typically one of the first organizations to be assigned to the incident
o Expands from the bottom up
o Organizes, assigns, and supervises all resources assigned to an incident
including the staging area

Planning
o Maintains resource status
o Maintains and displays situation status
o Prepares the Incident Action Plan
o Develops alternate strategies
o Provides documentation services
o Prepares the demobilization plan
o Provides a primary location for Technical Specialists assigned to the
incident

Logistics
o Ordering, obtaining, maintaining, distributing and accounting for essential
personnel, equipment and supplies, beyond those immediately accessible
to operations
o Developing the telecommunications plan
o Providing telecommunications/IT services and resources
o Setting up food services
o Setting up and maintaining incident facilities
o Providing support transportation
o Providing medical services to incident personnel
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
Finance and Administration
o Tracking timesheets for incident personnel and equipment
o Contract negotiation and monitoring, reimbursing expenses
o Making cost estimates for alternate response strategies
o Monitoring sources of funding
o Tracking and reporting of the financial usage rate
Within the cold zone, TEMS may activate some or all of the following functions, but are
not limited to:

Triage
o Patients are assessed medically, classified appropriately by acuity of
illness or injury and tagged for identification

Treatment
o Patients receive appropriate medical and first aid treatment for their
injuries, in priority of acuity, until transported from the Incident Site

Staging
o Resources and personnel are assigned to the Staging area
o Provide resources as required to the Incident Site

Transport
o Coordination of patient transport with the Communication Centre, based
on Patient acuity and specialized treatment requirement
3.1.3 Joint Area Command
TEMS may establish Joint Area Command in conjunction with allied emergency
services and other partners
 TEMS Area Command provides support and guidance to all TEMS Incident Sites
Some or all of the following IMS functions may be activated, but are not limited to:
 Area Command and Command Staff
 Area Operations
 Area Planning
 Area Logistics
 Area Finance and Administration
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3.1.4 TEMS Division Operations Centre (DOC)
TEMS may activate the TEMS DOC
 TEMS DOC provides support and guidance to TEMS Area Command and TEMS
General Operations Command within the City of Toronto
Some or all of the following IMS functions may be activated, but are not limited to:
 DOC Command and Command Staff
o Command staff may be expanded to include support from:
 Allied GTA Emergency Medical Services
 Local Health Integration Network (LHIN)
 Community Care Access Centre (CCAC)
 Ministry of Health and Long-Term Care (MOHLTC)
o Emergency Health Services Branch (MOHLTC EHSB)
o Emergency Management Branch (MOHLTC EMB)
 Ontario Hospital Association (OHA)
 Coroner's Office
 Others as required




DOC Operations
DOC Planning
DOC Logistics
DOC Finance and Administration

TEMS may coordinate with support agencies to assist in providing health and
medical services to citizens directly and indirectly impacted by the emergency
o This also includes response personnel and others involved in the incident

TEMS may coordinate the delivery of health and medical services with involved
federal and provincial organizations including Health Canada and Ministry of Health
and Long Term Care

TEMS may coordinate with the City's health and medical service providers, including
the Ontario Hospital Association, hospitals and health care facilities (including
medical and dental facilities)
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3.1.5 TEMS Basic Response Organizational Chart
Figure 3
Provincial
Emergency
Operations Center
Ministry of Health
Emergency
Operations Centre
Ministry of Health
Emergency
Management
Branch
Ministry of Health
Emergency Health
Services Branch
City of Toronto
Emergency Operations Centre
TEMS
Division Operations Centre
Joint Area Command
including Tactical Communications
TEMS General Operations Command
including Central Ambulance
Communications Centre
Incident Site Command
TEMS Operation Districts (5)
Joint Special Teams
HUSAR, CBRNE Team
(Hot and Warm Zones)
TEMS Site Operations
(Cold Zone)
Triage
(Cold Zone)
Staging
(Cold Zone)
Mass Casualty OSF – Approved April 2013
Treatment
(Cold Zone)
Transport
(Cold Zone)
13
4.0
Supporting Agencies / Divisions
4.1
Toronto Police Service
Police will be responsible for all site security and investigation including the following:





Establishing a security and credentialing system
Setting up a security perimeter and establishing a staffed entry/egress points.
Briefing and debriefing personnel when entering or leaving the staging area.
Removing unauthorized personnel from the scene.
Acquire, assemble and coordinate all necessary TPS personnel, the materials
required to support those personnel and the functions that will be required of
them
 Provide advice and up to date information to the Incident Commander regarding
TPS concerns, identifications or requirements of personnel.
 Apply special skills of officers within the identification processing group where
required during the investigation.
 Assist EMS as required and/or requested.
4.2
Toronto Fire Services
Toronto Fire Services is dedicated to protect life, property and the environment from the
effects of fires, illness, accidents, natural disasters and other hazards. We are
committed to enhancing fire safety and raising community awareness through education
and involvement.
Toronto Fire Services will pursue the acquisition and use of the most effective
technology, equipment and resources to ensure that we continue to perform in a
competent and professional manner. We will always seek new opportunities to fulfill our
mission.
Toronto Fire Services are dedicated to building a cohesive, equitable and unified
workforce. We provide high quality and caring services to those who live in, work
in and visit our City – safely, efficiently and effectively.
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4.3
Office of Emergency Management
The role of the Office of Emergency Management (OEM) is to strengthen the City's
ability to prepare, respond and recover from major emergencies. The OEM is
responsible for coordinating preparedness, mitigation, response and recovery activities
for any major emergency or disaster (manmade or natural) affecting the City of Toronto.
This is achieved through:
 Maintaining the City's Emergency Plan
 Acting as curator of this Mass Fatality Operational Support Function
 Ensuring that this OSF complies with the City's Emergency Plan, and all other
Operational Support Functions (OSFs), Risk Specific Plans and other relevant City of
Toronto, Provincial and Federal emergency management legislation
 Ensuring Emergency Operations Centre Readiness
 Supporting implementation of the City Incident Management System at both site and
Emergency Operations Centre levels
 Conducting Training
 Developing a multi-year comprehensive exercise program
 Conducting a Hazard Identification and Risk Assessment
 Delivering Public Education and Outreach
 Assisting Toronto Emergency Medical Services when updating this OSF based on
current City of Toronto emergency plan, emergency management training, exercises
and policies
Mass Casualty OSF – Approved April 2013