King County MCI Tasks & Tactics
Goals of the Revised Plan
• County wide plan that was not a lesson plan
• Reduce choke points and unnecessary actions
• Streamline efforts and utilize procedures that
are used every day
• A plan that is scalable and flexible
• A plan that is utilized and followed by all zones
in King County
Noticeable Changes
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Elimination of formal funnel points
Elimination of treatment tags
Changes to how patients are tracked
Elimination of patient numbering
County wide MCI designators
Hospital Control is now Disaster Medical
Control Center (DMCC)
Changes
Changes
What defines an MCI
• A mass casualty incident (MCI) is any incident
in which emergency medical services
personnel and equipment at the scene are
overwhelmed by the number and severity of
casualties at that incident
What you need to know to wear a vest
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Don the vest
Understand the Incident Objective
Know the vest that you are adjacent to
Provide progress reports
Manage and request resources
First Arriving Officer
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Unit signature
The location, or corrected location
Initial basic impression
Cause, if known
Scene Size Up
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Brief scene impression including known hazards
Level of PPE
Estimated total number of patients
Establish the command designator and command
post location
Initial company assignments
Designate the transportation corridor
Base and staging locations
Decide complex or not
Transportation Corridor
• One of the most important initial tasks
determined by the first in officer
• Must be clearly communicated early to next in
companies
• If the first in officer cannot establish the
transportation corridor then the next in unit
should take that responsibility
• Turn the corridor over to law enforcement
when applicable
Incident Commander
• Is responsible for directing and/or controlling
resources by virtue of explicit legal, agency, or
delegated authority
• The IC is responsible for all aspects of the
response, including developing incident
objectives and managing all incident
operations
Incident Commander
Incident
Commander
Recon
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Will be incident driven
Advanced scene size up
Will perform a 360 of the event
Should identify:
Equipment needs
Estimated number of patients
Hazards
Cause of the incident
Any physical barriers that may divide the incident,
or prevent ingress or egress
Recon
Incident
Commander
Operations
Recon
Medical Group
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Should be assumed by a senior ALS member
Responsible for:
Transport
Treatment
Triage
Activation of the DMCC
Green Patient Management
Medical Group
Incident Commander
Operations
Medical
Group
Recon
Triage
• Will report to Medical in smaller incidents and
Rescue if the situation dictates
• Will triage patients based on King Counties
“Sick/Not Sick” guideline
• Triage can be accomplished by a Triage Team,
Extraction Team, or after safely leaving the
area
• It is understood that triage is fluid and
dynamic and can change frequently
Types of Triage
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ABC (per King County EMT protocol)
RPM
Sacco
START
Red / Not Red
Triage
• County model of Sick vs. Not Sick
• Allows rescuers to use the same triage
mechanism that they use every day
• Sick = Red
• Not Sick = Yellow
Treatment
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Identifies appropriate treatment areas
Populates the treatment area appropriately
Supervising treatment of all pt’s
Responsible for re-triaging pt’s as necessary
Coordinating with Transport
Prioritizing pt’s for transport
Apply the tracking band if time allows
Treatment for Larger Incidents
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Assign a Red Treatment Leader
Assign a Yellow Treatment Leader
Request resources from Medical
Monitor and request medical supplies
Treatment
Incident
Commander
Recon
Operations
Medical
Group
Treatment
Red Unit
Leader
Yellow Unit
Leader
Transportation
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Reports directly to Medical Group
Communicates directly with the DMCC
Ultimately responsible for patient tracking
Works with law enforcement liaison to keep
the transportation corridor clear
• Responsible for Ambulance Staging
• Works directly with Treatment to coordinate
patient transport
Transportation for Larger Incidents
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Assign an Ambulance Staging Manager
Assign an Ambulance Loading Manager
Assign a DMCC coordinator
Assign a patient tracking aide
Request resources from Medical
Ambulance Staging Manager
• Best staffed by an Ambulance Supervisor
• Should be given a radio
• Needs to remain in contact with Ambulance
Loading or Transport Supervisor
Ambulance Loading Manager
• Coordinates the loading of transport vehicles
• Should be close to the treatment area to
minimize the distance of patient movement
DMCC Coordinator
• Only injury pattern that needs to be
communicated is burns, OB trauma, and if
applicable, pediatric patients
• Do not give individual patient status, let them
know what is loaded in the back of the
transporting unit
Tracking
• Ensures that all patients
have a tracking band
• All transport capable
vehicles in King County
will have two packs of
25.
Tracking
• Will place a tracking
sticker on a tracking
board
• All MSO’s and Medic
units will have tracking
sheets
Tracking
• Instruct all transporting
personnel to place a
tracking sticker on the
portion of the MIRF
that will stay with the
hospital
Transport
Incident
Commander
Operations
Medical Group
Ambulance
Staging
Treatment
Transport
Ambulance
Loading
DMCC
Coordinator
Tracking
Aide
Recon
Green Patient Area Manager
• Incident driven, 1 green pt or multiple green pts
• Needs to be away from the working incident
• Needs to have someone with medical authority
to re-evaluate pt’s as needed
• Coordinate to get pts to the hospital as needed
• Liaison with law enforcement
• Ensure patient tracking
Medical Org Chart
Incident
Commander
Operations
Medical
Group
Treatment
Transport
Recon
Rescue
• Reports directly to operations
• Should secure their own radio channel
• Is responsible for overseeing extraction,
extrication, and triage in larger incidents
• Responsible for requesting and releasing
resources as needed
Rescue
Incident
Commander
Recon
Operations
Medical
Group
Rescue
Extraction
• Mobilization of pt’s to the treatment area
• Extraction teams may also be assigned to
triage
• Extraction teams should manage pt care
during movement
Extraction
Incident
Commander
Recon
Operations
Rescue
Medical
Group
Extraction
Extrication
• Responsible for the physical disentanglement
of patients
• Utilizes physical rescue tools
Extrication
Incident
Commander
Recon
Operations
Medical
Group
Rescue
Extraction
Extrication
Growing Incident
Incident
Command
Recon
Finance
Planning
Logistics
Operations
Medical
Hazard
Mitigation
Rescue
Treatment
Transport
Triage
Red Unit
Extraction
Extrication
Fire
Ambulance
Staging
Ambulance
Haz Mat
Loading
Yellow Unit
DMCC
Coordinator
Tracking
Aide
Decon