EMS COMMAND
What we imagine is order is
merely the prevailing form of
chaos.
Kerry Thornley,
Principia Discordia, 5th edition
PROCEDURE
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At all medical incidents where Command has been
established, the Incident Commander will implement
the necessary components of the EMS Command
structure to ensure firefighter and public safety.
Additionally, he/she will effectively mitigate the
incident while maintaining strict accountability for all
patients and their personal belongings.
EMS COMMAND IMPLEMENTATION
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Implement EMS Command early.
Develop the system in a logical order.
Provide tactical objectives to subordinate positions
when you assign them.
Determine if your incident requires the expanded
EMS ICS structure to manage it.
Think about geography (Scene set-up).
Use visual indicators to assist responders and the
public.
TERMINOLOGY
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Mass-Casualty Incident – Any incident with
multiple patients that will significantly impact local
resources including area hospitals.
1st Alarm Medical – Through our established
Automatic Aid Agreement, a 1st Alarm Medical will
result in the response of 2 Engines, 2 Rescues, and
1 Command Officer. (No such thing as a 2nd Alarm
Medical)

EM’s System – The Medical Communications
Officer will activate the EM’s system through
Summit Regional. This system will indicate the
availability and status of all regional facilities.
(Flagstaff, Phoenix, Tucson, etc….)
ROLES AND
RESPONSIBILITIES
COMMAND
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Command :
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Establishes an effective command structure.
Manages Communications.
Utilize EMS Command tools to assist in this process.
EMS Tactical Worksheet
Command Checklist
MEDICAL
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Medical :
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Reports to Command .
Organizes incoming resources to mitigate large EMS
incidents.
Medical Branch Director Checklist
TRIAGE
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Triage :
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Reports to Medical/Command.
Recon incident area.
Is responsible for sorting and
casualties.
Triage Unit Leader Checklist
prioritizing all
Triage Team, reports findings up the
Chain of Command
Incident Command
Medical Branch
Triage Team
EXAMPLE:
“Medical , Triage Team 1 triaged 15 patients, 7Immediate, 7-Delayed, and 1-Dead or Dying”
TREATMENT
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Treatment :
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Reports to Medical/Command
Responsible for prioritizing casualties and
treating the injured.
Treatment Unit Leader Checklist
SUPERVISES TREATMENT AREA.
•
REPORTS TO MEDICAL /
COMMAND
•
Immediate Treat
Area
•
Minor Treat
Area
TREATMENT OFFICER
TEAM SETS UP TREATMENT
AREA
•
UTILIZE VISUAL CUES TO
DESIGNATE THE AREAS
Treatment Entry Point
TREATMENT OFFICER / TEAMS
•Treatment Teams are responsible for re-evaluating
and stabilizing patients brought by each assigned
“litter bearers.”
TRANSPORTATION
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Transportation
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Organizes and coordinates the transportation of all
casualties.
Transportation Unit Leader Checklist
Transportation Record
TRANSPORTATION OFFICER
• Remains around the designated
treatment area and works with the
Treatment Officer on transport
priorities.
• Assigns patients to transport units.
• Removes last tag and puts it into the
“Hospital Can”
• Reports to Medical / Command.
RESCUE
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Rescue/Extrication:
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Reports to Medical/Command
Removes trapped victims and provides for their
movement to triage/treatment area(s) (whichever is
most appropriate.)
Rescue Group Checklist
MEDS COMM
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Medical Communications (MEDS COMM)
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Reports to Medical/Command
Maintains communications with area hospitals
(EMSCOM) and dispatch to facilitate
transportation of victims to the appropriate
facilities.
MEDS COMM Checklist
MEDICAL COMMUNICATIONS
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Medical Communications Officer maintains
communication with area hospitals via EMSCOM.
Receiving hospitals availability in terms of #’s of
Immediate/Delayed/Minor pt’s they can take.
Report to receiving facilities the pt. triage level,
transport unit #, and ETA.
If requested by Medical Branch, implement the EM’s
system .
MEDICAL STAGING
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Medical Staging :
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Reports to Transportation/Medical
Establishes, organizes and maintains an area for
incoming medical resources.
Medical Staging Checklist
MORGUE
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Morgue:
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Report to Medical/Command.
Collect, protect, and identify deceased victims.
Morgue Manager Checklist
MORGUE MANAGER
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Mission-Collect,
Protect, and Identify
bodies
Establish morgue area
Utilize Law
Enforcement/Coroner
for assistance
Use litter bearers for
moving of dead
Morgue
MEDICAL SUPPLY
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Not included in the EMS Command Kits.
Treatment Officer assigns team to rob
equipment off of every truck.
Or, have trucks bring all equipment to
treatment area prior to being assigned to a
task.
As the MCI develops, other actions may need
to be taken to facilitate equipment.
(Department Stock).
EXAMPLE
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The following is an example of a typical
MCI and the associated command
structure.
IC
The ICS Structure
Triage Group
MEDS COM
Morgue
Treatment Group
Transportation Group
Triage Teams
Immediate Manager
Medical Staging
Litter bearers
Delayed Manager
Ground Ambulance
Manager
Minor Manager
Air Ambulance
Manager
Medical Supply
Rescue Group
Extrication Teams
IC
The ICS Structure
PIO
Medical Branch
Triage Group
Safety
Hazmat Branch
MEDS COM
Morgue
Treatment Group
Transportation Group
Triage Teams
Immediate Manager
Medical Staging
Litter bearers
Delayed Manager
Ground Ambulance
Manager
Minor Manager
Air Ambulance
Manager
Medical Supply
Fire Branch
Divisions
Rescue Group
Extrication Teams
Groups
IC
The ICS Structure
PIO
Operations
Medical Branch
Triage Group
Morgue
Treatment Group
Transportation Group
Triage Teams
Immediate Manager
Medical Staging
Litter bearers
Delayed Manager
Ground Ambulance
Manager
Minor Manager
Air Ambulance
Manager
Medical Supply
Planning
Hazmat Branch
MEDS COM
Safety
Logistics
Fire Branch
Divisions
Rescue Group
Extrication Teams
Groups
Admin/Finance
Immediate Treat
Minor Treat
Treatment Entry Point
Triage Area
Medical Staging