The Road Warrior
By Allen Baldwin

Managing Mass Casuality Incidents Requires Planning
For many fire departments and EMS providers, summer means an increase in community events and activities in our coverage areas, people traveling and invariably more emergency calls, some of them involving lots of victims.

We always need to be prepared for Mass Causality Incidents (MCI), but never more than in the summer. Face it, for some of us, an MCI could be a minivan accident with eight passengers. Or it could be an accident with a busload of kids or an incident at a large gathering or at an amusement park with a hundred patients or more.

Defining An MCI
Regardless of the time of year or the size of the incident, it’s always a good idea to review MCI preparedness, operations and available equipment resources to support operations.

The first step is to define an MCI as that will determine how we manage it. I like to think of it as you have more casualities than you have ambulances and personnel readily available to provide care.

Next, we should look at jurisdictional requirements or legislation. If there are requirements, we need to be familiar with them and comply.

A key part of any MCI response plan is the triage component, and that is what we are going to look at here. No matter what the number of patients or the situation, time is of the essence and you need to keep the methods simple.

Triage Sets The Stage
A good triage system and operation sets the stage for a successful mission. Triage means to sort, and that’s what we need to do. While sorting out the patients we need to look at the medical needs and urgency of each patient.

All of this sorting is done with limited information and is influenced by what resources are available. We are making the decision to prioritize the most serious, but realistically savable patients and try to treat them first. Patients unlikely to survive are given the lowest priority.

Dozens of firefighters and rescue workers, drawing on their mass casualty training, tend to injured middle school students from Carlisle, Pa., after a tire on their tour bus blew, causing it to overturn on Route 15 near Gettysburg, Pa., on May 19. Some 44 people were transported to hospitals, some by ambulances and some by bus. None of the injuries appeared life threatening, according to authorities.                              (Gettysburg Fire Department Photo)

There are some important reasons why we as responders and officers care about doing triage properly. First of all, it will bring organization to chaos, provide care to those who need it the most and who will benefit the most and improve resource allocation and delivery.

During an MCI, we will be resource challenged, but we must remember to try to do the best for each individual patient.

Everyday, we do the best for the single patient. On “the big one,” we must shift gears and do the greatest good for the greatest number. Triage systems can be as simple as ordering anyone who can walk and is not bleeding to get up and move to a designated area. Those designated areas can be marked with something as simple as a napkin, or a sheet of paper to at least start the sorting.

There are several systems available to help develop a MCI plan. One is the Simple Triage and Rapid Transport (START) system, which was developed by the Hoag Hospital and Newport Beach Fire Department. There are several Web sites that have information on START, and a quick search will lead straight to those sites. One is www.citmt.org/start, part of a site maintained by the Critical Illness and Trauma Foundation Inc. It has a self-study program.

The premise of START is to make a rapid assessment of every patient in less than a minute and determine in which of the four triage categories the patients should be placed.

One of the most important aspects of START is to make sure initial responders don’t stop to do more than the most basic patient interventions. Depending on the situation, you will have to make tough decisions, and it is unlikely that you will be able to save everyone.

Next, it’s important to determine what tools and equipment are available to help manage the MCI. It’s best to check with your local, regional and state EMS management agencies to see what requirements they might have and whether they have a plan template for handling an MCI. Get information about any training they may have available as well.

A basic component of virtually every MCI plan is triage tags. Take stock of how many your department has and make sure there’s a supply readily available, perhaps on a command vehicle. Many tags are regionally based, so make sure you have the same style tags as your neighbors as they will most likely be responding with you on the MCI or vice versa. It’s a detail that makes things a lot easier.

There are also several triage programs to help track patients. One is the Triage Software package that Med-Media

of Harrisburg, Pa., (www.med-media.com) has put together. It’s being used by the Pennsylvania Urban Search & Rescue (USAR) Taskforce.

Another simple tool is triage tape. It’s nothing more than vinyl survivor’s tape, which comes in a roll and is the same color as the triage tags. There’s not much room to write on it, other than the width of the tape itself, but, if you take the four different color rolls, tear off the appropriate color and tie the tape to the victim’s wrist or ankle, it’s possible to move through a field of patients very quickly. These rolls fit well in an aid bag or glove box. The full tags can be applied during a secondary triage.

Triage area flags and tarps, available from a host of vendors, are quite helpful and are used to mark designated areas where triaged patients are placed. They are especially helpful at very large incidents in an open area or in large building, like airport hangers.

Make A Kit
It’s important to remember command vests to identify the players in any MCI. Those personnel will need all the appropriate management forms, pens, paper and dry erase boards as well. It’s a good idea to put all of those kinds of supplies in a kit and have them staged on rescue or command vehicles. Just think about how many times you’ve reached in your command rig for a pen and paper and come up empty handed. It’s just plain frustrating to have thousands of dollars in communications equipment and not a single pen to complete the communications process.

Speaking of communications, all MCIs require portable radios and spares, and lots of them. Be sure to build a communications component into the MCI plan so everyone is operating on the right channel and knows how to get in touch with key personnel.

We have the greatest chance of saving the greatest number of victims if we use a well thought out and practiced MCI plan.

It cannot be overstated that the key is rapid triage. We also need to remember the treatment, staging and transport areas. Having these areas well organized and supported is just as important as having a good triage plan.

Have A System
Most MCIs will require lots of help, so make sure you have a system, such as box or run cards, that list and make the resources you need readily available. Consider basing your cards on the number of patients and the extent of injuries, or whether there will be extensive extrication.

There’s more to discuss, but the keys are to be ready, have a plan and know where to get the resources should the unthinkable happen.

And, as always, stay safe and return to quarters.