Mass Casualty Incident Management: Part 4

With the variety of different EMS systems (from metropolitan to ultra-rural, and everything in between) and the variety of commercially available MCI triage and management systems (including many "homegrown" systems), you might easily believe there is no single way to manage mass- or multi-casualty incidents (MCIs).

The thought of being the "first due crew" to even a low-impact MCI can be nerve-racking. Thankfully, there are a number of universal principles which can not only help unite multiple agencies' responses, but can also make life much easier when you get that MCI at 3 a.m. on the side of the road on a dark and stormy night.¹

One way to make MCI management systems manageable is to focus on five primary jobs and the five steps required for performing each job. The good news is that, while different MCI management systems may use different names for each key position, the jobs themselves are virtually universal. These jobs are, in order, EMS Officer (called EMS Branch Director in NIMS), Triage, Treatment, Transport and Staging.^2,3

Whether you are the first due crew and you have to call the MCI, or you come along later and get assigned a job, the steps are all easy, intuitive and universal.

The simple idea for approaching any job at an MCI is to approach it as you would any other employment.

When did you put in your application for a job at this MCI? Believe it or not, it was when you became an EMS provider. Whether you work in a busy system or a slower-paced one, real MCIs are a pretty common occurrence in EMS. When you pull up to a scene and identify more patients than your immediately available resources can handle: Congratulations! You're hired!

Step 1) Take the job: The first thing you do when you begin any job is get your true job description. As with any job, with an MCI you will know the general job description before you arrive but you can only find out the specifics when you start. Thus, when you first arrive at an MCI you need to accept the job (get an assignment) and your job description (briefing).

Step 2) Dress for success: You wouldn't show up for your first day of work looking like a slob, would you? After you take your job, you're not only going to dress with the best (put on that vest), you're going to gather the tools you'll need to do your new job. At an MCI that might include clipboards, radios, tags, tape and other equipment. If your MCI management system has been set up properly, the MCI toolbox for your job should be in one easily accessible place.

Step 3) Set up your work space: The last thing you have to do before beginning your hands-on work is set up your work space. This begins by finding which work space is yours. It works the same way with an MCI. You may get your work space assigned to you or you may be asked to choose it. Either way, you need to make sure that you, and everyone else on scene, understands what work space is yours. Let's face it, you can't do your job with other people breaking in and stealing your pencils.

Step 4) Go to work: Of course, the exact hands-on work will vary from job to job at an MCI, like it will in any business, but there's one thing that never, ever changes. The point of your job is to clear out your inbox. In administration, your inbox might be filled with papers. At an MCI it's filled with patients. Your job is to move them along.

Step 5) Communicate: To keep things moving at any job you have to be able to communicate with your coworkers. You don't have to talk with everyone at work though, just the people whose work directly affects yours. It's the same at an MCI. Whatever job you've been assigned, you have to make sure you are communicating with the positions which are upstream (where the patients are coming from, filling your inbox) and downstream (where your patients are going, emptying your inbox).

That's it. Five simple steps you can perform anytime, anywhere, in any system, and for any type of MCI. It doesn't matter which of the five jobs you do, all you need to do is take the job, dress for success, set up your workplace, go to work and communicate.

In next installment: First due!

References

1. Aylwin CJ, König TC, Brennan NW, et al. Reduction in critical mortality in urban mass casualty incidents: analysis of triage, surge, and resource use after the London bombings on July 7, 2005. The Lancet, 368(9554):2219–2225, 2006.

2. Limmer D, O'Keefe MF, Dickinson ET. Emergency Care. Upper Saddle River, NJ: Prentice Hall, 2011.

3. Mistovich JJ, Hafen BQ, Karren KJ. Prehospital Emergency Care 9th ed. Upper Saddle River, NJ: Prentice Hall, 2009.

Rom Duckworth has been an emergency responder for more than 20 years with career and volunteer fire departments, public and private emergency medical services, and hospital-based healthcare. He is an internationally recognized subject matter expert, fire officer, paramedic and educator. He is currently a career fire lieutenant, EMS coordinator and an American Heart Association national faculty member.