Mass Casualty Incident Management: Part 8

There’s a three-car MVA on the highway and you and your partner are responding. It doesn’t sound like the end of the world, but it might involve more patients than your city has ambulances immediately available for.

You arrive closely behind the first-in units and see a few people hurt, some in their cars, some walking around, and a bunch of people who could be bystanders or additional patients. The first due crew has designated this as an MCI and assigned you to be the transport officer. What next?

Step 1) Take the Job: The first thing you should do is coordinate with the EMS officer and get briefed. He should be able to give you an idea of the approximate number and severity of the patients involved and of your transport and destination resources. This will be key in coordinating the transport and tracking of the injured patients.

Step 2) Dress for Success: You will need to obtain and don the transport officer vest to identify yourself. You will also need to obtain any checklists and materials specific to the MCI management system that you use. Finally, you’ll need to accessorize with radios (or other appropriate devices to communicate with transport units and destination hospitals) and, if at all possible, obtain at least one assistant to help you work them all.

Step 3) Set Up Your Work Space: Your work space as transport officer will be largely determined by the treatment area and its relation to suitable loading areas for transport units. Despite what you might think, you may want to locate yourself well away from the actual loading area itself. Your work as transport officer will largely consist of telephone and radio communication, rather than direct contact with patients. Because of this, proximity to the noise and chaos of the MCI operational area may be your enemy.

Step 4) Go to Work: Your chief goal is to get the patients off the scene. Of course, nothing is ever that simple. You’ll need to coordinate with:

a) The staging officer to bring incoming transport units to the loading area.

b) The treatment officer to move patients to be loaded once transport units are ready.

c) Transport units to advise them of the destination of their patients.

d) Hospitals (or other definitive care endpoints) to determine their available care capacity and to advise them of the details of the patients being transported to their location.

e) The EMS officer to find out how many patients remain in need of transport and to advise him as to the number of patients already transported.

Of course, all of this communication and coordination can’t take place without appropriate patient tracking. The exact equipment and methods you use will depend upon the MCI management system your service employs, but typically you will have an incident management board on which you can list incoming transport units and their capacities, destination hospitals and their capacities, and special capabilities and patients in need of transport or already transported. You will also want to personally collect or, better yet, have someone else collect information from the triage tags of patients to be transported in order to relay that information to destination hospitals. It is typically the responsibility of the transport officer, not the transporting units themselves, to relay basic patient information to destination hospitals.

Step 5) Communicate: The transport officer should communicate upstream with both the staging officer to obtain transport units and the treatment officer to facilitate loading of patients from the treatment area. In order to move patients to the "outbox," (that is, the destination hospitals) the transport officer will also communicate downstream with those hospitals and, often, other local or regional communication centers whose job it is to ensure no one geographic area is either depleted of all resources nor inundated with patients and unable to deal with day-to-day operations.

The position of transport officer is one of great responsibility. To accomplish his job, the transport officer will typically need one or more assistants, which is why this position, if filled by an incoming unit, will typically take at least a two-person crew. Remember that the ultimate goal of MCI management is to move all of the patients off scene. In the end, it’s the transport officer who makes this happen.

In next installment: Staging. 

An emergency responder for more than 20 years with career and volunteer fire departments, public and private emergency medical services and hospital-based healthcare, Rom Duckworth 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.