Mass casualty incident: Difference between revisions

No edit summary
No edit summary
 
(4 intermediate revisions by 2 users not shown)
Line 6: Line 6:


==Management==
==Management==
[[File:ICS org chart.bmp|thumbnail|ICS Organization Structure]]
===Initial Triage===
===Initial Triage===
*In an MCI, triage differs slightly from normal Emergency Department triage.
*See [[Mass casualty incident triage]]
**Based not only on severity of injury/illness, but also on prognosis/survivability in the setting of limited resources<ref>Pesik N, Keim ME, Iserson KV. Terrorism and the ethics of emergency medical care. Ann Emerg Med. 2001 Jun;37(6):642-6.</ref>
*[[Mass casualty incident triage|START triage]] is the most common triage system utilized in the United States.
**Several other triage systems exist, but all (including START) lack validation or strong evidence (likely impossible given nature of MCIs)<ref name="Cross">Cross KP, Petry MJ, Cicero MX. A better START for low-acuity victims: data-driven refinement of mass casualty triage. Prehosp Emerg Care. 2015 Apr-Jun;19(2):272-8. doi: 10.3109/10903127.2014.942481.</ref><ref name="Kahn">Kahn CA, Schultz CH, Miller KT, Anderson CL. Does START triage work? An outcomes assessment after a disaster. Ann Emerg Med. 2009 Sep;54(3):424-30, 430.e1. doi: 10.1016/j.annemergmed.2008.12.035.</ref>
*Triage should be ongoing process, with patient statuses (and triage designations) updated as they change.


===Incident Command System (ICS)===
===Incident Command System (ICS)===
[[File:ICS org chart.bmp|thumbnail|ICS Organization Structure]]
*An Incident Command System (ICS) is designed to allow for coordination of response to an MCI by providing for an integrated organizational/command structure<ref name="FEMA">FEMA IS 0100.b - Introduction to the Incident Command System (ICS), Student Manual. http://training.fema.gov/emiweb/is/is100b/student%20manual/02ics100b_sm_october2013.pdf. Accessed 07/24/2015.</ref>
*Ensure the scene is safe
**ICS has been in use since the 1970's.
*Establish Incident Commander (IC)
**Designed to expand or contract in size in response to scope of incident.
*Request additional appropriate resources
*After the September 11, 2001 terrorist attacks, the Department of Homeland Security proposed the National Incident Management System (NIMS) in response to perceived deficiencies in coordination between emergency responders.<ref>Jensen J, Youngs G. Explaining implementation behaviour of the National Incident Management System (NIMS). Disasters. 2015 Apr;39(2):362-88. doi: 10.1111/disa.12103.</ref>
**Additional ALS/BLS
**NIMS mandates the use of ICS in the United States for MCI response<ref name="FEMA" />
**Fire resources (HAZMAT, heavy rescue, ect.)
 
**Medevac
==External Links==
***Establish landing zone
*[http://training.fema.gov/emiweb/is/icsresource/index.htm FEMA ICS Resource Center]
*Establish staging areas for resources
*[https://training.fema.gov/is/nims.aspx FEMA Online NIMS Training]
*No more than 8 people per supervisor
 
**3-5 preferred
==See Also==
*[[Mass casualty incident triage]]
*[[GEMC:Prehospital_/_Disaster_/_Mass_Casualty_Medicine]]


==References==
==References==

Latest revision as of 07:05, 23 October 2017

Background

  • Mass Casualty Incident (MCI) defined as an incident where the number of patients (or the rate of their arrival to a medical facility) overwhelms local resources (and the ability to immediately supplement them).[1][2]

Potential Causes of MCI

Mass casualty incident

Management

ICS Organization Structure

Initial Triage

Incident Command System (ICS)

  • An Incident Command System (ICS) is designed to allow for coordination of response to an MCI by providing for an integrated organizational/command structure[3]
    • ICS has been in use since the 1970's.
    • Designed to expand or contract in size in response to scope of incident.
  • After the September 11, 2001 terrorist attacks, the Department of Homeland Security proposed the National Incident Management System (NIMS) in response to perceived deficiencies in coordination between emergency responders.[4]
    • NIMS mandates the use of ICS in the United States for MCI response[3]

External Links

See Also

References

  1. Briggs SM. Disaster management teams. Curr Opin Crit Care. 2005 Dec;11(6):585-9.
  2. Lee JS, Franc JM. Impact of a Two-step Emergency Department Triage Model with START, then CTAS, on Patient Flow During a Simulated Mass-casualty Incident. Prehosp Disaster Med. 2015 Jun 24:1-7.
  3. 3.0 3.1 FEMA IS 0100.b - Introduction to the Incident Command System (ICS), Student Manual. http://training.fema.gov/emiweb/is/is100b/student%20manual/02ics100b_sm_october2013.pdf. Accessed 07/24/2015.
  4. Jensen J, Youngs G. Explaining implementation behaviour of the National Incident Management System (NIMS). Disasters. 2015 Apr;39(2):362-88. doi: 10.1111/disa.12103.