Mass Casualty Incident (MCI) Response

Establishing Incident Command (IC)

• First arriving responder assumes Incident Commander (IC) role until relieved by a higher authority.
• Size up the scene: Assess hazards, number of casualties, type of incident.
• Establish a command post (CP): Identify a safe and central location.
• Implement Incident Command System (ICS): Assign key roles as resources arrive.
• Request additional resources: Fire, EMS, law enforcement, public health, etc.
• Activate triage and treatment areas: Ensure coordination with hospitals.

Incident Command Structure and Roles

• Incident Commander (IC)
  • Overall scene management and coordination.
  • Establishes command and strategic objectives.
  • Communicates with dispatch, hospitals, and other agencies.
  • Delegates authority as incident grows.
• Public Information Officer (PIO)
  • Manages media and public communication.
  • Coordinates information release with agencies.
• Liaison Officer
  • Coordinates with assisting and cooperating agencies.
  • Acts as the contact for mutual aid and external organizations.
• Safety Officer
  • Ensures scene safety for responders and victims.
  • Monitors hazards and mitigates risks.

Operations Section

• Operations Chief
  • Manages tactical operations and personnel.
  • Coordinates on-scene response teams.
• Triage Unit Leader
  • Organizes rapid triage of patients using a triage system (START, JumpSTART).
  • Coordinates transport priority.
• Treatment Unit Leader
  • Oversees medical care in designated treatment areas.
  • Prioritizes stabilization of critical patients.
• Transportation Unit Leader
  • Arranges ambulance/helicopter transport.
  • Coordinates with receiving hospitals.
• Staging Area Manager
  • Manages incoming resources (EMS, fire, law enforcement).
  • Directs personnel and equipment to necessary areas.
• Rescue & Extrication Team
  • Conducts search and rescue.
  • Removes trapped victims safely.
• Law Enforcement
  • Provides scene security and traffic control.
  • Assists with evacuation and crowd management.

Planning Section

• Planning Chief
  • Develops action plans and contingency strategies.
  • Tracks incident progress and resource deployment.
• Situation Unit
  • Collects and evaluates incident data.
  • Provides status updates to command.
• Resource Unit
  • Tracks personnel and equipment status.
• Demobilization Unit
  • Plans orderly release of resources post-incident.

Logistics Section

• Logistics Chief
  • Provides resources, supplies, and personnel needs.
• Medical Unit
  • Monitors responder health and well-being.
• Communications Unit
  • Ensures effective radio and digital communication.
• Food & Supply Unit
  • Distributes necessary supplies and sustenance.

Finance/Administration Section

• Finance Chief
  • Tracks costs, compensations, and claims.
  • Manages personnel timekeeping.
• Procurement Unit
  • Handles contracts for emergency services.
• Compensation Unit
  • Documents injury claims for responders and victims.

MCI Management Process

Phase 1: Initial Response

1. First Responder Size-Up:
   • Assess safety, number of victims, and hazards.
   • Assume Incident Command and establish command post.
2. Activate ICS & Request Resources:
   • Assign ICS positions as help arrives.
   • Request additional fire, EMS, police, mutual aid.
3. Initiate Triage:
   • Use START or JumpSTART for pediatric cases.
   • Categorize patients (Immediate, Delayed, Minor, Deceased).
   • JumpSTART Triage Process for pediatrics:
4. Establish Treatment & Transport Areas:
   • Designate separate zones for each triage category.
   • Prepare for mass patient movement.

Phase 2: Operations & Patient Management

1. Deploy Tactical Teams:
   • Extrication teams remove trapped victims.
   • EMS treats and stabilizes.
2. Transport Coordination:
   • Assign patients to appropriate hospitals based on severity.
   • Maintain communication with hospitals.
3. Scene Security & Traffic Control:
   • Law enforcement ensures orderly access.

Phase 3: Sustained Operations & Demobilization

1. Ongoing Patient Management:
   • Ensure all casualties receive appropriate care.
   • Reassess triage and stabilize worsening cases.
2. Resource Management:
   • Continue monitoring supplies and personnel needs.
3. Demobilization & After-Action Review:
   • Gradually scale down response operations.
   • Conduct a debriefing for improvement planning.

Triage Categories and Decision Trees

Triage Categories

Adults - START Decision Tree

Steps:

1. Assess ability to walk
   • Walking → MINOR (Green)
   • Not walking → Move to step 2
2. Check Respirations
   • No breathing → Open airway
   • Starts breathing → IMMEDIATE (Red)
   • Still not breathing → DECEASED (Black)
   • Breathing rate > 30/min → IMMEDIATE (Red)
   • Breathing rate ≤ 30/min → Move to step 3
3. Check Perfusion (Capillary Refill)
   • No radial pulse or cap refill > 2 sec → IMMEDIATE (Red)
   • Pulse present & cap refill ≤ 2 sec → Move to step 4
4. Check Mental Status
   • Unconscious or unable to follow commands → IMMEDIATE (Red)
   • Follows commands → DELAYED (Yellow)

Decision Tree

1. Can they walk?  
   ├── YES → MINOR (Green)  
   └── NO  
        ↓  
2. Are they breathing?  
   ├── NO → Open airway  
   │   ├── Breathing starts → IMMEDIATE (Red)  
   │   ├── Still not breathing → DECEASED (Black)  
   ├── YES  
   │   ├── Respiratory rate >30? → IMMEDIATE (Red)  
   │   ├── Respiratory rate ≤30 → Continue  
   │  
3. Do they have radial pulse? (Cap refill ≤2 sec?)  
   ├── NO → IMMEDIATE (Red)  
   ├── YES → Continue  
   │  
4. Can they follow simple commands?  
   ├── NO → IMMEDIATE (Red)  
   ├── YES → DELAYED (Yellow)

Pediatrics - JumpSTART Decision Tree

Steps

Steps:

1. Assess ability to walk
   • Walking → MINOR (Green)
   • Not walking → Move to step 2
2. Check Breathing
   • Not breathing → Open airway
   • Spontaneous breathing → IMMEDIATE (Red)
   • Still not breathing → Check for pulse
   • Pulse present → Give 5 rescue breaths
   • Breathing resumes → IMMEDIATE (Red)
   • Still not breathing → DECEASED (Black)
   • No pulse → DECEASED (Black)
   • Breathing rate <15 or >45/min → IMMEDIATE (Red)
   • Breathing rate 15-45/min → Move to step 3
3. Check Perfusion
   • No palpable pulse → IMMEDIATE (Red)
   • Pulse present → Move to step 4
4. Check Mental Status
   • Inappropriate response (e.g., posturing, unresponsive) → IMMEDIATE (Red)
   • Appropriate but unable to walk → DELAYED (Yellow)

Decision Tree

1. Can they walk?  
   ├── YES → MINOR (Green)  
   └── NO  
        ↓  
2. Are they breathing?  
   ├── NO → Open airway  
   │   ├── Breathing starts → IMMEDIATE (Red)  
   │   ├── Still not breathing → Check for pulse  
   │       ├── Pulse present → 5 rescue breaths  
   │       │     ├── Breathing resumes → IMMEDIATE (Red)  
   │       │     ├── Still not breathing → DECEASED (Black)  
   │       ├── No pulse → DECEASED (Black)  
   ├── YES  
   │   ├── Breathing rate <15 or >45? → IMMEDIATE (Red)  
   │   ├── Breathing rate 15-45 → Continue  
   │  
3. Do they have a pulse?  
   ├── NO → IMMEDIATE (Red)  
   ├── YES → Continue  
   │  
4. Are they responding appropriately?  
   ├── NO (unresponsive, posturing) → IMMEDIATE (Red)  
   ├── YES (alert but unable to walk) → DELAYED (Yellow)