Chapter 47: Incident Management and Mass Casualty Incidents

Introduction

• Focus on the operational roles of paramedics in incident command systems (ICS) for ensuring safety.
• Key topics:
  • Purpose of medical incident management in ICS.
  • Components of the National Incident Management System (NIMS).
  • Triage methods and principles (START and JumpSTART).
  • Understanding mass casualty incidents (MCIs) and critical incident stress management.

Incident Types and Definitions

• Disasters: Declared at various government levels to provide resources and funds.
• Mass Casualty Incidents (MCIs): Declared when patient numbers and injury severity overwhelm resources.
• Multi-Casualty Incidents: Multiple patients not overwhelming resources.

National Incident Management System (NIMS)

• Improves incident management efficiency, regardless of size/complexity.
• Key Principles:
  • Flexibility, standardization, interoperability.
• Components:
  • Command and management via ICS.
  • Preparedness and resource management.
  • Communications and information management.

Incident Command System (ICS)

• Prepares responders for coordinated efforts.
• Ensures organization and resource efficiency.
• Limits span of control and prevents freelancing.
• Organizational Structure: Sections, branches, divisions, and groups.

Roles and Responsibilities within ICS

• Command: Includes public information, safety, and liaison officers.
• Operations: Manages tactical operations.
• Finance: Documents expenses and manages reimbursements.
• Logistics: Manages equipment, supplies, and support.
• Planning: Solves ongoing issues and manages demobilization.

Communication and Information Management

• Integrated communication systems for quick, effective coordination.
• Use clear text and professional communication.

EMS Response and Preparedness

• Preparedness: Plans and decisions made pre-incident.
• Scene Size-Up: Assess safety and resources needed.
• Establish Command: Early establishment by first-arriving or most experienced official.

Medical Incident Command

• Oversees triage, treatment, and transport operations.
• Assigns EMS units and tasks for efficiency.

Triage Systems

• START Triage: For adults, evaluates walking status, respiration, hemodynamic, and neurological status.
• JumpSTART Triage: For pediatrics, includes rescue breaths for non-breathing children with pulse.
• SALT Triage: Sorts and assesses for life-saving interventions, includes five patient categories.

Special Triage Considerations

• Managing patients with panic or hysterical behavior.
• Handling hazardous materials and special rescue situations.

Destination Decisions

• Use trauma field triage guidelines to determine appropriate transport destinations.

Critical Incident Stress Management (CISM)

• Address the emotional impact of MCIs on responders.
• Encourage debriefing and provide coping mechanisms.

After Action Review

• Post-incident review with participating agencies.
• Document observations and lessons for future improvement.

Conclusion

• Understanding and preparing for MCIs and disaster responses is crucial for safety and efficiency in emergency situations.