Chapter 40: Incident Management Principles

Overview

This lecture covered Chapter 40: Incident Management, focusing on the principles of triage, resource management, the incident command system (ICS), hazmat awareness, and key EMS procedures during mass casualty and disaster situations.

Incident Command System (ICS) & Resource Management

• ICS is designed to achieve responder/public safety and efficient resource use during mass casualty incidents (MCIs).
• NIMS (National Incident Management System) standardizes response terminology and procedures across agencies.
• ICS roles: Incident Commander (overall leader), Finance (tracks expenditures), Logistics (equipment/supplies), Operations (tactical response), Planning (develops/adapts plans).
• Command staff may include Public Information and Liaison officers.
• Communication should be clear, integrated, and use plain English, not 10 codes.
• Span of control: one supervisor manages 3–7 personnel.

EMS Branch in Mass Casualty Incidents

• EMS divides into triage, treatment, and transport with supervisors for each.
• Triage Supervisor: ensures patients are assessed and categorized before treatment.
• Treatment Supervisor: oversees patient care and secondary triage in treatment areas.
• Transportation Supervisor: tracks and disperses patients to hospitals, managing ambulance use.
• Staging Supervisor: coordinates vehicle/personnel staging away from the scene; controls scene access.
• Rehabilitation Supervisor: provides rest, hydration, and monitors responder health.
• Morgue Supervisor: coordinates body management in consultation with coroners.

Triage Principles and Systems

• Triage categorizes patients by injury severity: Red (immediate), Yellow (delayed), Green (minor), Black (deceased/unsurvivable).
• Primary triage occurs at the scene; secondary in the treatment area.
• START: Simple Triage and Rapid Treatment for adults; JumpSTART for pediatric patients.
• Hysterical or contaminated patients and sick/injured responders may require immediate priority.

Hazmat Awareness and Safety

• Hazmat incidents require scene assessment, recognition of hazardous materials, and staying upwind/uphill.
• Hazardous material identification: look for placards, MSDS sheets, containers, and unusual odors.
• Use visual/auditory senses, not smell, to assess scenes safely.
• Emergency Response Guidebook and binoculars are essential tools.
• Control zones: Hot (hazard), Warm (decontamination), Cold (safe/command/treatment).
• NFPA 704 classifies materials by toxicity (0=least, 4=deadly); PPE levels A–D correspond to hazard levels.

Exam-Style Q&A and Practical Application

• Always check in with incident command on arrival; expect sector reassignment as needed.
• Establish command early in incident response.
• Mass casualty is defined by resources being overwhelmed, not a specific number of patients.
• Highest triage priority: patients with ABC (airway, breathing, circulation) issues who are potentially survivable.
• Disasters may not always involve injuries; official declaration required for “disaster” status.
• Never enter hazardous scenes without proper identification, protection, and clearance.

Key Terms & Definitions

• Incident Command System (ICS) — Organizational framework managing emergencies.
• Mass Casualty Incident (MCI) — Event exceeding available medical resources.
• Triage — Rapid patient sorting by injury severity.
• START — Adult triage method: Simple Triage and Rapid Treatment.
• JumpSTART — Pediatric triage adaptation of START.
• Hazmat — Hazardous materials with risks to health/safety/environment.
• NFPA 704 — System for identifying chemical hazards (0–4 scale).
• Placard — Label indicating hazardous material type on containers/vehicles.
• MSDS — Material Safety Data Sheet, details chemical risks/handling.
• Hot/Warm/Cold zones — Scene areas for hazard, decontamination, and safety/operations.

Action Items / Next Steps

• Review ICS and NIMS protocols for your EMS organization.
• Practice triage procedures using START and JumpSTART systems.
• Study hazmat identification (placards, NFPA 704, and MSDS) and control zone setup.
• Prepare for the final chapter and ensure all required incident management courses are completed.