Maryland Triage System Incident Command

Revised Jan 2019 Establishing the Mul-Casualty Incident Command System

The program highlights appropriate components of the Naonal Incident Management System (NIMS) related to Emergency Medical Services Enabling Objecves

Upon compleon of this training the parcipant will be able to:

• Idenfy the posions and the organizaonal structure of the Incident Command System (ICS) as it applies to a Mul-Casualty Incident • Explain the responsibilies of the first unit arriving on scene • Explain paent flow through the ICS Mul-Casualty structure National Incident Management System (NIMS) Expanded Organizational Structure

Incident Command

Safety Officer Liaison Information Officer Officer( PIO)

Operations Planning Logistics Admin / Finance Section Section Section Section Chief Chief Chief Chief Staging Manager Medical Unit Leader Hazmat Fire / Rescue Multi-Casualty Branch Branch Branch Director Director Director Entry Medical Group Division A Group A Supervisor Supervisor Supervisor

Decon Division B Medical Group Group B Supervisor Supervisor Supervisor Research Rescue Medical Group Group Group C Supervisor Supervisor Supervisor

Extrication Transportation Group Group Medical Comms. Supervisor Supervisor Coordinator Inial EMS Response

Incident Command

Triage Unit

1st Engine Immediate Medical Crew Treatment Communications (Ambulance / Coordinator Medic Crew) (1st Paramedic)

Multi-Casualty Initial Response Organization (example) The Company Officer establishes or assumes command and the engine personnel begin Triage utilizing Simple Triage and Rapid Treatment (START) or (Jump-START) process by triaging victims and at the same time, assess any additional hazards (fuel spills, unstable vehicles, etc.). A Paramedic from the ambulance / medic unit becomes Medical Communications Coordinator (Med. Comm.) while the second member (PM or EMT) begins establishing Treatment Areas with the Immediate Area first. Paent Flow

Casualty Incident Collection Triage Unit Morgue Site Point Leader Manager

Treatment Unit Leader

Hospital A Red Immediate Manager Yellow Delayed Manager Green Minor Manager

Hospital B Treatment Dispatch Manager

Hospital C Staging Manager Transportation Group Supervisor Hospital D

Medical Communications Disposition Ambulance Coordinator Coordinator Transport First Unit/Incident Command

• Assess and Secure the Scene

• Ensure safety

• Establish or assume command

• Direct incoming units

• Request addional resources (Order Early and Order Big)

• Establish Triage Unit Leader First Unit/Incident Command

• Establish Medical Communicaons Coordinator

• Nofy hospitals (EMRC)

• Establish inial Treatment Area

• Establish Transportaon Group (when personnel available)

• Maintain the 5 S’s of the Mul-Casualty Incident: • Safety, Size-up, Send, Set Up, and START/JumpSTART Triage

Triage Unit Leader • Coordinate with Treatment Unit Leader to determine if triage will be conducted in: • Incident/extricaon area • Designated Casualty Collecon Point (CCP) • Treatment area • Approximate number and severity of vicms • Report this informaon to command • Supervise: • Triage Teams • Porter Teams (Lier Bearers) • Addional resources Triage Unit Leader

• Ensure safety of all personnel • Ensure triage of paents is based on START or JumpSTART Algorithm • Primary Triage (ribbons only) • Communicate resource requirements to IC or Medical Group Supervisor • Provide frequent progress reports • Establish Morgue if necessary Treatment Unit Leader

• Idenfy and establish Treatment Areas • Consider weather, size, accessibility, safety, and hazmat potenal

• Assign Treatment Area Managers • Nofy IC of Treatment Area locaons and

give status report Treatment Unit Leader • Establish communicaons with Triage Unit Leader

• Ensure each paent is issued a MIEMSS Triage Tag and does NOT leave area without one aached

• Ulize Paent Tracking Forms and/or Treatment Area Manager logs to track paents for each area Treatment Unit Leader

• Request sufficient medical caches and supplies as necessary • Provide access for Medical Care Support Units (MCSU) • Establish communicaons with paent Transportaon Group Supervisor • Consider delegang this task to Treatment Dispatch Manager

• Maintain accountability/safety for all paents and personnel • Assess mental and physical well being of personnel Treatment Area Managers

Red Immediate Manager Yellow Delayed Manager Green Minor Manager

• Define Entry and Exit points

• Clearly idenfy each area and delineate each area’s boundaries. • Morgue needs to be distant from treatment areas

• Prepare equipment and supplies

• Brief Treatment Crew(s)

• Ensure Secondary Triage is completed

• Ensure each paent has been issued a Triage Tag • Prepare and maintain a Treatment Log Sheet Treatment Dispatch Manager • Receive informaon from Treatment Area Managers • Establish and maintain communicaons with Medical Communicaons Coordinator • Coordinate with Treatment Managers and Medical Communicaons Coordinator to transport paents to appropriate medical facilies

• Ulize Triage tags for paent movement and/or mark the hospital desnaon on Transport Record of the Disaster Triage Tag

• This posion is oen combined with another posion Transportaon Group Supervisor

• Establish One Way Traffic Flow: There should always be a clear, unobstructed flow of transport units in and out of the transport area. Transport units should pull up, load, leave, but NOT execute a back-up of the vehicle

• Prepare and maintain a Log Sheet

• Establish exit point

• Assign Communicaons (SYSCOM/EMRC) and Air/Ambulance Disposion Coordinators Medical Communicaon Coordinator • Contact EMRC/Communicaons Center • Advise type of incident • Provide locaon • Describe incident • Provide approximate paent count (by priority if possible) • Request call down of hospitals

• Establish Communicaons Log

Medical Communicaon Coordinator

• Receive bed availability from Communicaons Center

• Communicate availability to Ambulance Disposion Coordinator • Update hospitals on incident status every 30 minutes

• Advise hospital(s) when incident is terminated Air/Ground Ambulance Disposion Coordinator • Receive bed availability from Medical Communicaon Coordinator (EMRC)

• Prepare log sheet for each hospital and their “ckets”

• Update informaon on Paent Tracking forms

MONTGOMERY COUNTY INCIDENT MANAGEMENT SYSTEM © TRANSPORT RECORDER PAGE OF

1 2 3

4 5 6

RECEVING MEDICAL FACILITY

MEDICAL GROUP 7 8

MCFRS MCI Worksheet # 4 Version 11/27/07 TRANSPORT STUBS SIMPLE MULTI-CASUALTY

Transport Supvr. and Med INCIDENT Comm. Coord. – Do Not Duplicate these roles in the incident

EMS Trans. Med Group Comm. Coord. Spvr. Triage Patriot Bus Company Crew 2 Medical Group Supvr.

EMS Loaders may be actual ambulance crew

Green Priority 3 Minor Treatment Area Green Area Patient Mgr. Patient Trans Treat Porters Record Dispatch Manager Treat Each Treatment Unit Area has a Leader Manager Casualty Yellow Red Collection Area Area Point Mgr. Mgr. Patient Transport Recorder – Reports to Ground Amb Coord. Gatekeeper for all Red Priority 1 ground evacuated Yellow Priority 2 Immediate Treatment Patient

M A B patents Delayed Treatment Area Area Porters

One Way Triage Giant Bus Company Med Crew 1 MCSU Supply Coord Staging Mgr

Staging Manager reports to Ops Section.

EMS ST ENGINE Triage 1 Unit EMS Leader Branch Command Post with IC and EMS EMS Branch Incident Command Tracking Paent Flow Treatment Unit Leader • Aach triage tag to ribbon • Each paent must receive a triage tag

• Circle priority at inial assessment Treatment Unit Leader • Remove treatment peel-off label and place on treatment log

• Note me on tag Treatment Unit Leader Red Immediate Paents

Yellow Delayed Paents Direct crew to appropriate paent area Green Minor Paents

Expectant

Morgue Treatment Area Managers

• Log paent into area • Take “other” barcode label and place on log Treatment Area Managers • Assign crew to care for paent • Reassess ABC’s • Stabilize life threatening condions (airway, needle decompression, tourniquet, andote) • Immobilize • Treat major fractures • Package paent for transport to appropriate facility • Ulize triage tag to note assessment and treatment intervenons and/or on triage tag • Ensure paent can be transported safely Transportaon Group Supervisor

•Coordinate loading of paents

•Assign • Medical Communicaon Coordinator • Air/Ambulance Disposion Coordinator Transportaon Group Supervisor Paent Loading • Contact Staging for transport units • Contact Treatment Dispatch Manager /Treatment Areas for paents ready to load • Scan triage tag and insert Unit Number and Priority • Write informaon on tear-off transportaon record secon (commonly called “Ticket”) part of triage tag

• Peel off a barcode label and place on log sheet Paent Loading • Load paent into transport unit

• Tear off Transportaon Record (“Ticket”) and hand to driver Paent Loading

• Remind provider to update or complete Transport Line on the Tag once hospital is assigned

• On hospital arrival, place Barcode Labels on official printout copies of the Electronic Paent Care Report (ePCR) or electronic Maryland EMS Data System (eMEDS) and hospital chart Medical Communicaon Coordinator

• Receive cket from Ambulance Disposion Coordinator • Communicate informaon to hospital • Unit, jurisdicon, and number • Number of paents with priority of each • Inial cket in the “Nofied” field

Paent Loading

• Direct Transport Unit to Ambulance Disposion Coordinator

• Maintain One Way traffic flow • Do NOT have unit back up or back in

One Way Ambulance Disposion Coordinator • Receive Transport Record (commonly called “Tickets”) from driver

• Transport “Tickets” go from the driver to the Disposion Coordinator Ambulance Disposion Coordinator

Discusses the desnaon hospital (appropriate for paent condion) with the Medical Communicaon Coordinator

Ticket Ambulance Disposion Coordinator • Give driver desnaon and confirm direcons • Write desnaon and transport me on cket • Give cket to Medical Communicaon Coordinator

Patient Transport Recorder Ambulance Disposion Coordinator

• Receives “cket” back from Medical Communicaons Coordinator • Tracks available beds at hospitals • Places “cket” label on hospital desnaon logs and notes me The Process in Review • Incident Occurs • Walking wounded sent to Casualty Collecon Point • Triage of Paents • Paent receives a ribbon by Triage Unit Leader or designee • Only aempt to life-saving intervenons (Airway, Needle decompression, Tourniquet, Andote) • Paent is moved to various treatment areas at direcon of Treatment Unit Leader and receives triage tag and treatment The Process in Review • Treatment Dispatch Manager coordinates with Transportaon Group Supervisor/Paent Transport Recorder • Arranges for paent to be moved to transport vehicle • Triage tag to remain with paent at all mes • EMS Staging Manager dispatches ambulance to designated pick-up area • Driver is given Transport Record “Ticket” piece of triage tag • Proceeds to Ambulance Disposion Coordinator The Process in Review • Driver gives “Ticket” to Ambulance Disposion Coordinator • Coordinates with Medical Communicaon Coordinator for hospital availability and dispatch • Driver is given hospital transport informaon prior to leaving scene • Paent is transported to designated hospital • Arrival me should be placed on triage tag Maryland Triage System

Maryland Instute for Emergency Medical Services Systems 653 West Pra Street Balmore, MD 21201 410-706-3996