UMC EMS
Emergency Operations Plan
And
Appendices
As of January 2, 2014
© 2014 UMC EMS Version 2014.01
This Page Intentionally Left Blank
January 2, 2014 Page 2
TABLE OF CONTENTS
Introduction ...... 4 Levels of Disaster Activation IMS Incident ...... 5 EMS Command Incident ...... 5 MCI: Initial Response and Notification ...... 6 Detection ...... 6 National Incident Management System (NIMS) ...... 7 Scene Security and Safety ...... 7 Assess Hazards ...... 7 Support ...... 7 Triage and Treatment ...... 7 Evacuation ...... 7 Recovery ...... 7 Command and Control ...... 8 Documentation ...... 9 Personnel Responsibilities ...... 9 Appendix A – D-I-S-A-S-T-E-R Paradigm ...... 10 Appendix B – Command and Control Positions ...... 13 EMS Command ...... 14 EMS Operations or EMS Branch Director ...... 15 Triage Group Supervisor ...... 16 Staging Area Manager ...... 17 Treatment Group Supervisor ...... 18 Transport Group Supervisor ...... 19 Support Group Supervisor ...... 20 Medical Unit Leader ...... 21 Appendix C – Flowcharts ...... 22 Appendix D – Initial Action Checklist ...... 27 Appendix E – Triage ...... 28 START ...... 29 Four Category System ...... 30 M.A.S.S...... 31 JumpSTART ...... 32 Appendix F – MCI Fatality Management ...... 33 Appendix G – Hazardous Material Response ...... 34 Appendix H – Weapons of Mass Destruction ...... 37 Appendix I – Transport Guidelines ...... 40 Appendix J – Communications Center Checklist and Phone List...... 41 Appendix K – Rehab Protocol ...... 48 Appendix L – Organized Citizens Response ...... 50 Appendix M – Forms ...... 51
January 2, 2014 Page 3 UMC EMS MCI PLAN
Introduction
UMC EMS, as a member of South Plains Emergency Medical Services, utilizes and supports the regional mass casualty plan. This document is a synopsis of that plan and specific procedures for UMC EMS. It is to be used as a guide during an actual event. All employees of UMC EMS should become familiar with this plan in order that on scene operations can run as needed from the onset.
The first arriving unit must establish effective command and control. Once a MCI has been declared, you are on a multi-agency scene, hazardous material incident, or weapon of mass destruction incident; the Incident Management System (IMS) will be utilized. Appropriate triage, patient management, and patient transport are also vital to a successful outcome.
EMS is responsible for two areas at any incident. The first is the care and transport of any sick or injured victims. Second, the medical care of the on scene responders is important as well. With these responsibilities, EMS should have a presence on scene for the duration of an incident.
Following are ten critical factors of successful MCI operations:
1. In a MCI, patients outnumber EMS providers. 2. The first arriving EMS unit MUST establish command and begin triage, not perform treatment. 3. The Incident Management System (IMS) establishes an EMS Branch under Operations; the key EMS areas are Triage, Treatment, and Transport. 4. Treatment is not effective without effective triage. 5. The Treatment Area must coordinate with the Triage and Transport Areas. 6. The Treatment Area is a noisy, busy place and a major resource consumer. 7. On small scale MCI events, EMS Command may be able to coordinate the entire Operation; on large incidents a separate Treatment Area is needed. 8. On large incidents the Treatment Area is divided into Red, Yellow, and Green treatment units. 9. Large-scale incidents or disasters may require separate divisions; each division is a geographic area that is an IMS structure and requires support. 10. In terrorism or hazmat incidents, the scene can be dangerous. Total scene awareness is critical.
January 2, 2014 Page 4 Levels of Disaster Activation
UMC EMS utilizes three different levels of activation for disaster response. These levels are listed below: 1. IMS Incident – (Incident Management System Incident) 2. EMS Command Incident 3. MCI – (Mass Casualty Incident)
An IMS Incident is activation resulting from a single incident. It is initiated due to having five (5) or more transportable patients on scene or requesting three (3) or more ambulances. Non-injured victims and those refusing transport are not counted in the number of patients to cause this activation. When one of the previous conditions is met, the following actions must be taken: 1. IMS will be instituted with one of the first medics on scene assuming role of EMS Command and sizing up the scene to determine needs and to make sure that triage has been performed. 2. All patients will be tagged with the current triage tag. 3. The on duty Chief or Assistant Chief will be dispatched to the scene to assume EMS Command.
An EMS Command Incident can be a single incident, but it will more likely be a combination of incidents, usually combined with poor weather conditions that overload the local EMS system. The main impact that causes activation of this level is that response times increase due to lack of available units. This level primarily effects operations within the Communications Center, except for manning backup units with off duty personnel. The following guidelines are to be used in this type of situation: 1. The on-duty EMS Shift Chief will be responsible for activating an EMS Command Incident and initiating callback of off duty personnel. 2. The Lubbock Fire Department will be used to first respond to any call that they would be closer. 3. Contact Lubbock Aid Ambulance to advise them that they may be needed to respond to emergency calls. Also, determine if they have units available to possibly post away from their normal stations. Make sure that you have determined the level of care on each ambulance that will be available and document the levels. 4. During poor road conditions, do not stage County units into the city of Lubbock unless advised by the Chief to do so. Try to leave them to cover their communities. If needed they can be called to respond to a call in the city, from their station, if they are the closest unit. 5. Anytime during an EMS Command Incident, the on-duty dispatchers can call in and off duty dispatcher to assist with Communication Center operations. This will be left up to their own discretion. This can be done without supervisor approval.
The remainder of this manual deals with the third level of disaster activation, the MCI.
January 2, 2014 Page 5 MCI: INITIAL RESPONSE AND NOTIFICATION
During the initial response it may or may not be known that a major incident exists. Dispatch should relay any information they might have that is suggestive of a major incident. Regardless of any information received, the initial EMS unit MUST make a size-up of the scene. Evaluate the nature of the incident, possible number of patients, type and severity of injuries, threats and dangers to the responders, and any specialized resources that might be needed.
After the initial size-up, a determination should be made as to whether a major EMS event or MCI exists; or whether there is neither. Dispatch should be advised as soon as possible. If a Major EMS Event is declared, notify dispatch of the number of patients and any other pertinent information. If a MCI is declared, the following information should be relayed to dispatch: 1. That an MCI has occurred; 2. Type of incident; 3. Who is in command of the EMS Branch; 4. Approximate number and severity of patients; 5. Location of Incident Command Post; 6. Location of Staging Area; 7. Number and types of transport vehicles; 8. Special hazards. See Appendix D for the Initial Action Checklist.
Successful management of a MCI, disaster, or any scene can be accomplished by using an approach called the D-I-S-A-S-T-E-R paradigm. It is a way to organize your preparation and response to disaster management. The key is to use it routinely apply the principles on every call. It is a means to continuously assess the current status and anticipate future status needs during an event. The items in the DISASTER paradigm are not in order of occurrence or importance.
D – Detection I – Incident Command S – Scene Security and Safety A – Assess Hazards S – Support T – Triage and Treatment E – Evacuation R – Recovery
Detection is awareness and recognition of a situation that will overwhelm the resources available on the scene. The key to detection preparedness is practicing detection skills on a daily basis. Before stepping out of the vehicle, look around for anything unusual. See Figure A2 in Appendix A for goals and checklist.
January 2, 2014 Page 6 National Incident Management System (NIMS) must be used on all MCI, disaster, Hazmat, and large incidents. It allows for the early coordination of all assets. See Page 6 for more detailed information on Incident Management.
Scene Security and Safety must be the immediate item addressed. This may require that law enforcement or fire services assure scene safety before EMS may access the patients. Scene safety begins before you arrive, while in route to the scene think of what hazards you might encounter. Be flexible in your approach, because the only thing that is certain is change. Don’t be selfish protect yourself. Scene priorities should be as follows: Protect yourself and your fellow personnel first; then protect the public; then protect the patients; and last protect the environment.
Assess Hazards by being aware of everything going on around you. Continual reassessment of the scene is vital to assessing hazards. Some examples of hazards are listed in Figure A4 of Appendix A.
Support includes personnel, supplies, facilities, vehicles and any other resources needed to successfully manage the incident. Depending on the assessment of hazards and the number of victims expected, you must determine what support is needed, and make the request. If the complete Incident Management System is activate, these requests should be routed through Logistics.
Triage and Treatment will begin when you have safe access to the patients. Triage is done to sort the patients into four categories; Immediate, Delayed, Minor, or Expectant/Dead. Initial triage is done by using either the S.T.A.R.T. system or the M.A.S.S. system. S.T.A.R.T. works for most incidents, but if there are large numbers of victims, hundreds and above, consider using the M.A.S.S. system. M.A.S.S. is still based on the S.T.A.R.T. system, but is able to handle a larger number of patients faster. See Appendix E for specifics on these systems. Then the Four Category System will be used as patients are moved to Treatment and for Transport. Remember that triage is a series of assessments not just one initial pass.
Evacuation of people during a MCI or disaster is the short-term overall goal of the event. Being resourceful and creative in your transportation options for evacuation is key. Use the most appropriate mode of transportation available.
Recovery begins when the incident occurred and attention to the long-term implications, costs, and the impact to the community must be considered. Recovery is the long-term objective and goal of MCI management. CISM for the response personnel is part of this phase.
January 2, 2014 Page 7 Command and Control
On scene EMS operations fall under the Command, Operations, and Logistics functions of the Incident Management System (IMS). IMS is used to allow organization for all agencies operating on the scene. IMS also allows for long term planning and organization of resources. IMS allows for standardization of terminology and a uniform system for coordination across agency lines. EMS command and control functions are EMS Command, EMS Operations or EMS Branch Director, Triage Group Supervisor, Treatment Group Supervisor, Transport Group Supervisor, Staging Area Manager, Support Group Supervisor, and Medical Support Unit Leader. Appendix A contains a listing for each position stating its radio call sign, area of operation, IMS functional area, and responsibilities. Appendix B contains diagrams showing command structure of IMS, EMS position assignments, patient flow, and communication flow. Position assignments should be assigned in the following order: first in unit, EMS Command and Triage Group Supervisor; Staging Area Manager; Treatment Group Supervisor, Transport Group Supervisor, EMS Operations or EMS Branch Director, Rehab Group Supervisor, and Support Group Supervisor. Any other positions that might be needed may be added when necessary. EMS Command fills all positions until they are assigned to someone else. When appropriate supervisory personnel arrive on scene they will take command, but only after being briefed by the current EMS Command.
One benefit of IMS is that you only have to expand it out as far as needed, and then you can shrink it back down when positions are no longer needed. There are five functional areas of IMS; Command, Operations, Logistics, Planning, and Finance. The Incident Commander is responsible for all incident or event activity. Although other functions may be left unfilled, there will always be an Incident Commander. He can be a single commander or there can be Unified Command. Unified Command is a process that allows all agencies that have jurisdictional or functional responsibility for the incident to jointly develop a common set of incident objectives and strategies. This is accomplished without losing or giving up authority, responsibility, or accountability. During Unified Command, the following applies: the incident will function under a single, coordinated Incident Action Plan; one Operations Section Chief will have responsibility for implementing the Incident Action Plan; and one Incident Command Post will be established. The Operations Section is responsible for directing the tactical actions to meet incident objectives. The Logistics Section is responsible for providing adequate services and support to meet all incident or event needs. The Planning Section is responsible for the collection, evaluation, and display of incident information, maintaining status of resources, and preparing the Incident Action Plan and incident related documentation. The Finance Section is responsible for keeping track of incident related costs, personnel and equipment records, and administering purchase contracts associated with the incident or event.
January 2, 2014 Page 8 Each of these functional areas can be expanded into organizational units with further delegation of authority. The individual designated as the Incident Commander (IC) has responsibility for all functions. The IC may elect to perform all or some of the functions, or delegate functions to other personnel. EMS should have a representative at each of the IMS functional areas.
Span of control is an important aspect in IMS. It relates to the number of individuals that a person is responsible for. As span of control exceeds one supervisor over three to five individuals, an adjustment to the organizational structure should be considered. The rule of thumb for IMS is one supervisor to five subordinates.
Documentation
Documentation at any major incident is a must. This documentation includes patient reporting as well as operational documents. Patient reports must be completed like any other EMS call that UMC EMS responds to. Documentation for each patient can be initially done on ED Report forms or the three part narrative continuation forms, which are carried in the MCI trailer. Run forms then can be done, as time permits, following the incident from these forms. Patient run forms should be completed as soon as possible after the incident. Documentation from operations includes; Staging forms for personnel and vehicles, activity logs, Transport Logs, Triage Tags, etc.
Personnel Responsibilities
On Duty Personnel 1. Respond as directed by Comm Center. 2. Stay on duty until cleared to leave by Supervisor. 3. Do not call or go into Comm Center unless directed to do so. 4. Stay in normal response areas, unless directed otherwise by Comm Center. Off-Duty Personnel 1. DO NOT CALL THE COMM CENTER UNLESS DIRECTED TO DO SO. 2. If called in, go where directed in the notification, or if no direction given, go to your normal station and standby there. On call personnel that are not given any direction will report to the nearest EMS station to their location. 3. If no call has come, but you know a disaster has occurred, check your communications source and if it is not functioning go to your normal station or closest station for on call personnel, and await instructions.
THE COMM CENTER WILL BE CONSIDERED ON LOCK DOWN AND NO ONE SHOULD GO THERE UNLESS DIRECTED TO DO SO.
January 2, 2014 Page 9 APPENDIX A
D-I-S-A-S-T-E-R PARADIGM
FIGURES
January 2, 2014 Page 10
Figure A1 D-I-S-A-S-T-E-R Paradigm Assessment Checklist: Do I detect something, what caused D – Detect this? I – Incident Command Is a safety or security issue present? S – Scene Security and Safety Did we assess the hazards that could A – Assess Hazards be here? S – Support Do we need to triage, how much T – Triage and Treatment treatment? E – Evacuation Can we evacuate/transport the R – Recovery victims? What recovery issues are present? Do we need an Incident Command, where?
The D-I-S-A-S-T-E-R paradigm Disaster or MCI present: organizes the responders preparation Is my need greater than my and response to disaster management. resources?
Figure A2 Detection Goal to Assess if: Checklist: - Disaster or MCI present - Are my capabilities or capacity - All-Hazards cause identified exceeded? - Identified, but UNSAFE - Does need exceed my resources? - Before you step out of the vehicle, look around. - If a threat or agent is suspected, what is it? - What do you see, smell or hear that is different? - What are bystanders saying or doing? - Is everyone coughing, crying, staggering or lying still?
Figure A3 Scene Security and Safety Don’t be selfish, protect yourself! - Protect Yourself and Your Team Members FIRST - Protect the Public - Protect the Patients - Protect the Environment
January 2, 2014 Page 11
Figure A4 Assess Hazards Examples - Power lines downed - Smoke or toxic inhalations - Debris/trauma - Natural gas lines - Fire/burns - Structural collapse - Blood and fluids - Weather conditions - Hazardous materials - Snipers - Flooding/drowning - Secondary devices - Explosions - NBC exposures
Figure A5 Support What do I need to get the job done? - How do we mitigate the disaster or MCI? - What human resources or skilled teams are needed? - What agencies are needed? - What facilities will be needed? - What supplies do I need? - What vehicles are needed?
January 2, 2014 Page 12 APPENDIX B
COMMAND AND CONTROL POSITIONS
January 2, 2014 Page 13 EMS COMMAND
Call Sign: EMS command, If functioning in Unified Command
ICS Functional Group: Command
Commanded By: Incident Command
Subordinates: EMS OPERATIONS OR EMS BRANCH DIRECTOR, TREATMENT GROUP SUPERVISOR, TRANSPORT GROUP SUPERVISOR, TRIAGE GROUP SUPERVISOR, STAGING AREA MANAGER, SUPPORT GROUP SUPERVISOR, and AIR OPERATIONS BRANCH DIRECTOR.
Function: Establish command, and control on-site EMS activities to insure the best possible care for the greatest number of patients.
Roles and Responsibilities:
- Responsible for all EMS operations on the scene - Establish Command Post, usually at Incident Command - Function within the unified command system - Delegate subordinate positions as needed and as personnel become available - Coordinate joint operations with all other commands and INCIDENT COMMAND
January 2, 2014 Page 14 EMS OPERATIONS or EMS BRANCH DIRECTOR
Call Sign: EMS Branch Director
ICS Functional Group: Operations
Commanded By: EMS COMMAND OR OPERATIONS SECTION CHIEF
Subordinates: TREATMENT GROUP SUPERVISOR, TRANSPORT GROUP SUPERVISOR, TRIAGE GROUP SUPERVISOR, STAGING AREA MANAGER, SUPPORT GROUP SUPERVISOR and AIR OPERATIONS BRANCH DIRECTOR.
Function: Field supervisor of all on-site EMS activities to insure the best possible care for the greatest number of patients.
Roles and Responsibilities:
- Supervise all field operations of EMS Branch - Represents EMS at any Operations meetings - Coordinates with EMS Command on resources needed - Move between EMS functional areas as needed to oversee operations
January 2, 2014 Page 15 TRIAGE GROUP SUPERVISOR
Call Sign: Triage
ICS Functional Group: Operations
Commanded By: EMS COMMAND or EMS BRANCH DIRECTOR
Subordinates: Triage Strike Team Leaders
Functions: Assume responsibility for coordination of EMS activities in areas actually impacted by the incident.
Roles and Responsibilities:
- Determine in cooperation with the fire department where triage is to be performed - Coordinate with fire department to insure that patients are immediately removed from danger areas - Evaluate resources needed for extrication of trapped patients, initial triage and primary treatment (maintaining airway and bleeding control) - Ensure personnel have tags and are trained in START triage and correct procedure for applying tags - Obtain adequate personnel and equipment to move patients to Treatment Area - Coordinate with fire department on rescue of any trapped patients - Communicate resource requirements to EMS COMMAND - Allocate assigned personnel - Supervise assigned personnel and resources - Report progress to EMS COMMAND - Advise EMS COMMAND when all patients have been delivered to Treatment Area
NOTE: Do not allow bodies of persons killed in the incident to be moved from their original locations unless absolutely necessary. If possible, take pictures and mark locations.
January 2, 2014 Page 16 STAGING AREA MANAGER
Call Sign: EMS Staging
ICS Functional Group: Operations
Commanded By: EMS COMMAND or EMS BRANCH DIRECTOR
Subordinates: AIR OPERATIONS BRANCH MANAGER, other personnel as needed
Function: Assume responsibility for coordination of Staging activities for ground and air transport units.
Roles and Responsibilities:
- Coordinate with law enforcement agencies to block streets and secure access as required for staging operations - Establishes Staging Area for incoming personnel and vehicles - Enlist a Deputy to assist in tracking incoming personnel - Insure all apparatus and vehicles are parked in an appropriate and orderly manner at Staging - Maintain log of units available and all personnel at Staging Area, and an inventory of all specialized equipment and medical supplies that might be required at the scene - Review with EMS COMMAND and EMS OPS/EMS BRANCH DIRECTOR what minimum resources must be maintained in the Staging Area - Request resources as needed, after coordinating with EMS Command and EMS OPS/EMS BRANCH DIRECTOR - Dispatch EMS vehicles and personnel to areas as requested by EMS COMMAND OR EMS OPS/EMS BRANCH DIRECTOR - Dispatch EMS vehicles to the Transport Area as directed by the TRANSPORT GROUP SUPERVISOR - Keep EMS COMMAND updated on status of staging operations - Establish Air Operations Area if needed and an Air Ops Branch Manager to oversee that area
NOTE: This role can be best filled by a dispatcher. This will free field trained personnel for caring for patients. Initially, it will probably be filled by a field person.
January 2, 2014 Page 17 TREATMENT GROUP SUPERVISOR
Call Sign: Treatment
ICS Functional Group: Operations
Commanded By: EMS COMMAND or EMS BRANCH DIRECTOR
Subordinates: Treatment Strike Team Leaders
Function: Assume responsibility for coordination patient care in the Treatment Area
Roles and Responsibilities:
- Establish Treatment Area of appropriate size at a location appropriate for weather conditions and the nature of the incident - Oversee treatment personnel - Ensure patients re-triaged as come into Treatment Area - Divide the Treatment Area by triage category; Red, Yellow, and Green - Avoid becoming directly involved in patient care unless absolutely necessary - Request resources as needed - Coordinate with Transport Group Supervisor to transport patients to proper facilities - Keep EMS COMMAND and EMS OPS/EMS BRANCH DIRECTOR updated on the status of treatment operations and report when the last patient has been treated and moved to the Transport Area - Coordinate with the Red Cross and the local or state Health Departments to establish holding areas for the Walking Wounded with OBVIOUS minor injuries - Consider need to provide long-term treatment on the scene - Coordinate with other areas as required - Coordinate with EMS OPS/EMS BRANCH DIRECTOR as needed to establish temporary morgue facilities
January 2, 2014 Page 18 TRANSPORT GROUP SUPERVISOR
Call Sign: Transport
ICS Functional Group: Operations
Commanded By: EMS COMMAND or EMS BRANCH DIRECTOR
Subordinates: Personnel, as needed
Functions: Coordination of patient transportation and maintenance of records relating to patient identification, triage category, mode of transport, and destination
Roles and Responsibilities:
- Establish a Transport Area near the Treatment Area - Communicate with Comm Center to obtain medical facility status and treatment capability - Coordinate with Treatment Group Supervisor on transport of patients - Retriage patients, and determine appropriate transport vehicle and destination - Enlist person to assist in documenting each transport, and to notify receiving facility of incoming patients - Request vehicles from Staging Area Manager as needed - Direct transport of patients to hospitals capable of providing appropriate treatment without exceeding hospital capabilities - Contact receiving facilities, via radio, and advise them of triage categories for each patient they are receiving and the estimated time of arrival as patients are transported, and notify EMS COMMAND of the same information - Maintain record of patient destinations - Notify EMS COMMAND and EMS OPS/EMS BRANCH DIRECTOR when the last patient has been transported - Coordinate with EMS OPS/EMS BRANCH DIRECTOR as needed to provide transport for the dead
January 2, 2014 Page 19 SUPPORT GROUP SUPERVISOR
Call Sign: EMS Support
ICS Functional Group: Operations, during initial phases
Commanded By: EMS COMMAND or EMS BRANCH DIRECTOR
Subordinates: Personnel, as needed
Function: Acquire and distribute appropriate medical equipment medical equipment and supplies as dictated by nature of incident and number and types of patients
Roles and Responsibilities:
- Establish suitable location for Support Area operations – normally near the Treatment Area - Determine the medical supply and equipment needs of other areas - Coordinate procurement of medical supplies from hospitals with TRANSPORT GROUP SUPERVISOR, AIR OPS BRANCH DIRECTOR, and EMS OPS/EMS BRANCH DIRECTOR - Works in the Resource Group of IMS - Coordinate procurement of additional supplies not available at hospitals - Ensures that requested resources are distributed to needed area - Report progress to EMS COMMAND and EMS OPS/EMS BRANCH DIRECTOR - Coordinate with other areas
January 2, 2014 Page 20 MEDICAL UNIT LEADER
Call Sign: Medical Support
ICS Functional Group: Logistics
Commanded By: INCIDENT COMMAND and LOGISTICS SECTION CHIEF
Subordinates: Rehab Team members
Function: Responsible for the physical and emotional health of the rescuers through all phases of the incident
Roles and Responsibilities:
- Establish Medical Support Area in proper location, out of direct view of incident - Enlist personnel to man the Medical Support Unit that will monitor and log the vital signs of all personnel going through the area, at least upon entering and leaving the area - See that personnel are monitored for critical incident stress and notify SAFETY OFFICER when signs are observed - Ensure rescuers are fit to return to duty prior to leaving Medical Support Unit - Coordinate with the American Red Cross and the Salvation Army for fluid and dietary needs of the rescuers
January 2, 2014 Page 21 APPENDIX C
FLOWCHARTS
EMS Command Structure
Incident Management System
Expanded IMS
Patient and Communication Flow Chart
January 2, 2014 Page 22 EMS COMMAND STRUCTURE
January 2, 2014 Page 23 INCIDENT MANAGEMENT SYSTEM
Incident
Command
Liaison Safety Officer
Operations Planning Logistics Finance
EMS Medical
Field Support
Operations
January 2, 2014 Page 24
Incident Command
Safety Public Information Officer Officer
Liaison Officer
Operations Planning Logistics Finance Section Section Section Section
Staging Service Support Group Branch Branch
Fire Medical Law Enforcement Medical Branch Branch Branch Support Unit
Triage Group
Lubbock EMS MCI IMS Structure Chart Treatment Revised May 10, 2005 Group
Transport Group
Support Group
January 2, 2014 Page 25 PATIENT AND COMMUNICATION FLOW CHART
January 2, 2014 Page 26 APPENDIX D
INITIAL ACTION CHECKLIST
Position vehicle at safe location that provides good visibility of the incident and easy access. Avoid having to relocate vehicle unless absolutely necessary.
Quickly “size up” the situation to determine: Nature of incident; Possible number of patients; Severity of patient injuries; Danger zones and nature of hazards present; and Need to establish multiple treatment areas.
Select Staging Area for EMS vehicles at location which can be easily accessed without having to back-up vehicles to turn them around.
Select a helicopter landing zone, if need for air transport exists. (Do not use if hazardous materials are involved.)
Contact 660 and provide: Your unit number and channel you are operating on; A statement that a MCI has occurred, that the MCI Plan should be activated, and that you are assuming EMS command; The nature of the incident; The number and types of casualties; The number of EMS and other transport vehicles needed; The location of the Staging Area and helicopter landing zone; The location of the current Command Post; Any additional information needed for a safe, efficient response.
Coordinate with the police to begin securing the perimeter, routes for EMS vehicles entering and leaving the scene, and the helicopter landing zone.
Coordinate with the fire department to begin search and rescue, and initial triage.
Establish locations for one or more Treatment Areas based on environmental conditions, the size of the incident, and your best estimate of the number of casualties.
As additional personnel arrive, make functional area assignments as needed: Triage Group Supervisor – Triage Strike Teams Staging Area Manager and Deputy – Air Ops Branch Director Treatment Group Supervisor – Treatment Strike Teams Transport Group Supervisor Support Group Supervisor
EMS Command must remain at Command Post until relieved of command.
January 2, 2014 Page 27 APPENDIX E
TRIAGE
S.T.A.R.T.
Four Category System
M.A.S.S
JumpSTART (Pediatric MCI Triage)
In order to maintain proficiency with the Triage Tag, all transported patients will be tagged on the 11th of each month.
January 2, 2014 Page 28 S.T.A.R.T. Simple Triage and Rapid Treatment
Anyone that can walk move to Treatment or holding area. BREATHING?
NO YES
POSITION AIRWAY BREATHING? >30/MINUTE <30/MINUTE
IMMEDIATE NO YES (RED)
ASSESS PERFUSION NONSALVAGEABLE IMMEDIATE (BLUE) (RED)
RADIAL PULSE OR CAPILLARY REFILL
PULSE ABSENT OR PULSE PRESENT OR REFILL > 2 SECONDS REFILL <2 SECONDS
IMMEDIATE ASSESS (RED) MENTAL STATUS
FAILS TO FOLLOW CAN FOLLOW SIMPLE COMMANDS SIMPLE COMMANDS
IMMEDIATE DELAYED (RED) (YELLOW)
January 2, 2014 Page 29
FOUR CATEGORY TRIAGE SYSTEM
Priority I (IMMEDIATE: Red)
All airway problems or potential airway problems All penetrating chest trauma Blunt chest trauma associated with shock, significant Dyspnea, paradoxical movement of chest wall, possible pneumo/hemothorax All penetrating abdominal trauma Blunt abdominal trauma associated with shock, altered level of consciousness, guarding, rigidity, or diffuse tenderness Uncontrolled or suspected severe hemorrhage All shock, regardless of cause All altered level of consciousness regardless of cause Major medical emergencies (non-traumatic chest pain, dysrhythmias, poisoning, status epilepticus, significant non-traumatic dyspnea, etc) Obstetrical complications Burns, if: a. Third Degree > 10% body surface area (BSA) b. Second Degree > 25% BSA c. Face or Necked Involved d. <11 or >50 years old e. Associated with additional major trauma or chronic illness f. Electrical
Priority II (DELAYED: Yellow)
Burns, if: a. Third Degree 2-10% BSA b. Second Degree 15-25% BSA c. Hands, Feet, or Perineum Involved Spinal injuries with or without spinal cord damage Blunt chest trauma without shock or significant dyspnea Blunt abdominal trauma without shock or signs of peritoneal irritation (guarding, rigidity, diffuse tenderness) Major orthopedic or soft tissue injuries, including open fractures, impaired neurological function, or loss of distal pulse
Priority III (Minor: Green)
Burns, if: a. Third Degree <2% BSA b. Second degree <15% BSA c. First Degree Minor orthopedic and soft tissue injuries, including closed fractures with distal neurovascular function intact
Priority IV (Expectant – Nonsalvageable: Blue/Black/White)
Full arrest without adequate manpower Neurological death (traumatic coma with areflexia and fixed, dilated pupils) Third Degree burns >80% BSA Obvious mortal wounds (severe open skull fracture; massive crushing trauma to chest, abdomen, or pelvis, etc.) Obvious D.O.S. (Decapitated, burned beyond recognition, dismembered)
January 2, 2014 Page 30 M.A.S.S. Triage
This method can be used when the number of casualties or number of Triage personnel make it difficult to achieve Initial Triage in a timely fashion. This method is still based off the S.T.A.R.T. system and is only for use in the Initial Triage phase. Reassessment is also a required throughout all patient contact.
M – Move A – Assess S – Sort S – Send
MOVE Of M.A.S.S. Triage Goal: Action: Category: Group ambulatory “Everyone who can hear Minor initial group patients me and needs medical attention, please move to the area with the green flag.” (or other identifier) Group awake, follow Ask the remaining victims Delayed initial group commands “Everyone who can hear me please raise an arm or leg so we can come help you.” Identify who is left Proceed immediately to Immediate initial group these patients and deliver immediate life-saving Or interventions (open airway and bleeding Expectant/Dead initial control) group
Tag all patients in the Delayed, Immediate, or Expectant/Dead categories. As you continue assessing patients their categories could change due to change in patient condition or change in available resources. As patients are moved to the Treatment area, they will be triaged by the Four Category System. The Four Category System will also be used in aiding which patients should be moved first to Treatment.
January 2, 2014 Page 31 Pediatric Initial Triage Jump START
Use this Triage Scheme if the majority of your patients are Pediatric.
January 2, 2014 Page 32 APPENDIX F
MCI FATAILITY MANAGEMENT
1. Persons found dead at the scene of a major EMS incident will be the responsibility of the Medical Examiner or Justice of the Peace for the affected jurisdiction(s).
2. Bodies will not normally be moved unless the responsible authority or his authorized deputy gives permission.
3. Obviously dead bodies will be tagged by the TRIAGE GROUP SUPERVISOR, then covered with a sheet or blanket until removal. While first priority will be given to the living, efforts will be made to safeguard bodies.
4. Personal belongings will be left on the bodies to aid in identification.
5. Bodies may be moved prior to the arrival of the responsible authority to provide patient care, to prevent further damage, or at the direction of law enforcement. Under these circumstances the following procedures must be followed: a. Do not remove any personal effects from the body; b. Attach a tag to the body with the following information: i. Date and time found ii. Exact location where found iii. Name and address of decedent, if known iv. If identified, how and when v. Name of person making identification or filling out tag c. Place body in disaster pouch or in plastic sheeting securely tied to prevent unwrapping. Attach a second tag to sheeting or pouch. d. If personal effects are found near the body and thought to belong to the body, place them in a separate container and tag. Do not assume that any loose articles belong to a specific body. e. If possible take photographs or mark location of body with stake and tag. f. Move the properly tagged bodies with their personal effects to one location, preferably one with refrigeration. Avoid exposure of bodies to heat or direct sunlight. If at all possible, do not locate temporary morgue facilities at or near Treatment Area(s). Do NOT use vehicles or storage area with a floor that can be permeated with body fluids, such as the wooden floor of a gymnasium. If refrigerated trucks or rail cars are used, COVER THE COMPANY NAME ON THE VEHICLE. 6. EMS COMMAND will coordinate with POLICE COMMAND, the authority responsible for the dead, and local health authorities in arranging for temporary morgue facilities and transportation of bodies.
7. EMS COMMAND will consult with local or state health authorities, if they are present, on appropriate procedures to safeguard the health of personnel assigned to move the dead. In absence of such advice, universal precautions against communicable disease will be exercised.
8. Release of information about persons killed in an incident will be the responsibility and prerogative of the Medical Examiner, Justice of the Peace, or authorized law enforcement officials.
January 2, 2014 Page 33 APPENDIX G
HAZARDOUS MATERIAL RESPONSE
January 2, 2014 Page 34
RECOGNITION
EMS responders must always be alert for the possibility of a hazardous material exposure. The exposure can be a single person exposed by a small amount, up to a large release. Without recognition more people could be exposed, and ambulances and hospitals could be contaminated, rendering them out of service. The following clues should help in recognition of hazardous materials: - Occupancy/Location - Container Shape - Markings and Colors - Placards and Labels - Shipping Papers/Manifests - Senses Recognition is the key to responder safety and effective management of the incident. Remember to use the “Rule of Thumb” as you approach a possible hazmat scene. “Rule of Thumb” is where you stay far enough away from the scene so that your thumb will cover the entire scene.
Occupancy and location is the first and safest clue to a hazmat scene. Manufacturing plants, laboratories (commercial and academic), construction sites, and agricultural sites are examples where hazardous materials could be located.
In most cases, solids, liquids and gases are stored in distinctive containers. Corrosives are usually stored in plastic drums. Containers with rounded ends usually contain liquids and pressurized gases.
Markings on tanks and containers should be looked at for indications of poisons, flammable substances, corrosives, explosives, radioactive materials, etc. Colors of compressed gas cylinders can also give an indication of contents.
Placards and labels are a valuable source in recognition of hazardous materials. If a placard is present, there is at least 1,001 pounds of that substance on board. If it is below that weight a placard is not required. Placards and labels should be observed from a distance if at all possible.
Shipping papers and manifests should list what is carried on transport vehicles. These papers are in different locations on different types of vehicles. Ask the operator of the vehicle, if possible, for the proper papers.
Senses include visual signs such as, vapor clouds, visible liquid or solid products; dead or incapacitated people or animals, dead vegetation; or damage to a vehicle with a visible placard. If you are experiencing skin, eye, or nasal irritation move back; you have been exposed to the material. The only sense that should be used due to safety is vision. Remember that these materials can also be tasteless, odorless, and colorless. Also, radioactive materials cannot be detected by the senses.
January 2, 2014 Page 35
TRIAGE ISSUES
Hazmat exposure influences triage in numerous ways. Access to patients and treatment may be delayed due to scene conditions and decontamination requirements. The time needed to decontaminate patients may delay definitive patient care. Chemicals can modify the physiologic response to trauma by amplifying signs and symptoms or decreasing the efficiency of various protective mechanisms. Some chemicals may also have delayed symptoms due to differing absorption rates. Triage must be a continuous process and patient’s condition charted so that an exposure history can be obtained.
DECONTAMINATION
Any potentially contaminated patients MUST be decontaminated prior to being placed in an ambulance. Consult the Emergency Response Guide for proper procedure, and coordinate with the fire department to achieve decontamination. A large portion of any contaminants can be removed by simply removing the patient’s clothing. All clothing should be bagged and sealed until it can be deconned. Under NO circumstances should a patient arrive at the emergency department still wearing potentially contaminated clothing.
MEDICAL SURVEILLANCE
EMS may also be called upon to provide medical support for the hazmat team members. The goal of medical surveillance is to provide pre-entry vital signs, exit vital signs, monitor current medical conditions of the rescuers, and to assess and manage any problems during the response. You should also obtain a current medical history pre-entry. Baseline pre-entry vital signs are important in order to evaluate the team member’s condition upon exit. These values must be documented and they become part of the incident report.
Transport of any patient that could possibly have been exposed to hazardous materials will NOT be initiated UNTIL the appropriate decontamination can be performed.
January 2, 2014 Page 36 APPENDIX H
WEAPONS OF MASS DESTRUCTION
January 2, 2014 Page 37 Emergency Response Challenges
Weapon of Mass Destruction (WMD) events can lead to four major challenges to first responders. First it will be a hazardous materials incident, and all the appropriate protection must be put into place. Second, it usually is a mass casualty incident because a terrorist wants to strike at a large number of people to reach his goal. Third, there is a higher incidence in the use of a secondary device towards the first responder. All responses should be aware and alert for these. Last, a WMD event is a crime scene and evidence must be preserved as much as possible and first responders must be alert to what they observe so that they can recount it later.
Recognizing Suspicious Incidents
The first responder’s index of suspicion should be increased if they are called to an incident if it meets certain criteria relating to occupancy, type of event, or timing of event. Certain types of occupancy should lead the first responder to be more suspicious. Symbolic or historic structures such as government buildings have been targets due to being the location of government or symbolic of our financial system. Public building or assembly areas are targets due to large number of persons in one contained area. Controversial businesses such as abortion clinics are targets of domestic terrorists. And, infrastructure systems, such as water systems, electrical systems, oil refineries, etc are targets. Type of event should also increase the responder’s level of suspicion. Explosion, fire, or firearms go without saying. Non-traumatic MCI can be an indicator to a chemical, biological, or nuclear release. Timing of the event is also an indicator. Significant dates such as the anniversary of Waco, or other major incident. Weekend or nights are also an indicator as the goal might not be to inflict a large number of casualties so they pick a time of limited occupancy. There can also be on scene warning signs such as unexplained patterns of illnesses or deaths; unexplained signs/symptoms, skin, eye, or airway irritation; or containers in unusual locations.
Self Protection
Self protection in a WMD event is best done by utilizing three concepts; time, distance, and shielding. Time is achieved by spending the shortest time possible in hazard area. This protects the crime scene and responders from exposure. Maximize your distance from the hazard by utilizing the “rule of the pinkie”, being able to cover the scene with the tip of your small finger. Shielding can be achieved by utilizing vehicles, buildings, and PPE.
January 2, 2014 Page 38 Below are some aids to help you protect yourself:
Staying SAFE S – Safety is first A – Assess before acting F – Focus on avoiding the hazard E – Evaluate the situation and report
Don’t rush in Don’t assume anything Don’t TEST (taste, eat, smell, or touch) Don’t become a victim
Remember RAIN R – Recognize a potential threat exists A – Avoid that threat, and make sure others avoid it as well I – Isolate the area and any exposed persons or materials N – Notify the appropriate authorities
Decontamination
All patients MUST be deconned before being placed in a transport vehicle by gross decon. A definitive decon should then be performed at the receiving facility.
Types of Harm
•Chemical •Biological •Radiological •Nuclear •Explosive
Establish Control Zones
•Obtain safe, secure area –Control Access •Self-Protection #1 Priority •Anticipate multiple hazard locations •Recognize and Evaluate Dangers
January 2, 2014 Page 39 APPENDIX I
TRANSPORT GUIDELINES
Once the patients have been triaged they must receive definitive care. This may be done at an on scene treatment center, or they must be transported to an appropriate facility. The patients will need to be evacuated in proper order to obtain treatment for the most severe down. Loads should still be mixed with Immediate and Delayed patients as appropriate. All transport decisions should be based on the Four Category Triage System. Immediate patients with injuries or illnesses, which cannot be managed initially on the scene, should be trans- ported first. The following list of conditions can be used in making decisions for transport.
The following patients should be considered for immediate transport: multi- system trauma; penetrating trauma to chest; sustained hypotension <90mm Hg; sustained pulse >120 or <50; pulmonary insufficiency, which includes respiratory rate >35 or <10 per minute or respiratory compromise/obstruction or clinical symptoms of hypoxia; Glasgow Coma Scale <8; Revised Trauma Score <10; traumatic amputation of limb; life threatening burns; cardiac chest pain; other life threatening injuries.
The judgment of the Triage, Treatment, and Transport Group Supervisors should be used to determine which patients should receive care and transport first. Full cardiac arrest patients can be treated and transported ONLY if adequate manpower is present to care for all other patients, and all patients with life threatening injuries have been transported.
Transport of any patient that could possibly have been exposed to hazardous materials; will not be initiated UNTIL the appropriate decontamination can be performed.
The transporting UMC EMS ambulance will use the actual Truck Number (ie 105), not the Unit Number (9741) when transporting patients. This will help keep confusion to a minimum. The transporting ambulance will contact the Comm Center with the Truck Number, Crew Members (if different than who responded to the scene on that truck), Destination and total number of each category of patient, and Code (1 or 3). Example: Truck 105, with Smith and Jones, transporting to UMC 229, 1 Red and 2 yellow patients, Code 3.
January 2, 2014 Page 40 APPENDIX J
COMMUNICATIONS CENTER CHECKLIST AND PHONE LIST
January 2, 2014 Page 41 UMC EMS Regional Communications Center MASS CASUALTY INCIDENT CHECKLIST
LOCAL MCI
A. Pre-Command Mode: When advised that a POSSIBLE MCI has occurred, the communications technician will notify the following personnel:
______1. On Duty Shift Chief
______2. UMC EMS Director, Division Chiefs and Comm Center (Chris Teague 224-5263, Alan Harrison 300-2561, Bruce Mowrey 438-5632, Renee Sandefur 790-9762, Tim Berry 535-6004, Shea Edge 928-1404) (i-Info)
______3. House Supervisor, at all city hospitals. Advise them of the type of POSSIBLE incident: UMC – 241-0286 Trauma Services – Intranet or Wendi 241-0377 Covenant Medical Center – 0800-2400 725-0611 2400-0800 761-8494 Grace Medical Center – 319-2224 Heart Hospital – 472-5373 ED CHARGE NURSE
______4. Extra Dispatcher, if needed
______5. UMC EMS Medical Director Dr. Gerad Troutman – 940-642-0100 (i-Info)
B. If the responding EMS unit advises that there is NOT a MCI situation. The Communications Center will so advise the above personnel.
C. If the responding EMS unit advises that a MCI HAS OCCURRED (document time confirmed ______), the Communications Center will insure that the following are contacted;
______1. Those above.
______2. All On-Duty UMC EMS stations and crews
______3. All applicable local public service and safety agencies available Via “direct” line in Communication Center’s radio console.
______4. Verify that Off-Duty Shift Chiefs, Assistant Chiefs, Training Coordinator, Senior Field Training Officers, Field Training Officers, and Off-Duty Personnel have been contacted by Comm Center. (i-Info)
January 2, 2014 Page 42
______5. All Lubbock County Volunteer EMS personnel via pagers.
______6. Aeromedical Services, place on NO LAUNCH STANDBY, until safe landing zone is secured Aerocare – 725-1100
______7. All local non-emergency ambulance and wheelchair services Lubbock Aid Ambulance – 792-2166 Wheelcare - 794-7573 (Leave message if no answer) Visiting Angels - 687-2780 Covenant Ambulance Service- 725-2255
______8. SPEMS Medical Direction-IF SPEMS SERVICES BEING ACTIVATED Dr. Sasin – 806-438-8684
______9. Notify EMTF 1 Coordinator (Rodney Hunt 806-292-5401; Jim Waters 806-535-2638) (i-Info)
CHECK HOSPITAL STATUS ON EMSYSTEM USER NAME: lubbems PASSWORD: lbkems660 WebEOC Login USER NAME: UMCEMSCommunications0660 PASSWORD: Umcems660
Notify those below only if directed to do so, by EMS Command
______10. Notify Salvation Army D.A.R.T. team. 765-9434
______11. Notify Red Cross 765-8534
______12. Other (specify)______
______
______13. Other (specify)______
______
______14. Other (specify)______
______
______15. Other (specify)______
______
January 2, 2014 Page 43 COMMUNICATIONS CENTER PHONE LIST
STA B 775-8725 775-8724 FAX STA 1 747-1081 747-1125 FAX STA 2 796-7290 796-7297 FAX
STA 4 748-1064 748-1250 FAX STA 5 747-1220 747-1274 FAX STA12 794-7627 698-8553 FAX CHIEF 796-7697
STA 6 – 9746 298-4138 298-2831 FAX STA 7 – 9747 892-2414 C. H. 892-9781 STA RUSS PERKINS STA 8 – 9748 828-2011 828-2012 FAX CHARLES STA 9 – 9749 866-4215 C. H. 866-9126 STA ADDINGTON STA 10 – 9750 832-4521 C. H. 832-0609 STA GARY VAUGHN STA 11 – 9751 797-0412 797-0514 FAX TIM SMITH STA 13 - 9753 RANDY TEETER LECD 747-6911 747-5803 FAX COL HEALTH DEPT 775-2933 1902 TEXAS AV TEXAS DSHS 744-3577 1109 KEMPER AV PHONES - LECD 632-1136 743-8382 PAGER ROBYN PLANT EQUIPMENT 1-800-491-1734 DISPATCH ONLY S W BELL 1-800-945-7776 1-800-280-3857 1-866-722-3911 RADIOS CITY RADIO SHOP 775-2326 JACK 777-4236 SOUTH PLAINS COMM 795-5823 JIM 239-7305 UMC COMM - PHONES 775-9000 EVENTIDE 1-800-708-6423 PARKINSON'S 1-800-332-7003 LRPS 762-0811 FLEET MAINTANENCE 799-5786 JEREMY 793-2727 928-8418 CELL TOMMY 241-0795 M POLLARD 797-3441 JOHN MALINOWSKI 548-2866 RESCUE TOWING 791-2287 AIRGAS 745-4658 O 1101 E SLATON RD CHAD SHADDEN 748-1276 F 535-4683 C
LUBBOCK AID 792-2166 799-5060 FAX DAVID EHLER 792-2167 792-9295 WHEELCARE 794-7573 445-0228 FAX BRANDON VISITING ANGELS 687-2780 1-888-434-5584 AEROCARE 725-1100 747-1562 FAX
January 2, 2014 Page 44 AEROCARE (cont’d) 725-1112 1-800-627-2376 CITIBUS 712-2010 SYRENA S. 786-0809 C John Wilson 794-4213 SUNRISE 740-1420 740-1569 FAX 740-1400 229 MAIN 775-8200 229 HOUSE SUPERVISOR 761-8874 775-8880 OFFICE 241-0286 C 229 SECURITY 775-9990 229 ER 775-9700 775-8460 FAX 229 NURSE DESK 775-8490 229 BILLING 775-8636 229 TRAUMA SERV INTRANET WENDI 241-0377
251 MAIN 788-4100 251 HOUSE SUPERVISOR 788-4196 O 928-0364 C 251 ER 788-4001 788-4377 FAX 788-4191
373 MAIN 687-7777 373 HOUSE SUPERVISOR 373 CHARGE NURSE 472-5373 373 ER 472-3876 472-3765 FAX 472-3877
624 MAIN 725-1011 725-0611 0800- 624 PT PLACEMENT 2400 761-8494 2400-0800 624 SECURITY 725-4054 624 ER 725-2233 725-0021 FAX 725-2288 725-2291 624 PEDI ER 725-0030 725-0015 FAX
672 MAIN 725-6000 672 SECURITY 725-4054
CLINICS ABERNATHY 298-5884 409 8TH ST CHATMAN 749-0024 2301 CEDAR AV FREEDOM 762-3597 1301 50TH ST IDALOU 892-2537 113 WALNUT KINGS PARK 792-8843 7501 QUAKER KP URGENT 788-3306 7501 QUAKER LAKERIDGE PRIMARY 794-9378 5130 82ND ST PARKWAY 767-9744 406 MLK SLATON 828-5822 130 N 7TH ST WOLFFORTH 866-0158 502 E HWY 62/82
LUBBOCK FIRE 765-5757(E) 775-3510 FAX 775-2635 775-3825 FAX
January 2, 2014 Page 45 LUBBOCK POLICE 763-5333(E) 762-4912 FAX 775-2865 DESK SARG 775-2817 SHERIFF'S OFFICE 767-1441(E) 775-1453 FAX 767-0417(E) 775-1480 775-1601 TTU PD 743-2000 742-3931 742-3900 FAX CC 742-3903 FAX PD COL ANIMAL CONTROL 775-2057 DPS 472-2794(E) 472-2795 FAX 472-4794(E) ABERNATHY POLICE 298-2545 NEW DEAL POLICE 746-5860 IDALOU POLICE 892-2500 CITY HALL 892-2531 892-3224 FAX RANSOM POLICE 829-2600 790-2501 CHIEF BUFFALO POLICE 747-0496 747-3353 SLATON POLICE 828-2020(E) 828-2023 FAX 828-2022 WOLFFORTH POLICE 866-4605 SHALLOWATER POLICE 832-4565 LIA POLICE 775-2044 TOWER 762-0329 LISD POLICE 766-1193 BNSF EMERGENCY 1-800-795-2673
CROSBY CO SO 675-7301 CAPROCK CONE CROSBYTON LORENZO RALLS
DAWSON CO SO 872-7560 872-2121 LAMESA PATRICIA
DICKENS CO SO 623-5533 DICKENS SPUR
GARZA CO SO 495-3595 JUSTICEBURG POST SOUTHLAND VERBENA
FLOYD CO SO 983-4901 FLOYDADA LOCKNEY
January 2, 2014 Page 46 HALE CO SO 296-2724 LINE 1 COTTON CENTER EDMONSON HALE CENTER HALFWAY HAPPY UNION PETERSBURG PLAINVIEW
HOCKLEY CO SO 894-3126 ANTON ARNETT LEVELLAND PETTIT ROPESVILLE SMYER SUNDOWN WHITHARRAL
LAMB CO SO 385-7900 AMHERST EARTH FIELDTON LITTLEFIELD OLTON SPADE SPRINGLAKE SUDAN
LYNN CO SO 561-4505 NEW HOME O'DONNELL TAHOKA WILSON
TERRY CO SO 637-2212 BROWNFIELD MEADOW UNION
SWISHER CO 995-3336 TULIA HAPPY KRESS VIGO PARK
COCHRAN CO 266-5211 BLEDSOE LEHMAN MORTON WHITEFACE
January 2, 2014 Page 47 APPENDIX K
REHAB PROTOCOL
January 2, 2014 Page 48 REHAB PROTOCOL
Heart Rate > 120 beats per minute or Blood Pressure >200mm Hg systolic or 1. Treat any of the Symptoms <90mm Hg systolic or present which are listed >110mm Hg diastolic or at the bottom of the page Any Injuries or YES 2. Provide: Temperature > 99.5 degrees Fahrenheit or A. Rest Any of the Symptoms listed in the box at the B. Rehydration * bottom of this page C. Food Taking any medications listed below
Reassess vitals NO after 20 minutes
Heart Rate > 120 beats per minute or Move to Rest Blood Pressure >200mm Hg systolic or and <90mm Hg systolic or Refreshment >110mm Hg diastolic or NO Area Any Injuries or For a Minimum Temperature > 99.5 degrees Fahrenheit or of 20 Minutes Any of the Symptoms listed in the box at the bottom of this page
Return to YES Duty
Continue to Monitor and Transport
Treat Immediately if present: * Rehydration Chest Pain If patient has a positive tilt test rehydrate Shortness of Breath with IV therapy per the Hypovolemia Palpitations Protocol Altered Mental Status If patient has a negative tilt rehydrate orally Skin that is hot and either dry or moist Irregular pulse Oral Temp >101 Special attention should be giv en medications Pulse > 150 bpm that can lower heart rate. Pulse > 140 bpm after cooldown acebutol alprenolol Adalat amlodipine Systolic BP > 200mm Hg after cooldown atenolol Betabloc betaxolol bisoprolol Diastolic BP > 110mm Hg at any time Blocadren bunolol bupranolol Cardene Cardizem Calan carteolol Catrol carvedilol Coreg Corgard Corzide Covera-HS Dilacor diltazem Diltia XT DynaCirc epanolol felodipine Inderal Inderide Isoptin isradipine Kerlone labetalol Lexxel Lopressor Lotrel metoprolol Monitan moprolol nadolol nicardipine nifedipine nisoldipine Normodyne Norvasc oxprenolol pamatolol Plendil practolol Prindolol Procardia propranolol Renedil Sectral Sular talinolol Tarka Teczem Tenoretic Tenormin Tiamate Tiazac Timolide timolol tiprenolol tolamolol toliprolol Toprol Trandate verapamil Verelan Visken Zebeta Ziac Responders taking any of these medications may not exhibit tachycardia
January 2, 2014 Page 49 APPENDIX L
ORGANIZED CITIZENS RESPONSE
History has shown that neighbors come to the aid of each other, especially Americans. The LA City Fire Department began to capitalize on this in the late 1980s and early 1990s by organizing and training citizen response teams to aid themselves and neighbors in earthquakes and wildfires. After the terror attacks of September 11, 2001, President Bush encouraged this type of system to be organized nationwide. This was the birth of the Citizens Corp. Citizens Corp is comprised of four programs; Community Emergency Response Teams (CERT), Medical Reserve Corps (MRC), Volunteers In Police Services (VIPS), Fire Corps and Neighborhood Watch. During a disaster, EMS responders will come into contact primarily with CERT. CERT is a group of volunteers trained in basic first aid, simple search and rescue, triage, small fire extinguishment, basic incident command, and other special training as needed. These teams are in place to help their families and neighbors until professional help arrives, but they could also be used by EMS after you arrive on scene.
January 2, 2014 Page 50 APPENDIX M
FORMS
Recognized IMS forms will be used where appropriate.
Initial Briefing: Map/Sketch ICS-201-1 Initial Briefing: Summary of Current Actions ICS-201-2 Initial Briefing: Initial Incident Organization ICS-201-3 Initial Briefing: Resource Summary ICS-201-4 Incident Action Plan: Incident Objectives ICS-202 Incident Action Plan: Organizational Assignment List ICS-203 Incident Action Plan: Division/Group Assignment List ICS-204 Incident Action Plan: Task Force/Strike Team Personnel ICS-204-2 Incident Action Plan: Incident Radio Communications Plan ICS-205 Incident Action Plan: Communications List ICS-205-A Incident Action Plan: Medical Plan ICS-206 Incident Action Plan: Safety Message/Plan ICS-208 Incident Action Plan: Incident Status Summary ICS-209 Incident Action Plan: Resource Status Change ICS-210 Check In/Out Log: Personnel and Equipment ICS-211 General Message/Resource Request ICS-213 Resource Request Message ICS-213-RR Unit Log ICS-214 Unit Log Continuation ICS-214-1 Incident Action Plan: Operational Planning Worksheet ICS-215 Incident Action Plan: Incident Action Plan Safety Analysis ICS-215-A Field Resource Status & Demobilization Request ICS-216 Incident Action Plan: Support Vehicle/Equipment Inventory ICS-218 Incident Action Plan: Air Operations Summary ICS-220 Demobilization Check-Out ICS-221 Incident Action Plan: Health and Safety Plan ICS-223 Incident Personnel Performance Rating ICS-225 Hospital Resource Inventory SPEMS-901 Patient Transport Log SPEMS-902 Comm Center Transport Log SPEMS-903 Comm Center MCI Documentation Sheet SPEMS-904
January 2, 2014 Page 51 Incident Briefing (ICS 201) 1. Incident Name: 2. Incident Number: 3. Date/Time Initiated: Date: Time: 4. Map/Sketch (include sketch, showing the total area of operations, the incident site/area, impacted and threatened areas, overflight results, trajectories, impacted shorelines, or other graphics depicting situational status and resource assignment):
5. Situation Summary and Health and Safety Briefing (for briefings or transfer of command): Recognize potential incident Health and Safety Hazards and develop necessary measures (remove hazard, provide personal protective equipment, warn people of the hazard) to protect responders from those hazards.
6. Prepared by: Name: Position/Title: Signature: ICS 201, Page 1 Date/Time:
Page 52 INCIDENT BRIEFING (ICS 201) 1. Incident Name: 2. Incident Number: 3. Date/Time Initiated: Date: Time: 7. Current and Planned Objectives:
8. Current and Planned Actions, Strategies, and Tactics: Time: Actions:
6. Prepared by: Name: Position/Title: Signature: ICS 201, Page 2 Date/Time:
Page 53 INCIDENT BRIEFING (ICS 201) 1. Incident Name: 2. Incident Number: 3. Date/Time Initiated: Date: Time: 9. Current Organization (fill in additional organization as appropriate):
Liaison Officer Incident Commander(s)
Safety Officer
Public Information Officer
Planning Section Chief Operations Section Chief Finance/Administration Logistics Section Chief Section Chief
6. Prepared by: Name: Position/Title: Signature: ICS 201, Page 3 Date/Time:
Page 54 INCIDENT BRIEFING (ICS 201) 1. Incident Name: 2. Incident Number: 3. Date/Time Initiated: Date: Time:
10. Resource Summary:
Resource Date/Time
Resource Identifier Ordered ETA Arrived Notes (location/assignment/status)
6. Prepared by: Name: Position/Title: Signature: ICS 201, Page 4 Date/Time:
Page 55 Incident Objectives (ICS 202) 1. Incident Name: 2. Operational Period: Date From: Date To: Time From: Time To: 3. Objective(s):
4. Operational Period Command Emphasis:
General Situational Awareness
5. Site Safety Plan Required? Yes No Approved Site Safety Plan(s) Located at: 6. Incident Action Plan (the items checked below are included in this Incident Action Plan): ICS 203 ICS 207 Other Attachments: ICS 204 ICS 208 ICS 205 Map/Chart ICS 205A Weather Forcast/Tides/Currents ICS 206 7. Prepared by: Name: Position/Title: Signature: 8. Approved by Incident Commander: Name: Signature: ICS 202 IAP Page _____ Date/Time:
Page 56
ORGANIZATION ASSIGNMENT LIST (ICS 203) 1. Incident Name: 2. Operational Period: Date From: Date To: Time From: Time To: 3. Incident Commander(s) and Command Staff: 7. Operations Section: IC/UCs Chief Deputy
Deputy Staging Area Safety Officer Branch Public Info. Officer Branch Director Liaison Officer Deputy 4. Agency/Organization Representatives: Division/Group Agency/Organization Name Division/Group Division/Group Division/Group Division/Group Branch Branch Director Deputy 5. Planning Section: Division/Group Chief Division/Group Deputy Division/Group Resources Unit Division/Group Situation Unit Division/Group Documentation Unit Branch Demobilization Unit Branch Director Technical Specialists Deputy Division/Group Division/Group Division/Group 6. Logistics Section: Division/Group Chief Division/Group Deputy Air Operations Branch Support Branch Air Ops Branch Dir. Director Supply Unit Facilities Unit 8. Finance/Administration Section: Ground Support Unit Chief Service Branch Deputy Director Time Unit Communications Unit Procurement Unit Medical Unit Comp/Claims Unit Food Unit Cost Unit 9. Prepared by: Name: Position/Title: Signature: ICS 203 IAP Page _____ Date/Time: Page 57
ASSIGNMENT LIST (ICS 204) 1. Incident Name: 2. Operational Period: 3. Date From: Date To: Time From: Time To: Branch: 1 4. Operations Personnel: Name Contact Number(s) Division: 1 Operations Section Chief: Group: 1 Branch Director: Staging Area: 1 Division/Group Supervisor:
5. Resources Assigned: Reporting Location,
Special Equipment and
Contact (e.g., phone, pager, radio Supplies, Remarks, Notes, Persons
Resource Identifier Leader of # frequency, etc.) Information
6. Work Assignments:
7. Special Instructions:
8. Communications (radio and/or phone contact numbers needed for this assignment): Name/Function Primary Contact: indicate cell, pager, or radio (frequency/system/channel) / / / / 9. Prepared by: Name: Position/Title: Signature: ICS 204 IAP Page _____ Date/Time:
Page 58 INCIDENT RADIO COMMUNICATIONS PLAN (ICS 205) 1. Incident Name: 2. Date/Time Prepared: 3. Operational Period: Date: Date From: Date To: Time: Time From: Time To: 4. Basic Radio Channel Use: Channel Zone Ch Name/Trunked Radio RX Freq RX TX Freq TX Mode Remarks Grp. # Function System Talkgroup Assignment N or W Tone/NAC N or W Tone/NAC (A, D, or M)
5. Special Instructions:
6. Prepared by (Communications Unit Leader): Name: Signature:
ICS 205 IAP Page _____ Date/Time: Page 59
COMMUNICATIONS LIST (ICS 205A) 1. Incident Name: 2. Operational Period: Date From: Date To: Time From: Time To: 3. Basic Local Communications Information: Method(s) of Contact Incident Assigned Position Name (Alphabetized) (phone, pager, cell, etc.)
4. Prepared by: Name: Position/Title: Signature: ICS 205A IAP Page _____ Date/Time:
Page 60
Medical Plan (ICS 206) 1. Incident Name: 2. Operational Period: Date From: Date To: Time From: Time To: 3. Medical Aid Stations: Contact Paramedics Name Location Number(s)/Frequency on Site? Yes No Yes No Yes No Yes No Yes No Yes No 4. Transportation (indicate air or ground): Contact Ambulance Service Location Number(s)/Frequency Level of Service ALS BLS ALS BLS ALS BLS ALS BLS 5. Hospitals: Address, Contact Travel Time Latitude & Longitude Number(s)/ Trauma Burn Hospital Name if Helipad Frequency Air Ground Center Center Helipad Yes Yes Yes Level:_____ No No
Yes Yes Yes Level:_____ No No
Yes Yes Yes Level:_____ No No
Yes Yes Yes Level:_____ No No
Yes Yes Yes Level:_____ No No 6. Special Medical Emergency Procedures:
Check box if aviation assets are utilized for rescue. If assets are used, coordinate with Air Operations. 7. Prepared by (Medical Unit Leader): Name: Signature: 8. Approved by (Safety Officer): Name: Signature: ICS 206 IAP Page _____ Date/Time:
Page 61
INCIDENT ORGANIZATION CHART (ICS 207) 1. Incident Name: 2. Operational Period: Date From: Date To: Time From: Time To: 3. Organization Chart Liaison Officer Incident Commander(s)
Safety Officer
Operations Section Chief Public Information Officer
Staging Area Manager
Planning Section Logistics Section Finance/Admin Chief Chief Section Chief
Resources Unit Ldr. Support Branch Dir. Time Unit Ldr.
Situation Unit Ldr. Supply Unit Ldr. Procurement Unit Ldr.
Documentation Unit Ldr. Facilities Unit Ldr. Comp./Claims Unit Ldr.
Demobilization Unit Ldr. Ground Spt. Unit Ldr. Cost Unit Ldr.
Service Branch Dir.
Comms Unit Ldr.
Medical Unit Ldr.
Food Unit Ldr.
ICS 207 IAP Page ___ 4. Prepared by: Name: Position/Title: Signature: Date/Time:
Page 62
SAFETY MESSAGE/PLAN (ICS 208) 1. Incident Name: 2. Operational Period: Date From: Date To: Time From: Time To: 3. Safety Message/Expanded Safety Message, Safety Plan, Site Safety Plan:
4. Site Safety Plan Required? Yes No Approved Site Safety Plan(s) Located At: 5. Prepared by: Name: Position/Title: Signature: ICS 208 IAP Page _____ Date/Time:
Page 63
INCIDENT STATUS SUMMARY (ICS 209) *1. Incident Name: 2. Incident Number: *3. Report Version (check *4. Incident Commander(s) & 5. Incident *6. Incident Start Date/Time: one box on left): Agency or Organization: Management Date: Organization: Initial Rpt # Time: Update (if used): Final Time Zone: 7. Current Incident Size 8. Percent (%) *9. Incident 10. Incident *11. For Time Period: or Area Involved (use unit Contained Definition: Complexity From Date/Time: label – e.g., “sq mi,” “city ______Level: block”): Completed To Date/Time:
______Approval & Routing Information *12. Prepared By: *13. Date/Time Submitted: Print Name: ICS Position: Time Zone: Date/Time Prepared: *14. Approved By: *15. Primary Location, Organization, or Print Name: ICS Position: Agency Sent To:
Signature: Incident Location Information *16. State: *17. County/Parish/Borough: *18. City:
19. Unit or Other: *20. Incident Jurisdiction: 21. Incident Location Ownership (if different than jurisdiction):
22. Longitude (indicate format): 23. US National Grid Reference: 24. Legal Description (township, section, range): Latitude (indicate format):
*25. Short Location or Area Description (list all affected areas or a reference point): 26. UTM Coordinates:
27. Note any electronic geospatial data included or attached (indicate data format, content, and collection time information and labels):
Incident Summary *28. Significant Events for the Time Period Reported (summarize significant progress made, evacuations, incident growth, etc.):
29. Primary Materials or Hazards Involved (hazardous chemicals, fuel types, infectious agents, radiation, etc.):
30. Damage Assessment Information (summarize A. Structural B. # Threatened C. # D. # damage and/or restriction of use or availability to Summary (72 hrs) Damaged Destroyed residential or commercial property, natural resources, E. Single Residences critical infrastructure and key resources, etc.): F. Nonresidential Commercial Property Other Minor Structures Other ICS 209, Page 1 of ___ * Required when applicable. Page 64
INCIDENT STATUS SUMMARY (ICS 209) *1. Incident Name: 2. Incident Number: Additional Incident Decision Support Information A. # This A. # This Reporting B. Total # Reporting B. Total # *31. Public Status Summary: Period to Date *32. Responder Status Summary: Period to Date C. Indicate Number of Civilians (Public) Below: C. Indicate Number of Responders Below: D. Fatalities D. Fatalities E. With Injuries/Illness E. With Injuries/Illness F. Trapped/In Need of Rescue F. Trapped/In Need of Rescue G. Missing (note if estimated) G. Missing H. Evacuated (note if estimated) H. Sheltering in Place I. Sheltering in Place (note if estimated) I. Have Received Immunizations J. In Temporary Shelters (note if est.) J. Require Immunizations K. Have Received Mass Immunizations K. In Quarantine L. Require Immunizations (note if est.) M. In Quarantine N. Total # Civilians (Public) Affected: N. Total # Responders Affected: 33. Life, Safety, and Health Status/Threat Remarks: *34. Life, Safety, and Health Threat Management: A. Check if Active A. No Likely Threat B. Potential Future Threat C. Mass Notifications in Progress D. Mass Notifications Completed E. No Evacuation(s) Imminent F. Planning for Evacuation G. Planning for Shelter-in-Place 35. Weather Concerns (synopsis of current and predicted H. Evacuation(s) in Progress weather; discuss related factors that may cause concern): I. Shelter-in-Place in Progress J. Repopulation in Progress K. Mass Immunization in Progress L. Mass Immunization Complete M. Quarantine in Progress N. Area Restriction in Effect 36. Projected Incident Activity, Potential, Movement, Escalation, or Spread and influencing factors during the next operational period and in 12-, 24-, 48-, and 72-hour timeframes: 12 hours:
24 hours:
48 hours:
72 hours:
Anticipated after 72 hours:
37. Strategic Objectives (define planned end-state for incident):
ICS 209, Page 2 of ___ * Required when applicable.
Page 65
INCIDENT STATUS SUMMARY (ICS 209) *1. Incident Name: 2. Incident Number: Additional Incident Decision Support Information (continued) 38. Current Incident Threat Summary and Risk Information in 12-, 24-, 48-, and 72-hour timeframes and beyond. Summarize primary incident threats to life, property, communities and community stability, residences, health care facilities, other critical infrastructure and key resources, commercial facilities, natural and environmental resources, cultural resources, and continuity of operations and/or business. Identify corresponding incident-related potential economic or cascading impacts. 12 hours:
24 hours:
48 hours:
72 hours:
Anticipated after 72 hours:
39. Critical Resource Needs in 12-, 24-, 48-, and 72-hour timeframes and beyond to meet critical incident objectives. List resource category, kind, and/or type, and amount needed, in priority order: 12 hours:
24 hours:
48 hours:
72 hours:
Anticipated after 72 hours:
40. Strategic Discussion: Explain the relation of overall strategy, constraints, and current available information to: 1) critical resource needs identified above, 2) the Incident Action Plan and management objectives and targets, 3) anticipated results. Explain major problems and concerns such as operational challenges, incident management problems, and social, political, economic, or environmental concerns or impacts.
41. Planned Actions for Next Operational Period:
42. Projected Final Incident Size/Area (use unit label – e.g., “sq mi”): 43. Anticipated Incident Management Completion Date: 44. Projected Significant Resource Demobilization Start Date: 45. Estimated Incident Costs to Date: 46. Projected Final Incident Cost Estimate: 47. Remarks (or continuation of any blocks above – list block number in notation):
ICS 209, Page 3 of ___ * Required when applicable.
Page 66
INCIDENT STATUS SUMMARY (ICS 209) 1. Incident Name: 2. Incident Number: Incident Resource Commitment Summary 49. Resources (summarize resources by category, kind, and/or type; show # of resources on top ½ of box, show # of personnel associated with resource on 51. Total bottom ½ of box): Personnel
Personnel Personnel (includes those associated
with resources
: – e.g., aircraft
ssigned to assigned to or engines –
48. Agency or . Additional and individual
not a resource Organization: 50 overhead):
52. Total Resources 53. Additional Cooperating and Assisting Organizations Not Listed Above:
ICS 209, Page ___ of ___ * Required when applicable.
Page 67
Resource Status Change (ICS 210) 1. Incident Name: 2. Operational Period: Date From: Date To: Time From: Time To: 3. Resource 4. New Status 5. From (Assignment 6. To (Assignment and 7. Time and Date of Change: Number (Available, and Status): Status): Assigned, O/S)
8. Comments:
9. Prepared by: Name: Position/Title: Signature: ICS 210 Date/Time:
Page 68
INCIDENT CHECK-IN LIST (ICS 211) 1. Incident Name: 2. Incident Number: 3. Check-In Location (complete all that apply): 4. Start Date/Time: Base Staging Area ICP Helibase Other Date: Time:
Check-In Information (use reverse of form for remarks or comments)
5. List single resource
personnel (overhead) by ,
to to
#
agency and name,
OR list resources by the
following format:
Unit or
Request
n
I
-
TF
IncidentContact Home DeparturePoint Methodof Travel IncidentAssignment OtherQualifications
sonnel or
Date/Time Leader’sName TotalNumber of ...... Data . Provided
. Order . . . .
State Agency Category Kind Type Resource Name or Identifier ST
6 7 Check 8 9 Per 10 Information 11 Agency 12 andDateTime 13 14 15 16 Resources Unit
ICS 211 17. Prepared by: Name: Position/Title: Signature: Date/Time:
Page 69
GENERAL MESSAGE (ICS 213) 1. Incident Name (Optional): 2. To (Name and Position):
3. From (Name and Position):
4. Subject: 5. Date: 6. Time
7. Message:
8. Approved by: Name: Signature: Position/Title: 9. Reply:
10. Replied by: Name: Position/Title: Signature: ICS 213 Date/Time:
Page 70
RESOURCE REQUEST MESSAGE (ICS 213 RR) 1. Incident Name: 2. Date/Time 3. Resource Request Number:
4. Order (Use additional forms when requesting different resource sources of supply.): Qty. Kind Type Detailed Item Description: (Vital characteristics, brand, specs, Arrival Date and Time Cost experience, size, etc.) Requested Estimated
Requestor
5. Requested Delivery/Reporting Location:
6. Suitable Substitutes and/or Suggested Sources:
7. Requested by Name/Position: 8. Priority: Urgent Routine Low 9. Section Chief Approval:
10. Logistics Order Number: 11. Supplier Phone/Fax/Email:
12. Name of Supplier/POC: 13. Notes:
Logistics 14. Approval Signature of Auth Logistics Rep: 15. Date/Time: 16. Order placed by (check box): SPUL PROC
17. Reply/Comments from Finance: e
Financ 18. Finance Section Signature: 19. Date/Time: ICS 213 RR, Page 1 Page 71
Activity Log (ICS 214) 1. Incident Name: 2. Operational Period: Date From: Date To: Time From: Time To: 3. Name: 4. ICS Position: 5. Home Agency (and Unit):
6. Resources Assigned: Name ICS Position Home Agency (and Unit)
7. Activity Log: Date/Time Notable Activities
8. Prepared by: Name: Position/Title: Signature: ICS 214, Page 1 Date/Time:
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ACTIVITY LOG (ICS 214) 1. Incident Name: 2. Operational Period: Date From: Date To: Time From: Time To: 7. Activity Log (continuation): Date/Time Notable Activities
8. Prepared by: Name: Position/Title: Signature: ICS 214, Page 2 Date/Time:
Page 73
OPERATIONAL PLANNING WORKSHEET (ICS 215) 1. Incident Name: 2. Operational Period: Date From: Date To:
Time From: Time To:
, ,
Group
(s)
Requested
Other
Branch WorkAssignment Resources Overhead Special Reporting .
. . . .
3 Division, 4. or 5 Special & Instructions 6 7. Position 8. Equipment & Supplies 9 Location 10 Time Arrival Req. Have Need Req. Have Need Req. Have Need Req. Have Need Req. Have Need Req. Have Need 11. Total Resources 14. Prepared by: Required Name: 12. Total Resources
Have on Hand Position/Title: Signature: 13. Total Resources
ICS 215 Need To Order Date/Time:
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INCIDENT ACTION PLAN SAFETY ANALYSIS (ICS 215A) 1. Incident Name: 2. Incident Number:
3. Date/Time Prepared: 4. Operational Period: Date From: Date To: Date: Time: Time From: Time To: 5. Incident Area 6. Hazards/Risks 7. Mitigations
8. Prepared by (Safety Officer): Name: Signature: Prepared by (Operations Section Chief): Name: Signature: ICS 215A Date/Time:
Page 75
ICS 216 Field Resource Status & Demobilization Request
Incident Name: Date Prepared: Time Prepared:
Operational Period Date: Operational Period Time: From: To: From: To:
General Information Branch Number: Division Number: Group Number: Task Force: Strike Team:
Resources Item Status1 Comments
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
N.
Sketch2
Prepared By: Company Name: ICS Position:
Approved By: Company Name: ICS Position:
ICS 216 (9/95)
Notes: 1. Show status as Assigned, Available, De-Mob, or Out-of-Service. 2. On sketch show geography, North arrow, resource location, wind and current speed/direction at the time of report. Use separate page if necessary. Page 76
SUPPORT VEHICLE/EQUIPMENT INVENTORY (ICS 218) 1. Incident Name: 2. Incident Number: 3. Date/Time Prepared: 4. Vehicle/Equipment Category: Date: Time: 5. Vehicle/Equipment Information Category/ Incident Order Vehicle or Vehicle or Kind/Type, Vehicle or Agency Operator Vehicle Incident Release Request Incident Equipment Equipment Capacity, or Equipment or Name or License or Incident Start Date Date and Number ID No. Classification Make Size Features Owner Contact ID No. Assignment and Time Time
ICS 218 6. Prepared by: Name: Position/Title: Signature:
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AIR OPERATIONS SUMMARY (ICS 220) 1. Incident Name: 2. Operational Period: 3. Sunrise: Sunset: Date From: Date To: Time From: Time To: 4. Remarks (safety notes, hazards, air operations special 5. Ready Alert Aircraft: 6. Temporary Flight Restriction Number: equipment, etc.): Medivac: Altitude:
New Incident: Center Point: 8. Frequencies: AM FM 9. Fixed-Wing (category/kind/type, make/model, N#, base): Air/Air Fixed-Wing Air Tactical Group Supervisor Aircraft:
Air/Air Rotary-Wing – 7. Personnel: Name: Phone Number: Flight Following Air Operations Branch Air/Ground Director Air Support Group Command Other Fixed-Wing Aircraft: Supervisor Air Tactical Group Deck Coordinator Supervisor Helicopter Coordinator Take-Off & Landing Coordinator Helibase Manager Air Guard
10. Helicopters (use additional sheets as necessary): FAA N# Category/Kind/Type Make/Model Base Available Start Remarks
11. Prepared by: Name: Position/Title: Signature: ICS 220, Page 1 Date/Time:
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AIR OPERATIONS SUMMARY (ICS 220) 1. Incident Name: 2. Operational Period: 3. Sunrise: Sunset: Date From: Date To: Time From: Time To: 12. Task/Mission/Assignment (category/kind/type and function includes: air tactical, reconnaissance, personnel transport, search and rescue, etc.): Category/Kind/Type Name of Personnel or Cargo (if applicable) Mission and Function or Instructions for Tactical Aircraft Start Fly From Fly To
11. Prepared by: Name: Position/Title: Signature: ICS 220, Page 2 Date/Time:
Page 79
DEMOBILIZATION CHECK-OUT (ICS 221) 1. Incident Name: 2. Incident Number: 3. Planned Release Date/Time: 4. Resource or Personnel Released: 5. Order Request Number: Date: Time: 6. Resource or Personnel: You and your resources are in the process of being released. Resources are not released until the checked boxes below have been signed off by the appropriate overhead and the Demobilization Unit Leader (or Planning Section representative). LOGISTICS SECTION Unit/Manager Remarks Name Signature Supply Unit Communications Unit Facilities Unit Ground Support Unit Security Manager
FINANCE/ADMINISTRATION SECTION Unit/Leader Remarks Name Signature Time Unit
OTHER SECTION/STAFF Unit/Other Remarks Name Signature
PLANNING SECTION Unit/Leader Remarks Name Signature Documentation Leader Demobilization Leader
7. Remarks:
8. Travel Information: Room Overnight: Yes No Estimated Time of Departure: Actual Release Date/Time: Destination: Estimated Time of Arrival: Travel Method: Contact Information While Traveling: Manifest: Yes No Area/Agency/Region Notified: Number: 9. Reassignment Information: Yes No Incident Name: Incident Number: Location: Order Request Number: 10. Prepared by: Name: Position/Title: Signature: ICS 221 Date/Time:
Page 80
ICS 223 Incident Action Plan Health and Safety Message
Incident Name: Date Prepared: Time Prepared:
Operational Period Date: Operational Period Time: From: To: From: To:
Major Hazards and Risks:
Narrative:
Prepared By: Company Name: ICS Position: Safety Officer Approved By: Company Name: ICS Position:
ICS 223 (9/95)
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INCIDENT PERSONNEL PERFORMANCE RATING (ICS 225) THIS RATING IS TO BE USED ONLY FOR DETERMINING AN INDIVIDUAL’S PERFORMANCE ON AN INCIDENT/EVENT 1. Name: 2. Incident Name: 3. Incident Number:
4. Home Unit Name and Address: 5. Incident Agency and Address:
6. Position Held on Incident: 7. Date(s) of Assignment: 8. Incident Complexity Level: 9. Incident Definition: From: To: 1 2 3 4 5 10. Evaluation Rating Factors N/A 1 – Unacceptable 2 3 – Met Standards 4 5 – Exceeded Expectations 11. Knowledge of the Job/ Questionable competence and Competent and credible authority on Superior expertise; advice and actions Professional Competence: credibility. Operational or specialty specialty or operational issues. showed great breadth and depth of expertise inadequate or lacking in Acquired and applied excellent knowledge. Remarkable grasp of Ability to acquire, apply, and key areas. Made little effort to grow operational or specialty expertise for complex issues, concepts, and share technical and professionally. Used knowledge as assigned duties. Showed professional situations. Rapidly developed administrative knowledge and power against others or bluffed growth through education, training, and professional growth beyond skills associated with rather than acknowledging professional reading. Shared expectations. Vigorously conveyed description of duties. (Includes ignorance. Effectiveness reduced knowledge and information with others knowledge, directly resulting in increased operational aspects such as due to limited knowledge of own clearly and simply. Understood own workplace productivity. Insightful marine safety, seamanship, organizational role and customer organizational role and customer knowledge of own role, customer needs, airmanship, SAR, etc., as needs. needs. and value of work. appropriate.) 12. Ability To Obtain Routine tasks accomplished with Got the job done in all routine situations Maintained optimal balance among Performance/Results: difficulty. Results often late or of and in many unusual ones. Work was quality, quantity, and timeliness of work. poor quality. Work had a negative timely and of high quality; required Quality of own and subordinates' work Quality, quantity, timeliness, impact on department or unit. same of subordinates. Results had a surpassed expectations. Results had a and impact of work. Maintained the status quo despite positive impact on IMT. Continuously significant positive impact on the IMT. opportunities to improve. improved services and organizational Established clearly effective systems of effectiveness. continuous improvement. 13. Planning/ Got caught by the unexpected; Consistently prepared. Set high but Exceptional preparation. Always looked Preparedness: appeared to be controlled by events. realistic goals. Used sound criteria to beyond immediate events or problems. Set vague or unrealistic goals. Used set priorities and deadlines. Used Skillfully balanced competing demands. Ability to anticipate, determine unreasonable criteria to set priorities quality tools and processes to develop Developed strategies with contingency goals, identify relevant and deadlines. Rarely had plan of action plans. Identified key information. plans. Assessed all aspects of problems, information, set priorities and action. Failed to focus on relevant Kept supervisors and stakeholders including underlying issues and impact. deadlines, and create a information. informed. shared vision of the Incident Management Team (IMT). 14. Using Resources: Concentrated on unproductive Effectively managed a variety of Unusually skilled at bringing scarce Ability to manage time, activities or often overlooked critical activities with available resources. resources to bear on the most critical of materials, information, money, demands. Failed to use people Delegated, empowered, and followed competing demands. Optimized and people (i.e., all IMT productively. Did not follow up. up. Skilled time manager, budgeted productivity through effective delegation, components as well as Mismanaged information, money, or own and subordinates' time empowerment, and follow-up control. external publics). time. Used ineffective tools or left productively. Ensured subordinates had Found ways to systematically reduce subordinates without means to adequate tools, materials, time, and cost, eliminate waste, and improve accomplish tasks. Employed direction. Cost conscious, sought ways efficiency. wasteful methods. to cut waste. 15. Adaptability/Attitude: Unable to gauge effectiveness of Receptive to change, new information, Rapidly assessed and confidently Ability to maintain a positive work, recognize political realities, or and technology. Effectively used adjusted to changing conditions, political attitude and modify work make adjustments when needed. benchmarks to improve performance realities, new information, and methods and priorities in Maintained a poor outlook. and service. Monitored progress and technology. Very skilled at using and response to new information, Overlooked or screened out new changed course as required. responding to measurement indicators. changing conditions, political information. Ineffective in Maintained a positive approach. Championed organizational realities, or unexpected ambiguous, complex, or pressured Effectively dealt with pressure and improvements. Effectively dealt with obstacles. situations. ambiguity. Facilitated smooth extremely complex situations. Turned transitions. Adjusted direction to pressure and ambiguity into constructive accommodate political realities. forces for change. 16. Communication Skills: Unable to effectively articulate ideas Effectively expressed ideas and facts in Clearly articulated and promoted ideas Ability to speak effectively and and facts; lacked preparation, individual and group situations; before a wide range of audiences; listen to understand. Ability to confidence, or logic. Used nonverbal actions consistent with accomplished speaker in both formal and express facts and ideas inappropriate language or rambled. spoken message. Communicated to extemporaneous situations. Adept at clearly and convincingly. Nervous or distracting mannerisms people at all levels to ensure presenting complex or sensitive issues. detracted from message. Failed to understanding. Listened carefully for Active listener; remarkable ability to listen listen carefully or was too intended message as well as spoken with open mind and identify key issues. argumentative. Written material words. Written material clear, concise, Clearly and persuasively expressed frequently unclear, verbose, or and logically organized. Proofread complex or controversial material, poorly organized. Seldom proofread. conscientiously. directly contributing to stated objectives.
Page 82
INCIDENT PERSONNEL PERFORMANCE RATING (ICS 225) 1. Name: 2. Incident Name: 3. Incident Number:
10. Evaluation Rating Factors N/A 1 – Unacceptable 2 3 – Met Standards 4 5 – Exceeded Expectations 17. Ability To Work on a Used teams ineffectively or at wrong Skillfully used teams to increase unit Insightful use of teams raised unit Team: times. Conflicts mismanaged or effectiveness, quality, and service. productivity beyond expectations. often left unresolved, resulting in Resolved or managed group conflict, Inspired high level of esprit de corps, Ability to manage, lead and decreased team effectiveness. enhanced cooperation, and involved even in difficult situations. Major participate in teams, Excluded team members from vital team members in decision process. contributor to team effort. Established encourage cooperation, and information. Stifled group Valued team participation. Effectively relationships and networks across a develop esprit de corps. discussions or did not contribute negotiated work across functional broad range of people and groups, productively. Inhibited cross boundaries to enhance support of raising accomplishments of mutual goals functional cooperation to the broader mutual goals. to a remarkable level. detriment of unit or service goals. 18. Consideration for Seldom recognized or responded to Cared for people. Recognized and Always accessible. Enhanced overall Personnel/Team Welfare: needs of people; left outside responded to their needs; referred to quality of life. Actively contributed to resources untapped despite outside resources as appropriate. achieving balance among IMT Ability to consider and respond apparent need. Ignorance of Considered individuals' capabilities to requirements and professional and to others’ personal needs, individuals’ capabilities increased maximize opportunities for success. personal responsibilities. Strong capabilities, and chance of failure. Seldom Consistently recognized and rewarded advocate for subordinates; ensured achievements; support for and recognized or rewarded deserving deserving subordinates or other IMT appropriate and timely recognition, both application of worklife subordinates or other IMT members. members. formal and informal. concepts and skills. 19. Directing Others: Showed difficulty in directing or A leader who earned others' support An inspirational leader who motivated Ability to influence or direct influencing others. Low or unclear and commitment. Set high work others to achieve results not normally others in accomplishing tasks work standards reduced productivity. standards; clearly articulated job attainable. Won people over rather than or missions. Failed to hold subordinates requirements, expectations, and imposing will. Clearly articulated vision; accountable for shoddy work or measurement criteria; held empowered subordinates to set goals irresponsible actions. Unwilling to subordinates accountable. When and objectives to accomplish tasks. delegate authority to increase appropriate, delegated authority to Modified leadership style to best meet efficiency of task accomplishment. those directly responsible for the task. challenging situations. 20. Judgment/Decisions Decisions often displayed poor Demonstrated analytical thought and Combined keen analytical thought, an Under Stress: analysis. Failed to make necessary common sense in making decisions. understanding of political processes, and decisions, or jumped to conclusions Used facts, data, and experience, and insight to make appropriate decisions. Ability to make sound without considering facts, considered the impact of alternatives Focused on the key issues and the most decisions and provide valid alternatives, and impact. Did not and political realities. Weighed risk, relevant information. Did the right thing recommendations by using effectively weigh risk, cost, and time cost, and time considerations. Made at the right time. Actions indicated facts, experience, political considerations. Unconcerned with sound decisions promptly with the best awareness of impact of decisions on acumen, common sense, risk political drivers on organization. available information. others. Not afraid to take reasonable assessment, and analytical risks to achieve positive results. thought. 21. Initiative Postponed needed action. Championed improvement through new Aggressively sought out additional Ability to originate and act on Implemented or supported ideas, methods, and practices. responsibility. A self-learner. Made new ideas, pursue improvements only when directed to Anticipated problems and took prompt worthwhile ideas and practices work opportunities to learn and do so. Showed little interest in action to avoid or resolve them. when others might have given up. develop, and seek career development. Feasible Pursued productivity gains and Extremely innovative. Optimized use of responsibility without guidance improvements in methods, services, enhanced mission performance by new ideas and methods to improve work and supervision. or products went unexplored. applying new ideas and methods. processes and decisionmaking. 22. Physical Ability for the Failed to meet minimum standards Committed to health and well-being of Remarkable vitality, enthusiasm, Job: of sobriety. Tolerated or condoned self and subordinates. Enhanced alertness, and energy. Consistently others' alcohol abuse. Seldom personal performance through activities contributed at high levels of activity. Ability to invest in the IMT’s considered subordinates' health and supporting physical and emotional well- Optimized personal performance through future by caring for the well-being. Unwilling or unable to being. Recognized and managed involvement in activities that supported physical health and emotional recognize and manage stress stress effectively. physical and emotional well-being. well-being of self and others. despite apparent need. Monitored and helped others deal with stress and enhance health and well-being. 23. Adherence to Safety: Failed to adequately identify and Ensured that safe operating procedures Demonstrated a significant commitment Ability to invest in the IMT’s protect personnel from safety were followed. toward safety of personnel. future by caring for the safety hazards. of self and others.
24. Remarks:
25. Rated Individual (This rating has been discussed with me): Signature: Date/Time: 26. Rated by: Name: Signature: Home Unit: Position Held on This Incident: ICS 225 Date/Time:
Page 83
HOSPITAL RESOURCE INVENTORY
HOSPITAL GREEN RED YELLOW AVAILABLE UTILIZED AVAILABLE UTILIZED AVAILABLE UTILIZED AVAILABLE UTILIZED AVAILABLE UTILIZED AVAILABLE UTILIZED AVAILABLE UTILIZED AVAILABLE UTILIZED AVAILABLE UTILIZED AVAILABLE UTILIZED AVAILABLE UTILIZED SPEMS - 901 Page 84
MAJOR EMS INCIDENT PATIENT TRANSPORT LOG PAGE _____OF______
LOCATION______
DATE______TR. MET NAME PRIORITY TRANS. TIME TAG# TAG# SEX (IF KNOWN) CODE DESTN. UNIT OUT M F G Y R M F G Y R M F G Y R M F G Y R M F G Y R M F G Y R M F G Y R M F G Y R M F G Y R M F G Y R M F G Y R M F G Y R M F G Y R M F G Y R M F G Y R M F G Y R M F G Y R M F G Y R M F G Y R M F G Y R M F G Y R M F G Y R M F G Y R M F G Y R M F G Y R M F G Y R SPEMS – 902 Page 85
EMS Major Incident Comm Center Transport Log Page _____ of _____
Incident Name:______Date:______
If one unit transports to multiple destinations use a line for each destination. Unit # Time # R # Y # G Destination Time at Crew Members Hospital
SPEMS - 903 Page 86
UMC EMS Comm Center MCI Documentation Sheet
Date:______Time Declared:______Time Cleared:______
Location:______Type of Incident:______
Estimated Number of Patients:______Red:______Yellow:______Green:______Black:______
Hazards Present:______
______
EMS Command:______
______Time Changed:______
Incident Command Post Location:______
Staging Area Location:______
Staging Area Manager:______
______Time Changed:______
Initial Resources Requested:______
______
______
Transport Group Supervisor:______
EMS Operations or Branch Director:______
Other Information:______
______
______
______
SPEMS - 904
Page 87