Mass Casualty Incident

• Incident Action Plan

  Template to communicate with Health Emergency Operations Centres
• ETHANE

  • Exact location
  • Type of incident
  • Hazards
  • Access & Egress
  • No. of pts
  • Emergency services
• Exact location

  • Landmarks, cross-streets, address
• Type of incident

  • Multi-vehicle collision, building collapse, mass casualty
• No. of pts

  • Severity of casualties
• Emergency services

  • What services already on scene and any other additional resources
• CBRIE

  Chemical, biological, radiological, incendiary, explosive
• Initial management of CBRIE

  1. Hot zone - Contaminated zone

  2. Warm zone - Uphill and upwind, decontamination and triage occurs here

  3. Cold/support zone - Where decontaminated patients are received, treated and transported
• Steps to respond to a CBRIE

  1. Notify dispatch or emergency using METHANE approach

  2. Step 1 - Only one collapsed casualty, approach using normal procedures

  3. Step 2 - Only two collapsed casualties, approach with caution

  4. Step 3 - Multiple collapsed casualties, do not approach scene, withdraw, contain, and report using METHANE, request specialist help

  5. If contaminated, isolate yourself and commence self-decontamination
• Incident Levels

  • 1 - Resolved through local or initial response resources, control is limited to the immediate area
  • 2 - Requires several health providers' response within an area
  • 3 - More substantial organisational structure across larger geographical areas to manage the emergency
  • 4 - Category 5 cyclone, widespread destruction across multiple states, all levels of government, military, international aid
• Example scenario for Incident Level 1: Multi-vehicle collision with 10 casualties, Ambulance crew
• Example scenario for Incident Level 2: Train derailment in rural area with 50 casualties, Police, additional ambulances, fire trucks, police
• Example scenario for Incident Level 3: Major bushfire threatening multiple towns, Evacuation
• Example scenario for Incident Level 4: Category 5 cyclone, widespread destruction across multiple states, All levels of government, military, international aid
• SITREP


  Situation Report
• SITREP


  • E - Exact location
  • T - Type of incident
  • H - Hazards
  • A - Access & Egress
  • N - Number / types of pt
  • E - Emergency services present or needed
• SiteHC


  Site Health Commander
• SiteHC


  • Commanding and ensuring the safety of SiteHTs
  • Maintaining situational awareness
  • Communicating and liaising with the Ambulance Commander AC and other commanders
  • Reporting back to the Health Incident Controller HIC using the ETHANE format
  • Prioritizing care at the casualty clearing post with the Ambulance Triage Officer
  • Making transport disposition decisions in conjunction with the HIC, AC, Ambulance Triage Officer, and Ambulance Transport Officer
  • Ensuring sufficient health resources are sent to the site via the HIC
  • Checking that all health personnel and equipment are clear of the site
• SiteHT


  Site Health Team
• SiteHT


  • A specialist medical response team trained in pre-hospital medicine, comprising doctors and nurses sent to an incident site to provide patient care
• SORT Triage


  Allows for a more thorough assessment compared to the initial rapid "triage sieve" done at the scene. It helps confirm the patient's condition and treatment priority before they are transported to the hospital.
• SORT Triage

  1. Sort - Re-assess pt condition

  2. Observe - Monitor vitals

  3. Rank - Re-prioritise pt based on Triage Trauma score

  4. Treatment - Provide stabilising treatment before transport
• Triage Trauma Score (TTS)

  • Code parameters from 0-4 based on magnitude of the physiologic derangement
  • 12 - Priority 3
  • 11 - Priority 2
  • 10 or less - Priority 1
• SMEACS-Q

  • Situation - Current situation and overview of the incident
  • Mission - Mission or objectives to be achieved
  • Execution - Execution plan, including tactics and strategies
  • Administration/Logistics -
  • Communications - Contact information
  • Safety - Safety considerations and hazards
  • Questions - Any outstanding questions or information needs
• Responsibilities of initial commander

  • Site assessment
  • Risk assessment
  • Risk controls
  • Site organisation
• Site assessment

  • Hazard identification (Place, Object, Person)
  • Manual tasks (lifting, removing debris, falls, slips, trips, uneven environment)
  • Unprotected live electrical wires, fires/explosions, floods
  • Biological hazards (blood, bodily materials, animal wastes, biological toxins)
  • Exposure to chemicals (asbestos, chlorine gas, carbon monoxide)
  • Psychological stress
• Risk assessment


  • Risk severity (minor injury to major death)
  • Existing control measures (available resources of PPE, triage setup, chemical spill kits)
  • Removing or containing hazards
  • Urgency of action to deal with risks
• Site organisation

  • Inner cordon (immediate incident scene, area of hazard or contamination)
  • Outer cordon (relevant support activities, e.g SiteHC and SiteHT responses)

  
• Triage tag colours

  • Red (immediate priority, life-threatening injuries)
  • Yellow (delayed priority, serious injuries)
  • Green (minimal priority, stable individuals)
  • Black (expectant or deceased, not expected to survive)
• Elements to consider when triaging trauma patients

  • Vital Signs Criteria
  • MOI Criteria
  • Patterns of Injury Criteria
• Vital Signs Criteria

  • Conscious State
  • RR
  • SpO2 (Room air)
  • HR
  • SBP
• Vital Signs Thresholds by Age

  • Neonate (First 28 days)
  • Infant (12 months)
  • Child (18 yrs)
  • Older child (9-12 yrs)
  • Adult (14 yrs old)
• MOI Criteria (High Risk)

  • Ejected from vehicle
  • Fall from height of 3m
  • Explosion incident
  • Involved in high impact RTC with vehicle structure intrusion
  • Vehicle rollover
  • RTC with fatality in same vehicle
  • Entrapped 30 minutes in vehicle accident
• Patterns of Injury Criteria

  • Head, neck, chest, abdomen, pelvis, axilla, groin (penetrating, sustained from blasts, involve two or more regions)
  • Amputation of limbs above ankle or wrist
  • Suspected c-spine injuries
  • Adults with burns 20% of body
  • Children with burns 10% of body
  • Complicated burn injuries
  • Serious crush injuries
  • Major open fracture / open dislocation with vascular compromise
  • Fractured pelvis
  • Fractures involving two or more: femur, tibia, humerus
• Life-saving Treatment

  • Opening or removing airway obstructions
  • CPR
  • Stabilising spine, neck, and head before moving
  • Controlling major haemorrhaging (femoral artery, severed limbs)
  • Basic airways management (head tilt, jaw thrust, mouth opening)
• GCS Trauma Score


  GCS: 13-15. Score = 4

  GCS: 9-12. Score = 3

  GCS: 6-8. Score = 2

  GCS: 4-5. Score = 1

  GCS: 3. Score = 0
• SBP Trauma Score


  SBP: >89. Score = 4

  SBP: 76-78. Score = 3

  SBP: 50-75. Score: 2

  SBP: 1-49. Score: 1
• RR Trauma Score


  RR: 10-29. Score = 4

  RR: >29. Score = 3

  RR: 6-9> Score = 2

  RR: 1-5. Score = 1
• Initial Commander


  Determines response and directs team
• Initial triage officer/clinician


  Estimates casualty numbers, tags patients, SORT triage, basic airway management