| Gary Ludwig |
EMS and ICS
| Gary Ludwig is the EMS Bureau Chief for the St. Louis Fire Department. He is currently serving his third term as an elected board member to the EMS Section for the International Association of Fire Chiefs and lectures quite frequently at fire and EMS conferences. This is Gary's last EMS column, having moved into our Editorial Board last issue. |
This article can be found on
page 56 of the Mar/Apr 1998
issue of 9-1-1 Magazine.
Sooner or later, your agency will encounter a multi-casualty incident, or MCI.
An MCI is any incident in which the number of patients overwhelms the capabilities of initial responders. If you work for a service in a rural environment where one ambulance covers an entire county, an MCI could be a serious auto accident with 5 critical patients. In a densely urban service, an MCI might be 15 or more patients.
Whatever the number, an EMS agency must have a plan in place which escalates incrementally based upon the number of patients. Usually, the EMS plan falls under the greater umbrella of an incident management system where there are various branches, divisions or groups reporting to one Incident Commander. The medical branch is only one such branch. Other groups may include a rescue group, fire group, police group, etc.
The whole purpose behind the Incident Command System is to establish a standardized form of order into what has or may become an overwhelming situation. Most businesses operate in some organized manner to accomplish their mission. Whether it be a bank, grocery store, or restaurant, there are various areas of responsibility which help the business accomplish its core mission. ICS has become so successful that the theory has been implemented in private businesses during a crisis or high intensity events.
Part of the planning process EMS agencies should go through when devising or modifying their MCI plan is to look at what can cause an MCI. Most MCIs can be broken down into two categories man-made and natural. Examples of man-made MCIs would be transportation accidents, chemical, biological or nuclear releases, bombings, etc. Tornadoes, hurricanes, earthquakes, flooding would be examples of natural disasters that can cause multiple injuries.
If you have a large amount of railroad traffic through your community, you might anticipate a chemical release if a derailment occurs. If that rail traffic includes Amtrak trains, you might anticipate a large number of injuries from a derailment.
Communities which have an interstate highway can predict a transportation accident with multiple casualties. This may come from passenger buses or trucks carrying hazardous materials.
EMS agencies in California are always conscious of earthquakes and have many pre-plans with task force staging areas they automatically report to in the event the radio system fails. After Hurricane Andrew devastated Florida, many EMS agencies in Florida developed contingencies in the event another tragedy of such magnitude would demolish their state again.
The key component for implementation during any multi-casualty event includes the proper triaging of the injured. To accomplish this, patients are prioritized based on the severity of their injuries. As patients are moved into a treatment area, a triage tag tells EMS personnel which sector of the treatment area the patients should go to. Deceased patients are triage tagged accordingly and not moved. The treatment area should be logically placed and those patients brought to the treatment should be arranged in a specific manner.
Any treatment group which is established should take into consideration egress and access of transport vehicles. Preferably, the red treatment group, or the highest priority patients, should be established closest to the egress point for transport vehicles.
One would think that red category patients should be the first leave a scene. But other schools of thought in a large multi-casualty event advocate the green tagged, or walking wounded. The theory is that walking wounded get in the way of emergency personnel and also take up valuable human resources since personnel are needed to watch over them. Thus, some suggest the walking wounded be put on a bus and moved away from the site with one medical person on board.
Occasionally, it may be necessary to establish special groups during a MCI depending upon the situation. During the Murrah Federal Building bombing in Oklahoma City, it was necessary to establish a special decontamination area just for biohazardous waste because of all the body fluid rescue personnel were exposed to.
Any MCI plan needs to be flexible. No two situations will ever be the same and you will find out MCI plans do not always follow the text book. Therefore, the more prepared, adaptable, and trained your department is, will determine your ability to respond to a MCI.
