Mass casualty incident - Revision history

Mholtz at 07:05, 23 October 2017

2017-10-23T07:05:54Z

← Older revision		Revision as of 07:05, 23 October 2017
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	===Initial Triage===		===Initial Triage===
	*~~In an MCI, triage differs slightly from normal Emergency Department triage.~~		*See [[Mass casualty incident triage]]
	**Based not only on severity of injury/illness, but also on prognosis/survivability in the setting of limited resources<ref>Pesik N, Keim ME, Iserson KV. Terrorism and the ethics of emergency medical care. Ann Emerg Med. 2001 Jun;37(6):642-6.</ref>
	*[[Mass casualty incident ~~triage\|START~~ triage]] ~~is the most common triage system utilized in the United States.~~
	**Several other triage systems exist, but all (including START) lack validation or strong evidence (likely impossible given nature of MCIs)<ref name="Cross">Cross KP, Petry MJ, Cicero MX. A better START for low-acuity victims: data-driven refinement of mass casualty triage. Prehosp Emerg Care. 2015 Apr-Jun;19(2):272-8. doi: 10.3109/10903127.2014.942481.</ref><ref name="Kahn">Kahn CA, Schultz CH, Miller KT, Anderson CL. Does START triage work? An outcomes assessment after a disaster. Ann Emerg Med. 2009 Sep;54(3):424-30, 430.e1. doi: 10.1016/j.annemergmed.2008.12.035.</ref>
	*Triage should be ongoing process, with patient statuses (and triage designations) updated as they change.

	===Incident Command System (ICS)===		===Incident Command System (ICS)===
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	==See Also==		==See Also==
			*[[Mass casualty incident triage]]
	*[[GEMC:Prehospital_/_Disaster_/_Mass_Casualty_Medicine]]		*[[GEMC:Prehospital_/_Disaster_/_Mass_Casualty_Medicine]]
	*[[Mass casualty incident triage]]

	==References==		==References==

Rossdonaldson1: Rossdonaldson1 moved page Mass casualty incidents to Mass casualty incident

2016-07-04T20:25:52Z

Rossdonaldson1 moved page Mass casualty incidents to Mass casualty incident

← Older revision	Revision as of 20:25, 4 July 2016
(No difference)

Mholtz at 01:58, 25 July 2015

2015-07-25T01:58:02Z

← Older revision		Revision as of 01:58, 25 July 2015
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	===Incident Command System (ICS)===		===Incident Command System (ICS)===
			*An Incident Command System (ICS) is designed to allow for coordination of response to an MCI by providing for an integrated organizational/command structure<ref name="FEMA">FEMA IS 0100.b - Introduction to the Incident Command System (ICS), Student Manual. http://training.fema.gov/emiweb/is/is100b/student%20manual/02ics100b_sm_october2013.pdf. Accessed 07/24/2015.</ref>
	*~~Ensure~~ the ~~scene is safe~~		**ICS has been in use since the 1970's.
	*Establish Incident ~~Commander~~ (IC)		**Designed to expand or contract in size in response to scope of incident.
	*~~Request additional appropriate resources~~		*After the September 11, 2001 terrorist attacks, the Department of Homeland Security proposed the National Incident Management System (NIMS) in response to perceived deficiencies in coordination between emergency responders.<ref>Jensen J, Youngs G. Explaining implementation behaviour of the National Incident Management System (NIMS). Disasters. 2015 Apr;39(2):362-88. doi: 10.1111/disa.12103.</ref>
	**~~Additional ALS/BLS~~		**NIMS mandates the use of ICS in the United States for MCI response<ref name="FEMA" />
	**Fire resources (~~HAZMAT~~, ~~heavy rescue, ect~~.)
	**~~Medevac~~
	***Establish landing zone
	*Establish staging areas for ~~resources~~
	*No more than 8 people per supervisor
	**3-5 preferred

	==External Links==		==External Links==
	[http://training.fema.gov/emiweb/is/icsresource/index.htm FEMA ICS Resource Center]		*[http://training.fema.gov/emiweb/is/icsresource/index.htm FEMA ICS Resource Center]
	[https://training.fema.gov/is/nims.aspx FEMA Online NIMS Training]		*[https://training.fema.gov/is/nims.aspx FEMA Online NIMS Training]

	==See Also==		==See Also==

Mholtz at 01:31, 25 July 2015

2015-07-25T01:31:12Z

← Older revision		Revision as of 01:31, 25 July 2015
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	==See Also==		==See Also==
	[[GEMC:Prehospital_/_Disaster_/_Mass_Casualty_Medicine]]		*[[GEMC:Prehospital_/_Disaster_/_Mass_Casualty_Medicine]]
	[[Mass casualty incident triage]]		*[[Mass casualty incident triage]]

	==References==		==References==

Mholtz at 01:24, 25 July 2015

2015-07-25T01:24:37Z

← Older revision		Revision as of 01:24, 25 July 2015
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	==Management==		==Management==
			[[File:ICS org chart.bmp\|thumbnail\|ICS Organization Structure]]

	===Initial Triage===		===Initial Triage===
	*In an MCI, triage differs slightly from normal Emergency Department triage.		*In an MCI, triage differs slightly from normal Emergency Department triage.
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	===Incident Command System (ICS)===		===Incident Command System (ICS)===
	~~[[File:ICS org chart.bmp\|thumbnail\|ICS Organization Structure]]~~
	*Ensure the scene is safe		*Ensure the scene is safe
	*Establish Incident Commander (IC)		*Establish Incident Commander (IC)
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	*No more than 8 people per supervisor		*No more than 8 people per supervisor
	**3-5 preferred		**3-5 preferred

			==External Links==
			[http://training.fema.gov/emiweb/is/icsresource/index.htm FEMA ICS Resource Center]
			[https://training.fema.gov/is/nims.aspx FEMA Online NIMS Training]

			==See Also==
			[[GEMC:Prehospital_/_Disaster_/_Mass_Casualty_Medicine]]
			[[Mass casualty incident triage]]

	==References==		==References==

Mholtz at 08:36, 24 July 2015

2015-07-24T08:36:03Z

@@ Line 1: / Line 1: @@
-==Pre-hospital==
+==Background==
-===ICS===
+*Mass Casualty Incident (MCI) defined as an incident where the number of patients (or the rate of their arrival to a medical facility) overwhelms local resources (and the ability to immediately supplement them).<ref name="Briggs">Briggs SM. Disaster management teams. Curr Opin Crit Care. 2005 Dec;11(6):585-9.</ref><ref name="Lee">Lee JS, Franc JM. Impact of a Two-step Emergency Department Triage Model with START, then CTAS, on Patient Flow During a Simulated Mass-casualty Incident. Prehosp Disaster Med. 2015 Jun 24:1-7.</ref>
 [[File:ICS org chart.bmp|thumbnail|ICS Organization Structure]]
 *Ensure the scene is safe
@@ Line 12: / Line 25: @@
 *No more than 8 people per supervisor
 **3-5 preferred
 ==References==

Pcoti: added info on hospital management

2015-07-22T23:09:55Z

added info on hospital management

← Older revision		Revision as of 23:09, 22 July 2015
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	*Call area hospitals and determine how many patients each can take		*Call area hospitals and determine how many patients each can take
	**Keep record of where each patient goes by tag number		**Keep record of where each patient goes by tag number

			==Hospital==
			*Expect no more than 10 minutes notice for arrival of patients
			*Discharge/move current ED patients to accommodate surge
			*Ensure large quantity of resources are easily accessible in the (medications, stretchers, ect.)
			*Triage all patients as they arrive, even if they were triage in prehospital setting
			*Optimal to have 1:8 trauma teams per patient<ref>Hirshberg A., 2010 Nov, Triage and trauma workload in mass casualty: a computer model. J Trauma. 69(5):1074-81</ref>

	==Differential Diagnosis==		==Differential Diagnosis==
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	==Diagnosis==		==Diagnosis==
	*[[Mass casualty incident triage]]		*[[Mass casualty incident triage]]

			==References==
			<References/>

	[[Category:Misc/General]]		[[Category:Misc/General]]
	[[Category:EMS]]		[[Category:EMS]]

Pcoti: /* ICS */ minor addition

2015-07-22T22:11:34Z

ICS: minor addition

← Older revision		Revision as of 22:11, 22 July 2015
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	===ICS===		===ICS===
	[[File:ICS org chart.bmp\|thumbnail\|ICS Organization Structure]]		[[File:ICS org chart.bmp\|thumbnail\|ICS Organization Structure]]
			*Ensure the scene is safe
	*Establish Incident Commander (IC)		*Establish Incident Commander (IC)
	*Request additional appropriate resources		*Request additional appropriate resources

Pcoti: added info on medical ops

2015-07-22T15:35:26Z

added info on medical ops

← Older revision		Revision as of 15:35, 22 July 2015
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	==Pre-hospital==		==Pre-hospital==
	===ICS===		===ICS===
			[[File:ICS org chart.bmp\|thumbnail\|ICS Organization Structure]]
	*Establish Incident Commander (IC)		*Establish Incident Commander (IC)
	*Request additional appropriate resources		*Request additional appropriate resources
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	*No more than 8 people per supervisor		*No more than 8 people per supervisor
	**3-5 preferred		**3-5 preferred

			===Medical operations===
			*Establish triage area
			**Utilize [[Mass casualty incident triage\|START triage]]
			**Ensure all patients receive physical tag
			**Depending on size on incident, setup shelter for triage area
			***In large incident, setup area for dead away from triage
			*Call area hospitals and determine how many patients each can take
			**Keep record of where each patient goes by tag number

	==Differential Diagnosis==		==Differential Diagnosis==

Pcoti: added info on ICS

2015-07-22T15:19:09Z

added info on ICS

← Older revision		Revision as of 15:19, 22 July 2015
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			==Pre-hospital==
			===ICS===
			*Establish Incident Commander (IC)
			*Request additional appropriate resources
			**Additional ALS/BLS
			**Fire resources (HAZMAT, heavy rescue, ect.)
			**Medevac
			***Establish landing zone
			*Establish staging areas for resources
			*No more than 8 people per supervisor
			**3-5 preferred

	==Differential Diagnosis==		==Differential Diagnosis==
	{{MCI types}}		{{MCI types}}