What Is A Multiple Casualty Incident?

A Multiple (or "Multi-" or "Mass"), Casualty Incident (MCI), is defined as any incident that outstrips the resources of the first responding units. An ambulance can care for two patients; 3 or more is a small MCI, needing at least one more ambulance.

Examples of multiple-casualty incidents (MCI), that might happen at any moment are:

1. a school bus accident (60+ patients)

2. A crowded tour bus accident (60+ patients)

3. Crowded tour boat accident (400+ patients!)

4. A fire, explosion, gas leak or other catastrophe affecting a restaurant, apartment complex, store, school, park or during a festival or sporting event

5. An industrial accident

6. Release of hazardous or toxic materials

7. A plane crash (large-capacity passenger planes fly in and out of Fort Drum, and we are close to busy air routes from New York City, Cleveland and Washington, DC back and forth to Montreal, Toronto and Quebec) (440+ patients)

These are things we hope never will happen in our community, but that could  happen. 

MASS CASUALTY INCIDENT RESPONSE

Here’s how it works:  

As TIERS personnel find a location that is safe from the effects of the incident--far enough away to make sure that smoke, fumes, flames or any other hazards cannot affect rescuers or patients--areas are laid out to separate patients into three distinct areas.

RED (Priority 1):  Critically-injured patients here are treated by Paramedics with assistance from Emergency Medical Technicians (EMTs), and other advanced medical personnel who may be on the scene. Their injuries are immediately life-threatening, and they are the first ones that will be transported to hospitals by ambulance or helicopter.  Severe head, chest, back or internal injuries, loss of consciousness, multiple fractures, arterial bleeding, deep or large-area burns, or any combination of these or other injuries that will lead to death belong here. Paramedics can administer some medications, insert intravenous (IV), fluids, put patients on cardiac monitors and perform life-saving resuscitation in case of a heart attack or if a patient stops breathing, insert a breathing tube (“intubate”), patients to assist in breathing, and even perform some minor operations to open a crushed or blocked airway, or relieve pressure caused by a build up of blood or air inside the chest cavity. 

YELLOW (Priority 2): Patients here are seriously injured, with injuries that may be—or become--life-threatening, including head, neck and chest injuries, major lacerations, possible internal injuries, more serious burns, eye injuries, difficulty breathing, etc. They will be treated and very carefully observed for any signs that their condition may be beginning to deteriorate.

GREEN (Priority 3): Patients in this area are injured, but stable, and need minimal medical attention. They can be attended to be Certified First Responders (CFR), EMTs, and even bystanders or family members under supervision of trained medical personnel. Injuries might include bumps, bruises, cuts, anxiety, simple fractures of small bones, smoke inhalation, minor burns etc. 

Depending on the situation, there may also need to be a BLACK area established for victims who are deceased, or whose medical condition is will obviously result in imminent death. This area would be placed in a more private location, away from survivors as much as practical.

Scene Organization

TIERS personnel at any MCI scene would organize into specific areas that would concentrate on specific operational functions. Some of these jobs might also be delegated to non-medical personnel on scene and volunteer their efforts.

• In the first crucial minutes of an MCI, a medical scene commander would coordinate all activities relating to patient triage and care and issue requests for additional help and supplies, make sure hospitals are notified of the large number of patients expected, quickly establish locations for patient treatment and establish open routes for emergency equipment to come and go from the scene without getting in each others’ way—including establishing safe landing zones for helicopters.

   Triage which means “to sort”, is accomplished by using a specially-designed SMART Triage kit. A small plastic pouch is attached to each patient with only the most vital information written on the form inside, which is then folded to show either a GREEN, YELLOW, RED or BLACK flag—based on the quick initial assessment—and put back in the pouch.

• Medical responders would then tend to the RED patients first, then the YELLOW patients, then the GREEN patients, adding more assessment and treatment information to the form. The folding form makes it easy to change a patient’s priority if his or her condition changes. 
• Once triage is underway, extrication teams of firefighters and medical personnel would begin victim removal from a scene. Less-seriously-injured victims may have to be moved to the treatment area first to allow rescuers to reach trapped victims with additional personnel and bulky rescue equipment. Commanders may also need to coordinate divers or boats as needed for water rescues. They would set priorities for which resources would be used for what patients based on their injuries and based on the the amount of time needed to extricate them from the scene. Patient Care would include further triage and on-scene care as described above.
• A TIERS member or qualified volunteer would be appointed to monitor the use of resources and attempt to get bandages, splints, oxygen, linens, stretchers or other materials from other ambulances, fire rescue vehicles or from the Jefferson County EMS Bureau or hospitals or other sources as needed.

• Transportation would be prioritized to make sure that appropriately-staffed ambulances are used for moving patients to hospitals, and to make sure that there is a clear traffic route in and out from the treatment area. More serious patients will require a paramedic-staffed ambulance or a helicopter for transport. Other patients may be able to go with EMT-staffed ambulances, based on their injuries and state and local medical protocols.

• Using radios and cell phones, one person would keep track of any developing hazards at the scene, relay requests for additional manpower or resources, help coordinate which hospitals have room for any more incoming patients, and try to coordinate news media coverage.

• Other helpers would have to establish tracking of all patient names, their treatments and status (green, yellow, red, black), and to which hospitals they may have been transported, and help complete the required medical treatment records.