VERMONT EMS DISTRICT #3. Mass Casualty Incident (MCI) Management Plan

Transcription

1 VERMONT EMS DISTRICT #3 Mass Casualty Incident (MCI) Management Plan July 2014 Appendix F Amended 8/13/2015

2 Table of Contents SECTION I: INTRODUCTION... 1 Introduction... 2 Concept of MCI Management... 3 Activation of Plan:... 3 Helicopter/Air Operations Branch:... 4 Helicopter Landing Zone Radio Frequency... 4 Standing Orders for EMS Operations... 5 Regional MCI Coordinators:... 5 Scalability of EMS Response... 5 Vermont MCI Trailer Locations... 6 SECTION II: EMS BRANCH... 7 FIRST EMS UNIT ON-SCENE... 8 EMS Control Role... 9 Scene Set Up Routine MCI Scene SECTION III: TRIAGE Triage Officer Triage Concepts Triage Methodology Triage Tags Mettag Triage Tag Instructions SALT (Sort, Assess, Lifesaving Interventions Treatment/Transport) SECTION IV: TREATMENT... ERROR! BOOKMARK NOT DEFINED. Treatment Officer Treatment Area Morgue Area SECTION V: TRANSPORTATION Transportation Officer Patient Transport & Destination Hospital Notification Transportation Log SECTION VI: STAGING UNIT Staging Officer Staging Concepts SECTION VII: COMMUNICATIONS Radio Language Primary On-Scene (Tactical) Channel Communications Scene to Hospital National Tactical Frequencies Alternate Communication Systems ii -

3 SECTION VIII: HAZMAT, TERRORISM, WEAPONS OF MASS DESTRUCTION Hazmat, Terrorism, Weapons of Mass Destruction Vermont Emergency Management Emergency Operations Center Scene Set Up: APPENDICES Appendix A: INCIDENT COMMAND SYSTEM (ICS) Appendix B: Instructions for Responding Mutual Aid Units Appendix C: EMS Agency Resource List Appendix D: EMS Command Job Action Sheets & Forms JOB ACTION SHEET Appendix E: BTV PHASE System Overview Appendix F: VT EMS District #3 Response Plan iii -

4 SECTION I: INTRODUCTION Page 17

5 Introduction It is the intent of Vermont EMS District 3 to create an environment where the fullest degree of understanding and cooperation among agencies that assist or require assistance under this plan is exercised. This plan adopts the National Incident Management System (NIMS) Incident Command System (ICS) as promulgated by the Federal Emergency Management Agency's National Emergency Training Center. This MCI Plan is designed to be used in response to emergencies caused by any natural or man-made incident and is also applicable to incidents of peaceful mass gatherings that overwhelm normal resources. It is the intent of this document to provide guidance rather than direct the operations of responding agencies. This Operational Plan does not prevent any of the parties from entering into cooperative agreements with any other party for mutual cooperation during day-to-day operations; and in fact, all parties are encouraged to enter into such agreements in the interest of providing the most efficient, expedient, and effective public safety service to the general public. The adoption of this regional plan ensures cooperative, systematic, congruent growth of incident management when the scope of the emergency grows above the capabilities of such agreements. This Mass Casualty Incident (MCI) Plan is intended to address field operations that must be employed when the number of patients exceeds immediately available resources. In addition, it serves as the basis for routine operations. The key elements for successfully managing any incident are COMMAND, CONTROL and COORDINATION as prescribed in the Incident Command System. All EMS providers should be have a thorough understanding of ICS and utilize it on a routine basis to ensure competency and proficiency. Emergency scenes can only have one entity answering to Command. At MCIs this person is generally the senior fire officer. The senior leader of the EMS function should avoid attaching command to their title to reduce confusion. EMS Control is the title currently in use for the leader of the EMS function. It is incumbent upon all Vermont EMS District 3 agencies to ensure that all personnel using this plan receive the training and have the qualifications necessary to perform the functions outlined within. - 2

6 Concept of MCI Management EMS efforts in a mass casualty incident will begin small and expand to meet the needs of the incident. Some EMS agencies may be capable of managing larger numbers of patients without mutual aid whereas other agencies will need resources from several jurisdictions to manage an incident of the same magnitude. Single resources will be requested from dispatch and told to report to staging, where they may be assembled into larger, multijurisdictional resources. In addition to ensuring adequate resources for the incident scene, the EMS agencies also need to consider the anticipated needs of their local communities. Entire geographic regions should not be stripped of EMS resources. Strategic deployment of resources to the incident scene as well as coverage of mutual aid agencies areas should be considered. Mass Casualty Incident Management Goals 1. Do the greatest good for the greatest number. 2. Make the best use of personnel, equipment and facility resources 3. Do not relocate the disaster. Activation of Plan: Mass Casualty Incident Plan Activation will be determined by the number of patients and capacity of the agencies involved. The first arriving EMS unit should establish command/ems Control, conduct a scene size-up, and determine what Emergency Medical Services resources will be needed. Due to the remoteness of some of our EMS agencies, proactive measures and early activation of the plan is better than waiting until the incident escalates beyond control. Some larger agencies may be capable of handling small-scale incidents without necessitating implementation of the MCI Plan. Additional resources may be needed to manage the incident, care for patients and establish the Incident Management System and should be called for as early as possible. - 3

7 Helicopter/Air Operations Branch: Helicopters are a valuable and effective resource in providing timely patient care and transportation, depending on weather conditions, the location of the incident and other factors. Consideration of helicopter resources should be made as early as possible to ensure timely response; the Emergency Department Communications Center (ED Comm Center) should consider including protocols for automatic helicopter support for any MCI. Aviation operations at an incident may be very simple, consisting of only a helicopter working in a tactical operation or providing logistical support. On some incidents, air operations can become very complex involving many helicopters, and/or a combination of helicopters and fixed-wing aircraft operating at the same time. When the EMS Control determines that conditions exist for the use of air evacuation services and the number of aircraft will be 1 or 2, requests should be coordinated with the Incident Commander; an appropriate landing site will need to be identified and established. Fire department personnel will assume responsibility for clearing and holding the landing area. On large incidents, such as a large scale search or a major wild land fire, an incident helibase may need to be established at or near the incident. Some incidents will also have one or more helispots designated. As the incident grows in complexity, additional "layers" of supervision and coordination may be required to support effective and safe air operations. It is important to recognize that, in air operations like any other part of the ICS organization, it is only necessary to activate those parts of the organization that are required. If multiple helicopters will be involved, an Air Operations Branch should be initiated within Incident Command by the Incident Commander to ensure communication and coordination exists between the helicopters and ground units. Helicopter Landing Zone Radio Frequency One common radio frequency should be dedicated solely for Air Support communications. Vermont has dedicated V-TAC CHANNEL 4 (FREQUENCY , PL 156.7) as the primary Helicopter Landing Zone (LZ) radio frequency - 4

8 Standing Orders for EMS Operations When communications with hospitals or Medical Control cannot be maintained or when there is an unavoidable delay in the transport of a patient to a medical facility, standing orders for EMS operations may be used. Standing orders will allow Advanced EMS providers to administer all drugs and perform all procedures within the advanced EMT and Paramedic certification and training. Regional MCI Coordinators: (Not Currently in place in Dist 3) Regional MCI Coordinators are highly qualified EMS providers appointed by the District Board to serve as a resource for EMS Commanders during any incident in which they are requested. Duties of the regional MCI coordinator are determined by the EMS commander on-scene and may include assisting EMS command with resource acquisition and allocation, gathering information, facilitating communication or assuming unfilled EMS Command roles. Regional MCI Coordinators carry alpha-numeric pagers and can be mobilized through any EMS Dispatch center. (Not currently in place in District #3) Scalability of EMS Response In an effort to make this document congruent with the National Incident Management System (NIMS), MCI Level guidelines have been suggested to allow for scalability based upon the needs of the individual incident or agency. Larger agencies may be capable of handling incidents with limited patients without necessitating implementation of the MCI Plan. The decision to determine the MCI Level is left to the Incident Commander. MCI Level Total # of Patients Ambulances Helicopters MCI Coordinators MCI Trailers * All 2 * MCI Level 3 will require assistance from Vermont Emergency Management in resource acquisition. ** These levels are guidelines to assist EMS Command with resource allocation. Several factors will require the EMS Commander to modify these levels; type & acuity of injuries, weather and transportation considerations, etc. - 5

9 Vermont MCI Trailer Locations MCI Trailers equipped with supplies (backboards, bandages, BLS & ALS kits, etc.) to manage victims have been strategically placed throughout the state by the Vermont Homeland Security Unit. Vermont Homeland Security has trailers maintained by the Burlington Fire Department and Essex Rescue which are available to all Vermont District 3 agencies and can be obtained by contacting: VT Emergency Management at BURLINGTON EMERGENCY DISPATCH AT ESSEX EMERGENCY DISPATCH AT _ If additional trailers are needed, the Incident Commander can again contact Vermont Emergency Management. - 6

10 SECTION II: EMS BRANCH - 7

11 FIRST EMS UNIT ON-SCENE Perform The Five S s SAFETY Assessment: Assess the scene observing for electrical hazards, flammable liquids, hazardous SIZE-UP the scene: materials or other life threatening situations Determine how big and how bad is it? Type and/or cause of incident. Approximate number of patients. Severity level of injuries (either Major or Minor). Area involved, including problems with scene access. Identify access and egress routes. SEND information: Notify the ED Comm Center of your size-up information. Identify self as EMS Control. Request additional resources. Consider use of regional MCI Trailer for additional supplies. Communicate the following to all responding agencies/personnel: o o o o Incident description including approximate number of patients Incident location and/or staging area and best access routes Radio frequency to use or Tactical frequency(s), if assigned Unusual circumstances/hazardous conditions Request activation of Regional MCI Coordinators (NOT in District# 3 at this time) Request notification of closest hospital. SETUP the Scene Assign EMS Branch Staff Designate Triage, Treatment, Transportation and Staging areas SALT Triage Assign 2 nd EMT to TRIAGE OFFICER role Sort, Assess, Lifesaving Interventions, Treatment/Transport See Triage Section - 8

12 EMS Control Role Establishing COMMAND, CONTROL & COORDINATION of the MCI scene is imperative to success of the operations. The FIRST EMT on-scene should NOT begin patient care. The First EMT onscene assumes command of EMS operations, assesses the scene, coordinates with the Incident Commander (generally the senior fire officer) and directs others to respond. FIRST EMT is EMS CONTROL EMS Control is responsible for directing all aspect of EMS Operations at the incident. This position may also be referred to as Medical Group Supervisor or EMS Branch Director Early establishment of EMS command structure has proven to be essential at MCIs. Initially, there may not be enough EMS personnel to fill all positions. It is recommended to assign EMS command positions in the following order: 1. EMS Control (also known as EMS Branch Director) 2. Triage Officer 3. Treatment Officer 4. Transportation Officer 5. Staging Officer As more EMS providers arrive, assign additional personnel to fill-in the other roles as needed. As additional personnel and resources allow and as the incident dictates, additional roles may be necessary. These may include: Communications Officer Transportation Recorder Treatment Unit Leader - 9

13 EMS Control should not perform any Primary Triage or get involved with patient care as he/she needs to be evaluating the entire situation and communicating with incoming units and other agencies. EMS Control should immediately report to Command Post (if established) to receive a situation status report from the Incident Commander or initiate a Command Post if one is not already established. EMS Control should then notify the ED Comm Center at Fletcher Allen that EMS Control has been established. It is recommended that when EMS Control is established that you give a name identifiable with the location (i.e. Acme 101 has established Pine Road EMS Control) EMS Control may relinquish any or all responsibility to another qualified EMS provider if appropriate. - 10

14 Role EMS/Medical Control Officer Triage Officer Treatment Officer Transportation Officer Function The EMS Branch Director is responsible for directing all aspects of EMS Operations at the incident. This position may also be referred to as Medical Group Supervisor or EMS Control FIRST EMT on-scene assumes the role of EMS CONTROL Appointed by and reports directly to EMS Control; usually the 2 nd EMT on-scene is assigned this role. Triage Officer assesses and sorts casualties according to established priorities for treatment and directs the removal of patients to the Treatment Area. Once the incident scene has been determined safe to enter by the Incident Commander, the TRIAGE OFFICER begins Primary Assessment of every patient using color-coded ribbons or Mettag Triage Tags to designate acuity and priority of evacuation from the incident scene to the treatment area Appointed by and reports directly to EMS Control Establishes the treatment areas and coordinates the continual reassessment and treatment of patients. Meets patients upon arrival at Treatment area; assigns patients to appropriate location and resources (EMS providers) May assign Treatment Unit Leaders to supervise the Immediate, Urgent & Non-Urgent Treatment areas Appointed by and reports directly to EMS Control Establishes a transportation area and coordinates all patient transportation and disposition of casualties. Assigns patients to ambulances & crew for transport to hospital Notifies Hospital of patients EMS Staging Officer Appointed by and reports directly to EMS Control Establish a staging area to maintain and control resources including manpower, vehicles and equipment. Maintain Roster of available equipment, personnel and resources - 11

15 TREATMENT AREA Ambulance Loading Area Scene Set Up Routine MCI Scene Incident Scene Primary Triage TREATMENT OFFICER Performs Secondary RED Critical YELLOW Urgent Patients GREEN Non-Urgent patients TRANSPORTATION OFFICER Morgue Deceased patients - 12

16 Section III: TRIAGE - 13

17 Triage Officer Triage Officer is appointed by and reports directly to EMS Control; usually the 2 nd EMT on-scene is assigned this role. Once the incident scene has been determined safe to enter by the Incident Commander, the TRIAGE OFFICER begins Primary Triage of every patient using colorcoded ribbons or Mettag Triage Tags to designate acuity and priority of evacuation from the incident scene to the treatment area. Triage Officer provides a tally of the number and color/priority of patients tagged to the EMS Branch Director. The Triage Officer rapidly and continuously assesses all patients to identify and immediately correct life-threatening problems: The Triage Officer performs and/or delegates to subordinates the following tasks: Circulate among all patients and identify life-threatening problems: airway, bleeding, and shock. Directs others, when available, to manage airway, bleeding, and shock. Continues to circulate among patients to assess life-threatening changes (airway, bleeding, and shock) until all patients have been moved to the treatment area. Triage Officer continues in this role until relieved or reassigned by the EMS Command Officer. Triage Concepts The purpose of Primary Triage is to rapidly identify the number and severity of patients needing medical assistance at the scene of an MCI and prioritize movement of patients to the Treatment Area Treatment interventions are to be limited to opening a patients airway and controlling severe hemorrhage. Patients will be prioritized for removal to the Treatment Area, where all other treatment will be performed Triage Methodology The standard method of initial field triage to be utilized in Vermont EMS District 3 is the SALT (Sort, Assess, Lifesaving Interventions Treatment/Transport) method. - 14

18 Triage Tags Triage Tags should be placed on all patients who were involved in the incident regardless whether they claim to be injured or not. During the Primary Triage at the incident scene, the Triage Officer may only complete the SAL of SALT triage and tear off the color-coded tag. All Triage Tag stubs should be saved and turned in to the Triage Officer for establishing the final patient count When the patient arrives in the treatment area, the triage tags should be filled out with as much information about the patient as the Treatment personnel are able to ascertain and complete. NOTE: If patients are dead, they should be tagged and left where they are until the appropriate State/Federal authority arrives. If a dead patient is moved, a tag should be placed at the site where found All victims must be tagged with a ribbon or Triage Tag. It is time consuming and potentially fatal to triage without tagging victims. Triage Tag Color Red Yellow Description Emergent. Life-threatening conditions airway management difficulties, cardiac compromise, severe hemorrhage, altered mental status Urgent. Less critical Potentially life-threatening Chest pain, Shortness of Breath Abdominal Pain Green Non-urgent. Non-life or limb threatening emergencies Sprain/Fractures, minor wounds Grey Black Expectant. Unlikely to survive Does not mean dead, very poor survivability even with maximum care Dead or Death Expected. Injuries so severe that patient is not expected to survive - 15

19 North American Rescue NART2 Tag - 16

20 Mettag Triage Tag Instructions Front A A Enter Date & time of Triage B Name of Patient (if available) B C Enter patient s home address (if known) C D D Enter pertinent medical history or observations E Name of person completing tag E F G BACK F Indicate location of injuries/pain on body diagram G Enter Vital Signs including Times H Enter IV and times I Enter IM injections and times H I Diagonal Corner Tabs: Diagonal tear-off tabs on corners may be used to indicate casualty position at MCI site, to attach to severed limbs, to place with personal effects or for any additional use deemed necessary Page 17

21 SALT (Sort, Assess, Lifesaving Interventions, Treatment/Transport) - 2

22 Section IV: TREATMENT - 3

23 Treatment Officer Appointed by and reports directly to EMS Control The Treatment Officer establishes and supervises all activities in a treatment area, and performs and/or delegates to subordinates the following tasks: o Sets up the treatment area; marks boundary lines for the location of redtagged, yellow-tagged AND Green-tagged patients. o Receives and reviews the condition of all patients as they arrive in the treatment area and assigns patients to locations within the treatment area according to tag color o Assigns EMS providers to patients, and supervises all patient care. o Maintains an inventory of supplies and equipment, and requests additional supplies and equipment as needed through the EMS Control Officer. o Coordinates transportation priority decisions with the Loading Officer and refers patients to the Loading Officer. Treatment Area Patients are placed in the Treatment Area where emergency medical care is provided on the basis of the triage priority. Patients arriving from the incident scene are prioritized for treatment using a more indepth assessment method (Secondary Triage) Think BIG; the Treatment Area must be capable of accommodating large numbers of patients and equipment. Consider the weather, safety of patients and personnel in relation to the incident site and possible dangers from hazardous materials. The area should be readily accessible and have clearly designated entrance area and exit area. The Treatment Area should be divided into 3-4 distinct and well-marked areas, corresponding to triage categories (red, yellow and green). The areas can be identified using color coded flags, barricade tape, and/or tarps. These areas are: - 4

24 Red (First Priority). - Seriously ill or injured patients. These patients most likely need rapid transport to a hospital. If there are large numbers of Red / critical patients, it may be necessary to further prioritize the Red-tagged patients into two categories in an effort to direct care toward saving patients who are likely to survive if treated: A. Patients who have easily correctable life-threatening conditions (shock, hypoxia, etc.) present or imminent, and who have a high probability of survival if given immediate care and transportation. B. Patients with major systemic injuries who have a low probability of survival regardless of care received (major head injuries, major uncorrectable chest injuries, severe shock with systemic complications, total body surface burns, etc.). Yellow (Second Priority). Patients with moderate injuries which need attention and/or may become life-threatening; these should be the second group of patients transported. Green (Third Priority). - Minor injuries (sometimes called the Walking Wounded). Treatment and transportation of these patients may be delayed. - 5

25 Morgue Area If patients are deceased at the incident scene, they should have a black triage tag applied and be left where found. However, if patients die while in the treatment area, a Morgue area should be established. To avoid psychological impact on patients, the morgue area should ideally be out of view of the treatment area. Location and security for the Morgue area should be coordinated with Law Enforcement through the Incident Commander. - 6

26 Section V: TRANSPORTATION - 7

27 Transportation Officer Appointed by and reports directly to EMS Control Assigns ambulance & appropriate level of personnel to transport patients. The Transportation Officer performs and/or delegates to subordinates the following tasks: o Establishes the loading area adjacent to the treatment area. o Organizes ambulances for rapid loading of several ambulances at a time. o Assigns patients cleared by the treatment officer to ambulances, and the ambulances to the appropriate receiving hospitals. o Provides all drivers with proper routing instructions and maps as necessary. Patient Transport & Destination Emergency Departments should be contacted early in the incident by the EMS Branch Officer or Transportation Officer to obtain information to assist with the most appropriate patient distribution to medical facilities. Patients are to be transported to the most appropriate receiving facility, (which may not necessarily be the closest facility), by the most appropriate means available, as determined by their injuries. If possible, do not overwhelm one hospital during an MCI. Consider ALL hospitals, including facilities outside of Burlington, as receiving facilities. Consider use of helicopters for the more serious patients and public transportation (buses, school buses, etc.) or private vehicles for green (walking wounded). If a non-medical transportation (bus, cars, etc.) is used to transport minor (Green) patients, a fully equipped EMS team should accompany the patients in the event a patient suddenly changes in medical status. If possible, several patients SHOULD be transported in each vehicle in order to maximize the transportation resources. EMS units should not be allowed to leave the incident scene with only 1 patient on-board. - 8

28 Hospital Notification During an MCI, routine ambulance-to-hospital communication procedures are suspended. ONLY the Transportation Officer should be communicating with Hospitals. o Ambulances should not contact the hospital directly unless changes occur in the patient s condition while enroute or medical direction is needed Hospital communication may take place via cellular phone, HEAR 1 frequency ( ) and/or HAM Radio if necessary HEAR I ( ) Reserved for Incident- to-hospital Communication ONLY Transportation Log Transportation Officer maintains a written transport log of each patient transported to include: Triage tag color, Triage tag number, Destination hospital, Patient name (if known) Transporting ambulance service, Time of departure. Transportation Officer communicates with receiving hospitals the following information for each patient: Ambulance service and/or identification Triage tag color and number Number of patients in the ambulance Patients sex and approximate ages Injuries Estimated time of arrival After all patients have been removed from the scene, the Transportation Officer will forward the Patient Destination Log to Fletcher Allen Health Care which in turn will convey the information to affected receiving facilities. - 9

29 Section VI: STAGING UNIT - 10

30 Staging Officer Appointed by and reports directly to EMS Control Maintains status of number and types of resources in STAGING AREA. As ambulances arrive, record names of all EMS providers (accountability) Notifies EMS Control when additional staffing, equipment, and resources are necessary. Ensures all personnel remain with their units until assigned. Establish an equipment pool location. Consider removing medical supplies from vehicles for relocation to TRIAGE and/or TREATMENT areas: Backboards/Straps, Splints/Bandages Oxygen Supplies, Blankets IV Supplies Etc. ENSURE THAT DRIVERS AND STRETCHERS ARE NOT SEPARATED FROM THEIR AMBULANCES. Staging Concepts Staging is the location where personnel and equipment are kept while waiting for tactical assignments; an area to maintain separate stockpiles of manpower & equipment away from the incident scene Staging should be located close enough to the incident for a timely response, yet far enough away to be out of the immediate impact zone If required, separate Fire and EMS Staging areas may be necessary; the location of the Staging Area should be coordinated with the Incident Commander & EMS Branch Director. The AMBULANCE STAGING AREA should: Be large enough to handle the expected number of units Have easy access to the TRANSPORT AREA Ensure unimpeded access and egress to and from staging - 11

31 Section VII: COMMUNICATIONS - 12

32 Radio Language In the event of a multiple casualty incident PLAIN ENGLISH will be used. All EMS units will identify themselves using the Agency s name as a prefix e.g., Acme ambulance 2 Radio transmissions should be brief and limited to essential information only; minimize radio traffic. Primary On-Scene (Tactical) Channel The statewide VHF channels are designed to provide a standard communications mechanism around Vermont. The following VHF plan will be employed in a region-wide event HEAR 2 ( ) is designated as the Primary EMS Tactical (on-scene) Channel All communication between the EMS Control and any ambulance and first responder agencies will occur on this channel. Communication on-scene or between agencies should NOT occur on the HEAR-1 frequency. This channel needs to be reserved for Scene-to-Hospital communication only In the event the Primary MCI Channel changes to a different frequency, it shall be the responsibility of EMS Control to notify all responding units, EMS Dispatch centers and the ED Comm Center of the new frequency. **Consider the use of V-Call ** Communications Scene to Hospital During an MCI, routine ambulance to hospital communication procedure is suspended. ONLY the TRANSPORT Officer will communicate patient information directly to Fletcher Allen Health Care (FAHC). FAHC will relay the information to other receiving hospitals/facilities as needed. This communication may take place via cellular phone, HEAR 1 frequency ( ) and/or HAM Radio if necessary HEAR-I ( ) is reserved for Incident to Hospital Communication - 13

33 National Tactical Frequencies In a large-scale, multi-agency incident, the Incident Commander or designated Communications Officer may assign specific National tactical radio frequencies for various branches or divisions (i.e. Fire Suppression, Extrication, EMS, Public Works, etc.). The National U-Call (U-Tac) & V-Call (V-Tac) frequencies are designed to improve interagency communication for all first responders. All Vermont Emergency Services should have the following frequencies installed on their radios: V-Call & V-Tac are VHF Channels typically used by Fire and EMS organizations Label Frequency CTCSS (PL/CG) Description V-CALL National Calling V-Tac VHF Tactical V-Tac VHF Tactical V-Tac VHF Tactical V-Tac Helicopter LZ Freq. U-Call & U-Tac are UHF Channels typically used by Law Enforcement organizations. Label Frequency CTCSS (PL/CG) Description U-CALL National Calling 40 U-Tac UHF Tactical U-Tac UHF Tactical U-Tac UHF Tactical Alternate Communication Systems Communication failures are common during disaster incidents. Due to the geography and lack of telecommunication infrastructure, reliance solely upon VHF/UHF radio, cellular phone or satellite phone technology does not guarantee operability. It is imperative that agencies have reliable and redundant communication systems in the event one system fails. Amateur (HAM) Radio Systems are a viable option in our region however it may take time to contact and deploy the necessary personnel & resources; EMS Command should consider early activation of HAM radio operators. Satellite Phone/Cellular Phones: Satellite or cellular phones may be an option for communication depending upon location. - 14

34 Section VIII: Hazmat, Terrorism, Weapons of Mass Destruction - 15

35 Hazmat, Terrorism, Weapons of Mass Destruction Chemical, Biological, and Radiological contamination is of great concern to responders. All victims of a suspected Hazardous Materials, or Terrorists Incident, should be considered Contaminated until proven otherwise. Proper decontamination of ALL victims during the event, and ALL equipment post event is essential. Once an event is identified as involving hazardous materials or terrorism, steps must be taken to ensure provider safety and victim decontamination. All personnel on scene and those responding must be informed of the nature of the event and agents/materials involved. Proper Personal Protective Equipment (PPE), following the recommendations of the ERG (DOT Orange Book) shall be utilized. Warn ALL personnel that this is a Hazardous Materials Incident. Relocate all personnel and equipment to a safe area. Isolate the hazard and establish working zones (Hot, Warm, and Cold). Deny entry into the Warm and Hot zone unless properly protected for hazard. Request additional resources (i.e. Hazmat Team, Fire, Police, etc.). Determine the need for Decon and the type of Decon needed o Gross o Technical o Mass Notify area hospitals of incident and inform them of the potential for contaminated patients arriving devoid of EMS care and proper decontamination. Note: Hazardous Materials (HAZMAT) and/or Weapons of Mass Destruction (WMD) requires the use of specialized local, state or federal resources. The capacity to assemble these resources will be limited by the time needed to assemble and deploy them. The Incident Commander should request State and Federal resources through the Vermont Emergency Management Emergency Operations Center ( ) - 16

36 TREATMENT AREA Ambulance Loading Area Scene Set Up: Hazmat/WMD Scene Diagram (Patients require Decontamination BEFORE moving to Treatment Area) Incident Scene DECONTAMINATION TREATMENT OFFICER Performs Secondary RED Critical patients YELLOW Urgent Patients GREEN Non-Urgent patients Morgue Deceased patients TRANSPORTATION OFFICER Treatment Officer - 17

37 APPENDICES - 18

38 Appendix A: INCIDENT COMMAND SYSTEM (ICS) It is the recommendation of Vermont EMS District 3 that Service Agencies within the region utilize the National Incident Management System and Incident Command System (ICS) for any multiple casualty incidents. Benefits: The use of the ICS is beneficial for the following reasons: Commonly used by most responder agencies nationally. Flexible and can expand or contract with the escalation and de-escalation of the incident. Ideal for large scale or potentially large-scale incidents in the same jurisdiction, as well as in situations where there are multiple agencies from different jurisdictions involved in the incident management. Common Objectives & Action Plans: On scene operations are usually orchestrated by the agency having the most involvement. The Incident command structure allows all agencies to participate in the development of the overall incident management objectives and insures integration of action plans and maximizes the use of resources. Span of Control: The Incident command structure plays an important role in managing the span of control for personnel that are operating on an incident. It assists those that have experience in managing large-scale incidents as well as those who do not commonly manage large-scale incidents. This span of control is vital to the success of a largescale incident. A manageable span of control should be kept at between 3 to 7 people, with an optimum number of 5 people. Scalability: As the incident escalates, the lines of responsibility can be expanded and enlarged. Conversely, as the incident de-escalates and there is a demobilization of resources, the system can be downsized to meet the needs of the incident size at that time, right down to termination of the entire incident. Continuity in Command: ICS affords the ability for relief or change in command during large scale or extended incidents that go beyond regular or customary shift or work patterns. - 19

39 Organizational Charts: The organizational charts that follow are a typical representation of the command structure that would be employed under the Incident Command System. EMS agencies within the region are strongly encouraged to utilize ICS in their planning and response to multiple casualty incidents. Please note that the terms Triage Officer, Treatment Officer and Transport Officer are all used interchangeably with the terms Triage Sector Officer, Treatment Sector Officer and Transport Sector Officer. These terms refer to the same individual. On a small scale, single agency response, the following command structure may be sufficient. At larger, multi-agency incidents, the ICS model evolves and EMS becomes one part of the entire system. At expanded/extended medical incidents, the Incident Commander or Operations Section Chief would appoint someone to manage the "MEDICAL" function. As an incident unfolds or there are several patients, the ICS model will expand to meet the needs. - 20

40 - 21

41 Appendix B: Instructions for Responding Mutual Aid Units 1. Respond to the site of the incident only when dispatched. 2. Ensure adequate coverage of your area is provided (mutual aid) 3. Ensure that vehicles are equipped with appropriate disaster supplies (extra Backboards, dressings, oxygen cylinders, splints, carrying devices, etc.) and that maximum staffing is provided before responding to the site of the incident. 4. DO NOT RESPOND TO THE INCIDENT SITE IN PRIVATE VEHICLES. 5. Once enroute, contact the Command Post (or Staging) by radio (V-Call ) for instruction and assignment. Keep radio transmissions brief. 6. For large scale incidents proceed directly to the personnel and equipment staging area, be prepared to drop additional personnel and equipment. 7. Position your vehicle in the area designated by the Incident Commander. Vehicle drivers must stay with their ambulance at all times. 8. Turn off all emergency lights upon arrival. 9. Ensure that wheeled ambulance stretchers remain in the ambulance. 10. Load patients as directed by the EMS Transportation Officer. 11. Receive instructions as to patient s destination from the EMS Transportation officer. 12. DO NOT communicate directly with the receiving hospital. This will be done by the EMS Transportation Officer. 13. Receive instructions from the Command Post (Staging) regarding re-assignment when leaving the Receiving Hospital. V-Call or designated incident operation channel. 14. Follow the directions of Police or Fire Police personnel regarding traffic flow. Page 17

42 Appendix C: Dist #3 EMS Agency Resource List Agency Name Type of Service Highest Level of EMS Certification # of Ambulances Radio Transmit Frequency Radio Receive Frequency PL or CG Tone Dispatch Phone Number Bristol Rescue Ambulance AEMT 2 Burlington Fire Dept Champlain Valley Expo Ambulance First Responder AEMT 4 EMT 0 Charlotte Rescue Ambulance AEMT/Paramedic 2 Colchester Center Vol Fire Co. First Responder EMT 0 Colchester Rescue Ambulance AEMT/Paramedic 2 Essex Fire Dept First Responder AEMT 0 Essex Jct Fire Dept First Responder EMT 0 EMS Command JAS and Forms

43 Agency Name Type of Service Highest Level of EMS Certification # of Ambulances Radio Transmit Frequency Radio Receive Frequency PL or CG Tone Dispatch Phone Number Essex Rescue Ambulance AEMT/Paramedic 3 Amb 1 ALS Vehicle FACT Ambulance Critical Care Transport 5 Grand Isle Rescue Ambulance AEMT 2 Hinesburg Fire Dept Huntington Fire Dept IBM Rescue First Responder First Responder First Responder AEMT 0 AEMT 0 AEMT 0 Lamoille Ambulance Malletts Bay Fire Dept Ambulance First Responder AEMT 4 EMT 0-24

44 Agency Name Type of Service Highest Level of EMS Certification # of Ambulances Radio Transmit Frequency Radio Receive Frequency PL or CG Tone Dispatch Phone Number Milton Rescue Ambulance AEMT 2 Richmond Rescue Ambulance AEMT 2 Shelburne Rescue Ambulance AEMT 2 South Burlington Fire Department Ambulance AEMT/Paramedic 2 South Hero Rescue Ambulance AEMT 1 Saint Michaels Rescue Ambulance AEMT/Paramedic 2 amb 1 ALS Vehicle UVM Rescue Ambulance AEMT 2 Vergennes Area Rescue (VARS) Ambulance AEMT 2-25

45 Agency Name Type of Service Highest Level of EMS Certification # of Ambulances Radio Transmit Frequency Radio Receive Frequency PL or CG Tone Dispatch Phone Number VTANG Fire Dept First Responder EMT 0 Williston Fire Department Ambulance AEMT 2 DHART Helicopter Critical Care Transport 2 ( 1-24 hrs, 1-10a-10p) both Ambulance Ambulance Ambulance Ambulance - 26

46 Agency Name Type of Service Highest Level of EMS Certification # of Ambulances Radio Transmit Frequency Radio Receive Frequency PL or CG Tone Dispatch Phone Number First Responder - 27

47 Appendix D: EMS Command Job Action Sheets & Forms EMS Command JAS and Forms

48 JOB ACTION SHEET EMS CONTROL Mission: Responsible for the overall management and coordination of personnel and resources responding to the incident. Report to: Incident Command Post Radio ID: EMS Control Tasks: SAFETY ASSESSMENT: o Assess current situation o Look for potentially hazardous situations SIZE-UP SCENE o Determine how big and how bad incident appears? o Survey incident scene for: Type and/or cause of incident. Estimate number of patients. Estimate severity level of injuries (either Major or Minor). Estimate area involved, including problems with scene access. Identify access and egress routes Dress in identifying vest. SEND Information o Assume EMS Control and notify dispatch of MCI and pertinent information from Size-up. Request additional resources. Consider use of regional MCI Trailer and early activation of helicopters. o Communicate the following to all responding agencies/personnel: o o Incident description including approximate number of patients Incident location and/or staging area and best access routes Radio frequency to use or Tactical frequency(s), if assigned Unusual circumstances/hazardous conditions Request activation of Regional MCI Coordinators Request notification of closest hospital. SET-UP scene o Assign EMS branch management positions in the following order: o Triage Officer Treatment Officer Transportation Officer Staging Officer Designate Triage, Treatment, Transportation and Staging areas SALT Triage o Assign Triage Officer to begin primary Triage o EMS Control should NOT perform Triage - 29

49 JOB ACTION SHEET: TRIAGE OFFICER Mission: To assess and sort casualties to appropriately establish priorities for treatment and transportation. Report to: EMS Control Radio ID: Triage Tasks: Dress in identifying vest. The first step is to begin where you stand. Identify those injured who can walk; those who can hear you, follow command and walk are consider Walking wound and should be tagged Green Relocate the Green Tagged Patients Move Green tagged patients to an easily recognized point away from immediate danger and outside the initial triage area. Move in an orderly fasion Assess each casualty you come to and mark the priority using triage tags/ ribbons. Maintain a patient count Mark each patient tagged on 2-3 inch tape on thigh. Responders can also save a small piece of triage ribbon and count each piece once tagging is completed. Provide Minimal treatment; only three patient interventions are used: o Open the airway. o Stop gross bleeding o Safe patient positioning Recovery position Keep moving! QUICKLY! o In an MCI, lengthy patient assessments are not practical. o SALT. assessments should last approximately 30 seconds per patient. REMEMBER: Triage personnel are responsible for sorting all the patients into the correct category of medical urgency. THEY ARE NOT TO PROVIDE MEDICAL CARE. - 30

50 SALT (Sort, Assess, Lifesaving Interventions, Treatment/Transport - 31

51 JOB ACTION SHEET: TREATMENT OFFICER Mission: Provide continuing assessment, triage, and care to patients awaiting transportation. Report to: EMS Control Tasks: Dress in identifying vest. Radio ID: Treatment Officer Acquire Portable Radio and develop communications with EMS Control and Transportation Officer Designate the treatment area; mark boundary lines or use tarps or flags to designate locations for red-tagged, yellow-tagged AND Green-tagged patients. Clearly identify the treatment Area (use tarps, flags, etc.) Establish a funnel or cattle chute entryway into and out of the Treatment area to control access. Receive and review the condition of all patients as they arrive in the treatment area and assign patients to locations within the treatment area according to tag color Have Minor/Green Patients ( Walking Wounded ) move to a Supervised out-ofthe-way area Assign ALS technicians to treatment area; Assign EMS providers to patients, and supervise all patient care. Maintain an inventory of supplies and equipment and request additional supplies and equipment as needed through the EMS Control Officer. Maintain contact with TRANSPORT Officer and assist in moving patients to the transportation area. Coordinate transportation priority decisions with the Transportation Officer Constantly reassess patients' conditions and priorities. Appoint a MORGUE MANAGER (if needed) - 32

52 Treatment Area Equipment List Supplies Adhesive Tape Advanced Airway (Endotracheal Tubes, King Airway) Backboards (w/head-blocks, straps, etc.) Bag-Valve-Mask (BVM) Devices Blankets Blood Pressure Equipment Burn Sheets Cervical Collars Cold Packs / Heat packs EKG Monitors Face Shields/Eye protection Gauze kling Wrap Gauze Pads (4x4, 2x2) Gloves (small, medium, large, extra-large) Gowns IV Catheters (14 ga, 16 ga, 18 ga, 20 ga) IV Solution (Normal Saline, Lactated Ringers) IV Tubing MAST (Adult / Pediatric) OB Kits Occlusive Dressings Oxygen (E-tanks, M-tanks) Oxygen Masks (NRB) Splints (long-bone, short-bone) Splints (Traction) Suction Units Trauma Dressings Triangular Bandages # Available # Additional Needed - 33

53 Treatment Area Patient Log Triage Tag # Red Triage Color Yellow Green Pt. Age Gender Assigned to Time In EMS Command JAS and Forms

54 JOB ACTION SHEET: TRANSPORTATION OFFICER Mission: To coordinate and document all patient transportation and maintenance of records relating to patient injuries as noted on triage tag. Report to: EMS Control Tasks: Dress in identifying Transport Officer vest. Radio ID: Transport Officer Acquire Portable or Mobile radio and develop communications with EMS Control, Treatment Officer and Coordinating Hospital. Locate in a visible position at the Treatment Area Exit ( Loading Area ) Establish the loading area adjacent to the treatment area. Request means of transport from EMS Control (e.g. ambulances, buses, helicopters) Organize ambulances for rapid loading of several ambulances at a time. Ensure that transport ambulances are parked to allow easy patient loading and egress without being blocked by other ambulances. Load ALL Red/Immediate Patients FIRST and then proceed to Yellow/Delayed Patients. Assign appropriate level & number of providers to each ambulance based upon patient conditions. Inform transport crews of their destination, whether they need to return or not and of refueling sites; Provide drivers with proper routing instructions and maps if available. Remind ambulance crews that they do not need to contact receiving facility Ensure communication is established with receiving hospitals. o If adequate personnel are available, appoint COMMUNICATIONS COORDINATOR to perform these duties Document patient and unit movements and destination. EMS Command JAS and Forms

55 Transportation Officer s Hospital Availability Chart Hospital Location HEAR Frequency Encoder # ED Phone Red Yellow Green Fletcher Allen Health Care Burlington, VT Fletcher Allen (Fanny Allen Campus) Colchester, VT Dartmouth Medical Center Lebanon, NH

56 Job Action Sheet: TRANSPORT RECORDER Mission: To assist in ensuring proper documentation of victim/patient and unit movements. Radio ID: Communication via Report to: Transportation Officer Transport Officer Tasks: Report to TRANSPORT. Dress in identifying vest. Locate at assigned patient egress point in the TRANSPORT area. Document patient transport information on triage tag and collect tag stubs. Report individual patient information to Coordinating ED as relayed by TRANSPORT. o Unit transporting o Destination hospital o Number of patients o Triage tag numbers o Triage category, major injuries and age of patients Deliver triage tag stubs to TRANSPORT as directed. HELPFUL HINTS Locate in close physical proximity to TRANSPORT areas. Maintain contact with designated Coordinating ED, relaying triage tag number, patient condition and destination. Maintain communications with TRANSPORT. - 37

57 Transportation Record Date: Ambulance & Unit ID Triage tag #/Pt name Incident Location: Pt Age Pt Gender Patient Status Hospital Destination Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Red Yellow Green Black Red Yellow Green Black Red Yellow Green Black Red Yellow Green Black Red Yellow Green Black Red Yellow Green Black Red Yellow Green Black Red Yellow Green Black Red Yellow Green Black Red Yellow Green Black Red Yellow Green Black Red Yellow Green Black Print Transportation Officer/Recorder s Name Time Off- Scene

58 JOB ACTION SHEET: STAGING OFFICER Mission: To maintain separate stockpiles of manpower, reserve equipment and expended equipment at a staging area away from the incident. Report to: EMS Control Radio ID: EMS Staging Tasks: Dress in identifying vest. Acquire Portable Radio and develop communications with EMS Control and Transportation Officer Establish STAGING AREA. Consider options for removing medical supplies from vehicles for relocation to TRIAGE and/or TREATMENT areas: Backboards/Straps Oxygen Supplies IV Supplies Splints/Bandages Blankets Establish the AMBULANCE STAGING AREA at a site away from the scene. The AMBULANCE STAGING AREA should: o o o Be large enough to handle the expected number of units Have easy access and egress Have easy access to the TRANSPORT AREA As ambulances arrive, record names of all EMS providers (accountability) Order drivers to remain with their vehicles. Order all personnel to remain with their units until assigned. Direct ambulance crews to leave stretchers in ambulances unless needed for patient movement. Maintain status of number and types of resources in STAGING AREA. Notify EMS Control if additional staffing, equipment, and resources are needed Ensure unimpeded access to and from staging