Marin County Emergency Medical Services Excellent Care Every Patient, Every Time

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1 Marin County Multiple Patient Management Plan Training Module June 2013

2 This training presentation is intended for use by EMS, hospital and law enforcement personnel e in Marin County, California. a It may not be used without expressed permission from the Marin County EMS Agency.

3 Introduction Marin County s guide for managing g MCIs has been the 1999 Emergency Medical Response Plan The Multiple Patient Management Plan (MPMP) replaces the EMRP effective July 1, 2013 The MPMP integrates guidance from: FIRESCOPE Field Operations Guide (aka FOG Manual) California Public Health and Medical Emergency Operations Manual (aka EOM )

4 References This Plan meets the standards of the following by reference or incorporation and may be used for guidance when required: National Incident Management System (NIMS) Standardized Emergency Management System (SEMS) Incident Command System (ICS) Simple Triage and Rapid Treatment (START) and JumpSTART FIRESCOPE FOG California Master Mutual Aid Agreement California Government Code California Emergency Services Act Marin County Fire Service Mutual Aid Plan California Public Health and Medical Emergency Operations Manual California Patient Movement Plan (TBD) County of Marin Emergency Operations Plan County of Marin Medical and Health Annex County of Marin ACS Plan County of Marin FTS Guide (TBD)

5 EMRP vs. MPMP EMRP Uses START triage Incident organization based on FIRESCOPE model 4 response levels Hospital most distant from the incident is assigned as the Coordinating Hospital MPMP Uses START triage Incident organization based on FIRESCOPE model Local MCI plus 3 response levels Level III Trauma Center is the Coordinating Hospital Integrates with State s Public Health & Medical Emergency Operations Manual

6 MCI Activation Levels in MPMP Local MCI Level I Level II Level III

7 Local MCI (6-15 patients*) Example: Multiple vehicle collision involving 15 patients requiring transportation. Operational Focus is on incident management including the use of resources necessary to mitigate the problem (scene safety, security, specialty response, on-scene triage, patient transportation, etc.). Managed with local jurisdiction (i.e., ALS zone) resources EMS system modifications may be implemented. (e.g. canceling diversions, using private ambulances for calls, amending dispatch criteria, etc.) * Guideline only actual number of patients may vary

8 Level I (16-30 patients*) Example: Aircraft collision, skilled nursing facility evacuation, large motor vehicle collision, involving patients. Operational and Strategic Focus shifts from individual incident management to maintaining the County s EMS system and a possible transition from focused patient care to population based care. In-county mutual aid from other ALS zones will be requested. EMS system modifications to be implemented. * Guideline only actual number of patients may vary

9 Level II ( patients*) Example: Large aircraft collision, hospital facility evacuation, isolated natural incident, involving 80 patients. Operational and Strategic Focus is on scene management, resources necessary to mitigate the incident and maintain the County s EMS System. This includes a transition from focused patient care to population based care. The use of out-of-county mutual aid resources is anticipated. Modifications to the daily system are made to support the incident and stability of the system. * Guideline only actual number of patients may vary

10 Level III (> 100 patients*) Example: Significant natural disaster or other incidents involving more than 100 patients. Operational and Strategic focus is on scene management, resources necessary to mitigate the incident and maintain the County s EMS System. This includes a transition from focused patient care to population based care. The use of out-of-county mutual aid resources from regional, state and federal partners is anticipated. Activation of Operational Area Patient Distribution Center likely Includes significant modifications to support the incident and maintain i response. * Guideline only actual number of patients may vary

11 MCI Alert & Activation The IC may initiate either an ALERT or an ACTIVATION ALERT: Notifies all EMS system participants of a potential multicasualty event ACTIVATION: Notifies all EMS system participants of a multi- casualty event in progress Alert or Activation should be cancelled when no longer needed Marin County Communications is responsible for sending the alert/activation/cancellation to EMS system participants

12 Patient Distribution MPMP allows for immediate transport of patients to local hospitals prior to a communications link being established with the Coordinating Hospital For a Local MCI, Marin s hospitals will accept: 1 Immediate 1 Delayed 2 Minor Trauma Triage Tool may still be considered For a Level 1 or higher, Marin s hospitals will accept: 2 Immediate 2 Delayed 4 Minor

13 MPMP Forms MPMP includes several forms that may be used by on- scene personnel: Patient Routing Worksheet for Local MCI & Level I Patient Routing Worksheet for Levels II & III ICS 214 Unit Log ICS 206 Incident Medical Plan Transportation Group Supervisor Worksheet ICS 255 Patient Status Sheet (for Marin) Job Action Checklists

14 Incident Command Incident Command Post First-arriving unit will establish Incident Command Then: Initiate an MCI Alert or Activation Assign ICS roles as needed Identify incident command post and staging area(s) Request tactical radio frequencies as needed Order additional resources

15 MCI Organization Incident Commander Operations Section Coordinating Hospital Staging Medical Group Fire Group Triage Unit Treatment Unit Patient Transport Unit Extrication Unit Single Resources Immediate Medical Communications Coordinator Morgue Delayed Ground Ambulance Coordinator Minor Air Ambulance Coordinator (Adapted from FIRESCOPE Field Operations Guide 420-1)

16 Broad Street MCI Ambulance Incident Staging g Staging g To Hospital Minor Eastern Street Broa ad Street Delayed Immediate MCI Scene Morgue

17 START S.T.A.R.T. Review Verbally direct walking wounded patients to one area These are MINOR patients For each remaining patient assess: Respirations p (<30/min.) Perfusion (Cap refill <2 sec.) Mental Status (follows commands) Tag IMMEDIATE if any of above not met Tag DELAYED if 30 2 Can Do

18 Triage Tag Marin EMS providers use a triage tag similar to the one shown Remove contaminated strip if not applicable Remove all colored triage strips below the one selected Attach tag to arm, leg or neck Front Back

19 MCI Trailers (50 pts) Marin County maintains three trailers stocked with equipment and supplies for an MCI Each can manage about 50 patients Trailers may be ordered by the IC MCI Trailer

20 MCI Trailers (25 pts) Eight low-profile trailers are strategically located throughout Marin Each can manage about 25 patients. Low Profile MCI Trailer

21 Air Operations Ordering air ambulances is at the discretion of the IC Air ambulance transportation will be directed by the Air Ambulance Coordinator Air ambulances will generally be used to transport immediate patients to hospitals outside Marin County

22 Dispatch Center Communications Center Marin County Communications Center will: Notify hospitals, providers, law enforcement, and EMS Agency of a multi-casualty incident Assign radio frequencies as needed for the incident Dispatch additional incident resources as requested by the IC

23 Coordinating Hospital Marin General Hospital The Coordinating Hospital will: Initiate an MCI using ReddiNet Coordinate patient distribution with the Medical Communications Coordinator (MedComm) Use ReddiNet to track all patients from an incident Level III Trauma Center (Marin General Hospital) is the coordinating hospital for MCIs

24 EMS Agency Marin County EMS Agency will: Be notified of all MCI alerts or activations May send an Agency Rep to the incident scene if requested Activate an Operational Area Patient Distribution Center if large numbers of patients must be transported outside Marin

25 OA Patient Distribution Center Large numbers of patients to be transported out of Marin may require activation of an OAPDC OAPDC works with Coordinating Hospital, MedComm, nearby OAs, Region II and State t to distribute ib t patients t to medical facilities outside Marin Directed by the MHOAC (Medical Health Operational Area Coordinator) and staffed by EMS Agency

26 Reno Championship Air Races Crash September 16, 2011

27 The Venue

28 Minutes Before

29 Milliseconds Before

30 The Impact

31 The Scene A highly-modified P-51 Mustang flown by veteran pilot, James Jimmy Leeward, suddenly dives directly into a VIP grandstand packed with spectators Initial response includes four ALS ambulances The pilot and 6 spectators are dead on arrival

32 The Aftermath 54 patients are triaged and transported in 62 minutes: 25 Immediate 18 Delayed 11 Minor 7 Dead 4 patients later die in the hospital

33 Now assume this incident has just occurred at Gnoss Field in Novato, and you are on duty

34 Questions 1. What would the initial dispatch of resources likely include? 2. When would you request an MCI activation? 3. Discuss the ICS organization needed for this incident. 4. How would you handle all the walking wounded? 5. What level MCI would this incident fall under according to the MPMP?

35 More Questions 6. How many ambulances will you need for this incident? Who orders them? 7. How many air ambulances? 8. Which ICS role handles patient distribution with the Coordinating Hospital? 9. How many patients can be sent to Marin s three acute hospitals right away? 10.How will patients be tracked from the scene to the hospital?

36 For a copy of Marin County s Multiple Patient Management Plan or this training presentation please go to: Copyright 2013 All rights reserved by Marin County EMS Agency

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