COUNTY OF LOS ANGELES FIRE DEPARTMENT CONTEXT TRAINING PROGRAM MULTI-CASUALTY INCIDENT OPERATIONAL PLAN

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1 3 INTRODUCTION MULTI-CASUALTY INCIDENT OPERATIONAL PLAN It is the intent of this plan to provide a system for managing large number of patients at a Multi-Casualty Incident (MCI). The main focus of the Multi-Casualty Incident Operational Plan is to get seriously injured patients off the scene as quickly as possible and provide treatment for those patients awaiting transportation. When the first units arrive at a MCI, they are certainly going to be overwhelmed. First, there will be a temptation to set up the management levels of the organization, so the operational levels will have supervision when they are assigned. To set up management levels to the incident, most organizations have to use personnel from the first or second wave of responding resource. This type of set up will remove first responders from the triage, transportation and treatment provider roles, creating a delay in getting patients to the hospital. This plan refers to the FIRESCOPE Incident Command System (ICS) Multi-Casualty Branch Organization. Common ICS dictates that personnel safety considerations are the first priority for arriving fire units. The Multi-Casualty Branch is intended to be implemented with other ICS modules, such as hazardous material, commercial structure fire, high-rise, terrorism incidents, etc. Patients that are severely injured during a MCI have a "golden hour" in which they have the need to receive definitive treatment at local hospitals. Working within a narrow time frame, a bottom-up approach to the MCI plan implementation is necessary (Context Training Program). It is important to make critical job assignments such as triage, treatment, medical communications and the transportation of patients to the awaiting ambulances, so they can be treated at hospitals. Higher ICS positions should be established as span of control dictates. It is more important to start immediately moving patients off-scene through the utilization of first and second alarm resources than it is to fill out the Multi-Casualty Branch Organization chart from top positions down. Situations calling for this action would include those in which the number of patients involved and or the severity of their injuries use of the Reddi Net / H.E.A.R. system. These types of incidents would overwhelm hospital communications through the normal paramedic base hospital communications system.

2 4 MULTI-CASUALTY SCENARIO CONDITIONS: A suitable location will be utilized where operations can be performed in a realistic environment. The drill site shall be prepared before the drill. The incident shall consist of Multi-Casualty Incident Command positions only. No Fire, Haz-Mat, Extrication situations etc., will be involved. There will be approximately 10 to 15 patients injured. Each patient shall be wearing a 4"x6" medical tag around their neck describing their injuries. The scenario location shall be large enough to establish a Triage, Treatment, and Transportation areas. Ambulance Companies will provide sufficient ambulances for the scenario. The Medical Alert Center will be notified and participate in the scenario. Command and Control will provide a dispatcher to participate on the command and tactical frequencies during the scenario. All medical equipment from each participating unit shall be utilized during the scenario. The Battalion medical cache shall be used. All personnel shall be in appropriate personal protective equipment. DESCRIPTION OF EVOLUTION: The Basic Skills Coordinator will have the participating unit captains draw a card when they arrive at the scenario location. The card will determine which unit shall be first-in, second-in, etc. The first-in Captain shall become Incident Commander and follow the Incident Commander Reporting Procedures. The Incident Commander shall be responsible for initiating all resource assignments. All assisting companies shall acknowledge and give status reports to the I.C. on the assigned tactical frequency upon completion of their assignments. All units shall receive a briefing from the Basic Skills Coordinator regarding the specifics of the scrimmage. The briefing will occur before the scenario begins. RESOURCE ASSIGNMENTS: Incident Commander Coordinator Triage Unit Leader Medical Communication Triage Personnel (S.T.A.R.T.) Treatment Unit Leader Ground Ambulance Litter Teams

3 5 INCIDENT COMMANDER REPORTING PROCEDURES References: Vol. 10, Chap. 1, Subj. 3, F.I.R.E.S.C.O.P.E. I.C.S Chap. 14. OBJECTIVES: 1. Exercise a bottom-up approach when utilizing the Incident Command components of F.I.R.E.S.C.O.P.E. Multi-Casualty Operational Plan. 2. Demonstrate proficiency managing large numbers of patients while performing related assignments and tasks. 3. Ensure that all injured patients from a Multi-Casualty incident are triaged, treated and transported as quickly as possible to a hospital within the "golden hour". 4. Provide for civilian and firefighter life safety throughout the incident. EQUIPMENT: 1. Appropriate Personal Protective Equipment (P.P.E.) for the Scenario 2. I.C.S. designator vest (If Available) 3. Form 59 Incident Command Worksheet, clipboard 4. Apparatus and H.T. radios a. Command b. Tactical DESCRIPTION OF EVOLUTION: 1. Initiate a Size-up Report a. Location of incident by address or intersection. b. Type of incident (e.g., overturned bus, chemical spill, terrorism, downed aircraft, etc.) c. Estimation on the number of patients. d. Special instructions; Possibility of Scene Contamination " Risk vs. Benefit". 2. Provide a staging area location for incoming units, prevent apparatus congestion. 3. Initiate a Follow-up Report a. Name the incident b. Identify incident command post location. c. Request additional resources (as necessary.) d. Identify "Check-In" location anal travel routes. e. May request additional tactical frequencies for 2 or more divisions from command and control. f. Provide status reports to command and control when requesting additional resources and at minute intervals.

4 6 INCIDENT COMMANDER REPORTING PROCEDURES References: Vol. 10, Chap. 1, Subj. 3, F.I.R.E.S.C.O.P.E. I.C.S Chap Upon request of the incident commander, have all incoming units come to the incident command post for an assignment and advise units to bring all medical equipment with them. 5. Assign a paramedic from the first arriving paramedic squad as medical communications. Instruct medical communications to establish communications with Medical Alert Center and obtain hospital availability. 6. Assign the second paramedic from the first arriving paramedic squad as initial triage personnel or as a temporary triage unit leader. Instruct triage personnel to initiate triage using triage tags and the S.T.A.R.T. system. Assign additional triage personnel as needed. 7. Assign a company commander as your triage unit leader or an individual who has radio communications and possess strong organizing, directing and managing skills. 8. Assign incoming resources as litter teams. Have litter teams report to the triage unit leader after a briefing from the incident commander. 9. Assign a company commander as your treatment unit leader or an individual who has radio communications and possess strong organizing, directing and managing skills. 10. Identify and communicate the exact location of the treatment area after collaboration with the triage unit leader and the treatment unit leader. 11. Assign a company commander as your ground ambulance coordinator or an individual who has radio communications and possess strong organizing, directing and managing skills. 12. Communicate to the ground ambulance coordinator to establish the ambulance loading area as close to the treatment area as possible. 13. Assure that medical communications repositions the first arriving paramedic squad adjacent to the ambulance loading area to ensure face to face communications with ground ambulance coordinator, treatment dispatch manager (if assigned) and treatment unit leader.

5 7 INCIDENT COMMANDER REPORTING PROCEDURES References: Vol. 10, Chap. 1, Subj. 3, F.I.R.E.S.C.O.P.E. I.C.S Chap Continually request status reports (situation, progress, needs) from each operational subordinate at the unit level Conduct a transfer of command briefing to the Battalion Chief or Evaluator, which includes a minimum of: a. Incident action plan "Verbal" (I.C.S. organization, goals and objectives, sequence order of events, time frames, communication plan, etc.) b. Situation status and resource status and their assignments on the incident. c. Specific safety hazards, life and property loss potentials. c. Additional resources needed to complete the I.A.P.

6 8 INCIDENT COMMANDER REPORTING PROCEDURES UNIT BN. SHIFT DATE CAPTAIN INDIVIDUALS NOT MEETING THE COMPANY SKILLS STANDARD WILL REQUIRE ADDITIONAL TRAINING IN THAT SKILL. INDIVIDUAL HAS MET THE STANDARD: YES NO COMMENTS: 1. Initiate a Size-up Report a. Location of incident by address or intersection. b. Type of incident. c. Estimation on the number of patients. d. Special instructions; Scene Contamination, "Risk vs. Benefit". 2. Provide a staging area location for incoming units, prevent apparatus congestion. 3. Initiate a Follow-up Report a. Name the incident. b. Identify incident command post location. c. Request additional resources. d. Identify "Check-In" location and travel routes. e. May request additional tactical frequencies for 2 or more divisions from command and control. f. Provide status reports to command and control at 30 to 40 minute intervals. 4. Have all incoming units come to the I.C.P. for an assignment and advise units to bring all medical equipment with them. 5. Assign a paramedic from the first arriving paramedic squad as medical communication. Establish communications with M.A.C.

7 9 INCIDENT COMMANDER - REPORTING PROCEDURES INDIVIDUAL HAS MET THE STANDARD: YES NO COMMENTS: 6. Assign the second paramedic from the first arriving paramedic squad as initial triage or as a temporary triage unit leader. Instruct triage personnel to initiate triage using S.T.A.R.T. system. 7. Assign a company commander as your triage unit leader or an individual who has radio communications and possess strong organizing, directing and managing skills. 8. Assign incoming resources as litter teams. Have litter teams report to the triage unit leader after a briefing from the I.C. 9. Assign a company commander as your treatment unit leader or an individual who has radio communications and possess strong organizing, directing and managing skills. 10. Identify and communicate the exact location of the treatment area after collaboration with the triage unit leader and the treatment unit leader. 11. Assign a company commander as your ground ambulance coordinator or an individual who has radio communications and possess strong organizing, directing and managing skills. 12. Communicate to the ground ambulance coordinator to establish the ambulance loading area as close to the treatment area as possible.

8 10 INCIDENT COMMANDER REPORTING PROCEDURES INDIVIDUAL HAS MET THE STANDARD YES NO COMMENTS: 13. Assure that medical communications repositions the paramedic squad adjacent to the ambulance loading area to ensure face to face communications with ground ambulance coordinator, treatment dispatch manager (if assigned) 14. Continually request status reports (situation, progress, needs) from each operational subordinate at the unit level. 15. Conduct a transfer of command briefing to the Evaluator which includes a minimum of: a. Incident Action Plan. "Verbal" I.C.S. organization, goals and objectives, sequence order of events, time frames, communications plan, etc.) b. Situation status and resource status and their assignments on the incident. c. Specific safety hazards, life and property loss potentials. d. Additional resources needed to complete I.A.P. RATER

9 11 TRIAGE UNIT LEADER References: Vol. 10, Chap. 1, Subj. 3; F.I.R.E. S.C.O.P.E. I.C.S Chap. 14; Vol. 10, Chap. 2, Subj. 5; Vol. 11, Chap. 10, Subj. 12. OBJECTIVES: 1. Provide supervision for triage personnel, litter teams and morgue manager. 2. Ensure triage management and movement of patients who are prioritized immediate first to the treatment area. 3. Request treatment area location and establish morgue. 4. Implement triage process using S.T.A.R.T 5. Develop an organization sufficient to handle the assignments. EQUIPMENT: 1. Appropriate Personal Protective Equipment (P.P.E.) for the Scenario. 2. I.C.S. designator vest (If Available) 3. Triage Tags (For Triage Personnel) 4. H.T. Radios a. Command b. Tactical DESCRIPTION OF EVOLUTION: 1. Acknowledge receiving assignment on the tactical channel from the I.C 2. Members shall wear appropriate P.P.E and have both H.T. radios, command and tactical before exiting apparatus. 3. Come to the incident command post and receive face-to-face briefing and I.C.S. designator vest from I.C. 4. Size-up triage area, develop a plan and inform the incident commander of resource needs (triage personnel and litter teams.) 5. Implement triage process with triage personnel utilizing S.T.A.R.T.

10 12 TRIAGE-UNIT LEADER 6. Face to face with initial triage personnel. How many patients are there? How many patients have been triaged? Are there additional patients requiring triage? Where have the minor patients been separated? 7. Assign one of the triage personnel to obtain an accurate account of triaged patients and their priority status (immediate, delayed or minor.) 8. Communicate an accurate total of triaged patients and their priority status to the incident commander. 9. Coordinate through the incident commander and the treatment unit leader the location of the treatment area. 10. Prioritize patient movement from the triage area to the appropriate treatment areas. 11. Reassign triage personnel as litter teams when triage has been completed. Identify the treatment area location for the litter teams. 12. Establish morgue as needed, delegate to law enforcement personnel.

11 13 TRIAGE UNIT LEADER UNIT BN. SHIFT DATE CAPT FFS FF FF INDIVIDUALS NOT MEETING THE COMPANY SKILLS STANDARD WILL REQUIRE ADDITIONAL TRAINING IN THAT SKILL. INDIVIDUAL HAS MET THE STANDARD: YES NO COMMENTS: 1. Acknowledge assignment on the tactical channel. 2. Wearing all personal protective equipment. 3. Member having both H.T. radios, command and tactical before exiting apparatus. 4. Come to the incident command post and receive face-to-face briefing and I.C.S. designator vest from I.C. 5. Size-up triage area, develop a plan and inform I.C. of resource needs. 6. Implement triage process with triage personnel utilizing S.T.A.R.T. 7. Face to face with initial triage personnel. How many patients are there? How many patients have been triaged? Are there additional patients requiring triage? Where have the minor patients been separated? 8. Obtain an accurate account of triaged patients and their priority status (immediate delayed or minor.)

12 14 TRIAGE UNIT LEADER INDIVIDUAL HAS MET THE STANDARD: YES NO COMMENTS: 9. Communicate accurate total of triaged patients and their priority status to the incident commander. 10. Coordinate through the incident commander and the treatment unit leader the location of the treatment area. 11. Prioritize patient movement from the triage area to the appropriate treatment areas. 12. Reassign triage personnel as litter teams when triage has been completed. Identify the treatment area location for the litter teams. 13. Establish morgue as needed, delegate to law enforcement personnel. RATER

13 15 MEDICAL COMMUNICATIONS References: Vol. 10, Chap. 1, Subj. 3; F.I.R.E.S.C.O.P.E. I.C.S Chap. 14; Vol. 10, Chap. 2, Subj. 5; Vol. 11, Chap. 10, Subj. 12. OBJECTIVES: 1. Position shall be operated by a paramedic. 2. Demonstrate proper operation of the H.E.A.R 3. Ensure proper patient hospital destination and transportation, coordinating information through treatment dispatch manager or ground ambulance coordinator. 4. Maintain appropriate hospital availability on form 62 and patient destination records on form 63. EQUIPMENT: 1. Appropriate Personal Protective Equipment P.P.E. for the Scenario 2. I.C.S. designator vest (If Available) 3. Clip board with hospital availability form Paramedic Squad and H.T. Radios a. Command b. Tactical c. H.E.A.R. channel, cell phone DESCRIPTION OF EVOLUTION: 1. Acknowledge receiving assignment on the tactical channel from the I.C. 2. Members shall wear appropriate (P.P.E.) and have both H.T. radios, command and tactical before exiting apparatus. 3. Come to the incident command post and receive face-to-face briefing and I.C.S. designator vest from I.C. 4. Establish communication with Medical Alert Center (MAC) on the Hospital Emergency Administrative Radio (HEAR) or via cell phone. 5. Give overall scene description when opening communications with MAC, type of incident, approximate numbers of patients and types of injuries.

14 16 MEDICAL COMMUNICATIONS 6. Request blanket orders from M.A.C., also follow pre-hospital care policy Obtain and record patient hospital availability status from M.A.C. on form 62, hospital availability worksheet. 8. Provide a copy of the hospital availability form 62 to the treatment dispatch manager (if assigned.) 9. When the transportation area has been established, reposition the paramedic squad adjacent to the ambulance loading area. This will ensure face-to-face communications with the ground ambulance coordinator, treatment unit leader and treatment dispatch manager (if assigned.) 10. Communicate hospital destinations from form 62 for each patient when asked by the ground ambulance coordinator or treatment dispatch manager (if assigned.) 11. Receive the green and yellow copy of form 63 with the bottom tab attached from the ground ambulance coordinator or treatment dispatch manager (if assigned.) Then communicate patient information from form 6-11 to M.A.C. 12. Update the incident commander with the total number of patients that have been transported including their priority status, (immediate, delayed and minor.) 13. Close communications with M.A.C. when all patients are transported off scene. Retain all copies of form 63 for incident documentation into F.I.R.S.

15 17 MEDICAL COMMUNICATIONS UNIT BN. SHIFT DATE CAPT FFS FF FF INDIVIDUALS NOT MEETING THE COMPANY SKILLS STANDARD WILL REQUIRE ADDITIONAL TRAINING IN THAT SKILL. INDIVIUDAL HAS MET THE STANDARD: YES NO COMMENTS: 1. Acknowledge assignment on the tactical channel. 2. Wearing all personal protective equipment. 3. Member having both H.T. radios, command and tactical before exiting apparatus. 4. Come to the incident command post and receive face-to-face briefing and I.C.S. designator vest from I.C. 5. Establish communications with Medical Alert Center (MAC) on the H.E.A.R. or cell phone. 6. Give overall scene description when opening communication with M.A.C. a. Type of incident. b. Approximate numbers of patients. c. Types of injuries. 7. Request blanket orders from M.A.C., follow pre-hospital care policy 806.

16 18 MEDICAL COMMUNICATIONS INDIVIDUAL HAS MET THE STANDARD: YES NO COMMENTS: 8. Obtain and record hospital availability from M.A.C on form 62, hospital availability worksheet. 9. Provide a copy of the hospital availability form 62 for the treatment dispatch manager (if assigned.) 10. When the transportation area has been established, reposition the paramedic squad adjacent to the ambulance loading area. Ensure face-to-face communications with the ground ambulance, treatment unit leader and treatment dispatch manager. 11. Communicate hospital destinations from form 62 for each patient when asked by the ground ambulance coordinator or treatment dispatch manager (if assigned.) 12. Receive the green and yellow copy of form 63 with the bottom tab attached from the ground ambulance coordinator or treatment dispatch manager (if assigned.) Then communicate patient information from form 63 to M.A.C. 13. Update the LC. with the total number of patients that have been transported including their priority status, (immediate, delayed and minor.) 14. Close communications with M.A.C. when all patients are transported off scene. Retain all copies of form 63 for incident documentation into F.I.R.S. RATER

17 19 TRIAGE PERSONNEL (S.T.A.R.T) References: Vol. 10, Chap. 1, Subj. 3; F.I.R.E. S.C.O.P.E. I.C.S Chap.14; L.A.C. EMT-1 Module 2; Vol. 11, Chap. 10, Subj. 12. OBJECTIVES: 1. Reinforce triage procedures using S.T.A.R.T. system. 2. Triage patients in seconds using S.T.A.R.T. 3. Assign patients to the appropriate treatment areas using triage tags. 4. Consider using triage personnel as a litter team (s) when triage assignments are complete. EQUIPMENT: 1. Appropriate Personal Protective Equipment (P.P.E.) for the Scenario. 2. I.C.S. designator vest (If Available) 3. Triage Tags (from triage unit leader or first arriving paramedic squad) 4. H.T. Radios (If Available) a. Command b. Tactical DESCRIPTION OF EVOLUTION: 1. Acknowledges assignment on the tactical radio or face-to-face communication. 2. Members shall wear appropriate P.P.E. and have H.T. radios, command and tactical, if available. 3. Report to designated, on scene, triage location. Receive face-to-face briefing from incident commander and triage unit leader when assigned. 4. Obtain triage tags from triage unit leader or first arriving paramedic squad.

18 20 TRIAGE PERSONNEL (S.T.A.R.T) 5. Triage & tag injured patients using the S.T.A.R.T. system. a. Announce if any patients can get up and walk. Have walking wounded proceed to an area that has been designated as "Minor" treatment area. (A short distance from the Immediate and Delayed treatment areas). b. Access respirations, present or non-present. c. No respiration's, position airway, no respiration's, tag patient deceased. d. No respiration's, position airway, respiration's restored, tag patient immediate. e. Patient has respirations over 30/per minute, tag patient immediate. f. Patient has respiration's under 30/per minute, proceed and check perfusion. g. Radial pulse absent / capillary refill over 2 seconds, control bleeding and tag patient immediate. h. Capillary refill under 2 seconds, proceed and check mental status. i. Radial pulse present, proceed and check mental status. j. Can't follow simple commands, tag patient immediate. k. Can follow simple commands, tag patient delayed. 6. Direct the movement of patients to proper treatment areas. 7. Provide appropriate medical treatment (ABC's) to patients prior to movement as incident conditions dictate. 8. After all patients are triaged, report to the triage unit leader for another assignment. (Litter teams)

19 21 TRIAGE PERSONNEL (S.T.A.R.T.) UNIT BN. SHIFT DATE CAPT FFS FF FF INDIVIDUALS NOT MEETING THE COMPANY SKILLS STANDARD WILL REQUIRE ADDITIONAL TRAINING IN THAT SKILL. COMPANY HAS MET THE STANDARD: YES NO COMMENTS: 1. Acknowledges assignment on the tactical radio or face-to-face communication. 2. Wearing all personal protective equipment. 3. Report to designated, on scene, triage location. Receive face-to-face briefing from I.C. or triage unit leader when assigned. 4. Obtain triage tags from triage unit leader or from first arriving paramedic squad. 5. Triage & tag injured patients using the S.T.A.R.T. system. a. Announce if any patients can get up and walk. Have walking wounded proceed to an area that has been designated as "Minor" treatment area. (A short distance from the Immediate and Delayed treatment areas). b. Access respirations, present or nonpresent. c. No respiration's, position airway, no respiration's, tag patient deceased.

20 22 TRIAGE PERSONNEL (S.T.A.R.T.) COMPANY HAS MET THE STANDARD: YES NO COMMENTS: d. No respiration's, position airway, respiration's restored, tag patient immediate. e. Patient has respirations over 30/ per minute, tag patient immediate. f. Patient has respirations under 30/ per minute, proceed and check perfusion. g. Radial pulse absent / capillary refill over 2 seconds, tag patient immediate. h. Capillary refill under 2 seconds, proceed and check mental status. i. Radial pulse present, proceed and check mental status. j. Can't follow simple commands, tag patient immediate. k. Can follow simple commands, tag patient delayed. 6. Direct the movement of patients to proper treatment areas. 7. Provide appropriate medical treatment (ABC's) to patients prior to movement as incident conditions dictate. 8. After all patients are triaged, report to the triage unit leader for another assignment. "Litter teams" RATER

21 23 TREATMENT UNIT LEADER References: Vol. 10, Chap. 1, Subj. 3; F.I.R.E.S.C.O.P.E. I.C.S Chap.14; Vol. 11, Chap. 10, Subj. 12. OBJECTIVES: 1. Supervises treatment managers and recorders (immediate, delayed, minor), and treatment dispatch manager, if assigned. 2. Ensure that immediate patients are removed first from the treatment area. 3. Assumes responsibility for treatment areas and directs the movement of patients to the ambulance loading area. 4. Ensure that patients within the treatment areas are continually being reassessed. EQUIPMENT: 1. Appropriate Personal Protective Equipment (P.P.E.) for the Scenario. 2. I.C.S. designator vest (If Available) 3. Salvage covers or colored tarps to identify treatment areas. 4. Form 63 book for each treatment area, clip boards, pen 5. H.T. Radios a. Command b. Tactical DESCRIPTION OF EVOLUTION: 1. Acknowledge receiving assignment on the tactical channel from the I.C 2. Member shall wear appropriate P.P.E. and have both H.T. radios, command and tactical before exiting apparatus. 3. Come to the incident command post and receive face-to-face briefing and I.C.S. designator vest from I.C. and request the treatment area location. 4. Obtain the treatment area packet from the first arriving paramedic squad M.C.I. kit. The treatment packet will include color coded tarps, vests, form 63, clipboards, etc. Utilize salvage covers until tarps become available. 5. Establish the treatment area by deploying color coded tarps or salvage covers to identify the immediate, delayed and minor treatment areas. a. Have the minor treatment area a short distance away from the immediate and delayed areas.

22 24 TREATMENT UNIT LEADER 6. Assign one recorder for each treatment area. The recorders shall record patient status on form 63 when directed by the treatment unit leader. The recorders will obtain patient information from the triage tags or from treatment team members directly. 7. Coordinate the movement of patients from the triage area to the treatment area with the triage unit leader. 8. Request from the incident commander additional paramedic and EMT resources and assign them to the immediate and delayed treatment areas first. Assign EMT's to the minor treatment area. 9. When prioritized patients are ready to be transported from the treatment areas, direct the recorders to document patient information onto form Request litter teams from the incident commander. Use litter teams to move the prioritized patients from the treatment area to the ambulance loading area. Obtain the availability of additional litter teams from the triage unit leader. 11. When the treatment recorders have completed patient documentation on form 63 for the patients identified for transportation, direct your recorders to remove form 63 from the form book with the bottom tab attached and give it to the treatment unit leader. The treatment unit leader will pass form 63 for each patient to the ground ambulance coordinator or the treatment dispatch manager (if assigned.) 12. Direct and supervise immediate, delayed and minor managers and recorders. Also the treatment dispatch manager (if assigned.) 13. Ensure triage tags and secondary triage are being updated and performed. Request sufficient medical caches and supplies through the incident commander as necessary. 14. Provide the incident commander with continual status reports.

23 25 TREATMENT UNIT LEADER UNIT BN. SHIFT DATE CAPT FFS FF FF INDIVIDUALS NOT MEETING THE COMPANY SKILLS STANDARD WILL REQUIRE ADDITIONAL TRAINING IN THAT SKILL. INDIVIDUAL HAS MET THE STANDARD: YES NO COMMENTS: 1. Acknowledge assignment on the tactical channel. 2. Wearing all personal protective equipment. 3. Member having both H.T. radios, command and tactical before exiting apparatus. 4. Come to the I.C.P. and receive face-to-face briefing and I.C.S. designator vest from I.C. and request the treatment area location. 5. Obtain treatment-area packet from the first arriving paramedic squad M.C.I. kit. The treatment packet will include color coded tarps, vests, form 63, clipboards etc. 6. Establish the treatment area by deploying color coded tarps or salvage covers to identify the immediate, delayed and minor treatment areas. a. Have the minor treatment area a short distance away from the immediate and delayed areas. 7. Assign one recorder for each treatment area. Recorders shall record patient status on form 63 when directed by the treatment unit leader.

24 26 TREATMENT UNIT LEADER INDIVIDUAL HAS MET THE STANDARD: YES NO COMMENTS: 8. Coordinate the movement of patients from the triage area to the treatment area with the triage unit leader. 9. Request from the I.C. additional paramedic and EMT resources and assign them to the immediate and delayed treatment areas first. a. Assign EMT's to the minor treatment area. 10. When prioritized patients are ready to be transported from the treatment areas, direct the recorders to document patient information onto form Request litter teams from the I.C. Use litter teams to move the prioritized patients from the treatment areas to the ambulance loading area. Use additional litter teams from triage. 12. When the treatment recorders have completed form 63, direct them to remove form 63 with the bottom tab attached and give it to the treatment unit leader. Then pass form 63 for each patient with the tab attached to ground ambulance coordinator. 13. Direct and supervise immediate, delayed and minor managers and recorders. 14. Ensure triage tags and secondary triage are being updated and performed. Request sufficient medical caches and supplies through the I.C. 15. Provide the I.C. with continual status reports. RATER

25 27 GROUND AMBULANCE COORDINATOR References: Vol. 10, Chap. 1, Subj. 3, F.I.R.E.S.C.O.P.E. I.C.S Chap. 14. OBJECTIVES: 1. Ensure appropriate communications with medical communications, treatment unit leader & treatment dispatch manager. 2. Establish ambulance-loading area near the treatment area. 3. Coordinate ambulance loading traffic patterns. 4. Assign ambulance staging (preferably ambulance supervisor). 5. Maintain accountability for all ambulances. 6. Maintain appropriate recording records, form 63. EQUIPMENT: 1. Appropriate Personal Protective Equipment (P.P.E.) for the Scenario 2. I.C.S. designator vest (If Available) 3. Clip board, with pen. 4. H.T. Radios a. Command b. Tactical DESCRIPTION OF EVOLUTION: 1. Acknowledge receiving assignment on the tactical channel from the I.C 2. Member shall wear appropriate P.P.E. and have both H.T. radios, command and tactical before exiting apparatus. 3. Come to the incident command post and receive face to face briefing and I.C.S. designator vest from I.C. and request the ambulance loading area location. 4. Delegate ambulance-staging responsibilities to ambulance personnel, preferably the ambulance supervisor, if available. Keep ambulance staging away from the ambulance loading area. Request additional transportation resources as appropriate. 5. Establish the ambulance loading area near the treatment area. Advise and identify the ambulance loading area location for the treatment unit leader.

26 28 GROUND AMBULANCE COORDINATOR 6. Provide ambulances with routes into and out of the ambulance loading area. 7. Establish communications with medical communications and treatment dispatch manager (if assigned.) 8. The treatment unit leader or treatment dispatch manager (if assigned), will advise you that patients are ready to be moved from the treatment area. The treatment unit leader will pass to you form 63 with the bottom tab attached for the prioritized patients ready for transportation. 9. Request ambulances from ambulance staging. Have two ambulances (if available) come to the ambulance loading area at one time. 10. Request patient hospital destinations for each patient from medical communications and record hospital destinations and air/ambulance information onto the bottom of form 63. Note: This function will be facilitated by the treatment dispatch manager when assigned on the incident. 11. As ambulances arrive in the ambulance loading area, instruct them to remove extra backboards. Provide an inventory of medical supplies available at the ambulance loading area for use on the incident. Instruct the ambulance personnel to unload their gurney and standby at the rear of the ambulance, (no freelancing.) 12. Direct litter teams bring patients from the treatment area to the designated transporting ambulances and place the patients onto the ambulance gurney. 13. As the prioritized patients are placed into the awaiting ambulances and form 63 is complete for each patient, detach the red (receiving facility) copy from form 63 and give it to the ambulance company personnel. Keep the bottom tab attached on form 63. Note: This function will be facilitated by the treatment dispatch manager when assigned on the incident. 14. Deliver the green and yellow copies of form 63 with the bottom tab attached to medical communications. Follow the same procedures for additional patients requiring transportation. Note: This function will be facilitated by the treatment dispatch manager when assigned on the incident.

27 29 GROUND AMBULANCE COORDINATOR UNIT BN. SHIFT DATE CAPT FFS FF FF INDIVIDUALS NOT MEETING THE COMPANY SKILLS STANDARD WILL REQUIRE ADDITIONAL TRAINING IN THAT SKILL. INDIVIDUAL HAS MET THE STANDARD: YES NO COMMENTS: 1. Acknowledge assignment on the tactical channel. 2. Wearing all personal protective equipment. 3. Member having both H.T. radios, command and tactical before exiting apparatus. 4. Come to the I.C.P. and receive face to face briefing and I.C.S. designator vest from I.C. and request the ambulance loading area location. 5. Delegate ambulance-staging responsibilities to ambulance personnel, preferably the ambulance supervisor. a. Keep ambulance staging away from the ambulance loading area. Request additional transportation resources as needed. 6. Establish the ambulance loading area near the treatment area. Advise and identify the ambulance loading area to the treatment unit leader.

28 30 GROUND AMBULANCE COORDINATOR INDIVIDUAL HAS MET THE STANDARD: YES NO COMMENTS: 7. Provide ambulances with routes into and out of the ambulance loading area. 8. Establish communications with medical communications and treatment dispatch manager (if assigned.) 9. The treatment unit leader or treatment dispatch manager (if assigned), will advise you that patients are ready to be moved to the treatment area. The treatment unit leader will pass to you form 63 for the prioritized patients ready for transportation. 10. Request ambulances from ambulance staging. Have two ambulances (if available) come to the ambulance loading area at one time. 11. Request patient hospital destinations for each patient from medical communications and record hospital destinations and air/ ambulance information onto form 63. Note: This function will be facilitated by the treatment dispatch manager when assigned. 12. As ambulances arrive to the ambulance loading area, instruct them to remove extra backboards. Provide an inventory of medical supplies available at the ambulance loading area. a. Instruct the ambulance personnel to unload their gurney and standby at the rear of the ambulance, (no freelancing.)

29 31 GROUND AMBULANCE COORDINATOR INDIVIDUAL HAS MET THE STANDARD: YES NO COMMENTS: 13. Direct litter teams bring patients from the treatment area to the designated transporting ambulances and place the patients onto the ambulance gurney. 14. As the prioritized patients are placed into the awaiting ambulances and form 63 is complete for each patient, detach the red (receiving facility) copy from form 63 and give it to the ambulance company personnel. Keep the bottom tab attached on form 63. Note: This function will be facilitated by the treatment dispatch manager when assigned. 15. Deliver the green and yellow copies of form 63 with the bottom tab attached to medical communications. Follow the same procedures for additional patients requiring transportation. Note: This function will be facilitated by the treatment dispatch manager when assigned. RATER

30 32 LITTER TEAMS References: Vol. 10, Chap. 1, Subj. 3; F.I.R.E.S.C.O.P.E. I.C.S Chap. 14. OBJECTIVES: 1. Litter Teams consist of three personnel minimum. 2. Fire companies assigned as litter teams kept intact throughout the incident. 3. Use proper lifting techniques, prevent back injuries. 4. Remove immediate patients first from the triage and treatment areas. EQUIPMENT: 1. Appropriate Personal Protective Equipment P.P.E. for the Scenario. 2. Backboards, Litter baskets, Miller boards, etc 3. H.T. Radios a. Command b. Tactical DESCRIPTION OF EVOLUTION: 1. Acknowledge receiving assignment on the tactical channel from the I. C. 2. All members shall wear appropriate (P.P.E.) and have both H.T. radios, command and tactical before exiting apparatus. 3. Come to the incident command post and receive face-to-face briefing. The I.C. should initially assign you to the triage unit leader for an assignment. 4. Obtain backboards, litter baskets, miller boards, etc., for the movement of patients from the triage area to the treatment area. 5. Report to the triage unit leader when assigned by the incident commander. Request the treatment area location from the triage unit leader. 6. Remove all immediate patients from the triage and treatment area first.

31 33 LITTER TEAMS 7. Deliver patients into either waiting ambulances or into the treatment area as directed by the triage unit leader. 8. Patients should be carried with a minimum of three personnel, two at the front of the litter and the third at the feet, (this helps to avoid tripping). 9. After all immediate patients are removed from the triage area, begin to move delayed patients in the same manner as above. 10. When directed by the triage unit leader, report to the treatment unit leader to move patients from the treatment area to the ambulance loading area. 11. Litter teams can be rotated throughout the incident as needed. Litter teams can rotate as treatment teams and treatment teams can rotate as litter teams.

32 34 LITTER TEAMS UNIT BN SHIFT DATE CAPT FFS FF FF INDIVIDUALS NOT MEETING THE COMPANY SKILLS STANDARD WILL REQUIRE ADDITIONAL TRAINING IN THAT SKILL. COMPANY HAS MET THE STANDARD YES NO COMMENTS: 1. Acknowledge assignment on the tactical channel. 2. Wearing all personal protective equipment. 3. Member having both H.T. radios, command) and tactical before exiting apparatus. 4. Come to the incident command post and receive face-to-face briefing. The I.C. should initially assign you to the triage unit leader for an assignment. 5. Obtain backboards, litter baskets, miller boards, etc., for the movement of patients from the triage area to the treatment area. 6. Report to the triage unit leader when assigned by the I.C. for an assignment. Request the treatment area location from the triage unit leader. 7. Remove all immediate patients from the triage and treatment area first. 8. Deliver patients into either waiting ambulances or into the treatment area as directed by the triage unit leader

33 35 LITTER TEAMS COMPANY HAS MET THE STANDARD YES NO COMMENTS: 9. Patients should be carried with a minimum of three personnel, two at the front of the litter and the third at the feet. 10. After all immediate patients are removed from the triage area, begin to move delayed patients in the same manner as above. 11. When directed by the triage unit leader, report to the treatment unit leader to move patients from the treatment area to the ambulance loading area. 12. Litter teams can be rotated throughout the incident as needed. Litter teams can rotate as treatment teams and treatment teams can rotate as litter teams.

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