Ecrn packet: Disaster Activity Responsibilities of the ecrn

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ECRN Packet: Disaster Activity Responsibilities of the ECRN

  • Condell Medical Center EMS System
  • Prepared by: Sharon Hopkins, RN, BSN, EMT-P
  • EMS Educator
  • Information contribution: Debbie Semenek, RN, RMT-P
  • Region X Multiple Victims & Mass Casualty Plan, July 2006


  • Upon successful completion of this module, the ECRN should be able to:
  • Define the differences between the Multiple Victim Policy from the Mass Casualty Plan
  • State the responsibilities of the ECRN based on being an Associate Hospital (LFH) versus Resource Hospital (CMC)
  • Identify resources utilized in-house
  • Successfully complete the quiz with a score of 80% or greater

Disaster Plans

  • Multiple Victim and Mass Casualty Plan
    • Local plan with local resources used
    • Resource Hospital for the fire department of the disaster site serves as communication link
  • Emergency Medical Disaster Plan
    • State response plan
    • POD hospitals serve as communication link
  • National Disaster Medical Systems (NDMS)
    • Large scale national response utilized

IDPH Regions

  • State of Illinois divided into 11 Regions
  • Geographically, Lake County is Region 10
  • 4 Resource Hospitals in Region 10
    • Condell Medical Center (CMC)
    • Highland Park Hospital (HPH)
    • St. Francis - Evanston
    • Vista Health East (Victory Memorial)
  • POD Hospital for Region X is Highland Park Hospital (for activation of State Disaster Plan)

CMC - As A Resource Hospital

  • Affiliated departments
    • Countryside Libertyville
    • Grayslake  Mundelein
    • Knollwood Ambulance  Round Lake
    • Lake Bluff  Wauconda
    • Lake Forest Fire
  • Associate Hospital
    • Lake Forest Hospital

What Is A Disaster?

  • Difficult to use a “number” for declaring a disaster
    • 15 patients at 2 pm may not be as big a problem as 15 patients at 2 am based on immediate availability of resources
  • A disaster is any incident that overwhelms your available resources at that particular time or for the particular circumstances of the disaster

Disaster Plans

  • EMS personnel need to declare and activate one of the plans early
  • Without early activation, hospitals have a hard time getting prepared; hospitals feel “behind the eight ball”
  • It is easier to cancel additional help summoned than to try to work short handed

Multiple Victim Incident

  • Responding EMS personnel can handle the situation with adequate numbers of additional personnel and equipment available within a short period of time. Normal levels of care and transportation can be provided.
  • Attempts are made to evenly distribute patients to receiving hospitals by field personnel
  • Hospitals may need to activate their internal disaster plan

Multiple Victim Incident

  • Field application
    • triage tags are not required
    • if possible, one patient per ambulance (normal transport conditions)
    • radio report called to the receiving hospital as normal
    • run reports completed by the transporting ambulance personnel

Multiple Victim Incident

  • Note:
    • The first critically injured victims most likely would be transported to the nearest, most appropriate hospital before or while the first communications are being established with the Resource Hospital
  • Bottom line:
    • When you hear of a disaster in your region, prepare immediately as if you are receiving patients (because you just might be!!!)

Multiple Victim Incident

  • Radio reports must be given on all transported patients
    • This means every transporting ambulance will be communicating about their individual patient with the receiving hospital and this will take coordination between the field and the ED
  • With coordination from hospitals and field personnel, goal is to avoid overwhelming any one hospital

Multiple Victim Incident

  • Think of these incidents as “mini-disasters”
    • similar to the busiest day you have had in the ED
    • just more patients with same or similar complaints are showing up within a tight time frame from of each other
  • MASS
  • PLAN

Mass Casualty Plan

  • Number of patients and nature of injuries make normal level of stabilization and care in field unachievable and/or
  • Number of EMS providers and ambulances that can be quickly brought to the scene is not enough
  • All attempts are to be made to evenly distribute the patients to receiving hospitals

Mass Casualty Plan

  • Practical application for a MCI
    • Triage tags will be used on all patients
    • Ambulances may transport more than one a patient at a time
    • No radio reports to receiving hospitals; care is delivered via SOP’s
    • Run reports are not necessary

Field Contact With Hospitals

  • Multiple Victim Incident
    • EMS to contact their specific Resource Hospital (CMC) ASAP
  • Mass Casualty Plan
    • EMS to contact their specific Resource Hospital (CMC) ASAP
  • Coordination of patient transportation will be done via the Resource Hospital

First Communications From Field

  • Radio report may be initially minimal
      • Type/nature of incident (MVC, explosion, building collapse, etc)
      • Incident location
      • Closest hospitals that could receive patients
      • Estimated number of victims & categories (red, yellow, green)
      • Types of injuries/illnesses (blunt, penetrating, burns, etc)
      • Special needs (ie: decontamination)
      • ETA for the 1st victims
      • Call back number & name to contact the scene (VERY IMPORTANT TO GET THIS NUMBER!)

The “Green” Disaster Victim

  • Important information to obtain from the field regarding the number of “green” patients:
    • what number of green patients can be placed in a wheelchair or otherwise left sitting up
    • what number of green patients will need a cart
      • these patients are categorized green but may need transportation with a cervical collar and/or backboard due to the nature of their injuries

Activities In The Field

  • Field personnel performing
    • triage first
      • injuries sorted; patient categories assigned (red, yellow, green, black)
    • followed by treatment
      • performed in the field in areas set up to provide treatment based on acuity levels (red is the most critical patient)
    • and finally transportation off the site

Triaging of Patients

  • Red - victims who are most critically injured; in need of immediate care for life-threatening injuries or illness
  • Yellow - those less critically injured; non-life threatening injuries
  • Green - those with injuries that are not life or limb threatening
  • Black - those who have died or whose injuries do not support survival
  • BACK

Disaster Tags - General Guidelines

  • Red
    • Treatable life-threatening illness or injures
    • Patient has a altered mental status - unable to follow simple commands
    • Carotid pulse present; radial pulse absent
      • if both carotid & radial pulses are present, categorized considering respiratory rate and mental status
    • Respirations < 10 or > 30

Disaster Tags - General Guidelines

  • Yellow
    • Serious but not life-threatening illness or injury
    • Delayed care
    • Patient is alert
    • Patient has a radial pulse
    • Respirations less than 30 per minute

Disaster Tags - General Guidelines

  • Green
    • Minor musculoskeletal injuries, minor soft tissue injuries
    • Patient may or may not be able to walk
    • Patient is alert
    • Patient has a radial pulse
    • Respirations less than 30 per minute

Disaster Tags - General Guidelines

  • Black
    • Dead or fatally injured patients
    • Resources limited and cannot be devoted to these patients
    • If resources are unlimited, arrested patients may become a Red (in very unique situations would this occur)

Hospital Use of Disaster Tags

  • Disaster tag should become a permanent part of the patient’s chart
    • EMS and ED staff can use the tags to initiate documentation
    • during Mass Casualty Plan, EMS run reports are not necessary so all the information from the field is most likely on the disaster tags

Resource Hospital Responsibilities (CMC)

  • Once notified, serves as medical control of the incident
  • Collaborate with field personnel to identify possible receiving hospitals based on:
    • incident location
    • transport routes open
    • volume/acuity of patients
  • ECRN to notify Charge Nurse immediately of the situation

ECRN at Resource Hospital

  • Begin filling out “Mass Casualty Incident Log”
  • Establish inter-facility communication
    • describe nature & location of incident,
    • approximate number of patients
    • acuity & type of patients
  • Continually monitor receiving hospital capabilities
  • Resource Hospital also is a receiving hospital

ECRN at Resource Hospital

  • Assess receiving hospitals’ resources
    • ability to receive patients divided into the number of red, yellow, green that can be accepted
    • blood inventory
    • ability to decontaminate patients
    • ability to send medical personnel and supplies

ED Bed Capacity

  • All staff need to remember:
  • This is a DISASTER.
  • This is a unique situation
  • It is a short term unusual operation
  • Take your numbers to the max - EMS in the field need all available beds, wheelchairs, hallways in order to transport patients off the scene

Excessive Casualty Load

  • ECRN must be prepared and anticipate notification of additional receiving hospitals when casualty load exceeds capabilities in closest receiving hospitals
  • May need to obtain status of specialized facilities as needed (ie: burn units, pediatrics, etc) for additional transport of patients with special needs

Communication With The Scene

  • ECRN at Resource Hospital (CMC) stays in communication with scene contact (usually Transportation; but could be Incident Commander or designee)
    • ECRN relays to the field the receiving hospital’s capabilities
    • Assists with transport management
    • If casualties imply need for transfusions, may need to coordinate with lab to notify LifeSource for blood

Communication From the Resource Hospital (CMC)

  • Transportation communicates with ECRN at Resource Hospital (CMC)
  • ECRN at Resource Hospital (CMC) communicates with ECRN at Associate hospital (LFH)
  • ECRN at Resource Hospital (CMC) is the one communication link for all hospitals
  • Maintaining consistent ECRN at the radio minimizes lost information

Communication Pathway

  • Transportation Officer*
  •  
  • Resource Hospital (CMC)
  •  
  • Associate Hospital (LFH)
  • *Communication contact from the scene to the hospital is most often made with Transportation Officer at the site

Receiving Hospital

  • In Mass Casualty Plan, notification triggered by Resource Hospital (CMC)
  • Report to Resource Hospital (CMC) ability to receive what number of red, yellow, green patients
    • Need to think “big”
    • Doesn’t help a mass casualty situation to say you’ll accept a small number of patients - everyone needs to think big and switch to “disaster mode” of operating/thinking/responding

Receiving Hospital

  • May need to activate internal plan depending on the situation
  • Maintain communication log with the Resource Hospital (CMC)
  • Report increases or limitations in capabilities to Resource Hospital (CMC) ASAP
  • Be prepared to send pre-assembled medical supply bags to the scene

Patient Flow

  • Most critical victims from the scene may be transported to closest appropriate hospital before sophisticated communication network established
  • DO NOT attempt to stop patient flow from individual ambulances not associated with the disaster activity
    • These ambulances will carry on normal communication practices


  • All communication must go through the Resource Hospital (CMC)
    • Associate Hospitals (LFH) are not to contact the scene directly
    • Associate Hospitals (LFH) are not to divert individual ambulances
  • Associate Hospital (LFH) receiving 1st field call from EMS needs to direct EMS to contact the Resource Hospital (CMC)

Medical Personnel To The Scene

  • May be requested by Incident Command at the site
  • Team assembled based on need at the scene
  • Supplies specific to the incident should be brought with
  • Police escort to be provided
    • coordinated between Resource Hospital & Incident Command (or designee) at the site
  • Team to report to Command Post for assignment
  • Should be uniformed for easy identification

Dispatch To The Scene

  • Self-dispatching of medical personnel to a disaster site is strictly prohibited
    • Causes additional chaos due to additional undisciplined and unmonitored persons congesting at the scene
    • For safety, need organized method to know who the rescuers are and where they are functioning

After Action Report

  • All hospitals and fire departments involved in the Region X multiple victim/mass Casualty plan to to complete a written report following any incident or scheduled mass casualty drill
  • Helps during the critique process

After-Incident Report The Critique

  • Form utilized for post-incident critiques by the Region X DMSC committee with intent of continually reviewing and improving the multiple victim/mass casualty plan as well as the education of fire/rescue/hospital and communication personnel
  • PLAN

Internal Hospital Plan

  • Better to call for additional help and turn them away than not to have them and wish you did!

Internal Disaster Plan

  • ECRN needs to coordinate with:
    • ED MD
    • Administrator on duty
      • authorizes the activation of the internal disaster plan and authorizes the cancellation of the plan

Hospital Incident Command

  • Typical lines of authority in-house
    • Administration on-duty; on-call
    • Nursing Supervisor on duty
    • ED MD
  • The identified person of authority makes and implements decisions to handle the situation
  • Often located in a “Command Center” manned by personal with phone access

Additional Resources

  • You need to know when to get help and where to find the help at your facility
    • Decontamination capabilities
    • Trained staff to man key areas of the ED or alternate treatment areas
      • will serve as a resource for float personnel
      • how will you identify an ED staff member?
        • ie: vests, arm bands

Additional Resources

    • RN’s - especially experienced or comfortable in the ED
    • MD’s - based on nature of illness or injury
    • Support personnel - clerks/secretaries/registrars
    • Runners/transporters
    • Persons to man phones
    • Security - control flow of traffic

CMC versus LFH Disaster Plans

  • The following pages are more specific for CMC staff
  • The following information can be applied to most facilities any of us could be working at
  • LFH staff need to determine specific language and locations for their facility based on the information given in the following slides

Hospital Disaster Plans

  • Many principles and practices are generic across most hospitals
  • Know where your hospital manual resources are kept (usually close to the radio)
    • Where are your manuals and what do they look like?
    • When is the last time you opened & looked at yours?

CMC Paging of Disaster

  • Code Green External
    • influx of patients from external source
  • Code Green Internal
    • Need to recruit man-power for unusual activity related to unusual working conditions
      • power outage
      • lack of functioning emergency generators
      • evacuation is needed
      • need for all personnel on duty or off duty to be called in
      • damage to patient care areas (ie: flood, fire, contamination)

Manpower Resource Center

  • Under direction of VP of Human Resources
  • Located in patient Registration waiting area off main lobby
  • Able to deploy staff to areas of need
  • If called from home, hospital personnel respond to this area (unless preassigned to respond elsewhere)
  • ED staff called from home respond to the ED Disaster charge nurse

Manpower Resource Center and Additional Resources

  • When you need additional help, you inform the charge person for your area
  • Charge person needs to contact Command Center for additional help
  • Additional help to be assigned as needed/requested

Responding Staff Members

  • If called from home:
  • If on-duty at time of disaster page
    • Return to your work unit
    • Await reassignment if necessary
    • Do not respond to an area unless assigned there; adds confusion and does not help tracking of resources


  • To control access points and flow of traffic by foot and vehicle
    • onto the campus
    • into the facility
    • at key points within the building

Internal Communication

  • Walkie talkies are provided by Security
  • Key persons need to have easy and quick access for communication to each other
  • Communication support (ie: walkie talkies) need to be requested through the Command Center

ED Charge RN

  • Makes assignment of on-duty and responding staff
  • Coordinates ED activity
  • Communicate need for additional resources to the Command Center
  • Need to continue to take care of non-disaster involved patients that will still be arriving by personal car and ambulance

ECRN Radio Nurse

  • Preferably have one person assigned to the radio
    • continuity of conversation decreases missed and mixed messages
  • Use runner to get messages to the Charge RN
  • Keep Charge RN apprised of incoming messages
  • Keep Triage RN apprised of incoming type and number of patients

Treatment Areas

  • Triage
    • At ambulance bay entrance
    • Patients assigned a location based on condition
  • Main ED
    • Red, critically ill/injured patients
  • Lower level dining room
    • Additional treatment area for yellow and green categorized patients


  • If 10 or less patients (<10) can be provided in the ED decon room
  • If more than 10 patients (>10) to be provided in the locker room at the Centre Club - Libertyville
  • Manpower Resource Center to disseminate supplies as needed

Infection Control

  • Remember to consider proper use of PPE’s (personal protective equipment) based on the situation
    • If patients are coughing, think of an airborne problem
    • Provide and help place surgical masks on the patient (surgical mask helps contain spread)
    • The medical personnel should also put on a mask
      • The N95 mask will protect the medical provider from inhaling microscopic matter

Clerical Support

  • Assigned to areas of need
    • triage
    • patient registration
    • manning phones
  • Registrars have patient chart packets at main desk that need to be given out at Triage
  • Disaster log maintained


  • Public Relations personnel to serve as liaison between hospital and media
  • No staff member should provide ANY kind of information to any persons not privileged to have the information
  • Public Relations to coordinate with the Command Center information being provided
  • Goal - keep media as far away as possible from victims & family

System Wide Crisis Preparedness

  • A Region X policy to enhance communication between EMS System Resource Hospital, Associate Hospital, EMS providers and community agencies
  • To be used for potential or actual area-wide crisis such as:
    • overcrowding events for patients with same or similar signs and symptoms
    • weather related problems
    • special events

System Wide Crisis Preparedness

  • Purpose of activating this plan is to help all agencies involved be prepared for a crisis that may impact any or all parties
    • ie: summer heat wave in Chicago resulting in large number of deaths
  • Any individual involved can identify a potential or actual crisis
  • The agencies’ supervisor is contacted
  • Resource Hospital EMS Coordinator or designee is contacted

System Wide Crisis Preparedness

  • The decision is made to activate this policy
    • POD hospital is notified (HPH for this area)
    • POD hospital member will contact IDPH if necessary
  • Communications continued between all applicable parties

Surge Capacity

  • Remember to anticipate a larger number of victims than you think you are getting
  • Not all patients come by ambulance where you receive an advanced call
  • Many victims will self-transport (ie: private car)
  • Often, the “worried well” think they have symptoms that they want evaluated
  • How are you going to handle this surge?
  • SO,,,,

Example #1

  • Non-CMC sponsored fire department calls with information regarding a disaster in their town (ie: Gurnee, Lake Villa, Highland Park, Lincolnshire)
  • The ECRN should direct the fire department to their Resource Hospital

Example #1

  • The respective Resource Hospital (ie: Vista East or Highland Park Hospital) would call potential receiving hospitals (ie: CMC, LFH) to report pertinent information

Example #2

  • LFH receives a call from Lake Forest Fire that they are responding to an incident involving 50 plus students from a local school overcome with fumes
  • LFH should direct Lake Forest Fire Department to contact CMC (Resource Hospital) with the information and assistance with patient distribution

Example #3

  • Lake Forest Fire calls Lake Forest Hospital with report of 10 persons injured in a 2 vehicle crash.
  • Lake Forest Hospital directs Lake Forest Fire to contact the Resource Hospital (CMC) to assist in patient distribution

Example #4

  • Grayslake Fire contacts CMC with information regarding an incident involving 30 persons injured in a bleacher collapse
  • CMC, as the Resource Hospital, will coordinate location of receiving hospitals
  • CMC will also function as a receiving hospital
  • Each hospital decides if they need to activate their own internal disaster plan for resources

Example #5

  • A mass casualty incident occurs in the southern end of Lake County
  • Highland Park Hospital (Resource Hospital for that fire department) will be the communication link between incident and receiving hospitals
  • HPH contacts CMC, LFH, and other indicated hospitals to determine patient capabilities
  • HPH does the communication to the incident site & back and forth to hospitals

Example #6

  • Libertyville Fire Department responds to an incident on the tollway involving 7 patients
  • Libertyville Fire Department calls CMC
  • CMC can take all 7 victims
  • No additional involvement with other receiving facilities is necessary - CMC can handle all the injuries with minimal use of some additional resources in-house

Example #7

  • CMC receives a call from NWCH stating we are going to be receiving patients from an incident in Buffalo Grove
  • What is CMC’s response?
    • CMC is functioning as a receiving hospital
    • Communication will occur through NWCH to the site and NWCH to the receiving hospitals
    • CMC does not function as a Resource Hospital
    • Communication to LFH would be from NWCH, if LFH would be receiving patients

Bottom line...

  • Know where your Disaster Manuals are and how to use them
  • Review the disaster manuals often enough to be comfortable to respond without much prompting
  • Be familiar with your own facilities resources, know who functions in the charge role, and know how to get the disaster response activated

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