- 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
Objectives - 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
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
- 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 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
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
Communication - 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
- HOSPITAL
- DISASTER
- PLAN
- ACTIVATION
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?
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
Security - 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
Decontamination - 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
Media - 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,,,,
- WHAT DO THESE DISASTER PLANS MEAN TO ME?
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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