Board Meeting Packet 3-18-10 - Southwest Virginia Emergency

Transcription

Board Meeting Packet 3-18-10 - Southwest Virginia Emergency
BOARD OF DIRECTORS MEETING
6:30 P.M.—March 18, 2010
Southwest Virginia Higher Education Center, Abingdon, VA
PROPOSED AGENDA
I.
Call to Order
A. Approval of March 18, 2010 Meeting Agenda
B. Approval of December 17, 2009 Meeting Minutes
C. Approval of Financial Statements – 3rd Quarter FY2010
II.
Reports and Action:
A. President and Executive Officers—Lonny Gay, President
B. Executive Director—Gregory Woods
1. Activity Report
2. Second Quarter FY 2010 Deliverable Report (OEMS)
3. OEMS 3rd Quarter 2010 Quarterly Report
C. Regional Medical Director—Dr. Norman Rexrode/Dr. Paul
Phillips
D. EMS Advisory Board Representative—L.V. Pokey Harris
E. OEMS Program Representative(s)—Ron Kendrick/Paul
Fleenor
F. Committees
1. Training and Education
2. Public Information & Education
3. Performance Improvement
4. Critical Incident Stress Management Team
5. Communications & Transportation
6. Medical Direction Committee
7. Emergency Planning & Preparedness
8. Trauma-Triage Plan Review Workgroup
III.
Public Comment
IV.
Unfinished Business
V.
New Business
A. Review/Revision of regional plans
1. Strategic EMS Plan
2. WMD/MCI Plan
3. Medication and EMS Supplies/Medication Kit
Exchange
VI.
Adjournment
Southwest Virginia EMS Council, Inc.
Board of Directors
Southwest Virginia Higher Education Center
December 17, 2009
7:00 p.m.
Members Present:
Lonny Gay – President
J.C. Bolling – Vice-President
Maxie Skeen – Secretary
Delilah Long – Treasurer
Roger Burke
Bryan Saunders
Dr. French Moore, Jr.
Pokey Harris
Steve Wallace
Earl Carter
Paul Phillips
Charlie Smith
Carol Barr
Ronald Passmore
Topic/Subject
Call to Order
Approval of December 17,
2009 Meeting Agenda
Approval of September 17,
2009 Draft Minutes
Approval of Financial
Statements – 2nd Quarter 2010
Reports and Actions:
A.
President and
Executive Officers –
Members Absent:
Dr. Norman Rexrode
Freda Ayers
Dreama Chandler
Ron Kendrick
Ann Fleming
Joe Roma
Dr. Gary Williams
William Dub Ford
Rhudy Keith
Ronald Sexton
Rusty Osborne
Jerry Bledsoe
David Brash
William Mays
Staff:
Gregory Woods – Exe. Director
Theresa Kingsley – Lead Field Co.
Kathy White – Admin. Asst.
Others:
Steve Harris
Hannah Long
Lora Testerman
Dr. Melba Bolling
Lynn Weeks
Johnny Skeen
Kandice Woods
Discussion
Recommendations, Action/Followup; Responsible Person
The Chair called the meeting to order at 7:00 p.m.
A motion was made and carried to approve the December 17, 2009 meeting agenda as presented.
A motion was made and carried to approve the September 17, 2009 meeting minutes as presented.
A motion was made and carried to approve the Second Quarter 2010 financial statements as presented.
Mr. Lonny Gay welcomed everyone to the meeting and thanked the council staff for the meal.
1
Topic/Subject
Discussion
B.
Executive Director-
Mr. Gregory Woods provided the Board with his Executive Director’s report. Mr. Woods informed the
Board of all the activities the Council has been involved with over the last few months. The Council
has completed all the deliverable for the First Quarter of 2010 and corrected all the items from the
Designation Process for the Office of EMS.
C.
Regional Medical
Director
Dr. Norman Rexrode was absent from the meeting but Dr. Paul Phillips reported that the Regional
Medical Directors met before the Board meeting. At this meeting the OMD’s continued to work on
updating the Protocols and Drug Box wish list for the southwest region.
D.
EMS Advisory Board
Representative
Ms. L.V. Pokey Harris informed the Board of all the activities taking place with the Advisory Board.
Ms. Harris reported that she is First Vice-Chair Officer and Communications Chair for the Advisory
Board. Ms. Harris attended the state Symposium, very good training weekend and great to get CE
hours. She informed the Board that the state offices are in talks of not having the Symposium in the
future. Ms. Harris talked about the train-the-trainer course last week; all the Councils were left out and
had no information on the training. Ms. Harris plans to speak with Mr. Brown on this matter. Also,
Ms. Harris went to the state FARC committee meeting in early December, she feels that the southwest
region faired very well in this cycle.
E.
OEMS Program
Representative(s)
F.
Recommendations, Action/Followup; Responsible Person
Mr. Ron Kendrick/Paul Fleenor was unable to attend the meeting. No report was given.
Committees
1.
Training and
Education
Ms. Theresa Kingsley informed the Board of the current training in the area. This committee will be
reconstructing some of the classes and continues to work on the Instructor Database for Southwest
Virginia.
2.
Public
Information and
Education
Ms. Kathy White informed the Board that this committee has not met. The PI &E committee will meet
in January 2010 to begin working on the Regional EMS Awards.
3.
Performance
Improvement
Mr. Woods provided this report for Mr. Bryan Kimberlin. Only six agencies provided information for
this quarter. The Council continues to seek more agency involvement with PI.
2
Topic/Subject
Discussion
4.
Critical Incident
Stress
Management
Team
Mr. Charlie Smith informed the Board that the CISM Team will meet in January 2010. A meeting was
scheduled for December 22, 2009 but had to be cancelled due to Robert Hill guest speaker‘s schedule.
The CISM team had one debriefing in Wytheville for this quarter. Also, they are looking to raise
membership for the team.
5.
Communications
& Transportation
Mr. Woods reported that this committee met on October 15, 2009 to review and grade the RSAF Grants.
6.
Medical
Direction
Committee
Dr. Paul Phillips provided the report. This committee met prior to the Board of Directors’ meeting.
The MDC continues to work on Protocol revisions for the region. The MDC adopted a draft TraumaTriage plan with minor changes.
7.
Emergency
Planning &
Preparedness
Ms. Theresa Kingsley informed the Board that this committee is waiting on the Office of EMS to
provide direction for MCI/WMD planning activities.
8.
Trauma-Triage
Plan Review
Workshop
III. Public Comment
IV. Unfinished Business
V. New Business
1. COOP Plan
VI. Other
Adjournment
Recommendations, Action/Followup; Responsible Person
Mr. Woods discussed the draft plan and revision process. A motion was made and carried to adopt the
Trauma-Triage Plan with the changes recommended by the Medical Direction Committee.
Mr. Steve Harris thanked the Board of Directors for providing the meal for the meeting.
Mr. Woods reported that the church building the Council has been looking to purchase is still for sale.
A motion was made and carried to make an offer on purchasing the building.
Mr. Woods discussed the revised Continuity of Operational Plan as presented. A motion was made and
carried to approve the COOP Plan with corrections.
The next meeting on the Board of Directors will be March 18, 2010.
The meeting adjourned at 9:15 p.m.
3
Southwest Virginia EMS Council
Regional EMS Plan FY2011
Southwest Virginia EMS Council
1000 West Main Street
Abingdon, Virginia 24210
(276) 628-4151
www.southwest.vaems.org
REVISED MARCH 2010
BACKGROUND:
The Southwest Virginia EMS Council’s 2011 strategic plan is completed as part of a
statewide emphasis on strategic EMS planning under contract with the Office of
Emergency Medical Services. The plan focuses entirely on operational areas that need
to be strengthened and on new initiatives that need to be introduced to meet the needs
of the region’s EMS system. The plan does not focus on areas where performance is
high or areas of routine or continued service.
The template utilized to create this document was provided by Renaissance Resources,
a firm contracted by the Office of Emergency Medical Services to assist in strategic
planning efforts across the state.
An analysis of organizational strengths, weaknesses, opportunities, and threats was
conducted by the Board of Directors in March 2011. Opportunity was given to local
governments and EMS agencies to provide suggestions and comments related to plan
development. The results of that analysis are listed below:
Strengths
• Local financial support of EMS
agencies
• Ability to respond to local needs
• Ability to service council area
• Experienced and knowledgeable staff
• Representative Board
• Momentum since reorganization
• Improved public perception
• Organizational adaptability
• Understanding of local customer needs
Opportunities
• Collaboration with other agencies
• Involvement in EMS education
programs
• Alternative funding sources
• Review/revision of existing programs
• Participation in planning activities
• Pool of potential OMDs
• Inter-regional collaboration
Weaknesses
• Limited ALS certification programs
• Limited BLS instructors in certain areas
• Limited funding
• Large geographic service area
• Recent restructuring
• Poor local economies
• Limited number of active OMDs
• Potential monetary loss (due to
economy)
Threats
• Reduction in locality funding
• Attrition of quality EMS providers in
the region
• Rising gas and operational costs
• Loss of training/testing personnel
• Increased responsibilities without
increased funding
• Loss of staff due to salary/benefits
• Loss of volunteers
Based on this analysis, regional needs, state contract requirements, and the mandates
of the state EMS plan (as defined in the Code of Virginia § 32.1-111.3), strategic
initiatives were developed to direct Council work. Those initiatives are outlined in this
plan.
Southwest Virginia Strategic Plan Page 2 of 8—Revised March 2010
The regional EMS plan will be reviewed annually and revised as necessary to respond
to environmental threats and opportunities. Comments and suggestions concerning the
regional EMS Plan may be submitted in writing to the Southwest Virginia EMS Council.
VISION:
To become known as a foremost source of knowledge and a comprehensive resource
for assistance related to all aspects of the EMS system development and operation by
providing administrative support, educational opportunities, EMS planning, and
assistance with resource acquisition and retention to insure that all individuals facing
medical or traumatic emergencies in our region receive the highest possible standard of
prehospital care.
MISSION:
To reduce death and disability resulting from sudden or serious injury and illness in the
Southwest region through planning and development of a comprehensive, coordinated
EMS system and provision of other technical assistance and support to enable the EMS
community to provide the highest quality emergency medical care possible to those in
need.
Southwest Virginia Strategic Plan Page 3 of 8—Revised March 2010
Core Strategy 1: Develop Partnerships
Key Strategic Initiatives
1.1. Promote collaborative approaches.
1.1.1. Develop and foster relationships with federal, state, and local partners,
and other regional EMS Councils. (2009-2012)
1.1.2. Strengthen on-going relationships with other state departments, public
safety, public health and medical facilities. (2009-2012)
1.1.3. Work with Western Virginia EMS Council and the Blue Ridge EMS Council
to coordinate and standardize programs as identified by our Board of
Directors.
1.1.4. Cultivate grass roots support for strategic initiatives. (2009-2012)
1.1.5. Strengthen and expand relationships with educational institutions. (20092012)
1.1.6. Maintain involvement with the Appalachian Stroke Network. (2009-2012)
1.1.7. Work with other localities and entities to facilitate interoperable
communications (2009-2012)
1.2. Attract and support outstanding health care providers.
1.2.1. Cultivate partnerships with universities, colleges, accredited training
programs, and others to attract and educate EMS providers. (2009-2012)
1.2.2. Recruit and assist in retaining EMS physicians. (2008-2012)
1.3. Further community based prevention.
1.3.1. Encourage illness and injury prevention programs through collaboration
with other agencies and organizations. (2009-2012)
1.3.2. Participate with Appalachian Stroke Network prevention and awareness
programs (2009-2012)
1.4. Identify resources for responses to emergencies both natural and manmade.
1.4.1. Enhance relationships with local emergency managers and other federal,
state, and local agencies. (2009-2012)
1.4.2. Support ongoing training, evaluation and develop resources for
emergency preparedness and response. (2009-2012)
1.4.3. Assist in the setup and training of Community Emergency Response
Teams (CERT)
Southwest Virginia Strategic Plan Page 4 of 8—Revised March 2010
Core Strategy 2: Utilize Tools and Resources
Key Strategic Initiatives
2.1. Facilitate EMS quality assurance and related research.
2.1.1. Support and encourage research and other projects utilizing collected
EMS data. (2009-2012)
2.1.2. Promote quality assurance in EMS service and trauma triage compliance.
(2009-2012)
2.1.3. Develop QA/QI plans and resources for EMS agencies. (2009-2012)
2.1.4. Foster active PI committee participation and regionally representative
membership (2009-2012)
2.1.5. Coordinate region-wide PI projects for EMS, Trauma, and System issues
2.1.6. Publish findings and recommendations based on quarterly PI data review
(2009-2012)
2.2. Support quality education and evaluation of EMS personnel.
2.2.1 Promote and provide enhanced resources for quality EMS education.
(2009-2012)
2.2.2. Expand availability of ALS Training. (2009-2012)
2.2.3. Support and improve processes for evaluation of ALS & BLS candidates.
(2009-2012)
2.2.4. Support accreditation of ALS program sites (2009-2010)
2.3. Foster appropriate use of EMS resources.
2.3.1. Support education, legislation and programs to promote the appropriate
use of EMS resources. (2009-2012)
Southwest Virginia Strategic Plan Page 5 of 8—Revised March 2010
Core Strategy 3: Develop Infrastructure
Key Strategic Initiatives
3.1 . Develop and strengthen Board of Directors
3.1.1. Annually review and revise Board of Directors governing documents.
(2009-2012)
3.1.2. Cultivate board participation through board orientation, continuing
education, and communication. (2009-2012)
3.2. Adequately staff the Southwest Virginia EMS Council.
3.2.1. Ensure adequate staffing to support the variable nature of the EMS system
requirements and challenges within the region. (2009-2012)
3.2.2. Assess and adapt the Council’s role in ensuring appropriate EMS provider
training. (2009-2010)
3.2.3. Provide ongoing workforce development and supporting resources to
recruit and retain proficient staff. (2009-2012)
3.2.4. Examine Council staffing structure to insure the region is adequately
served either through staff duties or establishment of sub-regional offices
as suggested by the 2007 Regional Council Study (2009-2012)
3.3. Focus recruitment and retention efforts.
3.3.1. Support and promote recruitment and retention campaigns within the
region. (2009-2012)
3.3.2. Launch regional recruitment and retention project. (2009-2010)
3.3.3. Promote use of recruitment/retention resources. (2009-2012)
3.3.4. Promote and conduct annual EMS award programs. (2009-2012)
3.3.5. Promote and offer scholarships for EMS provider education as funding
permits. (2009-2012)
3.3.6. Support regional crisis intervention initiatives. (2009-2012)
3.3.7. Utilize website to promote regional EMS activities
3.4. Upgrade technology and communication systems.
3.4.1. Promote improved EMS communications systems. (2009-2012)
3.4.2. Promote the use of technology in EMS reporting and quality assurance.
(2009-2012)
3.4.3. Assist EMS agencies in complying with narrow banding standards. (200920010)
3.4.4. Promote and support interoperability efforts in the region. (2009-2012)
3.5. EMS funding.
3.5.1. Encourage pursuit of alternative funding sources including revenue
recovery and increasing operating efficiencies. (2009-2012)
Southwest Virginia Strategic Plan Page 6 of 8—Revised March 2010
3.5.3. Participate in RSAF grant process. (2009-2012)
3.5.4. Ensure appropriate stewardship of EMS council funds. (2009-2012)
3.5.5. Support and advocate for a stable funding stream for state and regional
infrastructure. (2009-2012)
3.6.
Regional Drug Box Standardization.
3.6.1. Develop grass roots support for regional standardized drug box program
by EMS physicians, EMS agencies, localities, and medical facilities.
(2008-2009)
3.6.3 Procure funding to implement regional standardized drug box program.
(2009-2010)
3.6.3. Implement regional standardized drug box program by 2010
Southwest Virginia Strategic Plan Page 7 of 8—Revised March 2010
Core Strategy 4: Promote Other Regional Initiatives
Key Strategic Initiatives
4.1.
Evaluate/expand Council training program
4.1.1. Explore additional course offerings in addition to current course offerings
(2009-2012)
4.1.2. Foster active Training Committee involvement. (2009-2012)
4.1.3. Evaluate effectiveness of current course offerings. (2009-2012)
4.1.4. Review/revise training policies to reflect changing business environment
(2009-2012)
4.1.5. Evaluate course income and expenses to insure profitability of training
program. (2009-2012)
4.1.6. Explore use of technology to streamline course registration and tracking
(2009-2012)
4.1.7. Establish regional instructor network to support regional training programs
4.1.8. Promote and grow the Southwest Virginia EMS and Fire Symposium
4.2.
Promote regional disaster planning and preparedness
4.2.1. Support and facilitate disaster training throughout the region (2009-2012)
4.2.2. Expand relationships with other preparedness organizations (2009-2012)
4.2.3. Participate in regional disaster planning activities whenever possible
(2009-2012)
4.2.4. Foster active involvement and participation by the regional Planning and
Preparedness Committee (2009-2012)
4.2.5. Coordinate regional MCI/WMD Planning in accordance with state
guidelines. (2009-2012)
Comments, suggestions, or comments should be addressed to:
Executive Director
Southwest Virginia EMS Council
1000 West Main Street
Abingdon, VA 24210
(276) 628-4151
[email protected]
Southwest Virginia Strategic Plan Page 8 of 8—Revised March 2010
SOUTHWEST VIRGINIA EMS COUNCIL
REGIONAL MEDICATION KIT
EXCHANGE/EMS SUPPLIES
RESTOCKING PLAN
Revised March 2009
1000 West Main Street
Abingdon, VA 24210
Phone: (276) 628-4151
Fax: (276) 676-0800
Website: www.southwest.vaems.org
Email: [email protected]
I.
Purpose:
This plan is to facilitate a regional medication kit exchange/restocking program in which
a majority of regional hospitals and agencies participate. This plan applies to all EMS
agencies and hospitals within the Council’s service area. The regional medication kit
exchange/restocking program is a voluntary program. Agencies and hospitals will be
asked to sign participation agreements. The goal is to establish a restocking program that
will allow EMS agencies regardless of transport destination to acquire the supplies
needed to insure a regional standard of prehospital patient care.
II.
Background:
The Southwest Virginia EMS Council is tasked with insuring that individuals receive the
best possible prehospital patient care. It is essential that EMS agencies have the
resources necessary to insure a regional standard of care. Medications and supplies are
essential for proper prehospital treatment.
A.
Council Medication Exchange/Ambulance Restocking Program
The Council annually revises (as needed) and distributes ALS Drug Box Exchange
Policies and Procedures and Ambulance Restocking/Patient Destination Policies to
EMS agencies and hospitals in the Council’s service area and to out-of-state hospitals
to which EMS agencies routinely transport. The policies/agreements contain
recommended lists of medications and supplies to be restocked.
During fiscal year 2006, these policies contained agreement language asking for
participation in and adherence to these guidelines. Agencies and hospitals were asked
to return these agreements to the Council indicating either agreement to abide by
those guidelines or non-agreement to abide by those guidelines. Reasons for nonagreement were requested. Similar ambulance EMS supplies restocking agreements
were also distributed to both groups. The Council received limited response from
both EMS agencies and hospitals. Those signed agreements were open-ended
containing no terminal agreement date. Restocking agreements did contain contract
language to allow any agency who so desires to terminate the agreement. No
termination requests were received. The following EMS agencies and hospitals
signed agreements as noted below:
EMS Agencies
Abingdon Ambulance Service
Big Stone Gap Rescue
Bland Co. Rescue Squad
Bluefield Rescue Squad
Bristol Fire Department
Bristol Lifesaving Crew
Castlewood Fire Rescue
Chilhowie Fire Department
Chores & Errands Ambulance Service
Cleveland Lifesaving Crew
Clintwood Rescue Squad
Damascus Fire Department
Damascus Rescue Squad
Dickenson County Ambulance Service
SVEMS Medication Kit Exchange/EMS Supplies Restocking Plan Page 1 of 7 Rev. 03/2009
Dismal River Rescue Squad
Dugspur Rescue Squad
Elk Creek Rescue Squad
Fries Fire Department and Rescue
Galax Fire and Rescue
Glade Spring Lifesaving Crew
Guardian Ambulance Service
Haysi Rescue Squad
Hillsville Rescue Squad
Independence Rescue Squad
Jonesville Rescue Squad
Lambsburg Rescue Squad
Laurel Rescue Squad
Lead Mines Rescue Squad
Med Flight of Eastern Kentucky
Med Flight II
Mt. Rogers Fire Department and Rescue
Norton Rescue Squad
Pound Rescue Squad
Richlands Rescue Squad
Rural Retreat VES
Saltville Rescue Squad
Scott Co. Lifesaving Crew
Smyth County Ambulance Service
Sugar Grove Lifesaving Crew
Tannersville Rescue Squad
Thomas Walker Rescue Squad
Troutdale Volunteer Rescue
Valley Rescue Squad
Valley Volunteer Fire Department
Washington County Fire Rescue
Wise Rescue Squad
Wythe County Rescue Squad
Hospitals
Bluefield Regional Medical Center
Indian Path Medical Center
Johnston Memorial Hospital
Norton Community Hospital
Wellmont Lonesome Pine Hospital
Wythe County Community Hospital
B.
Other Regional Medication Kit/Ambulance Restocking Programs
Many hospitals in the Southwest Region participate in medication kit exchange/
restocking programs with specific EMS agencies. The Council monitors these
programs to insure that medications and supplies are adequately available to all
regional EMS providers to insure resources are available to insure a standard of care.
These restocking programs are described below:
Hospital Name
Lee Regional Medical Center
Lonesome Pine Hospital
Norton Community Hospital
Mt. View Reg. Med. Center
Buchanan General Hospital
Smyth County Comm. Hosp.
Johnston Memorial Hospital
Description of Program
Restock 1-for1 for any volunteer agency
Restock standard drug box for Appalachia Rescue, Big
Stone Gap Rescue, Valley Fire Rescue, Keokee Vol.
Fire Rescue, and Appalachia Fire Department
Restock 1-for-1 all items for volunteer agencies only
Restock 1-for-1 all items for volunteer agencies only
Restock 1-for-1 drugs only
Restock 1-for-1; exchange box for box for Smyth
County EMS agencies
Restock specific supplies; exchange standard drug box
for Washington County EMS agencies
SVEMS Medication Kit Exchange/EMS Supplies Restocking Plan Page 2 of 7 Rev. 03/2009
C.
Weakness of Current System
There are some problems with existing medication kit exchange/restocking programs.
Notably, limited response/participation from agencies limits the effectiveness of the
current Council program. A major deficiency is the absence of a monitoring
mechanism built into the participation agreements to insure compliance. Likewise,
because the program is voluntary, there is not way to enforce compliance. Because of
that, there is the possibility that actual restocking arrangement vary from the
guidelines established by the Council. Monitoring is contacted by field staff through
interaction with EMS agencies and hospitals. This monitoring system is qualitative
rather than quantitative; therefore, it has limited accuracy.
Other regional programs are generally tailored only to specific agencies within the
hospital’s surrounding geographic area. This does not adequately address the
medication kit exchange issue of EMS agencies that are transporting to that facility
from an outlying or surrounding area. This is specifically problematic when an
agency is diverted from their closest facility to another hospital. Because the agency
being diverted does not participate in the receiving facility’s exchange program, they
are left with incomplete supplies of medications and/or supplies. This is particularly
problematic when the agency receives a second alert before they are able to restock at
the facility with which they participate. There is no standardization among these
programs.
III.
Scope of Plan:
A.
Analysis of Current Medication Kit Exchange/Restocking Policies
An electronic survey concerning regional medication kit exchange and EMS
supplies restocking was posted on the Council’s website during the 2008 fiscal
year and publicized to all EMS agencies. Twenty-eight EMS agencies submitted
responses. Ninety-three percent of respondents indicated that they would support
regional medication kit exchange and EMS supplies restocking programs. The
majority of agencies responding indicate that they favor a system where any EMS
agency can exchange medications and restock supplies at no cost for emergency
(911 originating) calls. While respondents felt that non-billing EMS agencies
should be able to exchange for non-emergency (not 911 originating) calls at no
cost, the results were unclear regarding billing agencies. It was also unclear
whether volunteer agencies who bill should be treated the same as commercial
EMS agencies.
B.
Meetings with Hospital Staff
Meetings have begun with hospital administrators and Council staff on this
project. Representatives of the two major hospital systems in our region have
been contacted concerning this regional project. Representatives of both
Mountain States Health Alliance and Wellmont Health System have expressed
SVEMS Medication Kit Exchange/EMS Supplies Restocking Plan Page 3 of 7 Rev. 03/2009
willingness to further discuss this project and move toward implementation. A
meeting with Twin County Regional Hospital, one of the region’s independent
hospitals, is scheduled for April 2, 2009, to discuss this project.
C.
Program Design and Development
In December 2007, the regional Medical Direction Committee voted to move
forward with regionalization of medication kit exchange and EMS supplies
restocking programs. This committee is ultimately responsible for determining a
standard medication list. Likewise, this group is responsible for insuring that any
necessary changes are reflected in the regional patient care protocols. Council
staff members work closely with the Medical Direction Committee to accomplish
these tasks.
The Medical Direction Committee has met quarterly throughout this year
reviewing both medications and protocols. A tentative medication list was
approved by the Committee at its July 24, 2008, meeting. Regional protocol
reviews began in October 2008. Protocol Review Workbooks were distributed to
all committee members in attendance at that meeting. Due to low attendance, the
Committee recommended that Protocol Review Workbooks be distributed to all
regional Operational Medical Directors to facilitate review and comment from all
regional OMDs. Protocol review is ongoing with emphasis on standardization of
protocols with a regional medication kit. It is anticipated that the process will be
ongoing with implementation occurring in 2010.
A Committee of EMS providers was established to review current protocols and
the recommended medication kit list and make recommendations to the Medical
Direction Committee. The Committee met in February 2009 and continues work
on this project.
D.
Program Policies and Participation Agreements
The Committee will establish program policies and guidelines. These will be
distributed to all EMS agencies and hospitals along with participation agreements.
Only those EMS agencies and/or hospitals who return agreements will be allowed
to participate in the Council-sponsored program. These agreements will be used
to determine program logistics including the quantity of drug boxes that will be
needed and the storage capabilities needed.
A listing of participating EMS agencies and hospitals will be distributed to all
EMS agencies and hospitals in the region. The listing will be periodically
updated. Ongoing efforts will be made to engage EMS agencies and hospitals in
participation in this program. This will involve additional meetings. It is
anticipated that participating agencies/hospitals will become increasingly
involved in obtaining peer participation in the program.
SVEMS Medication Kit Exchange/EMS Supplies Restocking Plan Page 4 of 7 Rev. 03/2009
E.
Procurement of Funding
Upon analysis of the number of boxes needed, costs will be projected for
implementation of the program. Projections will include extra boxes for newlysigned agencies/hospitals and/or replacement boxes. All possible funding sources
will be explored, including the Rescue Squad Assistance Fund Grant Program.
F.
Implementation
Upon procurement of necessary funding, medication kits will be purchased and
placed in all participating hospitals and on all ALS licensed vehicles operated by
participating agencies. It is anticipated that much of the request will come
through the RSAF program and will depend on the speed with which negotiations
with hospitals and agencies progress. It is the goal of the program to achieve
implementation at the earliest possible date.
G.
Assurance of Regional Program
It is the goal of this program to insure exchange programs in all areas of our
service region. Because of the voluntary nature of such programs and the absence
of any regulatory requirement for participation, it is anticipated that not every
EMS agency or hospital will participate. Ongoing efforts will be made to gain
regional participation.
It is a concern that a hospital’s refusal to participate may render agencies in that
area without exchange/restocking mechanisms. The Council will work with
agencies in those areas to address these issues. Factors considered will include:
1)
Possibility of a specific medication exchange/restocking program
between the hospital and agencies in that area.
2)
Investigation into a localized medication kit/restocking program.
This may require obtaining DEA/Board of Pharmacy approval.
3)
Discussion with OEMS program representative and/or other
OEMS staff to find an alternative solution.
4)
Other options to address agency needs.
H.
Monitor and Review
The program will be reviewed annually. Method of review will include
qualitative and quantitative analysis (when applicable). Surveys of EMS agencies
and hospitals will be conducted at least biennially to gauge effectiveness of the
program.
Program policies will include a mechanism to address concerns raised about the
program. Although the actual plan will be developed by the committee, it is
anticipated that such concerns will be submitted in writing and reviewed by the
SVEMS Medication Kit Exchange/EMS Supplies Restocking Plan Page 5 of 7 Rev. 03/2009
committee and/or other Council committees (Medical Direction, Emergency
Facilities).
SVEMS Medication Kit Exchange/EMS Supplies Restocking Plan Page 6 of 7 Rev. 03/2009
Southwest Virginia Mass
Casualty Incident Response
Guide
Southwest Virginia EMS Council
1000 West Main Street
Abingdon, Virginia 24210
(276) 628-4151
www.southwest.vaems.org
REVISED JUNE 2009
Southwest Virginia Mass Casualty Incident Response Guide
April 2009
PREFACE
The title of this document is Southwest Virginia Mass Casualty Incident Response Guide. This
manual is published by the Southwest Virginia Emergency Medical Services (EMS)
Council. The Southwest Virginia Mass Casualty Incident Response Guide is intended as the
primary reference and guideline for training, guidance and assistance of first responders and
medical control personnel in the management of mass casualty incidents. It is recommended that
a copy of this Guide be kept in a readily accessible location in every EMS Supervisor’s Car,
Battalion Chief’s and other Command Vehicles; at each EMS agency, Emergency
Commications/911 Center and in each jurisdiction’s Emergency Operations Center; and adjacent
to the radio consoles in hospital emergency departments.
This plan is adapted from HAMPTON ROADS MASS CASUALTY INCIDENT RESPONSE
GUIDE a provided by the Peninsulas and Tidewater Emergency Medical Services (EMS)
Councils.
To request additional copies of the Guide, or to submit questions, comments, or suggestions
please contact:
Southwest Virginia EMS Council, Inc.
1000 West Main Street
Abingdon, VA 24210
Telephone: 276-628-4151
Facsimile: 276-676-0800
E-mail: [email protected]
Web Site: http://southwest.vaems.org
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SCOPE AND PURPOSE
The Southwest Virginia Mass Casualty Incident Response Guide is intended to address
techniques in field operations that must be employed when the number of patients exceeds
immediately available resources. In addition, this Guide may also serve as the basis for routine
operations. This Guide standardizes operations during mass casualty incidents. It is intended to
be an “all hazards” Guide to meet the needs of any multiple or mass casualty incident regardless
of what caused the incident. If necessary, these procedures can be modified based on the number
of patients, the cause or severity of injuries, and special circumstances involved in the incident.
The initial response will be determined by the number of patients. The first arriving unit must
estimate what Emergency Medical Services (EMS) resources will be needed as part of the initial
scene size up. Additional supervisory resources may also be needed to establish the Incident
Management System and should be called for as required by your local procedures.
The Southwest Virginia EMS Council strongly encourages this plan be exercised in conjunction
with the local Emergency Operations Plan.
**Every effort has been made to include the most up to date and current listing of
resources. Should additions, deletions or revisions be necessary, please contact the
Council office.
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Table of CONTENTS
Chapter 1: General Concepts and Considerations ..........................................................1
Introduction ................................................................................................................1
The Incident Command System and Mass Casualty Incident Management..............1
Scene Safety and Security ..........................................................................................2
Personnel Accountability ...........................................................................................2
Multiple Casualty vs. Mass Casualty Event ..............................................................2
Multiple Casualty Incidents ...........................................................................3
Mass Casualty Incidents ................................................................................3
Multiple Simulataneous Incidents..................................................................3
Management of Catastrophic MCIs ...............................................................3
Victims with Special Needs & Assistance Animals ..................................................3
Chapter 2: Concept of MCI Levels ...................................................................................5
Concept of Mass Casualty Incident Levels ................................................................5
Definition of Mass Casualty Incident Levels.............................................................5
MCI Level 1 ...................................................................................................5
MCI Level 2 ..................................................................................................5
MCI Level 3 ...................................................................................................5
MCI Level 4 ..................................................................................................6
Contaminated Patients ...............................................................................................6
Requesting Additional Resources ..............................................................................6
Chapter 3: Basic Principles ................................................................................................7
Mass Casualty Incident Management Goals ..............................................................7
Overview of the Response—Critical Tasks ...............................................................7
EMS Initial Actions ...................................................................................................8
First Arriving Unit Responsibilities ...............................................................8
Emergency Department/Hospital Notification ..............................................9
Establishing Incident Command ....................................................................9
Request Additional Resources .......................................................................9
Chapter 4: Triage ................................................................................................................10
Standard Trauma Triage Methods .............................................................................10
Initial Triage...................................................................................................10
Secondary Triage ...........................................................................................10
START Triage Algorithm ..............................................................................11
JumpSTART Triage Algorithm .....................................................................12
Triage and Mass Patient Care ........................................................................13
Chapter 5: Emergency Management of Uncontaminated Patients ................................14
First Arriving Unit Actions ........................................................................................14
The Incident Scene .....................................................................................................14
The Treatment Area ...................................................................................................14
Secondary Triage ...........................................................................................14
Continual Evaluation .....................................................................................15
Designating Treatment Area Sections ...........................................................15
Treatment Area Space Requirements.............................................................15
The Transportation Area ............................................................................................15
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Scene Layout ............................................................................................................16
Uncontaminated Patient Flow Diagram .....................................................................16
Victims with Special Needs and Assistance Animals................................................17
Chapter 6: Emergency Management of Contaminated Patients ....................................18
First Arriving Unit Actions ........................................................................................18
Designation of the Hot, Warm, Cold Zones ..............................................................18
Hot Zone ........................................................................................................18
Warm Zone ....................................................................................................18
Cold Zone.......................................................................................................19
Decontamination ............................................................................................19
Victims with Special Needs and Assistance Animals................................................20
Hazardous Materials Response ..................................................................................20
Regional Hazardous Materials Officer ..........................................................20
Regional Hazardous Materials Teams ...........................................................20
The Incident Scene .....................................................................................................21
The Treatment Area ...................................................................................................21
Secondary Triage ...........................................................................................21
Continual Evaluation .....................................................................................21
Designating Treatment Area Sections ...........................................................21
Treatment Area Space Requirements.............................................................22
The Transportation Area ............................................................................................22
Packaging Radiologically Contaminated Patients for Transport ...............................24
Transportation Considerations ...................................................................................24
Scene Layout ..............................................................................................................24
Scene Diagram ...........................................................................................................25
Chapter 7: Prehospital to Emergency Department Communications ...........................26
Tactical Communications ..........................................................................................26
Radio Language .............................................................................................26
Communications Order ..................................................................................26
VHF Communications ...................................................................................26
Scene-to-Emergency Department Communications ..................................................26
Transport Group/Medical Communications ..................................................27
Patient Distribution ........................................................................................27
Regional Medical Protocols/Standing Orders ................................................27
Ambulance-to-Emergency Department Communications .........................................27
Coordinating Emergency Department Communication Responsibilities ..................28
Coordinating Emergency Department’s Role in Patient Distribution .......................28
Chapter 8: Hospital to Hospital Communications...........................................................29
Coordinating Emergency Department Communication Responsibilities ..................29
Hospital-to-Hospital Communication Methods .........................................................29
The Hospital HEAR Radio System................................................................29
F.C.C. Rules and Regualations ......................................................................29
VHHA-MCI WebEOC Internet Communications System ............................29
Intraregional Communications...................................................................................30
Regional Healthcare Coordination Center .................................................................30
Capabilities & Functions of the Regional Healthcare Coordinating Center ..30
Far Southwest Virginia RHCC ......................................................................31
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Chapter 9: Air Operations .................................................................................................32
The Air Operations Branch ........................................................................................32
The Air Medical Transport Decision .........................................................................32
Requesting Air Ambulance Services .........................................................................32
Airspace Restrictions .................................................................................................32
Aircraft Communications...........................................................................................33
Scene to Aircraft Communications ................................................................33
Aircraft to Aircraft Communications .............................................................33
Communications and Multiple Aircraft Response .........................................33
Helispot (Landing Area) Requirements and Safety ...................................................34
Helispots and GPS Coordinates .................................................................................36
Patient Destinations ...................................................................................................36
Alternative Uses of Air Ambulance Services ............................................................36
Chapter 10: Demobilization, Evaluation, and Post Incident Activities .........................37
Demobilization...........................................................................................................37
Critical Incident Stress Management .........................................................................37
Debriefing/Hotwash ...................................................................................................37
After Action Report ...................................................................................................38
Improvement Plan ......................................................................................................38
After Action Report Conference ................................................................................38
Lessons Learned Information Sharing .......................................................................38
Annex A: Emergency Communications Directories ........................................................39
Annex B: Prehospital MCI Forms.....................................................................................42
Annex C: Prehospital MCI Job Checklists .......................................................................45
Annex D: Emergency Department/Hospital MCI Forms ...............................................64
Annex E: Driving Directions to Hospitals ........................................................................70
Annex F: MCI Resources ...................................................................................................76
Annex G: State MCI Resources .........................................................................................78
Annex H: Federal MCI Resources ....................................................................................81
Annex I: Mass Casualty Training Resources ...................................................................85
Annex J: Glossary ...............................................................................................................87
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CHAPTER 1: GENERAL CONCEPTS AND CONSIDERATIONS
Introduction
The Southwest Virginia Mass Casualty Incident Response Guide is intended as the primary
reference and standard operating procedure for training, guidance and assistance of first
responders and medical control personnel in the management of mass casualty incidents.
In addition, it serves as the basis for routine operations; the Southwest Virginia Mass Casualty
Incident Response is also intended to address techniques in field operations that must be
employed when the number of patients exceeds immediately available resources. The Southwest
Virginia EMS Council strongly encourages each agency to be familiar with their respective
locality’s Emergency Operations Plan and its procedures.
The Incident Command System and Mass Casualty Incident
Management
EMS efforts in a mass causality incident will begin with the first arriving unit and expand to
meet the needs of the incident. The first arriving unit should establish Incident Command. That
unit is responsible to assess scene Safety, conduct a scene Size-up and Send that information to
the Emergency Communications/911 Center, begin to Set up the triage and treatment areas, and
begin to triage victims using the START and JumpSTART triage methods.
Remember, the three priorities of incident management are:
1. Life Safety
2. Incident Stabilization
3. Property Conservation
The incident command structure will expand or contract as needed based on the size and
complexity of the incident, and in order to maintain the span of control. Only those
functions/positions that are necessary will be filled and each element must have a person in
charge.
In most MCIs the following functions ICS functions/positions must be staffed: The incident
command, staging, extrication, triage, treatment and transportation. In a small scale incident, one
person may assume more than one function, i.e. triage and treatment may be done by the same
person or transportation and staging can be handled by the same person. In a larger incident, the
Incident or Unified Commander may establish a Medical Group or Medical Branch to oversee
some or all of the above functions.
Larger agencies may be capable of managing greater numbers of patients without mutual aid
whereas other agencies may need mutual aid resources from several jurisdictions to manage an
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incident of the same magnitude. Some incidents may be so large, or the sense of danger so
pervasive (such as a terrorist incident), that victims may not wish to remain on the scene and will
self-refer to known medical facilities.
During such incidents, EMS triage and treatment resources may have to be co-located at
hospitals, assembled at multiple locations, and/or situated a great distance away from the initial
scene location to ensure the safety of first responders and victims. In an effort to assist the
Incident commander, the concepts of MCI Levels have been integrated into this Guide. The
definition of the MCI Levels can be found in Chapter 2.
Scene Safety and Security
Scene safety is always the first consideration in an MCI of any level. Responder safety must be
consistently monitored throughout the event. A Safety Officer should be appointed as soon as is
practical to ensure that operations are safely carried out.
Recent history has proven that first responders have become choice targets for domestic and
international terrorists as seen in the Atlanta, Georgia bombings. Due to the potential for the
presence of secondary devices or people targeting first responders, operations should be carried
out in such a way as to assure the security of both first responders and victims. First responders
must be alert for the presence of secondary devices and the presence of people who don’t fit into
the scene picture. All suspicious items, devices, or people must be immediately reported to the
Incident Commander. In addition, all first responders should adhere to the prudent safety rule
which is, “If you did not bring it into the scene with you, then don’t touch it!”
EMS personnel must also be aware that one or more of the victims resulting from a suspicious or
terrorist incident may actually be the perpetrator of the crime and therefore pose a threat to first
responders, the victims, patients, and the public. EMS personnel must be on alert for the
presence of armed and possibly violent victims or patients.
Personnel Accountability
A personnel accountability system must be implemented at mass casualty incidents to help
ensure the safety of first responders and efficient operations. The jurisdiction in which the
incident occurs will have overall responsibility for the personnel accountability system. It will
be the responsibility of the Incident Commander to assure that all personnel are accounted for in
accordance with local procedures.
Multiple Casualty vs. Mass Casualty Event
The U.S. Fire Administration defines the difference between a multiple casualty and a mass
casualty event as follows:
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Multiple Casualty Incidents
Multiple casualty incidents are incidents involving multiple victims that can be managed,
with heightened response (including mutual aid, if necessary), by a single EMS agency or
system. Multi-casualty incidents typically do not overwhelm the hospital capabilities of a
jurisdiction and/or region, but may exceed the capabilities of one or more hospitals within
a locality. There is usually a short, intense peak demand for health and medical services,
unlike the sustained demand for these services typical of mass casualty incidents.
Mass Casualty Incidents
Mass casualty incidents are incidents resulting from man-made or natural causes resulting
in injuries or illnesses that exceed or overwhelm the EMS and hospital capabilities of a
locality, jurisdiction, or region. A mass casualty incident is likely to impose a sustained
demand for health and medical services rather than a short, intense peak demand for these
services typical of multiple casualty incidents.
The Southwest Virginia Mass Casualty Incident Response can be applied to both multiple
and mass casualty incidents.
Multiple Simultaneous Incidents
The resources needed to mitigate multiple simultaneous incidents are dependant on the
size and complexity of the incidents as well as their location. Expected Mutual Aid
resources may not be available or they may be significantly delayed. Providers must be
prepared to sustain their patients for long periods. Non-traditional modes of
transportation and alternate patient transport destinations will need to be considered.
Management of Catastrophic MCIs
A catastrophic MCI will require assistance from the state and federal government. This
level of MCI will also force responders to establish casualty collection points and may
also require the establishment of intermediate care facilities. In addition some resources
may be needed to assist with patient care at air heads established by the National Disaster
Medical System (NDMS).
Victims with Special Needs & Assistance Animals
Care must be taken to meet the communication, mobility, cognitive and other needs of victims
with special needs. Responders must make certain that assistive devices and equipment are
transported with the victim or patient. (i.e. glasses, hearings aids, and mobility devices such as
walkers and wheel chairs.) Theses items should be labeled with the patient’s name if known or
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the patient’s Virginia Triage Tag number.
In addition, a patient should not be separated from their assistance animal. Assistance animals
are vital to the recovery of these patients and their prompt return to the activities of daily living.
If the patient must be transported to a health care facility then arrangements must be made for the
housing and care of the assistance animal. Information of the location of the animal must be
provided to the patient and/or their family or other care giver. This also applies to canine law
enforcement officers. (e.g. drug dogs, bomb detection dogs, etc.), search and rescue dogs, and
cadaver dogs.
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CHAPTER 2: CONCEPT OF MCI LEVELS
Concept of Mass Casualty Incident Levels
Each defined MCI Level provides the Incident Commander with a suggested minimum number
and type of resources that should be requested as part of the initial response package. These
MCI levels are based upon the number of high acuity (Red Tagged/Immediate) patients, not just
the total number of victims involved. Ultimately, the type and number of resources requested is
dependent on the nature and location of the incident.
Definition of Mass Casualty Incident Levels
The four MCI Levels are defined as shown below. A list of recommend minimum resources is
provided for each MCI level. These lists serve as a guideline from which to begin requesting
additional resources.
MCI Level 1 (3-10 Immediate/Red Tagged Victims)
Larger agencies may be capable of handling incidents less than 10 Red
Tagged/Immediate patients without implementing the Southwest Virginia Mass Casualty
Incident Response or requesting mutual aid resources. The
decision to declare an MCI Level I is left to the Incident Commander.
The recommended minimum resources needed to manage this incident are:
• 5 Ambulances
• 2 Engine Companies or minimum of six first responders
• 1 EMS Supervisor/Operational Chief
MCI Level 2 (11-20 Immediate/Red Tagged Victims)
The recommended minimum resources needed to manage this incident are:
• 10 Ambulances
• 5 Engine Companies or fifteen first responder personnel
• 2 EMS Supervisors/Operation Chiefs
• 1 MCI Trailer
MCI Level 3 (21-100 Immediate/Red Tagged Victims)
A medical disaster of this magnitude will frequently require the activation of one or more
regional and/or state specialty teams. The addition of these teams will require the
establishment of a Unified Command and the expansion of the Incident Management
Structure to include the Planning, Logistics, and/or Finance and Administration Sections.
The recommended minimum resources needed to manage this incident are:
• 15 Ambulances
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• 10 Engine Companies or thirty first responder personnel
• 3 EMS Supervisors/Operation Chiefs
• 2 - 4 MCI Trailers
MCI Level 4 (101-1000 Immediate/Red Tagged Victims)
A medical disaster of this magnitude will frequently require the activation of one or more
regional, state and/or federal specialty teams. The addition of these teams will require the
establishment of a Unified Command and the expansion of the Incident Management
Structure to include the Planning, Logistics, and/or Finance and Administration Sections.
The recommended minimum resources needed to manage this incident are:
• 20 ambulances
• 10 Engine Companies or thirty first responder personnel
• 2 or more Busses
• 5 EMS Supervisors/Operation Chiefs
• 6-8 MCI Trailers
• 1 Communications Trailer
Contaminated Patients
If the victims of the mass casualty incident are contaminated, or potentially contaminated with a
chemical, biological or radiological agents or materials, activate the Regional
Hazardous Materials (HAZMAT) Team. Refer to Chapter 6: Emergency Management of
Contaminated Patients for additional information.
Requesting Additional Resources
Additional resources must be requested as soon as a potential need for them has been identified.
Annex I identifies regional specialty teams and task forces that may be requested to respond to a
mass casualty incident. Annexes J and K identifies state and federal teams and task forces that
may be requested to respond to a mass casualty incident This annexes include a synopsis of
each team or task force’s mission, capabilities, and specific information on how to activate the
team or task force.
State and Federal resources must be requested via your local jurisdiction’s Emergency
Operations Center and from the Virginia State Emergency Operations Center (VaEOC). The
VaEOC’s telephone number is 1-800-468-8892.
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CHAPTER 3: BASIC PRINCIPLES
Mass Casualty Incident Management Goals
There are three primary goals of multiple and mass casualty incident management:
• Do the greatest good for the greatest number. The primary concern must be to
save as many lives as possible with the resources available, while protecting the first
responders and bystanders.
• Manage scarce resources. In a resource limited environment heroic resuscitative
efforts are not appropriate. These heroic efforts take too much time, require too many
people to perform, and require the use of supplies and equipment that should be used for
salvageable patients. In normal day-to-day circumstances four or more providers may
work on a single patient. In mass casualty incidents this provider to patient ratio is
reversed. Scarce resources management recognizes that you do not have enough
providers, equipment, vehicles, or time to provide the normal level of prehospital care.
Providers must focus their efforts on salvaging as many patients as possible while waiting
for the arrival of additional resources.
• Do not relocate the disaster. Do not relocate the incident by transporting all of the
patients to one hospital. Providers must use triage to determine patient prioritization for
transport. The first arriving EMS units may never transport a single patient, often it is
better to establish a treatment area and wait for more units to arrive and provide patient
transportation. Communications must be established with the Coordinating Emergency
Department. Effective scene to hospital communications, combined with triage will
ensure that patients will be distributed to the appropriate receiving hospital, in the correct
order and quantity.
Overview of the Response – Critical Tasks
The primary concern must be to save as many lives as possible with the resources available,
while at the same time protecting the first responders and bystanders. To accomplish this, EMS
personnel should respond to the incident and perform the sequential critical tasks depicted in the
figure below:
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EMS Initial Actions
•
First Arriving Unit Responsibilities. It is the responsibility of the first arriving unit
to establish command and to perform the initial scene size-up using what is known as
the “5 S’s shown below and reporting the information to their dispatcher:
1. SAFETY assessment: Assess the scene for safety by looking for:
Electrical hazards.
Flammable liquids.
Hazardous Materials
Other life threatening situations.
Be aware of the potential for secondary explosive devices.
2. SIZE UP the scene: How big and how bad is it? Survey the incident scene for:
Type and/or cause of incident.
Approximate number of patients.
Severity level of injuries (either Major or Minor).
Area involved, including problems with scene access.
3. SEND information:
Contact dispatch with your size-up information.
Request additional resources.
Notify the closest hospital.
4. SETUP the scene for management of the casualties:
Establish staging.
Identify access and egress routes.
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Identify adequate work areas for Triage, Treatment, and Transportation.
5. START Triage. Triage all patients using Simple Triage and Rapid Treatment
(START) and JumpSTART triage methods as appropriate. (The triage algorithms
may be found in Chapter 4 of this document.)
Begin where you are.
Ask anyone who can walk to move to a designated area.
Use surveyor’s tape to mark patients.
Move quickly from patient to patient.
Maintain patient count.
Provide only minimal treatment.
Keep moving!
The First Unit On-Scene Scene Size-up Checklist can be found in Annex C of this
document.
•
Emergency Department/Hospital Notification. It is vital that the First Arriving
Unit tell the Dispatcher to contact the closet Emergency Department, or contact
the closest Emergency Department directly, and inform the facility that there is
a MCI in progress. This notification should include the nature or apparent cause of
the event, the estimated number of victims, and whether or not the victims may be
contaminated. The Emergency Department(s) will not be prepared to receive the
influx of patients from the MCI unless they are immediately notified of the mass
casualty incident.
•
Establishing Incident Command. The senior crewmember on the first arriving unit
becomes the Incident Commander and reports that they have command to their
dispatcher. This person will remain in charge until command is transferred to a
higher authority. It is the responsibility of the Incident Commander to perform the
initial scene size-up using the “5-S’s”.
•
Request Additional Resources. Once the initial scene size-up has been completed the
Incident Commander must request additional resources based on his/her assessment
of the incident and available resources. The Incident Commander’s request for
additional resources should be accompanied by the identification of the Incident
Staging Area(s). The MCI Level definitions found in Chapter 2 provide a list of
recommended resources for each MCI level.
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CHAPTER 4: TRIAGE
Standard Trauma Triage Methods
The purpose of triage is to assign treatment and transportation priorities to patients by separating
the victims into easily identifiable groups. The method of initial field triage to be utilized is the
Simple Triage and Rapid Treatment (START) method for adult patients. Pediatric patients, ages
8 and under, will be better served by using the JumpSTART triage method. The START and
Jump START algorithms are found on pages 4-2 and 4-3.)
There are some incidents where START Triage may not be the most appropriate tool to sort
patients. Patients who have been exposed to various HAZMAT or CBRNE may need to be
triaged using guidelines that are specific to the agent to which they have been exposed. Patients
who have been exposed to certain CBRNE weapons may have different triage needs than trauma
patients. START Triage is the preferred tool for sorting trauma patients.
Initial Triage
The initial triaging of victims must begin right where the patients lay. The EMS Provider
must begin to triage patients right where they enter the scene and then progress in a
deliberate and methodical pattern to ensure that all of the victims are triaged. When using
both the START and JumpSTART triage methods all ambulatory patients are initially
directed to a designated Green/Minor treatment area where they will be assessed and
further triaged as personnel become available. It is appropriate to provide these patients
with self-care kits, if available, so that they may begin treating themselves while awaiting
the arrival of EMS providers. For all remaining patients, triage personnel must quickly
triage each patient and apply the appropriate color-coded triage ribbons (surveyor's tape).
The initial triage of the victims establishes the order in which non-ambulatory patients
will be moved to the treatment area. Red Tagged/Immediate victims should be moved
first, Yellow Tagged/Delayed second. All Green Tagged patients should already be in the
Treatment Area as outlined above by moving ambulatory patients first. Deceased victims
(Black Tagged/Deceased) are left where they are found unless they must be moved to
gain access to living patients or if the remains are in danger of being destroyed.
Secondary Triage
Secondary triage is the first step in patient treatment. Every patient is brought from
the scene to a single point where one of the most medically qualified people on scene
will triage the patient, making a determination of what triage color category the
patient should be placed in for treatment, and ensure that the Virginia Triage Tag is
applied to the patient. Secondary triage is a more in depth reassessment of each
patient and is based on the clinical experience and judgment of that provider.
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Ongoing triage is then performed periodically thereafter depending upon the
patient’s condition. Additional triage assessments must be performed during
transport to and again upon the patient’s arrival at the Emergency Department.
START Triage Algorithm:
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JumpSTART Triage Algorithm:
JumpSTART
Field Pediatric Multicasualty Triage System
Patients aged 1 - 8 years
Identify and direct all ambulatory patients to
designated Green area for secondary triage and
treatment. Begin assessment of non-ambulatory
patients as you come to them.
MINOR
(Green)
Spontaneous
Respirations?
Yes
No
Open
Airway
Spontaneous
Respirations?
Yes
No
IMMEDIATE
(Red)
Peripheral
pulse?
Yes
No
Perform 15 sec.
mouth to mouth
DECEASED
(Black)
Spontaneous
Respirations?
Yes
No
IMMEDIATE
(Red)
DECEASED
(Black)
<15/min or
> 40/min or
irregular
15 - 40/min
and regular
IMMEDIATE
(Red)
Peripheral
pulse?
Yes
No
Mental
Status?
IMMEDIATE
(Red)
(AVPU)
Appropriate
Inappropriate
(alert, verbal
stimuli)
(painful stimuli,
unresponsive)
DELAYED
(Yellow) or
MINOR (Green)
IMMEDIATE
(Red)
(c) Lou Romig 1995
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Triage and Mass Patient Care
Today’s EMS providers can expect to face a non-traditional multiple or mass casualty incident
resulting from a man-made biological event (e.g. anthrax attack), a natural occurring pandemic
disease event (e.g. influenza), or a natural disaster or other event resulting in a large number of
victims becoming ill, or where patients with preexisting conditions become increasing ill due to
the exacerbation of their illness or condition.
Massive region wide infrastructure damage that may result from these types of incidents and may
also result in the loss of hospitals, physicians offices, dialysis centers, other healthcare facilities
and home healthcare services. Patients who live with controlled chronic illnesses and conditions
may suddenly find themselves separated from their existing family members/care givers, and/or
their normal healthcare system. Many of these patients may be unable to obtain needed
medications, oxygen, dialysis, cancer treatments, etc. due to the destruction or disruption in the
healthcare system. This situation will exacerbate their medical conditions forcing many of these
patients to turn to the EMS system for care. The principles of triage still apply during these
incidents and serve to assist providers by prioritizing patient care and transportation.
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CHAPTER 5: EMERGENCY MANAGEMENT OF
UNCONTAMINATED PATIENTS
First Arriving Unit Actions
The first arriving unit on a potential MCI must restrain themselves from rushing into the
scene. The first arriving unit should use the “5-S’s” to properly assess the scene and report the
information to their dispatch center. This step is vital to initiate a response appropriate to the size
of the MCI.
The Emergency Department closest to the scene MUST be notified immediately that an
MCI has been declared.
If this is a Level 3 or 4 MCI consider requesting the appropriate mutual aid at this time.
The Incident Scene
Initial triage must be conducted at the incident scene if it is safe to do so.
• All injured victims must be rapidly triaged.
• Make certain that triage ribbons are applied.
Ambulatory (Green Tagged/Minimal) patients must be directed to a safe place as soon as one is
identified.
• Green Tagged/Minimal patients should be asked to assist other patients if they are able
to do so.
• Self treatment kits or supplies should be distributed to patients in the Green section of
the treatment area.
Non-ambulatory patients (Red Tagged/Immediate or Yellow Tagged/Delayed) are removed from
the scene to the Treatment Area by porters.
Deceased victims (Black Tagged/Deceased) are left where they are found, unless they must be
moved to gain access to living patients or if the remains are in danger of being destroyed.
All incident victims must be accounted for. This includes victims who may be uninjured,
trapped, or who have been rescued or extricated.
The Treatment Area
Secondary Triage
A more in-depth assessment method, known as secondary triage, must be conducted on
all patients arriving at the treatment area from the incident scene. Each patient will have a
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Virginia Triage Tag applied upon their entry into the treatment area.
Continual Evaluation
Patients in the treatment area must be continuously reevaluated (re-triaged) throughout
their stay in the treatment area.
Designating Treatment Area Sections
Patients are placed in the Treatment Area and emergency medical care is provided on the
basis of the triage priority. If needed, separate areas may be created in the Treatment
Area for Red Tagged/Immediate, Yellow Tagged/Delayed, and Green Tagged/Minimal
patients. Personnel, equipment and supplies are allocated to patients based on their triage
priority.
Designate a separate, secure and isolated area for the Incident Morgue. The incident
morgue is for the placement of victims who die in the Treatment Area. (This area should
be secured by Law Enforcement Officers not EMS providers.)
Treatment Area Space Requirements
It is important to provide enough space between patients to allow providers room to
place, treat and move safely between patients. Each patient should have three feet of open
space on all four sides of the patient as shown in the figure below. Many agencies stock
colored tarps for use in designating treatment areas. Be aware that the treatment area
required will easily exceed the size of the tarps. Responders must expand and/or relocate
the treatment area during an incident to accommodate increasing space requirements.
The Transportation Area
Emergency Departments will be contacted as soon as an MCI has been identified. The
Emergency Department located closest to the incident scene automatically becomes the
Coordinating Emergency Department. The Coordinating Emergency Department will contact
other Emergency Departments and obtain Emergency Department bed availability data by triage
category. It will be that Emergency Department’s decision based on their capabilities at the time
as to whether they will accept or decline the role of Coordinating Emergency Department.
If the Emergency Department closest to the scene chooses to do so they may transfer the role of
the Coordinating Emergency Department to a hospital, normally the closest Level 1 or Level 2
Trauma Center, (i.e. Wellmont Bristol Regional Medical Center, Holston Valley Medical Center,
etc.).
Each of these facilities is the default coordination site for their respective areas. This decision
must be coordinated with on-scene Emergency Medical Services (EMS) personnel. There may
be situations where the on-scene EMS personnel will tell the Coordinating Emergency
Department that they cannot transfer the role of Coordinating Emergency Department due to
communications problems or other issues.
In either case, the Transport Group Supervisor/Unit Leader or Medical Communications
Coordinator must contact the Coordinating Emergency Department to obtain bed availability
information to assist with the appropriate distribution of patients to various Emergency
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Departments, hospitals, and/or other medical facilities.
Transportation resources are assigned based on triage priority.
Patients are moved to the Transportation Area to the appropriate vehicle by Porters/Transport
Loaders.
Patients are transported to the most appropriate medical facility by the most appropriate means
available. Emergency medical care is continued en route to the hospital. At a minimum all
medical care must be documented on the Virginia Triage Tag. If time and resources allow
medical care may also be documented on the Prehospital Patient Care Report (PPCR).
Patient transports to receiving Emergency Departments are documented on the MCI Patient
Tracking Form located in Annex B of this document.
Scene Layout
It is important for responders to establish an orderly flow of patients from the incident scene
through the transport area. The uncontaminated patient flow diagram shown on the next page
provides a sample diagram of just one way to organize the scene. Ultimately the way a scene is
organized will depend on scene security & location, terrain, weather, the number of patients, and
numerous other factors.
Uncontaminated Patient Flow Diagram:
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Victims with Special Needs and Assistance Animals
Care must be taken to meet the communication, mobility, cognitive and other needs of victims
with special needs. Responders must make certain that assistive devices and equipment are
transported with the victim or patient. (i.e. glasses, hearings aids, and mobility devices such as
walkers and wheel chairs.) Theses items should be labeled with the patient’s name if known or
the patient’s Virginia Triage Tag number.
Patients should not be separated from their assistance animals. Assistance animals are vital to the
recovery of these patients and their prompt return to their activities of daily living. If a patient
must be transported to a health care facility then arrangements must be made for the housing and
care of the assistance animal. Information on the location and health of the animal must be
provided to the patient, their family, or other care giver. This also applies to canine law
enforcement officers. (e.g. drug dogs, bomb detection dogs, etc.), search and rescue dogs, and
cadaver dogs.
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CHAPTER 6: EMERGENCY MANAGEMENT OF
CONTAMINATED PATIENTS
First Arriving Unit Actions
The first arriving unit on a potential HAZMAT or CBRNE incident must restrain
themselves from rushing into the scene by remaining uphill and upwind of the incident.
The successful initial management of a HAZMAT or CBRNE incident is based upon the first
arriving unit using the “5-S’s” to properly assess the hazard and report the information to their
dispatch center. This step is vital to the safety of all first responders, victims, and the community
alike.
The Emergency Department closest to the scene MUST be notified immediately that an
MCI involving hazardous material has been declared.
Request the Regional HAZMAT Team to respond. If this is a Level 3 or 4 MCI and/or involves a
large number of contaminated victims, advise the EOC when the request is made to enable other
HAZMAT Teams to be called in from other regions.
The first arriving unit should also make an effort to control the scene by designating a “danger
zone” and a “safe zone”. Consult the Emergency Response Guide (ERG), green section, for
initial isolation distances.
Designation of the Hot, Warm, and Cold Zones
Upon arrival the HAZMAT Team will assess the incident scene and designate a “Hot Zone,
“Warm Zone” and a “Cold Zone”.
Hot Zone
The hot zone is the area that immediately surrounds a hazardous materials incident. The
hot zone normally extends out in a 360 degree radius around the incident scene. The hot
zone is also referred to as the exclusion zone or restricted zone in other documents.
Warm Zone
The warm zone is the area where personnel and equipment decontamination and hot zone
support takes place. The warm zone access control points which assist in reducing the
spread of contamination. This is also referred to as the decontamination, contamination
reduction, or limited access zone in other documents. The warm zone will often be the
first place that patients will be decontaminated, receive antidotes and other life saving
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treatments. Once patients have been decontaminated, they will be transferred into the care
of EMS Providers in the cold zone.
Note: The administration of life saving treatments takes precedence over decontamination
for radiologically contaminated patients.
Cold Zone
The cold zone serves as the control zone for a hazardous materials incident. The cold
zone contains the Incident Command Post and other incident support facilities. This zone
is also referred to as the clean zone or support zone.
In some cases victims may remove themselves from the contaminated area. It is
important to channel these victims into a hasty decontamination corridor consisting of the
flush, strip, and flush activities. This action may be necessary to save lives and protect
first responders before a more formal contamination reduction corridor has been
established.
Decontamination
Patient decontamination, if required, should be carried out in the warm zone by properly trained
personnel wearing appropriate chemical-protective clothing and respiratory equipment. (i.e.
Regional HAZMAT Team, etc.)
Refer to established protocols to:
• Determine of the potential for secondary contamination and the necessity for, and extent
of, decontamination.
• Select appropriate personal protective equipment to be worn by personnel in the warm
zone.
• Decontaminate patients when the exposure is to an unidentified gas, liquid, or solid
material.
• Provide emergency decontamination for patients with critical injuries and illness
requiring immediate patient care or transport.
• Identify and consider crime scene related issues such as the preservation of evidence,
chain of custody, etc.
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Victims with Special Needs and Assistance Animals
Care must be taken to meet the communication, mobility, cognitive and other needs of victims
with special needs. Responders must make certain that assistive devices and equipment are
transported with the victim or patient. (i.e. glasses, hearings aids, and mobility devices such as
walkers and wheel chairs.) Theses items should be labeled with the patient’s name if known or
the patient’s Virginia Triage Tag number.
Patients should not be separated from their assistance animals. Assistance animals are vital to the
recovery of these patients and their prompt return to their activities of daily living. If a patient
must be transported to a health care facility then arrangements must be made for the housing and
care of the assistance animal. Information on the location and health of the animal must be
provided to the patient, their family, or other care giver. This also applies to canine law
enforcement officers. (e.g. drug dogs, bomb detection dogs, etc.), search and rescue dogs, and
cadaver dogs.
Hazardous Materials Response
Regional Hazardous Materials Officer
Jack Tolbert, Area 6
(276) 328-2329
Territory: Bland, City of Bristol, Buchanan County, Carroll County, Dickenson County,
City of Galax, Giles County, Grayson County, Lee County, City of Norton, Pulaski
County, City of Radford, Russell County, Scott County, Smyth County, Tazewell
County, Washington County, Wise County and Wythe County
Regional Hazardous Materials Teams
There are 3 HAZMAT regional response teams available to assist with HAZMAT and
CBRNE incidents occurring in our region. The Regional HAZMAT Teams consist of
personnel trained to the Hazardous Materials Technician level. The HAZMAT Team can
rapidly extricate victims from the hot zone, and contain the incident. The HAZMAT
Team also conducts environmental monitoring and performs plume monitoring as needed
to protect first responders and the community from harmful exposures.
•
Bristol Team: City of Bristol, Grayson County, Scott County, Smyth
County and Washington County
•
Giles County Team: Bland County, Carroll County, Floyd County, City
of Galax, Giles County, Montgomery County, Pulaski County, City of
Radford, Tazewell County and Wythe County
•
Wise County Team: Buchanan County, Dickenson County, Lee County,
City of Norton, Russell County, Scott County, Tazewell County and Wise
County
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The Incident Scene
Initial triage must be conducted at the incident scene if it is safe to do so.
Ambulatory (Green Tagged/Minimal) patients must be directed to a safe place as soon as one is
identified.
• Green Tagged/Minimal patients should be asked to assist other patients if they are
able to do so.
•
Self treatment kits or supplies should be distributed to patients in the Green
section of the treatment area.
All victims must be accounted for. This includes victims who may be uninjured, trapped, or who
have been rescued or extricated, and those who have left the incident scene prior to the arrival of
first responders.
• All injured victims must be rapidly triaged.
•
Make certain that triage ribbons are applied.
Non-ambulatory patients are removed from the scene to the Treatment Area by porters.
Contaminated patients should be decontaminated prior to leaving the
incident scene and before arriving in the Treatment Area.
Deceased victims (Black Tagged/Deceased) are left where they are found unless they must be
moved to gain access to living patients or if the remains are in danger of being destroyed.
The Treatment Area
Secondary Triage
A more in-depth assessment method, known as secondary triage, must be conducted on
all patients arriving from the incident scene. Each patient will have a triage tag applied
upon their entry into the treatment area.
Continual Evaluation
Patients in the treatment area must be continuously reevaluated (re-triaged) throughout
their stay in the treatment area.
Designating Treatment Area Sections
Patients are placed in the Treatment Area and emergency medical care is provided on the
basis of the triage priority. If needed, separate areas may be created in the Treatment
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Area for Red Tagged/Immediate, Yellow Tagged/Delayed, and Green Tagged/Minor
patients. Personnel, equipment and supplies are allocated to patients based on their triage
priority.
Designate a separate, secure and isolated area for the Incident Morgue. The incident
morgue is for the placement of victims who die in the Treatment Area. (This are should
be secured by Law Enforcement Officers not EMS providers.)
Treatment Area Space Requirements
It is important to provide enough space between patients to allow providers room to
place, treat and move safely between patients. Each patient should have three feet of open
space on all four sides of the patient as shown in figure below. Many agencies stock
colored tarps for use in designating treatment areas. Be aware that the treatment area
required will easily exceed the size of the tarps. Responders must expand and/or relocate
the treatment area during an incident to accommodate increasing space requirements.
The Transportation Area
Emergency Departments will be contacted as soon as an MCI has been identified The
Emergency Department located closest to the incident scene automatically becomes the
Coordinating Emergency Department. The Coordinating Emergency Department will contact
other Emergency Departments and obtain Emergency Department bed availability data by triage
category. It will be that Emergency Department’s decision based on their capabilities at the time
as to whether they will accept or decline the role of Coordinating Emergency Department.
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If the Emergency Department closest to the scene chooses to do so they may transfer the role of
the Coordinating Emergency Department to a hospital, normally the closest Level 1 or Level 2
Trauma Center.
Each of these facilities is the default coordination site for their respective areas. This decision
must be coordinated with on-scene Emergency Medical Services (EMS) personnel. There may
be situations where the on-scene EMS personnel will tell the Coordinating Emergency
Department that they cannot transfer the role of Coordinating Emergency Department due to
communications problems or other issues.
In either case, the Transport Group Supervisor/Unit Leader or Medical Communications
Coordinator must contact the Coordinating Emergency Department to obtain bed availability
information to assist with the appropriate distribution of patients to various Emergency
Departments, hospitals, and/or other medical facilities.
Transportation resources are assigned based on triage priority.
Patients are moved to the Transportation Area to the appropriate vehicle by Porters/Transport
Loaders.
Patients are transported to the most appropriate medical facility by the most appropriate means
available. Emergency medical care is continued en route to the hospital. At a minimum all
medical care must be documented on the Virginia Triage Tag. If time and resources allow
medical care may also be documented on the Prephospital Patient Care Report (PPCR).
Patient transports to receiving Emergency Departments are documented on the MCI Patient
Tracking Form located in Annex B of this document.
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Packaging Radiologically Contaminated Patients for Transport
Do not withhold lifesaving treatment from a patient solely because they are contaminated
with radiation. In this instance the rendering of life saving treatment takes precedence over
decontamination. Unstable ALS patients requiring immediate transport can be “packaged” to
reduce the likelihood of spreading contamination to providers, the ambulance or the hospital.
1. Cover ground or floor up to location
of patient.
2. Place two sheets on a clean
(uncontaminated) ambulance
cot/stretcher.
3. Bring in the clean ambulance
cot/stretcher.
4. Transfer the patient to the new
ambulance cot or stretcher.
5. Wrap one sheet around patient, then
the other.
6. Perform radiological monitoring of
the ambulance cot/stretcher and
wheels to reduce the spread of
contamination.
A properly packaged
radiologically contaminated
patient.
Transportation Considerations
Clinically unstable, radiologically contaminated patients must be transported via ground
ambulance to an Emergency Department. These patients should be packaged as outlined in the
above paragraph and the receiving Emergency Department must be notified that they will be
receiving a contaminated patient.
Air ambulances will NOT transport contaminated patients of any kind. If there are any questions
as to whether or not a patient is safe to fly, consult with the pilot of the responding air
ambulance. The pilot has the final authority as to whether or not the patient will be accepted
Scene Layout
It is important for responders to establish an orderly flow of patients from the incident scene
through the transport area. The contaminated patient flow diagram shown below provides a
sample diagram of just one way to organize the scene. Ultimately the way a scene is
organized will depend on scene security & location, terrain, weather, the number of patients, and
numerous other factors.
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CHAPTER 7: PREHOSPITAL TO EMERGENCY DEPARTMENT
COMMUNICATIONS
Tactical Communications
Radio Language
Common Language Protocol will be used at all times for communications throughout the region.
During MCI events units will identify themselves using the Agency’s name as a prefix, e.g.
“Abingdon Ambulance Unit 32".
Communications Order
When an order has been received briefly restate an order received to allow confirmation that
the receiver did receive the order, understands the order, and is proceeding with correct
action.
VHF Communications
Surrounding local jurisdictions may have 800 MHz mutual aid channels for routine use.
However, in a large-scale incident, resources may be called from outside their normal
response area. Statewide frequencies are designed to provide a standard
communications mechanism throughout Virginia.
Use of the following frequencies may be employed in a region-wide event:
155.205 MHz - Statewide Mutual Aid: Used for communications between incoming
units and staging officer.
155.340 MHz - HEAR Radio: Used for communications between ambulances and
hospitals.(Note: Many hospitals do not have a HEAR radio in the Emergency
Department. Ambulances should use their normal methods for conducting ambulance to
hospital communications unless otherwise directed by the Incident Communications
Plan.)
Scene-to-Emergency Department Communications
The early notification of Emergency Departments is vital to the preparation of the Emergency
Department to receive patients.
The responding EMS agency will contact the closest Emergency Department immediately after a
mass casualty incident has been identified. The responding EMS agency must advise that
hospital of the incident, incident location, the approximate number of patients, possible types of
injuries involved, and the presence or absence of chemical, biological or radiological
contamination.
Early Emergency Department notification allows Emergency Department and hospitals time to
move, release, or postpone the care of less acute patients to make room for patients arriving from
the MCI scene. It also gives the Emergency Department some time to begin calling in additional
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staff members.
Transport Group/Medical Communications
The Transport Group Supervisor/ Unit Leader will establish and maintain
communications with the Coordinating Emergency Department.
Patient Distribution
The Transport Group Supervisor/Unit Leader will use the Emergency
Department/hospital capacity and bed status data received from the Coordinating
Emergency Department, to determine the destination for each patient. He/she will consult
with the Coordinating Emergency Department to determine the best distribution of
unique cases (i.e. multiple burn victims in excess of the capacity of the nearest Burn
Center).
The Transport Group Supervisor/Unit Leader will notify the Coordinating Emergency
Department when ambulances depart the scene and provide them with the following
information for each transport:
• EMS Agency and Ambulance Number with the destination hospital
• Patient Triage Tag Number(s)
• Triage Color of each patient.
• Age and gender of Patient
• Nature of Injury; Contaminated/Decontaminated and Contaminate
• Estimated time of arrival
It is the responsibility of the Coordinating Emergency Department to forward the
information to the receiving Emergency Departments/hospitals.
Should patients be ready for transport prior to receipt of bed status capacities from the
Coordinating Emergency Department, the Transport Group Supervisor/Unit Leader will
distribute patients based on normal transport patterns.
Regional Medical Protocols/Standing Orders
Once communication has been established with the Coordinating Emergency
Department, a request to follow Regional Medical Protocols as delineated for the various
skills levels can be granted by Medical Control. This will allow providers to perform
skills approved for their level of certification without having to contact Medical Control
during the MCI.
Ambulance-to-Emergency Department Communications
During an MCI, routine ambulance-to-Emergency Department communications are suspended.
The Transport Group Supervisor/Unit Leader or Medical Communication Coordinator will
communicate patient information directly to the Coordinating Emergency Department. The
Coordinating Emergency Department will relay the information to the receiving Emergency
Departments.
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Transport Group Supervisor/Unit Leader or Medical Communication Coordinator will work with
the Coordinating Emergency Department via the most reliable communication methods and
channels. Contact options are as follows:
• Local agency-to-hospital 800 MHz radio channel *
• COR (UHF)
• HEAR (VHF)
• Telephone
* If the dedicated local channel is utilized, the Incident Commander should request that the
dispatcher restrict usage of the channel to this incident only. Ambulances working calls
elsewhere in the community will need to utilize alternate means of communications.
Coordinating Emergency Department Communication
Responsibilities
In the early stages of the incident, a Coordinating Emergency Department must be established.
The Transport Group Supervisor/Unit Leader or Incident Commander should contact the closest
Emergency Department to advise them of the emergency. The Emergency Department closest to
the scene becomes by default, the Coordinating Emergency Department. That Emergency
Department must then decide based on their capabilities at the time as to whether they will
accept or decline the role of Coordinating Emergency Department.
Should the closest Emergency Department opt not to assume the role of Coordinating
Emergency Department, the Emergency Department must contact the closest Level 1 or Level 2
trauma center.
Coordinating Emergency Department’s Role in Patient Distribution
The Coordinating Emergency Department will provide the Transport Group Supervisor/Unit
Leader with a bed status report for each receiving Emergency Department and/or hospital. (Bed
status will be obtained by querying all Emergency Departments/hospitals in the region using
either WebEOC, the intrahospital 700 MHz radio system, or telephone.)
The Coordinating Emergency Department will serve as an advisor to the Transport Group
Supervisor/Unit Leader when distributing unique cases (i.e. multiple burn victims in excess of
the capacity of the nearest Burn Center).
If patients are ready for transport prior to receipt of capacities from the Coordinating Emergency
Department, the Transport Group Supervisor/Unit Leader will commence the distribution of
patients based on normal transport patterns. The Coordinating Emergency Department must
obtain this information from the Transport Group Supervisor/Unit Leader and pass the
information on to each receiving facility.
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CHAPTER 8: HOSPITAL TO HOSPITAL COMMUNICATIONS
Coordinating Emergency Department Communication
Responsibilities
In the early stages of the incident, a Coordinating Emergency Department must be established.
The Transport Group Supervisor/Unit Leader or Incident Commander should contact the closest
Emergency Department to advise them of the incident. It is anticipated that the nearest facility
will receive many patients who leave the scene on their own, so early notification is essential.
The closest Emergency Department should be advised of the situation, number of patients, and
types of injuries involved. It will be that Emergency Department’s decision based on their
capabilities at the time as to whether they will accept or decline the role of Coordinating
Emergency Department.
If the Emergency Department closest to the scene chooses to do so they may transfer the role of
the Coordinating Emergency Department to a hospital, normally the closest Level 1 or Level 2
Trauma Center. Each of these facilities is the default coordination site for their respective areas.
This decision must be coordinated with on-scene Emergency Medical Services (EMS) personnel.
There may be situations where the on-scene EMS personnel will tell the Coordinating
Emergency Department that they cannot transfer the role of Coordinating Emergency
Department due to communications problems or other issues.
Hospital-to-Hospital Communication Methods
The Hospital HEAR Radio System
This system allows for direct radio communications between all hospitals in the
Commonwealth of Virginia.
F.C.C. Rules and Regulations
All radio operators should familiarize themselves with pertinent sections of
Federal Communications Commission (FCC) Rules and Regulations that are
applicable to radio voice communications. The use of profanity or obscenity is
expressly forbidden. Persons broadcasting false call letters or initiating a false
distress call are subject to fine and imprisonment. A current station authorization
card shall be posted adjacent to each base transmitter.
VHHA-MCI WebEOC Internet Communications System
VHHA-MCI WebEOC is a real-time internet based hospital emergency management web
page that can be utilized by hospitals to enter and display hospital operational or
diversion status.
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and bed capacity information. The VHHA-MCI WebEOC system has been adopted by every
hospital within the Commonwealth of Virginia. First responders and other appropriate parties
with “view only” access can use this system to view patient capacities based on triage
categories, (i.e. red, yellow, green) for a single hospital or a group of hospitals.
Intraregional Communications
All hospitals in the region possess equipment to routinely communicate with each other using
telephone, cellular phones and facsimile devices. Ideally, Emergency Department and hospitals
should use either the hospital radio systems and/or VHHA-MCI WebEOC as their primary
method of communications during a MCI since telephone lines and cell towers in the area of the
MCI may be overwhelmed with calls.
It is incumbent upon the responding EMS agency to immediately notify the Emergency
Department closest to the incident scene as soon as possible, and advise that Emergency
Department of the situation, number of patients and types of injuries involved.
Emergency Department/Hospital MCI Forms should be kept readily available at the
Emergency Department radio console.
Regional Healthcare Coordination Center
Emergency coordination between hospitals at the regional level within the Commonwealth is
provided by the establishment of Regional Healthcare Coordinating Centers (RHCC). These
centers are responsible for serving as the contact between regional healthcare facilities, other
regions and the statewide response system through the hospital representative seat at the Virginia
Department of Health Emergency Communications Center (VDH/ECC).
The hospital seat at the VDH/ECC serves as the contact between the healthcare provider system
and the statewide emergency response system. This function provides an interface through the
VDH/ECC to the Virginia Emergency Operations Center (EOC).
It must be emphasized, that the structure noted above is in addition to and does not replace the
relationships and coordinating channels established between the individual health-care facilities
and their local emergency coordinating centers and/or health department officials. This structure
is intended to enhance the communication and coordination of specific issues related to the
healthcare component of the emergency response system.
Capabilities and functions of the Regional Healthcare Coordinating Center
The RHCC has a 24-hour contact that is available by multiple communication methods.
(i.e. phone, pager, cell phone and/or e-mail). The RHCC is physically located in the
respective hospital in an area supplied with emergency power, phones, and supplies. In
addition, the RHCC also has satellite phone, video teleconferencing (Polycom), a backup
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radio system, interoperable with state agency systems; regional hospital status data
system and statewide integrated hospital status data system via hospital VHHA-MCI
Web-EOC access.
The functions and responsibilities of the RHCC is as follows:
Activate the RHCC and regional plan at request of the Virginia
Department of Health (VHD) and/or per regional plan
Distribute emergency information within the region at request of VDH
and/or per regional plan
Collect information within the region at request of VDH and/or per
regional plan
Facilitate coordination of regional emergency response activities at request
of VDH and within the scope of the regional plan
Participate with VDH and regional facilities on communications exercises
and drills
Conduct duties of RHCC as defined in the regional plan
Coordinate diversion status/patient distribution within region as defined in
the regional plan
Provide regional situation reports to VDH during emergency
Notify VDH of activation of regional emergency plan or coordinating
center
Coordinate regional sharing of healthcare resources during emergencies
based on guidelines developed in regional plan
Far Southwest Virginia RHCC
Far Southwest Virginia Hospital Preparedness Commission
Wellmont- Bristol Regional Medical Center
Regional Hospital Coordinator:
David Rasnick 423-844-2821, 423-844-2826 or have paged at
423-844-1121
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CHAPTER 9: AIR OPERATIONS
The Air Operations Branch
The Incident Commander or Operations Section Chief may establish an Air Operations Branch
depending upon the needs of the incident. Air operations at major incidents are complicated.
Flight safety is and must remain a vital concern of all personnel involved in air operations.
The Air Medical Transport Decision
Aeromedical ambulances should be considered when their use can:
•
•
•
•
•
•
Decrease transport time from the incident scene to the hospital.
Provide advanced critical care not available from ground EMS Units.
When special medical resources must be brought to the scene or moved to an
intermediate care facility.
When ground EMS Units cannot access or egress the scene.
Evacuate critical ill patients from the affected disaster area or local hospitals
Provide the Incident Commander with an aerial scene evaluation.
Requesting Air Ambulance Services
The initial request for air ambulance services will follow normal request procedures from the
incident commander, via the jurisdiction’s dispatch center, to the dispatch center of the closest
air ambulance service provider.
Contact the Virginia Emergency Operations Center at 1-800-468-8892 if air ambulance services
are needed from providers outside of the Southwest Virginia EMS Council region.
Airspace Restrictions
Airspace over an MCI is regulated by the Federal Aviation Administration (FAA). Questions or
requests concerning the use or restriction of that airspace during an MCI should be directed to
the FAA at 1-800-TELL-FAA (866-835-5322).
Temporary flight restrictions for disaster areas are designated by the ARTCC which will notify
other FAA facilities as appropriate. The Virginia EOC at 1-800-468-8832, has access to
additional contact information to assist in this function.
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Aircraft Communications
The primary incident Emergency Communications Center / 911 Dispatch Center will normally
contact air ambulance services to request medevac services. The scene helispot (landing area)
location, coordinates, control and frequency information will be given to the pilots by their
agency’s own dispatch center when the aircraft is dispatched.
Scene to Aircraft Communications
Ground to helicopter communications. The Virginia Medevac Committee recommends
using EMS Statewide Mutual Aid channel to communicate with air ambulances.
Helicopters
whose primary base of operations is not in Virginia cannot communicate on 800 MHz
channels.
However, all of these helicopters can communicate using VHF frequencies.
The designated mutual aid VHF frequency is as follows:
155.205 MHz - Statewide Mutual Aid
Ground to helicopter communications may also be performed on a locally assigned VHF
channel that does not interfere with incident communications. Communications may also
be
established using 800 MHz channels IF the responding air ambulance service has that
capability.
Aircraft to Aircraft Communications
Helicopter to helicopter communications are accomplished using the 123.025 VHF
frequency, allowing pilots to communicate flight or scene hazards to each other.
Communications and Multiple Aircraft Response
The use of multiple aircraft in an incident response brings with it an increased risk of
an aircraft related mishap. The Air Operations Branch Director must establish
effective and clear communications with each responding aircraft. During landing
area operations, all aircraft-ground communications must occur on an assigned and
common incident radio frequency, ideally the VHF 155.205 MHz - Statewide Mutual
Aid channel as recommended by the OEMS Virginia Medevac Committee.
Alternate radio communications between aircraft may be accomplished using VHF
123.025 MHz.
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The following multiple aircraft response communications procedure has been
recommended for adoption by all agencies involved in air operations at any incident
where more than one air ambulance, or aircraft, is responding. This procedure was
designated as a “Best Practice” by the OEMS Virginia Medevac Committee in
January 2008:
1. The initial request for medevac services should be made to the jurisdictions
primary medevac service provider (air ambulance service).
2. If requests were made for additional air ambulances or other aircraft to
respond to the scene the requesting emergency communication center must
contact the dispatch center for each air ambulance or other aircraft and advise
them that this is a multiple aircraft response.
3. The medevac service provider/air ambulance service’s dispatch or
communications center should take the following actions after they are
notified that another aircraft has been requested to the facility or scene.
o Contact all other responding aircraft communications centers and advise
them of the multiple aircraft response.
o Inform their prospective aircraft of multiple helicopters or aircraft are
responding and replay the following information to the individual flight
crews:
The number of inbound aircraft
The assisting aircraft’s name (i.e. Med-Flight II, WINGS)
Helispot (Landing Area) Requirements and Safety
The following guidelines should be used to select and establish a helispot for rotary wing
aircraft:
• Locate an area that is large enough to land a helicopter safely. The touchdown or
landing area should be 100 X 100 feet for most air ambulances such as Med-Flight II and
WINGS. The area should be on level, firm ground which is free of overhead obstructions,
rocks, and other ground debris. If landing more than one helicopter each aircraft must
have its own 100’ x 100’ designated area to land in.
NOTE:
The landing area should be clear of people, vehicles, and obstructions such as trees,
poles and wires. Keep in mind that wires cannot be seen from the air. The landing
area must be free of stumps, brush, posts and large rocks.
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• Consider wind direction. Helicopters must land and take off into the wind. The
approach and departure path should be clear of obstructions. If there are obstructions
in and around the landing zone, advise the crew on the radio.
• Mark the four corners of the landing zone. Road flares are an intense source of
ignition and must be closely managed. Other light sources are preferred if available.
At night, assure that spotlights, floodlights, and hand lights used to define the area are
not pointed toward the helicopter. Turn off non-essential lights. White lights ruin the
pilot's night vision and temporarily blinds him. Red lights are very helpful in finding
accident locations and do not affect the pilot's night vision.
• Keep spectators at least 200 feet from the touchdown area and keep emergency
service personnel at least 100 feet away. Have fire equipment standing by. Assure
that everyone who will be working near the helicopter wears eye protection. If
helmets are worn, chin straps must be securely fastened. Have firefighters wet down
the touchdown area if it is extremely dusty. All personnel should have apparatus or
some barrier between them and the aircraft during take-off and landing to protect first
responders from flying debris. This barrier also services to protect first responders in
case of an aircraft mishap resulting in a hard or crash landing of the aircraft.
Once the helicopter has landed, do not approach the helicopter. The flight crew will
approach you when it is safe to do so.
• Helicopter and helispot security. Be prepared to assist the flight crew by providing
security for the helicopter. If asked to provide security, do not allow anyone but the
flight crew to approach the helicopter. Ideally responsibility for this function should
rest with local law enforcement.
• Approaching the aircraft. Once the patient is packaged and ready to load, allow the
crew to select two or three personnel to assist with loading the patient onto the
helicopter. When approaching or departing the helicopter, always be aware of the tail
rotor and always follow the flight crew's direction for your safety.
When working around helicopters, never approach from the rear. Always approach
and depart the aircraft towards the front so you can see the pilot and he/she can see
you. When approaching the helicopter, remember to keep low to avoid the main rotor
because winds can cause the rotor to flex down. If the helicopter is landed on a slope,
approach and depart from the down-slope side only.
When the helicopter is loaded and ready for takeoff, keep the departure path free of
vehicles and spectators. If an emergency were to occur, the aircraft may need this area to
land. Keep the landing zone open at all times. If the aircraft were to experience
problems after lift-off, they will return to this landing zone due to familiarity.
• Air Operations Branch Director. The Air Operations Branch Director is often
referred to as “LZ Command”. This role must be filled by someone who is familiar
with aircraft communications, landing area designation, hazard identification, and
aircraft safety rules.
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Helispots and GPS Coordinates
Many jurisdictions have predesignated one or more helispots (landing areas) within their
jurisdiction. If the GPS coordinates for these sites are known, this information should be
included in the scene flight request information given to that air ambulance service’s dispatch
center. In addition, the OEMS and the licensed air ambulance services maintain an on-line
database of all hospital helipads.
Many incidents will require new landing areas to be designated for use during a particular
incident. The dispatch centers operated by the individual air ambulance services have the
technology to convert scene landing area information, e.g nearby roads, an intersection, into GPS
coordinates for the pilot to enter into the aircraft’s navigational system.
Patient Destinations
The Transport Group Supervisor/Unit Leader will determine patient destinations based upon
Emergency Department and hospital capacity/bed status data reported by the Coordinating
Emergency Department. Specialty patients must be transported to the appropriate facilities
(burns and pediatric). The aircraft’s pilot has the authority to change the patient’s destination due
to severe weather or other aircraft safety issues.
Alternative Uses of Air Ambulance Services
Air ambulances may also be used to transport medical supplies & equipment to an MCI incident.
The air ambulances are limited to carrying what is safe for them to transport, what will fit into
the aircraft, and what will not exceed the aircrafts weight capacity. The availability of this action
is at the discretion of the pilot of the aircraft.
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CHAPTER 10: DEMOBILIZATION,
POSTINCIDENT ACTIVITIES
EVALUATION AND
Demobilization
The Transport Group Supervisor/Unit Leader should notify both the Medical Group
Supervisor/Medical Branch Director and the Coordinating Emergency Department when all
living patients have been transported from the incident scene and all patient care activities have
been completed.
Demobilization of EMS personnel on scene should be accomplished in accordance with the
Demobilization Plan developed by the Planning Section/Demobilization Unit. If a
Demobilization Plan was not developed then demobilization should precede at the direction of
the Incident Commander or his/her designee.
Critical Incident Stress Management
Consider making Critical Incident Stress Management (CISM) services available to all first
responders. CISM Team services are available from the Southwest Virginia EMS Council. These
services are confidential and free to the emergency services community. The teams provide
stress defusing, debriefings, one-on-one sessions, demobilization, family support and educational
programs. Any emergency worker in the Southwest Virginia EMS Council’s region can call for
the CISM team. An on-call team leader will respond back to the caller, discuss the situation and
determine if and which type of CISM response is needed.
Southwest CISM Team: 24 Hour Dispatch: (276) 676-6277 and ask for CISM.
Debriefing/Hotwash
Immediately following the resolution of the mass casualty incident, the Incident Commander
should facilitate an incident debriefing or hotwash with responders representing the various
incident assignments. The incident debriefing/hotwash is an opportunity for first responders to
voice their opinions regarding the response to the incident and their own performance. At this
time agency leaders can also seek clarification regarding actions taken during the incident, and
what prompted first responders to take those actions. The incident debriefing/hotwash should not
last more that 30 minutes. Scribes should be assigned to take notes during the incident
debriefing/hotwash and include these observations in their analysis. The resulting notes will be
used to compile the incident After Action Report.
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After Action Report
The After Action Report (AAR) is the culmination of the incident response. It is a written report
outlining the strengths and areas for improvement identified by the response. The AAR will
include the incident timeline, executive summary, incident description, mission outcomes, and
capability analysis. The AAR will be responsibility of the local jurisdiction, and may include
individuals from each public safety agency involved in the incident response.
Improvement Plan
The IP identifies how recommendations will be addressed, including what actions will be taken,
who is responsible, and the timeline for completion. It is created by key stakeholders from the
participating agency officials during the After Action Report Conference.
After Action Report Conference
The After Action Conference is a forum for jurisdiction officials to hear the results of the
evaluation analysis, validate the findings and recommendations in the draft AAR, and begin
development of the Improvement Plan (IP).
Lessons Learned Information Sharing
The improvement process represents the comprehensive, continuing preparedness effort of which
the incident response activities are a part. The lessons learned and recommendations from the
AAR are incorporated into an Improvement Plan (IP). A copy of the After Action Reports from
actual mass casualty incidents should be forwarded to the licensed EMS Agency’s respective
EMS Council and the Virginia Office of EMS. The incident AAR and lessons learned form the
response should also be considered for posting on the Department of Homeland Security’s
Lessons Learned Information web site (LLIS.gov) located at https://www.llis.dhs.gov/
Lessons Learned Information Sharing (LLIS.gov) is the national network of Lessons Learned
and Best Practices for emergency response providers and homeland security officials. LLIS.gov's
secure, restricted-access information is designed to facilitate efforts to prevent, prepare for and
respond to acts of terrorism and other incidents across all disciplines and communities
throughout the US. All Lessons Learned and Best Practices are peer-validated by homeland
security professionals. LLIS.gov serves as a clearing house for AARs and Lessons Learned from
exercises and actual incidents.
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ANNEX A: EMERGENCY COMMUNICATIONS DIRECTORY
Southwest Virginia Emergency Dispatch Centers
Jurisdiction
Bland County
Bristol, City of
Buchanan County
Carroll County
Dickenson County
Galax, City of
Grayson County
Lee County
Norton, City of
Russell County
Scott County
Smyth County
Tazewell County
Washington County
Wise County
Wythe County
Primary Telephone
Number for PSAP
276-688-4311
276-645-7400
276-935-2313
276-236-8101
276-926-1650
276-236-8101
276-236-8101
276-346-7777
276-679-1211
276-889-8033
276-386-9111
276-782-4056
276-988-0645
276-676-6277
276-328-8439
276-223-6000
Northeastern Tennessee Emergency Dispatch Centers
Jurisdiction
Bristol Tn, City of
Kingsport, City of
Sullivan County
Primary Telephone
Number for PSAP
423-989-5600
423-246-9111
423-279-7500
State Police Dispatch Center
Jurisdiction
Virginia State Police
Primary Telephone
Number for PSAP
800-542-8716
Aeromedical (Air Ambulance) Resources
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Primary Telephone
Number
800-433-1028
Agency
VSP Med-Flight II
(Abingdon, Va)
Wings Air Rescue
(Marion, Va)
800-946-4701
Comments
Search and Rescue Capability
Three other aircraft available
from surrounding regions
Virginia Department of Transportation
Regional Office
Division Four Headquarters
(Wythe County)
Area 25 Office
(Galax)
Area 26 Office
(Wytheville)
Area 27 Office
(Bristol)
Area 28 Office
(Tazewell)
Area 29 Office
(Vansant)
Area 30 Office
(Wise)
Primary Telephone
Number
800-542-8716
Area Served
All
Carroll and Grayson
276-236-5461
Bland, Smyth and
Wythe
Scott and Washington
276-223-4204
Russell and Tazewell
276-964-4477
Buchanan and
Dickenson
Lee and Wise
276-597-7440
276-669-2641
276-328-0198
Supplemental Resources
Resource name
Southwest Virginia
Medical Reserve
Corps
American Red Cross
Primary Telephone
Number
276-274-0555
276-645-6650
Comments
Health Care
Volunteers
Disaster Relief
Virginia Department of Health Resources
Health District
Lenowisco
Mount Rogers
Cumberland Plateau
Director
Sue Cantrell, MD
Craig Smith, MD
John Dreyzehner, MD
Emergency Planner
Rob Peters
Judy Cooling
Vacant
Epidemiologist
Delilah Long
Julia Banks
Paige Lucas
Hospitals
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Hospital
Bluefield Regional Medical Center
Buchanan General Hospital
Clinch Valley Medical Center
Dickenson County Medical Center
Johnson City Medical Center*
Johnston Memorial Hospital
Lee Regional Medical Center
Mountain View Regional Medical Center
Norton Community Hospital
Russell County Medical Center
Smyth County Community Hospital
Tazewell Community Hospital
Twin County Regional Hospital
Wellmont Bristol Regional Medical Center**
Wellmont Holston Valley Medical Center*
Wellmont Lonesome Pine Hospital
Wythe County Community Hospital
Phone
304-327-1500
276-935-1155
276-596-6153
276-926-0312
423-341-6561
276-676-7240
276-546-1440
276-679-1151
276-679-9648
276-883-8200
276-782-1380
276-988-2506
276-236-8181
423-844-2104
423-224-5121
423-523-3111
276-228-0258
*denotes a Level I Trauma Center
**denotes a Level II Trauma Center
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ANNEX B: PREHOSPITAL MCI FORMS
Patient Transportation & Distribution Worksheet
Date: _______________
Incident Name / Location: _______________________________________
Number of Patients Reported By Triage Category
On-Scene
Location
Red
(Immediate)
Yellow
(Delayed)
Green
(Minimal)
Black
(Deceased)
Total Number
of Victims
Available Transport Units
Patient Distribution
ED or Hospital
Name
Capacity
(R/Y/G)
No. of Pts Sent
ED or Hospital
Name
Capacity
(R/Y/G)
No. of Pts Sent
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MCI Patient Tracking Form (Front)
#
Triage Tag
No.
Priority
R/Y/G
Patient’s Primary Injuries
Unit Transporting
Pt to ED/Hospital
Time Left
Scene
Patient Destination
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
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MCI Patient Tracking Form (Back)
#
Triage Tag
No.
Priority
R/Y/G
Patient’s Primary Injuries
Unit Transporting
Pt to ED/Hospital
Time Left
Scene
Patient Destination
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
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ANNEX C: PREHOSPITAL MCI JOB CHECKLISTS
Position Checklists
This Annex contains position checklist for those positions and functions needed during most
mass casualty incidents. The position checklists are formatted so there is one position checklist
per page. The position checklist may include the front and back side of the page.
•
Transport Loader
•
Safety Officer
•
Public Information Officer
•
Air Operations Group Supervisor
•
Incident Morgue Manager
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Position: First Unit On Scene
Mission/Tasks: First unit on scene gives visual size-up, assumes and announces command,
and confirms incident location, then performs the 5 S's:
SAFETY assessment. Assess the scene observing for:
□ Electrical hazards.
□ Flammable liquids.
□ Hazardous Materials
□ Other life threatening situations.
□ Be aware of the potential for secondary explosive devices.
SIZE UP the scene: How big and how bad is it? Survey incident scene for:
□ Type and/or cause of incident.
□ Approximate number of patients.
□ Severity level of injuries (either Major or Minor).
□ Area involved, including problems with scene access.
SEND information:
□ Contact dispatch with your size-up information.
□ Request additional resources.
□ Contact closest hospital.
SETUP the scene for management of the casualties:
□ Establish staging.
□ Identify access and egress routes.
□ Identify adequate work areas for Triage, Treatment, and Transportation.
START (Simple Triage And Rapid Treatment) and JumpSTART (for pediatric patients).
□ Begin where you are.
□ Ask anyone who can walk to move to a designated area.
□ Use surveyor’s tape to mark patients.
□ Move quickly from patient to patient.
□ Maintain patient count.
□ Provide only minimal treatment.
□ Keep moving!
•
Remember…Establish COMMAND, SAFETY, SURVEY, SEND, SET-UP AND
START/JumpSTART
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Position: Incident Commander
Mission: Responsible for the overall management and coordination of personnel and resources
responding to the incident.
Tasks:
□ Assumes command and announces name and title to the communications center.
□ Identify potentially hazardous situations.
□ Assess current situation.
□ Estimate number of patients.
□ Request additional resources as appropriate.
□ Notify closest Emergency Department.
□ Establish a visible command post.
□ Initiate, maintain and control communications.
□ Assign ICS functions.
□ Assign and direct resources.
□ Track current resources committed.
□ Develop, evaluate and revise operational plans.
□ Coordinate with other agencies.
□ Control and facilitate media.
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Initial Incident Command Position Assignments
Name
Position
Radio Frequency
Staging Area Manager
Extrication Group Supervisor/Unit
Leader
Triage Unit Leader
Treatment Unit Leader
Transport Group Supervisor/Unit
Leader
Public Information Officer
Safety Officer
Fire Suppression Group
Supervisor
Medical Group Supervisor
HAZMAT Leader
HRMMST Task Force Leader
Other
Helpful Hints
Use a mobile radio when possible.
Many units will be coming in so be sure to stage them "Down the Street".
Appoint a STAGING Area Manager early on to handle this for you, if necessary.
Remember the Incident Management System concept - you cannot do it all!
As tasks are completed, move people on to other tasks
Note: If Incident Commander is also acting as the Medical Group Supervisor, refer to the
Medical Group Supervisor check list.
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Position: Medical Group Supervisor/Medical Branch Director Check
List
Mission: To insure that supervision and coordination is provided for extrication triage,
treatment, and transportation of all patients.
Tasks:
□ Report and provide frequent updates to the INCIDENT COMMANDER or Operations
Section Chief. The Medical role may be assumed by the Incident Commander on small
incidents.
□ Dress in identifying vest.
□ Locate in a visible position.
□ Assume responsibility of MEDICAL GROUP.
□ Coordinate, direct and manage all MEDICAL GROUP operations.
□ Account for all personnel assigned to this group.
□ Monitor safety and welfare of group personnel.
□ Consider relief crews.
□ Consider Critical Incident Stress Management (CISM) assistance.
□ Appoint and assign Medical Group Leaders and support staff:
Name
Position
Radio Frequency
Triage Unit Leader
Treatment Unit Leader
Transport Group Supervisor/Unit
Leader
Medical Communications
Coordinator
* Request separate ambulance staging area if needed.
* On small incidents the Incident Commander may assume responsibility for the Medical
Group/Branch.
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Position: Staging Area Manager Check List
Mission: To maintain separate stockpiles of manpower, reserve equipment and expended
equipment at a staging area away from the incident.
Tasks:
□ Report to INCIDENT COMMANDER (or OPERATIONS CHIEF if appointed)
□ Dress in identifying vest.
□ Locate in a visible position.
□ Establish STAGING AREA in conjunction with INCIDENT COMMAND or Operations
as needed.
□ Provide appropriate staffing, vehicles, equipment, and supplies as requested.
□ Maintain status of number and types of resources in STAGING AREA.
□ Recommend additional staffing, equipment, and resources when necessary.
□ Order all personnel to remain with their units until assigned.
□ Establish an equipment pool location.
□ Control and document all resources entering and leaving the STAGING AREA.
□ Ensures unimpeded access and egress to and from staging area.
□ Coordinate security for staging area.
Helpful Hints
Maintain communications with OPERATIONS and TRANSPORT.
Locate and secure buses for use by TRANSPORT GROUP
SUPERVISOR/UNIT LEADER.
Use a mobile radio when possible to communicate with incoming units.
Size of incident may require that a separate AMBULANCE STAGING area be
established.
Direct ambulance crews to leave stretchers in ambulances unless needed for
patient movement.
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Position: Ground Ambulance Coordinator Check List
Mission: To maintain resources of EMS manpower and EMS transport vehicles at a location
close to the treatment / transportation area and with good access from and egress to major
transportation routes (may be included as part of incident STAGING).
Tasks:
□ Report to TRANSPORTATION (or MEDICAL GROUP SUPERVISOR) or STAGING
OFFICER.
□ Dress in identifying vest.
□ Establish the AMBULANCE STAGING AREA at a site away from the scene. The
AMBULANCE STAGING AREA should:
□ Be large enough to handle the expected number of units
□ Have easy access and egress
□ Be close to major transportation routes
□ Have easy access to the TRANSPORT AREA
□ Provide appropriate vehicles, equipment, and resources as requested.
□ Order all personnel to remain with their vehicles.
□ Maintain and document the status of number and types of resources in AMBULANCE
STAGING.
Helpful Hints
Maintain communications with MEDICAL and TRANSPORT.
Consider options for alternate transportation vehicles (buses, etc).
Consider options for removing medical supplies from vehicles for relocation to TRIAGE
and/or TREATMENT areas:
Backboards/Straps
Splints/Bandages
Oxygen Supplies
Blankets
IV Supplies
Etc.
ENSURE THAT AMBULANCE COTS ARE NOT SEPARATED FROM UNITS.
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Position: Triage Unit Leader
Mission: To assess and sort casualties to appropriately establish priorities for treatment and
transportation.
Tasks:
□ Report and provide updates to INCIDENT COMMANDER (or MEDICAL)
□ Dress in identifying vest.
□ Locate in a visible position between the incident site and the treatment area.
□ If danger exists, move all patients out of INCIDENT AREA before establishing
TRIAGE.
□ Establish controlled pathway from the incident site to the treatment area.
□ Direct walking wounded to designated treatment area.
□ If START/JumpSTART not yet completed by first arriving crews, appoint triage teams to
perform START/JumpSTART using triage ribbons.
□ Continue to use START/JumpSTART algorithms, triage patients constantly.
□ Coordinate the transfer of patients to TREATMENT area with EXTRICATION. Request
"porters" from INCIDENT COMMAND (or MEDICAL) as necessary.
□ Appoint "porters" to transport patients via backboards to treatment area. This function
may be performed by personnel from EXTRICATION/RESCUE. Coordinate with
EXTRICATION/RESCUE. At hazardous materials incidents, a team must be assigned to
move patients from the decontamination line to the treatment area.
□ Maintain communications with MEDICAL, EXTRICATION, TREATMENT and
TRANSPORTATION.
Helpful Hints
Continue START/JumpSTART until all patients have been triaged. Have triage teams
work in an orderly fashion.
All Patients are taken to Secondary Triage at the TREATMENT AREA.
Move all RED patients to the TREATMENT AREA first, unless tight quarters necessitate
moving others first in order to gain access to RED patients.
Move YELLOW patients next.
Have GREEN patients walk to a designated location at the TREATMENT AREA.
Leave ALL BLACK tags in place unless the remains interfere with the ability to reach
the survivors. Have command notify the Medical Examiner if black tags are issued.
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Position: Extrication Group Supervisor/Unit Leader
Mission: To ensure the safe and rapid removal of entrapped patients and their prompt delivery
to treatment area.
Tasks:
□ Report to and provide updates to INCIDENT COMMANDER (or MEDICAL)
□ Dress in identifying vest.
□ Locate in a visible position with clear view of overall extrication operation.
□ Supervise and coordinate the EXTRICATION process
□ Determine if triage can be conducted at the incident site of if victims must be moved to a
safe area prior to triage.
□ Locate and remove trapped victims/patients and deliver them to the treatment area.
□ Determine need for emergency medical care for patients undergoing extended/delayed
extrication and request additional medical resources.
□ Maintain patient and team safety during all phases of the extrication.
□ Request relief crews to maintain progress towards extrication objectives.
□ Request specialized equipment and/or supplies through MEDICAL.
□ Request additional manpower and/or fire suppression personnel to protect entrapped
victims during the extrication process.
□ Provide essential and frequent progress reports to TRIAGE and MEDICAL as
appropriate.
Helpful Hints
If in hazardous area, EXTRICATE patients rapidly and move to TREATMENT AREA.
Maintain close contact with TRIAGE and TREATMENT LEADERS.
Assist TRIAGE in orderly transfer of patients to TREATMENT Area moving ALL RED
TAGS FIRST.
Assist TREATMENT and TRANSPORT GROUP SUPERVISOR/UNIT LEADERS in
moving patients when all extrications are complete (if needed).
It’s unlawful to move a deceased individual unless it impedes the accessibility of a
survivor.
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Position: Treatment Unit Leader
Mission: Provide continuing assessment, triage, and care to patients awaiting transportation.
Tasks:
□ Report and provide updates to the INCIDENT COMMANDER (or MEDICAL)
□ Dress in identifying vest.
□ Locate in a visible position.
□ Establish TREATMENT Area.
□ Initiate Secondary Triage, then retriage continuously (refer to Secondary Triage
Decisions)
□ Apply triage tags as patients are moved into the treatment area.
□ Appoint Red Tagged/Immediate, Yellow Tagged/Delayed and Green/Minor Care
managers as needed.
□ Appoint a MEDICAL SUPPLY COORDINATOR (if needed).
□ Determine order of transfer of patients and most appropriate transport.
□ Maintain contact with the appropriate Red Tagged/Immediate, Yellow Tagged/Delayed
and Green/Minor Care managers as to personnel, and equipment needs.
□ Constantly reassess patients' conditions and priorities.
□ Appoint a MORGUE MANAGER (if needed)
Helpful Hints
Arrange and clearly mark TREATMENT Area.
Identify areas for each triage category using colored tarps, flags, tape, etc.
Isolate emotionally disturbed patients.
Have Minor/Green Patients (“Walking Wounded”) move to a supervised out-of-the-way
area.
Continuously triage ALL patients. Remove ribbons once tags applied since patient
conditions may have changed.
Assign ALS technicians to treatment area. Consider establishing special teams (i.e. IV
teams, bandaging teams, etc).
Maintain contact with TRANSPORT and assist in moving patients to the transportation
area.
Establish "cattle shoots" staffed with triage personnel as "gatekeepers" at entrance to and
exit from TREATMENT AREA to control patient flow.
*Refer to Secondary Triage Decisions.
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Secondary Triage Decisions
Most secondary triage decisions in an MCI are based on clinical experience and judgment.
Review the following:
IMMEDIATE (RED)
Life threatening injuries/illnesses.
Risk of asphyxiation or shock is present or imminent.
High probability of survival if treated and transported immediately.
Can be stabilized without requiring constant care or elaborate treatment.
DELAYED (YELLOW)
Potentially life threatening injuries/illnesses.
Severely debilitating injuries/illnesses.
Can withstand a slight delay in treatment and transportation.
MINOR (GREEN)
Non-life threatening injuries.
Patients who require a minimum of care with minimal risk of deterioration.
DECEASED/NON-SALVAGEABLE (BLACK)
Deceased in route to treatment area or upon arrival.
Unresponsive with no circulation; cardiac arrest.
CATASTROPHICALLY INJURED
Not yet deceased.
Low probability of survival even with immediate treatment and transport.
NOTE: Catastrophically injured patients are tagged DELAYED (YELLOW PRIME) and hash
marks (///) are placed across the card. They are placed separately in the DELAYED (YELLOW)
treatment area. These patients should be treated and transported before the minor (GREEN)
patients, but only after IMMEDIATE (RED) patients and DELAYED (YELLOW) patients are
treated and transported. It is ultimately the decision of TREATMENT AND TRANSPORT to
determine when these patients will be transported to the hospital.
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Position: Transport Group Supervisor/Unit Leader
Mission: To coordinate and document all patient transportation and maintenance of records
relating to patient injuries as noted on triage tag.
Tasks:
□ Report and provide updates to the INCIDENT COMMANDER (or MEDICAL)
□ Dress in identifying vest.
□ Locate in a visible position.
□ If not already accomplished establish Ambulance STAGING area and appoint Ground
Ambulance Coordinator, ensuring that drivers remain with units.
□ Appoint EMS/MEDICAL COMMUNICATIONS COORDINATOR and ensure
communications link is established with designated Coordinating Emergency
Department.
□ Appoint TRANSPORT RECORDER for each area of patient egress.
□ Appoint TRANSPORT LOADERS.
□ Arrange transport for those patients whom TREATMENT has selected for transport.
□ Utilize different modes of transport based on patient needs and capabilities at the
STAGING AREA and/or AMBULANCE STAGING AREA.
□ Inform transport crews of their destination, whether they need to return or not and of
refueling sites.
□ Remind ambulance crews that they do not need to contact receiving facility.
□ Document patient and unit movements and destination.
□ Appoint LANDING AREAOFFICER as necessary.
□ Maintain close communications with INCIDENT COMMAND or MEDICAL,
TREATMENT, GROUND AMBULANCE COORDINATOR, and AIR OPERATIONS.
Helpful Hints
Suggest means of transport to MEDICAL (e.g. buses, helicopters, etc.)
Ensure that transport ambulances are parked to allow easy patient loading and egress
without being blocked by other ambulances.
Load ALL Red Tagged/Immediate Patients FIRST and then proceed to Yellow
Tagged/Delayed Patients.
Summon equipment for TREATMENT IF NEEDED!
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Position: Transport Recorder
Mission: To assist in ensuring proper documentation of victim/patient and unit movements.
Tasks:
□ Report to TRANSPORT.
□ Dress in identifying vest.
□ Locate at assigned patient egress point in the TRANSPORT area.
□ Document patient transport information on triage tag and collect tag stubs.
□ Ensure that MEDICAL COMMUNICATIONS/TRANSPORT has the following
information on each patient leaving TREATMENT:
o Unit Transporting
o Destination Hospital
o Patient Tag Number
o Classification of Patient (Red, Yellow, or Green)
o Any vital information available on the patient (i.e. sex, age, nature of injuries)
o ETA to hospital
□ Deliver triage tag stubs to MEDICAL COMMUNICATIONS/TRANSPORT as directed.
Helpful Hints
Determine whether or not TRANSPORT will be handling the MEDICAL
COMMUNICATIONS role or will the function be assigned to a separate individual.
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Position: Transport Loader
Mission: To assist in ensuring the proper loading of patients aboard ground transportation and
to provide directions to receiving facilities.
Tasks:
□ Report to TRANSPORT GROUP SUPERVISOR/UNIT LEADER.
□ Dress in identifying vest.
□ Ensure patients selected for transportation are:
o Ready for transport
o Loaded aboard the ambulance designated by TRANSPORT GROUP
SUPERVISOR/UNIT LEADER
□ Provide the following information to ambulance personnel:
o Directions to the receiving hospital (available in Annex C)
o Whether or not to return to the scene after delivering the patients.
□ Maintain close communications with TRANSPORT GROUP SUPERVISOR/UNIT
LEADER and TRANSPORT RECORDER.
□ Ensure all patients being loaded have triage tags attached and the transport stub has been
removed.
Helpful Hints
Obtain maps or directions to area hospitals for distribution to ambulance crews.
If the TRANSPORT Area is some distance from TREATMENT, consider using a
stretcher from a committed ambulance to move patients to the receiving units.
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Position: Medical Communication Coordinator
Mission: To maintain and coordinate medical communications at the incident scene between
TRANSPORT GROUP SUPERVISOR/UNIT LEADER and the Designated Coordinating
Emergency Department.
Tasks:
□ Report to TRANSPORT GROUP SUPERVISOR/UNIT LEADER.
□ Dress in identifying vest.
□ Remain in close proximity to the TRANSPORT and TREATMENT areas.
□ Establish and maintain a dependable communications link with the designated
Coordinating Hospital. The following minimal information should be provided and
updated:
o Type of incident
o Number of patients
o Severity of injuries
□ Coordinate patient distribution with the Coordinating Emergency Department.
□ Report individual patient information to Coordinating Emergency Department as relayed
by TRANSPORT GROUP SUPERVISOR/UNIT LEADER.
o Unit transporting
o Destination hospital
o Number of patients
o Triage tag numbers
o Triage category, major injuries and age of patients
□ Assist TRANSPORT GROUP SUPERVISOR/UNIT LEADER with documentation.
Helpful Hints
Locate in close physical proximity to TRANSPORT areas.
Maintain contact with designated Coordinating Emergency Department, relaying triage
tag number, patient condition and destination.
Maintain communications with TRANSPORT GROUP SUPERVISOR/UNIT LEADER.
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Position: Safety Officer
Mission: To monitor and assess hazardous and unsafe situations and develop measures for
ensuring personnel safety.
Tasks:
□ Report to the INCIDENT COMMANDER.
□ Dress in identifying vest.
□ Provide a ring of safety around the incident.
□ Take immediate corrective action or stop unsafe situations or practices.
□ Notify the INCIDENT COMMANDER if unsafe situations are observed
□ Observe the rescue ground for:
o unsafe practices
o use of protective equipment
o need for relief crews
o need for personnel rehab
□ Observe structural integrity.
□ Consider setting up safety teams with safety officers from HAZMAT, MMRS, DEM,
etc…
□ Monitor hazardous/toxic environments and exposure levels of emergency personnel.
□ Investigate injuries to department personnel and ensures proper levels of care are
provided.
□ Assure that personnel accountability system is in use and operating effectively.
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Position: Public Information Officer
Mission: To disseminate factual and timely reports to the news media concerning the nature
and extent of the incident, emergency medical care, and treatment of victims.
Tasks:
□ Report to the INCIDENT COMMANDER.
□ Dress in identifying vest.
□ Contact the INCIDENT COMMANDER for a briefing.
□ Develop complete and accurate information regarding the incident.
□ Establish a media area away from the COMMAND POST.
□ Establish a Joint Information Center (JIC) with other agency PIOs (if needed)
□ Act as liaison to the press.
□ Prepare Press Releases with Incident Commander.
□ Be the only person to deal with the media.
□ Release accurate information in a timely manner.
□ Educate the media about MCI/ICS Systems.
□ Facilitate interviews, brief responders, document actions
The media should be given the following information:
Time of incident.
Type of incident.
Extent of incident.
Location of incident.
Number of rescue personnel on scene.
Rescue efforts underway.
Amount of equipment.
Number of people rescued/injured.
Nature of injuries.
Hospitals to which injured patient(s) are taken.
Never release patient names without ensuring that the Next of Kin have been
notified. The Medical Examiner’s PIO will release the names of the deceased.
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Position: Air Operations Group Supervisor
Mission: To assume responsibility for the coordination and landing of all aircraft in the
LANDING AREA.
Tasks:
□ Report to TRANSPORT GROUP SUPERVISOR/UNIT LEADER.
□ Assign personnel and a fire unit, if available to establish a HELISPOT. (Most commonly
a helispot for one or more medical evacuation helicopters)
□ Maintain sufficient helispot size (See Annex G for landing area space requirements)
□ Maintain helispot/landing area security
□ Maintain radio contact with incoming helicopters. (All helicopters stationed in Virginia
can communicate on the Statewide Mutual Aid on VHF 155.205)
□ Coordinate loading and transport of patients with TRANSPORT GROUP
SUPERVISOR/UNIT LEADER.
Helpful Hints
Ensure that the landing area is large enough to accommodate the type of helicopter.
(See Annex G)
Advise the flight crew of the following BEFORE landing:
Obstructions at the landing area, as well as "near-by" (e.g. radio tower,
telephone lines).
Wind direction or ground wind gusts.
Designate an upwind landing area during HAZMAT incidents.
Use of white lights should be avoided.
Road flares should be used with caution.
All markers should be put out and/or cut off before take off.
Assign personnel to secure helispot after landing.
NEVER APPROACH THE CRAFT DURING LANDING OR TAKE OFF.
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Position: Incident Morgue Manager
Mission: To establish and maintain an incident morgue area for deceased persons who die in
route to or in the Treatment Area.
Tasks:
□ Report to TREATMENT.
□ Dress in identifying vest.
□ Contact the closest Office of the Chief Medical Examiner:
□ Ensure that no bodies are moved from the incident site prior to the arrival and approval of
the Medical Examiner/chief law enforcement officer.
□ Leave all medical interventions in place (i.e. IV’s, bandages, etc.)
□ Establish a morgue area remote from the TREATMENT AREA and not readily
accessible to vehicles (i.e. emergency vehicles, law enforcement).
□ With the assistance of Law Enforcement, keep the area off-limits to all unauthorized
personnel and provide security to the morgue area.
□ Coordinate with the Medical Examiner's Office, funeral directors, and law enforcement
as necessary.
□ Maintain records, including victims' identities (if available), location found, personal
effects, etc.
Helpful Hints
The only bodies that should be moved to the incident morgue are those whose location is
hindering rescue operations or victims who died in route to or in the treatment area.
Cover patient(s) with body bags.
Provide for limited access to morgue area by cordoning off the area.
Maintain appropriate records.
Don’t allow photographs in the morgue without the medical examiner’s permission.
Request assistance from Law Enforcement to secure the incident morgue area.
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ANNEX D: EMERGENCY DEPARTMENT/HOSPITAL MCI
FORMS
This annex contains forms that may be used by hospitals during a multiple or mass casualty drill
or incident. The following forms are contained in this Annex:
•
•
•
•
•
Emergency Department MCI Alert Procedure (Actual and Drill)
Emergency Department/Hospital Emergency Situation Report
Emergency Department/Hospital Emergency Capacity Inventory – Peninsulas Bed Status
Report
Emergency Department/Hospital Emergency Capacity Inventory – Southside Bed Status
Report
Emergency Department/Hospital Mass Casualty Patient Tracking Form
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Emergency Department MCI Alert Procedure (Actual and Drill)
"This is ___________________________________________ Hospital."
"THIS IS A DISASTER ALERT (DRILL), THIS IS A DISASTER ALERT (DRILL).All area
EDs and hospitals please record the following information." (Pause)
"There has been
(describe incident)
SITUATION REPORT).
." (USE FORMAT OF EMERGENCY
"This is a disaster alert. Each hospital please acknowledge this transmission. Come in
___________________________ . . . come in__________________________, etc."
* Level 1 Trauma Center
** Level 2 Trauma Center
AFTER EDs/HOSPITALS ACKNOWLEDGE, CONTINUE WITH:
"This is _______________ ED/Hospital - - will each area hospital activate its
'Emergency Capacity Inventory' and standby. Be prepared to report back in 10 minutes
with information contained in the 'Emergency Capacity Inventory'. This is
______________________ ED/Hospital standing by."
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Emergency Department/Hospital Emergency Situation Report
Date:
Time:
Operator:
ED/Hospital:
Name of Person Calling:
Agency:
Call Originating From Telephone Number:
Type of Emergency:
Location:
Estimated Number of Casualties:
Adult:
Pediatric:
Types of Injuries:
Where are the initial casualties being sent?
Additional Information:
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Emergency Department/Hospital Emergency Capacity Inventory
Bed Status Report
Date: ___________________________ Time: ____________________
Organization Name
Buchanan County General
Hospital
Clinch Valley Medical
Center
Johnson City Medical
Center
Dickenson Community
Hospital
Johnston Memorial
Hospital
Lee Regional Medical
Center
Mountain View Regional
Medical Center
Norton Community
Hospital
Russell County Medical
Center
Tazewell Community
Hospital
Twin County Regional
Wellmont Bristol Regional
Medical Center
Wellmont Holston Valley
Medical Center
Clinical
Status
Red
Yellow Green
Burn
Decon
Comments
Level I Trauma
Center/Pediatric
Level II Trauma
Center
Level I Trauma
Center
Wellmont Lonesome Pine
Hospital Total:
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Emergency Department/Hospital MCI Patient Tracking Form (Front)
ED/Hospital Name:
___________________________
Patient
Count
MCI Triage Tag
Number
Date:
___________
Patient’s Name
(Last, First, M.I. – If Known)
Registration Clerk :
________________
Hospital Registration
Number
1
2
3
4
5
6
7
8
9
10
11
12
13
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Emergency Department/Hospital MCI Patient Tracking Form (Back)
Patient
Count
MCI Triage Tag
Number
Patient’s Name
(Last, First, M.I. – If Known)
Hospital
Registration Number
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
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ANNEX E: DRIVING DIRECTIONS TO HOSPITALS
Bluefield Regional Medical Center
500 Cherry Street
Bluefield, WV 24701
304-327-1500
From Tazewell: Rt.19/460 East (turns into Bluefield Avenue), then right onto Cherry Street.
From Bland: 77 North, take exit 66 ramp to the right. Follow signs for VA-598. Left onto US52, staying straight onto SR-598. Turn left onto US West, then right onto Maryland Avenue.
Follow Maryland Avenue to Cherry Street.
Buchanan General Hospital
Slate Creek Road
Grundy, VA 24614
From all directions: Travel US 460 to Grundy. Turn onto Slate Creek Rd (Hwy 83). Travel Slate Creek Road to
Golden Wave Drive.
Clinch Valley Medical Center
2949 West Front Street
Richlands, Va 24641
276-596-6153
From Grundy: US-460 East for approximate 28 miles, Clinch Valley Medical Center will be on
the left side of the road.
From Abingdon: Take US-19 N, turn left onto US-460 West for approximately 5.7 miles. Clinch
Valley Medical Center will be on the right side of the road.
From Bluefield: Take US-460 West towards Tazewell, turn right onto US-460 West for
approximately 5.7 miles. Clinch Valley Medical Center will be on the right side of the road.
Indian Path Medical Center
2000 Brookside Drive
Kingsport, Tn 37660
423-392-7134
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From Knoxville Tn: North on I-81, take Exit 57B onto Interstate 181N to Kingsport. After 5
miles, take exit 51 (Wilcox Drive) right onto Highway 93N (John B. Dennis Highway). Go 6
miles. Hospital will be on left. Take first Medical Center entrance.
From Bristol Va: South on I-81. Take exit 74 onto US-11W, TN-1 and go West for 17.6 miles.
Bear right onto John B. Dennis Highway. Proceed .2 miles. Hospital will be on left. Take first
Medical Center entrance.
Johnston Memorial Hospital
351 Court Street NE
Abingdon, Va 24210
276-676-7000
From Interstate 81: exit 17 onto Cummings Street headed back into town. Go to Valley Street
and take a right (at T-intersection). Turn left onto Court Street, Johnston Memorial will be on
your left.
From Russell County on Route 19/58: Left onto Russell Road, follow to Valley Street, taking a
left onto Valley. Turn left onto Court Street, Johnston Memorial will be on your left.
Lee Regional Medical Center
1800 W. Morgan Avenue
Penninton Gap, Va 24277
276-546-1440
East of Pennington Gap VA: Travel west on Alt 58 toward Ben Hur VA. Turn right onto North Combs Road.
Arrival at Lee Regional Medical Center.
West of Pennington Gap VA: Travel east on Alt 58 toward Pennington Gap VA. Turn left onto North Combs Road.
Arrival at Lee Regional Medical Center.
Norton Community Hospital
100 15th Street NW
Norton, Va 24273
276-679-9648
West, North, and South of Norton VA: Follow Us 23 to Exit 1 Highway 619. Follow Highway 619 to Park Ave
North East. Turn Left onto Park Ave North East to 15th Street North East. Turn Right onto 15th Street North East.
East of Norton VA: Travel West on Alt 58 to Norton VA. Continue on Alt 58 which will turn into Park Ave.
Continue on Park Ave to 15th Street North East. Turn Right onto 15th Street North East.
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Russell County Medical Center
58 Carroll Street
Lebanon, Va 24266
276-883-8200
From Route 19N: take Lebanon Business exit, go right at the end of the ramp onto Main
Street. At third traffic light (notice statue of soldier), turn right and bear to the left in front of the
church. The hospital is 100 feet on your right.
From 19S: take the first Lebanon exit (notice the blue hospital sign), go right at the end of the
ramp; turn left at traffic light onto Main Street; turn left onto Flannagan Avenue; the hospital is a
short distance on your left.
Mountain View Regional Medical Center
310 Third Street, NE
Norton, Va 24273
276-679-1151
West, North, and South of Norton VA: Follow Us 23 to Exit 2 Park Ave. Follow Park Ave to Business US 23.
Turn Right onto Business US 23 to 3rd Street North East. Turn Left onto 3rd Street North East.
Smyth County Community Hospital
565 Radio Hill Road
Marion, Va 24354
From Interstate 81: Take exit 47, left at Rifton Drive, left at Lee Hwy, right onto Park
Boulevard, right onto Radio Hill.
Tazewell Community Hospital
141 Ben Bolt Avenue
Tazewell, Va 24651
276-988-2506
From US 19/58: take exit 2 toward Tazewell, right onto Tazewell Avenue, left onto E. Fincastle
Street, right onto Ben Bolt Avenue.
From 77 N: exit 66, left at US-52, continue on Bland Road/E River Mtn Route, left at US 460,
left at Clearfork Road.
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Twin County Regional Hospital
200 Hospital Drive
Galax, Va 24333
276-236-8181
From 221/58 (E Stuart Drive): turn onto Glendale Road, turn onto Valley Street, left onto
Hospital Drive.
Wellmont Bristol Regional Medical Center- Level II Trauma Center
1 Medical Park Boulevard
Bristol, Tn 37620
423-844-2104
From Bristol: Travel south on U.S. Hwy. 11W/West State Street. Turn left onto Medical Park
Boulevard.
From Kingsport: Travel north on U.S. Hwy. 11W. Turn right onto Medical Park Boulevard.
From Tennessee: Travel north on Interstate 81. Take Exit 74A onto U.S. Hwy. 11W. Turn right
onto Medical Park Boulevard.
From Southwest Virginia: Travel south on Interstate 81. Take Exit 74A onto U.S. Hwy. 11W.
Turn right onto Medical Park Boulevard.
Wellmont Holston Valley Medical Center- Level I Trauma Center
130 West Ravine Road
Kingsport, Tn 37662
423-224-5121
From Bristol: Go west on 11W/Stone Drive. Pass the Holston Valley Outpatient Center and turn
left onto Clinchfield Street. At the first traffic signal (Ravine Road) turn left. Holston Valley is
on the left.
From Gate City, Va. on U.S. Highway 23: Take Interstate 181 exit in Weber City. Follow I-181
to Exit 55. Turn left onto Stone Drive/Highway 11W. Go to the sixth traffic signal (Clinchfield
Street) and turn right. At the first traffic signal (Ravine Road), turn left. Holston Valley is on the
left.
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Wellmont Lonesome Pine Hospital
1990 Holston Avenue
Big Stone Gap, Va 24219
276-523-3111
From Norton: Travel south on U.S. Hwy. 23. Take exit 2 to Big Stone Gap exit and turn right
onto Powell Valley Road, which becomes 4th Avenue. After traveling for 1 ½ miles, turn left
onto 19th Street. After a few hundred yards, turn left onto Shawnee Avenue, and then turn
quickly right onto Armory Road. Drive up the hill to Holton Avenue on the right.
From Kingsport: Travel north on U.S. Hwy. 23. Take exit 2 to Big Stone Gap exit and turn left
onto Powell Valley Road, which becomes 4th Avenue. After traveling for 1 ½ miles, turn left
onto 19th Street. After a few hundred yards, turn left onto Shawnee Avenue, and then turn
quickly right onto Armory Road. Drive up the hill to Holton Avenue on the right.
Wythe County Community Hospital
600 West Ridge Road
Wytheville, Va 24382
276-228-0258
From Interstate 81: Take exit 70 toward Wytheville, right onto N 4th Street, turn right onto West
Ridge Road.
From Interstate 77: Take exit 40 to merge with Interstate 81 South, follow above directions.
Dickenson County Medical Center
312 Hospital Drive
Clintwood, Va 24228
276-926-0312
From all directions: Travel Highway 83 to Clintwood. Turn onto Main Street. Follow Main
Street to Hospital Drive. Turn onto Hospital Drive.
Johnson City Medical Center- Level I Trauma Center
400 N. State of Franklin Road
Johnson City, Tn 37604
423-431-6561
From the North: From I-26 East, take Exit 19 (old exit 36) (State of Franklin Road, TN 381).
Exit right onto State of Franklin Road. Proceed approximately 3 miles (crossing Market Street,
US 11E). Johnson City Medical Center will be on your left.
From the South: From I-26 West, take Exit 24 (old exit 31) (University Parkway, Elizabethton;
US 321). At the stop light, turn left onto US 321 South. This will be University Parkway.
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Proceed to State of Franklin Road at the 5th stop light (following US 321) and turn left. After
approximately 1 mile, Johnson City Medical Center will be on your right.
From the East: From US 321 South, proceed into Johnson City. This will become University
Parkway just past I-26 overpass. Follow University Parkway past East Tennessee State
University; turn left onto State of Franklin Road. After approximately 1 mile, Johnson City
Medical Center will be on your right.
From the West: US 321 North and US 11E North will become Market Street in Johnson City.
Move to the right hand lane and turn right at State of Franklin Road (TN 381 and US 321 North).
Johnson City Medical Center will be on your left.
Pulaski Community Hospital
2400 Lee Hwy
Pulaski, Va 24301
540-980-6192
From Interstate 81: Take exit 89 toward Pulaski, turn right onto 5th Street NE/US 11.
Carilion New River Valley Medical Center- Level III Trauma Center
2900 Lamb Circle
Christiansburg, Va 24073
540-731-2000
From Interstate 81: Take exit 109 toward Radford, take a slight right at Tyler Road, hospital will
be on your left on Lamb Circle.
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ANNEX F: MCI RESOURCES
General
First and foremost the Incident Commander must practice scarce resource management. Single
resources will be requested from the Emergency Communications/911Center and told to report
to the designated Staging Area, where they may be assembled into Strike Teams or Task Forces.
This leaves to the Incident Commander or Operations Section Chief to manage the number of
ambulances assembled. As patients are transported, units should be directed by the Transport
Group Supervisor/Unit Leader Group on whether they should clear then return to staging or clear
and return to their stations. The capacity to assemble Strike Teams will be limited by available
resources and by the time needed to assemble and deploy them.
Medical Supplies & Equipment
Mass Casualty Trailers
The Far Southwest Virginia Hospital Preparedness Commission possesses four (4) disaster
trailers for response to MCI’s. The trailers are currently housed at: Smyth County Community
Hospital, Wythe County Community Hospital, Ridgeview and Buchanan County General
Hospital. To request trailers please contact David Rasnick at 423-844-2821, 423-844-2826 or
have paged at 423-844-1121
Medical Transportation Resources
Ambulance Services
Buchanan County
Mercy Ambulance Service
Rescue 33 Ambulance Service
276-889-3099
276-935-4911
Carroll County
Carroll County EMS
276-730-3195
Dickenson County
Dickenson County Ambulance Service
276-926-8896
Galax
Galax-Grayson EMS
276-236-3441
Friendship Ambulance Service
276-328-9111
Lee
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Beacon of Life Ambulance Service
276-762-7727
Highlands Ambulance Service
Mercy Ambulance Service
276-889-5877
276-889-3099
Russell
Scott County
Beacon of Life Ambulance Service
Smyth County
Chilhowie Ambulance Service
Smyth County Ambulance Service
276-628-8470
276-783-9795
Tazewell
Chores & Errands Ambulance Service
Mercy Ambulance Service
276-964-2972
276-889-3099
Washington County
Abingdon Ambulance Service
276-628-8470
Wise County
Beacon of Life Ambulance Service
Friendship Ambulance Service
Lifecare Ambulance Service
Dickenson County Ambulance Service
276-762-7727
276-328-9111
276-679-4375
276-926-8896
Wythe County
Guardian Ambulance Service
276-647-6137
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ANNEX G: STATE MCI RESOURCES
During emergency and large scale non-emergency events, the Health and Medical Emergency
Response Teams (HMERT) are available to provide trained emergency medical services
personnel to assist the Virginia Department of Health, Office of Emergency Medical Services in
state health and medical disaster response. Task Forces, Coordination Teams, and specialized
Strike Teams provide services to meet a locality’s needs.
HMERT members train in the entire scope of disaster management, including all areas of
emergency operations. They work closely with the Virginia Department of Emergency
Management and U.S. Public Health Service, to effectively coordinate local, state, and federal
government response.
Health and Medical Emergency Response Teams
Mission
HMERTs are capable of providing emergency medical services to the affected jurisdiction upon
exhaustion of local and mutual aid resources.
Capabilities
The Office of Emergency Medical Services, in cooperation with EMS agencies around the state,
has established the Health and Medical Emergency Response Teams (HMERT) to provide
trained emergency medical services personnel to assist the OEMS in responding to a health and
medical disaster response. EMS Task Forces, Coordination Teams, and specialized Strike
Teams can provide emergency medical services to meet a locality’s needs.
HMERT members are trained in the entire scope of disaster management, including all areas of
emergency operations. They work closely with the Virginia Department of Emergency
Management and U.S. Public Health Service, to effectively coordinate local, state, and federal
government response.
Emergency Team Activation
HMERT resources must be requested via your local jurisdiction’s Emergency Operations Center
and from the Virginia State Emergency Operations Center (VaEOC).
The VaEOC’s telephone number is 1-800-468-8892.
EMS Disaster Task Forces
Mission
EMS Disaster Task Forces are designed to be used as units to either undertake specific tasks or
to supplement the needs of the requesting jurisdiction. EMS Task Forces will remain under the
command of their Task Force Commander and should not be broken up.
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Capabilities
The OEMS can deploy either the task force personnel, or the task force personnel and their
vehicles depending upon the needs of the jurisdiction. In most case a task force deployment will
include both personnel and vehicles.
These Task Forces are made up of:
1 Basic Life Support Ambulance with crew
1 Advanced Life Support Ambulance with crew
1 Rescue (Squad) Truck with crew
1 Quick Response Vehicle (QRV) or Chief's Car (optional)
1 Disaster Truck or Trailer (optional)
1 Specialty Unit (technical rescue, water rescue, etc.) or Trailer (optional)
1 Task Force Commander
EMS Task Forces will attempt to come supplied for 72 hours, not including water, fuel or
expendable supplies.
Task Force Configurations
EMS Disaster Task Forces can be deployed in three configurations. The requesting jurisdiction
should identify the specific configuration needed.
Standard Task Force: Composed of one Basic Life Support (BLS) ambulance, one Advanced
Life Support (ALS) ambulance, one heavy-duty or medium-duty rescue truck, and a disaster
truck or trailer if available, with a Task Force Commander and minimum of eight (8) EMS
providers.
Personnel Package: Composed of standard Task Force staffing with appropriate transportation.
No equipment other than personal kits is carried by providers.
Augmentation Package: A standard Task Force with vehicles and personnel tailored to meet the
needs of the requesting jurisdiction.
Emergency Team Activation
HMERT resources must be requested via your local jurisdiction’s Emergency Operations Center
and from the Virginia State Emergency Operations Center (VaEOC).
The VaEOC’s telephone number is 1-800-468-8892.
Coordination Teams (C-Teams)
Mission
The Coordination Team coordinates Task Force actions in the impact area, ensures that Task
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Forces have the logistics support needed and collect current situation information and activity
reports for the ESC. In a major event of any type, Coordination Teams can be deployed. When a
Task Force is deployed, so is a Coordination Team.
Capabilities
This six-person team works with local government and EMS agencies. Coordination Team
members are trained as experts in the Incident Command System, to work with other state
government response agencies and to operate in the ESC if needed to augment HMERT.
Emergency Team Activation
HMERT resources must be requested via your local jurisdiction’s Emergency Operations Center
and from the Virginia State Emergency Operations Center (VaEOC).
The VaEOC’s telephone number is 1-800-468-8892.
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ANNEX H: FEDERAL MCI RESOURCES
National Disaster Medical System
The National Disaster Medical System (NDMS) is a federally coordinated system that augments
the Nation's medical response capability. The overall purpose of the NDMS is to establish a
single integrated National medical response capability for assisting State and local authorities in
dealing with the medical impacts of major peacetime disasters and to provide support to the
military and the Department of Veterans Affairs medical systems in caring for casualties
evacuated back to the U.S. from overseas armed conventional conflicts.
The National Response Plan utilizes the National Disaster Medical System (NDMS), as part of
the Department of Health and Human Services, Office of Preparedness and Response, under
Emergency Support Function #8 (ESF #8), Health and Medical Care, to support Federal agencies
in the management and coordination of the federal medical response to major emergencies and
federally declared disasters including: natural disasters, technological disasters, major
transportation disasters, and acts of terrorism including weapons of mass destruction events.
Mission
It is the mission of the National Disaster Medical System to design, develop, and maintain a
national capability to deliver quality medical care to the victims of - and responders to - a
domestic disaster. NDMS provides state-of-the art medical care under any conditions at a
disaster site, in transit from the impacted area, and into participating definitive care facilities.
Components of the National Disaster Medical System
• Medical response to a disaster area in the form of teams, supplies, and equipment.
• Patient movement from a disaster site to unaffected areas of the nation.
• Definitive medical care at participating hospitals in unaffected areas.
NDMS Teams
NDMS Operations are partially supported by the various teams that comprise the NDMS:
Disaster Medical Assistance Team (DMAT)
DMAT is a group of professional and para-professional medical personnel (supported by
a cadre of logistical and administrative staff) designed to provide medical care during a
disaster or other event. DMATs are designed to be a rapid-response element to
supplement local medical care until other Federal or contract resources can be mobilized,
or the situation is resolved. DMATs deploy to disaster sites with sufficient supplies and
equipment to sustain themselves for a period of 72 hours while providing medical care at
a fixed or temporary medical care site. To supplement the standard DMATs, there are
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highly specialized DMATs that deal with specific medical conditions such as crush
injury, burn, and mental health emergencies.
In mass casualty incidents, their responsibilities may include triaging patients, providing
high-quality medical care despite the adverse and austere environment often found at a
disaster site, and preparing patients for evacuation. DMATs are designed to be a rapidresponse
element to supplement local medical care until other Federal or contract resources can be
mobilized, or the situation is resolved.
Disaster Mortuary Operational Response Teams (DMORT)
DMORTs provide victim identification and mortuary services. These responsibilities
include: temporary morgue facilities; victim identification, forensic dental pathology,
forensic anthropology methods, processing preparation, and disposition of remains.
DMORTs are composed of funeral directors, medical examiners, coroners, pathologists,
forensic anthropologists, medical records technicians and scribes, finger print specialists,
forensic odontologists, dental assistants, x-ray technicians, mental health specialists,
computer professionals, administrative support staff, and security and investigative
personnel.
Disaster Portable Morgue Units (DPMU) Team
The DMORT DPMU promotes the most dignified handling and positive identification of
fatalities in federally declared emergencies by supporting all DMORT teams through the
efficient and effective management of federal mortuary assets throughout the planning,
preparation and response phases. The DPMU is responsible for pre-deployment
equipment activities including maintenance, equipment purchases, upgrades and resupply
after missions. The DMORT DPMU Team consists of members from throughout
the country who possess advanced skills in logistics management and all areas of
mortuary operations.
Veterinary Medical Assistance Teams (VMATs)
VMATs provide assistance in assessing the extent of disruption, and the need for
veterinary services following major disasters or emergencies. These responsibilities
include: assessing the medical needs of animals, medical treatment and stabilization of
animals, animal disease surveillance, zoonotic disease surveillance and public health
assessments, technical assistance to assure food and water quality, hazard mitigation, and
animal decontamination.
VMATs are composed of clinical veterinarians, veterinary pathologists, animal health
technicians (veterinary technicians), microbiologist/virologists, epidemiologists,
toxicologists and various scientific and support personnel.
National Nurse Response Team (NNRT)
The NNRT is a specialty team used in any scenario requiring hundreds of nurses to assist
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in chemoprophylaxis, a mass vaccination program, or a scenario that overwhelms the
nation’s supply of nurses in responding to a weapon of mass destruction event. The
NNRTs are composed of approximately 200 civilian nurses.
National Pharmacy Response Teams (NPRTs)
NPRTs assist in chemoprophylaxis or the vaccination of hundreds of thousands, or even
millions of Americans, or perhaps in another scenario requiring hundreds of pharmacists,
pharmacy technicians, and students of pharmacy.
NDMS Activation
The NDMS cannot be activated by local emergency management authorities. The state must
request NDMS activation as a component of the Federal response package.
Strategic National Stockpile
The Centers for Disease Control and Prevention (CDC) maintains the Strategic National
Stockpile (SNS). The SNS has large quantities of medicine and medical supplies to protect the
American public if there is a public health emergency (i.e. terrorist attack, flu outbreak,
earthquake) severe enough to cause local supplies to run out. Once Federal and local authorities
agree that the SNS is needed, medicines will be delivered to any state in the U.S. within 12
hours. The Virginia Department of Health (VDH) has plans in place to receive and distribute
SNS medicine and medical supplies to local communities as quickly as possible.
The SNS is a national repository of antibiotics, chemical antidotes, antitoxins, life-support
medications, IV administration, airway maintenance supplies, and medical/surgical items. The
SNS is designed to supplement and re-supply state and local public health agencies in the event
of a national emergency anywhere and at anytime within the U.S. or its territories.
The SNS is organized for flexible response. The first line of support lies within the immediate
response 12-hour Push Packages. These are caches of pharmaceuticals, antidotes, and medical
supplies designed to provide rapid delivery of a broad spectrum of assets for an ill defined threat
in the early hours of an event. These Push Packages are positioned in strategically located, secure
warehouses ready for immediate deployment to a designated site within 12 hours of the federal
decision to deploy SNS assets.
If the incident requires additional pharmaceuticals and/or medical supplies, follow-on vendor
managed inventory (VMI) supplies will be shipped to arrive within 24 to 36 hours. If the agent is
well defined, VMI can be tailored to provide pharmaceuticals, supplies and/or products specific
to the suspected or confirmed agent(s). In this case, the VMI could act as the first option for
immediate response from the SNS Program.
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Requesting the SNS
To receive SNS assets, the affected state’s governor’s office will directly request the deployment
of the SNS assets from CDC or HHS. HHS, CDC, and other federal officials will evaluate the
situation and determine a prompt course of action.
FEMA Urban Search and Rescue Task Forces
If a disaster event warrants national US&R support, the Federal Emergency Management
Agency (FEMA) will deploy the three closest task forces within six hours of notification, and
additional teams as necessary. The role of these task forces is to support state and local
emergency responders' efforts to locate victims and manage recovery operations.
Each task force consists of two 31-person teams, four canines, and a comprehensive equipment
cache. US&R task force members work in four areas of specialization: search, to find victims
trapped after a disaster; rescue, which includes safely digging victims out of tons of collapsed
concrete and metal; technical, made up of structural specialists who make rescues safe for the
rescuers; and medical, which cares for the victims before and after a rescue.
In addition to search-and-rescue support, FEMA provides hands-on training in search-and-rescue
techniques and equipment, technical assistance to local communities, and in some cases federal
grants to help communities better prepare for urban search-and-rescue operations.
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ANNEX I: MASS CASUALTY TRAINING RESOURCES
Mass Casualty Incident Management – Module I Course
This course is designed by the Virginia Office of Emergency Medical Services and taught by an
OEMS certified Emergency Operations Instructor.
This awareness-level course addresses basic concepts of mass casualty incidents. The course
recognizes key on-scene indicators of a mass casualty event as well as appropriate notification
measures. The course also covers the command and control structure associated with on-scene
activities.
Contact your local EMS Council or the Virginia Office of Emergency Medical Services for
information on upcoming courses.
Mass Casualty Incident Management – Module II Course
This course is designed by the Virginia Office of Emergency Medical Services and taught by an
OEMS certified Emergency Operations Instructor.
This operations-level course prepares students who would assume staff positions and direct
effective actions within the Medical Group/Branch during a mass casualty incident response.
This course provides the student with in depth information on managing mass casualties,
including creating the medical command structure. A table top exercise helps practice the skills
taught in the class.
Contact your local EMS Council or the Virginia Office of Emergency Medical Services for
information on upcoming courses.
Mass Casualty Incident Management – Module V Course
This course is designed to increase the integration of pediatric issues in state disaster response
plans. Upon completion of this course participants will have a better understanding of pediatric
triage, pediatric medical control, psychosocial needs of pediatrics, and pediatric transport plans.
This course is designed by the Virginia Office of Emergency Medical Services and taught by an
OEMS certified Emergency Operations Instructor. For more information contact the Virginia
Office of Emergency Medical Services at (804) 864-7600 or toll free from within Virginia
1-800-523-6019.
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Mass Casualty Incident Management (Module I & II) Instructor Course
This course is designed and taught by the Virginia Office of Emergency Medical Services staff.
Successful completion of this course of instruction certifies the student as a Emergency
Operation Instructor. Emergency Operations Instructors may teach both the Mass Casualty
Incident management – Module I and Module II courses. To be eligible to take this course
students must have successfully completed both the Mass Casualty Incident Management
Module I & II within the previous 12 months. Contact your local EMS Council or the Virginia
Office of Emergency Medical Services for information on upcoming courses.
EMS Operations at Multi-Casualty Incidents Course (Q157)
This is an on-line course offered by the National Fire Academy. The course is designed to help
EMS providers respond more effectively to multiple and mass casualty incidents, including
MCIs resulting from a chemical, biological, radiological, nuclear, or explosive agent or device.
Students must complete all lessons and pass the final examination to receive course credit.
Students may register to take this and other courses at: http://www.nfaonline.dhs.gov/index.shtm.
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ANNEX K: GLOSSARY
This glossary is provided to assist readers with potentially unfamiliar acronyms, terms and
definitions.
AAR
After Action Report
ARTCC
The Federal Aviation Administration’s Washington Air Route Traffic Control
Center
CBRNE
Chemical, Biological, Radiological, Nuclear & Explosive
Chief
The ICS title for individuals responsible for management of functional
sections: Operations, Planning, Logistics, Finance/Administration, and
Intelligence (if established as a separate section).
CISM
Critical Incident Stress Management
Cold Zone
The control zone for a hazardous materials incident; contains the Incident
Command Post and other incident support facilities. Also referred to as the
clean zone or support zone.
Command
The act of directing, ordering, or controlling by virtue of explicit statutory,
regulatory, or delegated authority.
Command Staff
(Officer) In an incident management organization, the Command Staff
consists of the Incident Command and the special staff positions of Public
Information Officer, Safety Officer, Liaison Officer, and other positions as
required, who report directly to the Incident Commander. They may have an
assistant or assistants, as needed.
Communications Unit
An organizational unit in the Logistics Section responsible for
providing communication services at an incident or an EOC. A
Communications Unit may also be a facility (e.g., a trailer or mobile van) used
to support an Incident Communications Center.
COR
Coronary Observation Radio
Critical Care Transport
An ambulance transport of a patient from a scene or a clinical setting whose
condition warrants care commensurate with the scope of practice of a
physician or registered nurse (e.g., capable of providing advanced
hemodynamic support and monitoring, use of ventilators, infusion pumps,
advanced skills, therapies, and techniques).
Deputy
A fully qualified individual who, in the absence of a superior, can be delegated
the authority to manage a functional operation or perform a specific task. In
some cases, a deputy can act as relief for a superior and, therefore, must be
fully qualified in the position. Deputies can be assigned to the Incident
Commander, General Staff, and Branch Directors.
Division
(Supervisor) The partition of an incident into geographical areas of operation.
Divisions are established when the number of resources exceeds the
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manageable span of control of the Operations Chief. A division is located
within the ICS organization between the branch and resources in the
Operations Section.
DoD
Department of Defense; includes the U.S. Army, U.S. Navy, U.S. Marine
Corps and the U.S. Air Force
ECC
Emergency Communications Center
Emergency Medical
Task Force
An Emergency Medical Task Force is any combination (within span of control)
of resources (Ambulances, Rescues, Engines, Squads, etc) assembled for a
medical mission, with common communications, and a leader (supervisor).
Self-sufficient for 12 hour operational periods, although it may be deployed
longer, depending on need.
EOC
Emergency Operations Center
EMS
Emergency Medical Services
EMS Strike Team
A team comprised of five resources or less of the same type with a supervisor
and common communications capability. Whether it is five resources or less,
a specific number must be identified for the team. For instance, a basic life
support (BLS) strike team would be five BLS units and a supervisor or, for
example, an advanced life support (ALS) strike team would be comprised of
five ALS units and a supervisor.
EMS Task Force
A team comprised of five resources or less of the same type with a supervisor
and common communications capability. Whether it is five resources or less,
a specific number must be identified for the team. For instance, an EMS task
force might be comprised of two ALS teams and three BLS teams and a
supervisor.
Engine Company
A Fire apparatus consisting of a minimum of three (3) firefighters one of which
is assumed to be qualified as a company level officer. Additional manpower
is encouraged. In an MCI event the Engine Company can expect to be used
both as manpower and to perform patient care to their level of training. There
should be an expectation that they will be broken up into Individual Resources
at the discretion of Command.
ERG
Emergency Response Guide
ETA
Estimated Time of Arrival
FAA
Federal Aviation Administration’s
FCC
Federal Communications Commission
Function
Function refers to the five major activities in ICS: Command, Operations,
Planning, Logistics, and Finance/Administration. The term function is also
used when describing the activity involved, e.g., the planning function. A sixth
function, Intelligence, may be established, if required, to meet incident
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management needs.
General Staff
A group of incident management personnel organized according to function
and reporting to the Incident Commander. The General Staff normally
consists of the Operations Section Chief, Planning Section Chief, Logistics
Section Chief, and Finance/Administration Section Chief.
Group
Established to divide the incident management structure into functional areas
of operation. Groups are composed of resources assembled to perform a
special function not necessarily within a single geographic division. Groups,
when activated, are located between branches and resources in the
Operations Section. (See Division.)
HAZMAT
Hazardous Materials
HEAR
Hospital Emergency Administrator Radio
HMERT
Health and Medical Emergency Response Team
HRMMST
Hampton Roads Metropolitan Medical Strike Team
HRMMRS
Hampton Roads Metropolitan Medical Response System
Helibase
A location at where helicopters may be parked, maintained, fueled, and
equipped.
Helispot
A temporary location where helicopters can land and load and off load
personnel and mission equipment.
Hot Zone
The area that immediately surrounds a hazardous materials incident; normally
extends out in a 360 degree radius around the incident scene and far enough
to prevent adverse effects from hazardous materials releases to personnel
outside the zone. Also referred to as the exclusion zone or restricted zone in
other documents.
Incident Action Plan
(IAP)
An oral or written plan containing general objectives reflecting
the overall strategy for managing an incident. It may include the identification
of operational resources and assignments. It may also include attachments
that provide direction and important information for management of the
incident during one or more operational periods.
Incident Command Post
(ICP)
The field location at which the primary tactical-level, on-scene incident
command functions are performed. The ICP may be collocated with the
incident base or other incident facilities and is normally identified by a green
rotating or flashing light.
Incident Command
System (ICS)
A standardized on-scene emergency management construct specifically
designed to provide for the adoption of an integrated organizational
structure that reflects the complexity and demands of single or multiple
incidents, without being hindered by jurisdictional boundaries. ICS is the
combination of facilities, equipment, personnel, procedures, and
communications operating within a common organizational structure,
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designed to aid in the management of resources during incidents.
It is used for all kinds of emergencies and is applicable to small as well as
large and complex incidents. ICS is used by various jurisdictions and
functional agencies, both public and private, to organize field-level incident
management operations.
Incident Commander
(IC)
The individual responsible for all incident activities to include the development
of strategies and tactics and the ordering and the release of resources. The
IC has overall authority and responsibility for conducting incident operations
and is responsible for the management of all incident operations at the
incident site.
IP
Improvement Plan
JIC
Joint Information Center
JumpSTART
Jump Simple Triage and Rapid Treatment; A pediatric triage method adopted
for use in the Commonwealth of Virginia.
Liaison Officer
A member of the Command Staff responsible for coordinating with
representatives from cooperating and assisting agencies.
Logistics
Providing resources and other services to support incident management.
Logistics Section
The section responsible for providing facilities, services, and material support
for the incident.
Mass Casualty Incident
An incident resulting from man-made or natural causes resulting in injuries or
illnesses that exceed or overwhelm the EMS and hospital capabilities of a
locality, jurisdiction, or region. A mass casualty incident is likely to impose a
sustained demand for health and medical services rather than a short, intense
peak demand for these services typical of multiple casualty incidents.
MHz
Megahertz
Multiple Casualty
Incident
An incident involving multiple victims that can be managed, with heightened
response (including mutual aid, if necessary), by a single EMS agency or
system. Multi-casualty incidents typically do not overwhelm the hospital
capabilities of a jurisdiction and/or region, but may exceed the capabilities of
one or more hospitals within a locality. There is usually a short, intense peak
demand for health and medical services, unlike the sustained demand for
these services typical of mass casualty incidents.
NDMS
National Disaster Management System
NIMS
National Incident Management System
NFPA
National Fire Protection Association; serves as the world's leading advocate
of fire prevention and is an authoritative source on public safety.
OEMS
The Virginia Office of Emergency Medical Services
OCME
The Office of the Chief Medical Examiner; responsible for determining the
cause and manner of deaths that occur under certain circumstances in
Virginia.
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Operations Section
The section responsible for all tactical incident operations. In the Incident
Command System this section will normally includes subordinate branches,
divisions, and/or groups.
Personnel Accountability
The ability to account for the location and welfare of incident personnel. It is
accomplished when supervisors ensure that ICS principles and processes are
functional and that personnel are working within established incident
management guidelines.
Planning Section
Responsible for the collection, evaluation, and dissemination of operational
information related to the incident, and for the preparation and documentation
of the IAP. This section also maintains information on the current and
forecasted situation and on the status of resources assigned to the incident.
Public Information
Officer (PIO)
A member of the Command Staff responsible for interfacing with the public
and media or with other agencies with incident-related information
requirements.
RHCC
Regional Healthcare Coordinating Center; there are two RHCC’s in Hampton
Roads they are located at Riverside Regional Medical Center and Sentara
Norfolk General Hospital
RRMC
Riverside Regional Medical Center, a level 2 trauma center located in
Newport News, Virginia.
Safety Officer
A member of the Command Staff responsible for monitoring and assessing
safety hazards or unsafe situations and for developing measures for ensuring
personnel safety.
Section
(Chief) The organizational level having responsibility for a major functional
area of incident management, e.g., Operations, Planning, Logistics,
Finance/Administration, and Intelligence (if established). The section is
organizationally situated between the branch and the Incident Command.
SNGH
Sentara Norfolk General Hospital, a level 1 trauma center located in Norfolk,
Virginia.
Span of Control
The number of individuals a supervisor is responsible for, usually expressed
as the ratio of supervisors to individuals. (Under the NIMS, an appropriate
span of control is between 1:3 and 1:7.)
Staging Area
Location established where resources can be placed while awaiting a tactical
assignment. The Operations Section manages Staging Areas.
START
Simple Triage and Rapid Treatment; An adult triage method adopted for use
in the Commonwealth of Virginia
Strike Team
A set number of resources of the same kind and type that have an
established minimum number of personnel.
Task Force
Any combination of resources assembled to support a specific mission or
operational need. All resource elements within a Task Force must have
common communications and a designated leader.
An ambulance capable of transporting patients from the scene. Minimum
staffing will be at least two Virginia EMT-B’s one of which is released as an
Transport Unit
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Attendant In Charge.
Trauma Center
A specialized hospital facility distinguished by the immediate availability of
specialized surgeons, physician specialists, anesthesiologists, nurses, and
resuscitation and life support equipment on a 24-hour basis to care for
severely injured patients or those at risk for severe injury. In Virginia, trauma
centers are designated by the Virginia Department of Health as Level I, II or
III.
Unified Command (UC)
An application of ICS used when there is more than one agency with incident
jurisdiction or when incidents cross political jurisdictions. Agencies work
together through the designated members of the UC, often the senior person
from agencies and/or disciplines participating in the UC, to establish a
common set of objectives and strategies and a single IAP.
Unit
(Unit Leader) The organizational element having functional responsibility for a
specific incident planning, logistics, or finance/administration activity.
USCG
United States Coast Guard
USFA
United States Fire Administration
VDOT
Virginia Department of Transportation
VaEOC
Virginia Emergency Operations Center located in Richmond, Virginia.
VHF
Very-high frequency
Warm Zone
Area where personnel and equipment decontamination and hot zone support
takes place; includes control points for access corridor. Also referred to as the
decontamination, contamination reduction, or limited access zone.
WebEOC
A real-time internet based emergency management information system,
designed to deliver real-time emergency information to any size Emergency
Operations Center or exchange information between multiple centers,
hospitals and the field.
WMD
Weapons of Mass Destruction
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