Mass Casualty Management System

MASS CASUALTY
MANAGEMENT
SYSTEM
ROMEO ALMAZAN BITUIN, MD, MHA

Health Emergency Management Staff Coordinator
Dr. Jose Fabella Memorial Hospital
Department of Health
1
OUTLINE OF PRESENTATION
I.
Overview of Mass Casualty
II. Establishing Mass Casualty
Management System
III. Field Management
IV. Management of Victims
V.Transfer Organization
2
QUESTION 1
Define Mass Casualty
QUESTION 2
What is a Mass Casualty Management
System
Overview of Mass
Casualty
GLOBAL TREND
1. Kobe Earthquake, Japan

1995
2. Sarin attack in Tokyo, 1995
3. New York 911 Tragedy,
2001
4. Iraq Crisis, 2003
5. Terrorism WMD
6. Asian Tsunami
7. Leyte Landslide, 2006
Overview of Mass
Casualty
WORLD
Since 1900
Top 5 hazards by
frequency of
19.6
occurrence
mass accidents
wind storm
32.8
flood
earthquake
drought
18.0
7.5
6.0
83.9
mass accidents
wind storm
37.2
flood
earthquake
epidemic
18.4
8.0
4.0 6
87.4
ASIA
Top 5 hazards by
frequency of
19.7
occurrence
Overview of Mass
Casualty
Mass Casualty Incident
Produces several patients

As few as six or as many as several hundred
Affects local hospitals
Patients are greater than resources of the
initial responders
7
Overview of Mass
Casualty
Preparation for Mass Casualty
Pre-planning and training are critical

Establish guidelines and procedures
Early implementation of Incident Command
First five minutes will determine next five
hours
8
Overview of Mass
Casualty
Response Categories for Mass Casualties
Mass Casualties can occur in a variety of

ways
Effect on emergency response and
community impact
Include transportation, violent crimes and
building collapse
9
Overview of Mass
Casualty
Response Categories of Mass Casualties
Hazardous materials incidents

Civil disturbances
Natural disasters
Major fires
Terrorist attacks
10
Overview of Mass
Casualty
Problems in Mass Casualty Incidents

Most common being:
Who is in command of the incident
Location of the Command Post
Lack of communication between agencies
leading to conflicting priorities and orders
11
Overview of Mass
Casualty
Problems in Mass Casualty Incidents
Perimeter establishment delayed or not done

at all
Large crowds of people
Media involvement
Political involvement
Inadequate resources
12
Establishing Mass
Casualty Management
System
13
Establishing a Mass Casualty Management System

Any event resulting in a number of victims
large enough to disrupt the normal course of
emergency and health care services
14
Casualty Management
Management of victim of a mass casualty
event
Objective is to minimize loss of life and
disabilities
15
Mass Casualty Management System

The group of Units, Organizations, Sectors which work
jointly during a mass casualty event
Based on:
- Pre-established procedures
- Maximization of use of existing resources
- Multi-sectoral preparation and response
- Strong pre-planned and tested coordination
16
Different Approaches to MCI

1. Scoop and Run
2. Classical Approach
3. Mass Casualty Management System
17
Scoop and Run

Most common
Does not require specific technical
ability from rescuers
Justified for small numbers occurring near a
hospital
May just transfer problem to the hospital
18
Classical Approach
First responders are trained (basic triage
and field care)
Disregard the receiving hospitals from the
field
Quickly result to chaos
19
Mass Casualty Management Approach

Most sophisticated approach includes preestablished procedures for:
a. resource mobilization
b. field management
c. hospital reception
20
Mass Casualty Management Approach

Training of various level of responders
Incorporates links between field and health
care facilities
Command Post
Multi-sectoral Response
Dependent on the availability of large
amounts of human & material resources
21
Problems in Developing MCM

Limited human resources
limited material resources
facility
transport
communication
Poor communication
topography
isolation
Political
22
Activities at various levels of responses:

alerting process
E/Disaster
Site/Scene
initial assessment
command / control / coordinate
manage information
search/rescue
field care-- mostly health activities
transport/traffic control
facility reception at ER / A&ED
hospital mass casualty mgt. & command
system
23
Field Management
Definition:
Encompass procedures used to organize the disaster area in order to
facilitate the management of victims
Components
Alerting Process
Search and Rescue
Pre-identification of
Field Areas
Field Care
Safety/ Security
Evacuation
Command Post
(EMC) Emergency
Management Center
24
RESCUE CHAIN---SECTORAL
Impact
Zone
*SEARCH*
*RESCUE*
*First Aid*
Command
Post
Triage
Stabilizatio
n
Evacuation
CP / AMP
Pre-Hospital Organization
Traffic Control
ER
Regulation of Evacuation
or
A&ED
Hospital Organization
25
Field Organization
Alerting Process
Definition: Sequence of activities implemented to
achieve the efficient mobilization of
adequate resources
Aim:
- Confirm the initial warning
- Evaluate the extent of the problems
- Ensure that appropriate resources are informed
and mobilized
26
Field Organization
Alerting Process
Dispatch Center:
Core of the Alerting Process
(Operation/Communication Center)
Functions:
receives all warning messages (radio/phone)
mobilize a small assessment team (Flying
Team) from police, fire or ambulance services
27
Initial Assessment
Precise location of the event

Time & type of the event
Estimated number of casualties
Added potential risk
Exposed population
Resources needed
28
Pre-Identification of Field Areas
Impact Zone
Command Post
Collecting Area in unstable location
Advance Medical Post Area (3-T Principle)
Evacuation Area
VIP & Press Area (Information Officer)
Access Roads (geographical presentations if
available)
Check point for resources (Staging Area)
29
Safety
Best practice technique to protect victims,
responders & exposed population:
immediate/potential risk
Measures:
Direct action:
- risk reduction - fire fighting
- contain hazardous material
- evacuation of exposed population
Preventive actions: establish field areas

- primary- impact zone
- secondary- rescue/ICP/AMP
- tertiary-buffer zone; tri-media
30
Safety
Personnel: fire services; specialized units
hazardous
materials & explosives (bio-nuclear
and
radioactive materials) experts,
etc.,
airport manager,
chemical plant expert
31
Security Measures
Non-interference of external elements:
- crowd/traffic control
Contribute to safety:
protect workers from external influence;
additional stress
free flow: victims/resources
protect general public from risk exposure
ensured by police officers / special units (security:
airport/building/hospital/establishments, etc..)
32
Command Post ( CP / or ICP)

Multi-sectoral control unit to:
Coordinate sectors involved in field/scene management

Linked w/ back-up system: provide information &
mobilization resources
Supervise victim management
REQUISITE: radio communication network: main

criterion to be effective
Purpose: coordination / communication hub of people

who dont work routinely (pre-hospital setting)
Location: external boundary of restricted area (impact
zone) close to AMP/ Evacuation Area/ accessible/easily
identified
* should accommodate: com./visuals/maps/boards
33
Personnel
High ranking officer (government police, fire, health,

defense)
- plant manager/ airport manager/ chief security, etc
- fire officer / police officer skilled in ICS / MCM
Identified by name/position, coordinator / commander

May depend on what type of incident
Must be familiar with each others roles during
previous meetings/ drills/ simulation exercises (policy)
This core group cooperate with volunteer organizations
34
METHOD
The communication / coordination hub of the

pre- hospital organization. By constant reassessment, CP will identify needs to
increase / decrease resources:
- organize timely rotation of rescue workers exposed
to stressful/exhausting conditions in
close
coordination
w/ back-up system
- ensure adequate supply of equipment / manpower
- ensure welfare / comfort of rescue workers
- provide info to back-up system, other officials, and
tri-media thru an Information Officer
- release as soon as situation allows E staff and reestablish normal operations
- determine termination of field operations
35
MANAGEMENT OF VICTIMS
Search & Rescue

- locate victims
-
remove victims from unsafe locations collecting area

assess victims status (on-site triage)
provide first aid , if necessary (no CPR on-site in MC Event)
transfer victims to AMP thru entry triage (medical triage)
under supervision of the CP/ IC/ or Commander/Coordinator
may in special situation, require medical personnel (trained)
to stabilize/resuscitate/amputate (trapped) victim before
extrication.
36
Management of Victims
Field Care
- Pre-established capabilities / inventory: preplanning
- Integrated community plan: practiced w/ policy
support
- The Golden Hour Principle
37
Recent progress in pre-hospital

emergency / disaster medicine
Establish AMP with specially skilled /trained
---- disaster field medical teams
- good triage / stabilization capacity
- specifically trained / up-skilled medical teams
- good (radio) communications between the
field
scene & medical facility
Dont transfer chaos in the scene,
to the hospital
38
TRIAGE
Basis: urgency (victims status)
survival (chance or likelihood)
care resource availability and capability
Objectives:
Quick identification for immediate stabilization
for life-saving (measures) and surgery
Levels:
On-site----- where they lie
Medical ----- at Advance Medical Post
Evacuation --- transport
39
On-site T:
Medical T:
Acute
Non-acute
Red
Yellow
Green
Black
Evacuation T - transport:
Red
Yellow
Green
Black
Red:
transferred as soon as
possible to tertiary
facilities
in an equipped
ambulance with medical
escort
Yellow: after evacuation of Red,
without life-threatening
problem
Green: walking wounded-to
AS/OPD
Black: to morgue Forensic
Services
Public Health & PsychoSocial
40
interventions to
First Aid
Personnel:
volunteers, fire, police staff, special units, EMTs,

and medical personnel
Location:
on-site, before moving victim

at collecting point/ area in an unstable environment.
Green Area of AMP
ambulance in transit to facility
Action:
primarily to transfer with consideration of the ABCs

order of priority
41
Advance Medical Post (AMP)

Purpose:
reduce loss of life & limb - save as many as

possible in the context of existing & available
resources/ situation
victims status; chance of survival; resources
Location:
50-100 meters from Impact Zone (walking distance

)
direct access to: Evacuation Road. / Command Post
Clear Radio-Com Zone and SAFE (Upwind)
tent / bldg / open / mobile field hospital..??
42
Advance Medical Post (AMP)

Role:
Provide entry medical triage

Effective stabilization for victims of a MCI/Situation
intubation, tracheostomy, chest drainage,

shock mgt , analgesia , fracture immobilization
fasciotomy, control external bleed & dressing
Convert red to yellow category as maybe possible

Organize patient transfer to designated care
facility/ties
AMP 3-T principle: Tag Treat Transfer.
Personnel:
ER (A&ED), physicians/ nurses (trained & skilled)

support: Anesthetists / Surgeons / EMTs / Nurses / Aiders,
43
etc.
AMP
NON-ACUTE
TRIAGE
C
P
Black
Green
NON-ACUTE
evacuation
ACUTE
Red
Yellow
ACUTE
C P Collecting Point
44
COLLECTION AREA
(in unstable condition)
TRIAGE AREA
(color tagging of
victims)
COMMAND POST
TREATMENT
(management
and stabilization)
AREA
1st
3rd
PRIORITY III
2nd
PRIORITY II
T R A N S P O R T
PRIORITY I
A R E A
45
Field Management Plan: Diagram
Working
Area
Triage
Evacuation
AMP
Impact Zone
T
r
a
f
f
i
c
C
o
n
t
r
o
l
Command Post
Strictly Restricted
Restricted
Access Route
Traffic
46
Transfer Organization
Procedures used to ensure that victims of a MC

situation is safely, quickly, and efficiently
transferred by appropriate vehicles to the
appropriate and prepared facility
Preparation for Evacuation:

1. Single Reception Facility
2. Multiple Reception Facilities
* type of vehicle required
* type of escort required
* destination
47
Preparation for Transport

Evacuation Officer reporting to ATM:
assess patients status: vital signs, ventilation /

hemostasis
check security of equipment / & accessories
ensuring efficiency of immobilization measures
ensure triage tags: secure/& clearly visible
Evacuation Procedures: Regulation

Principles
- not to overwhelm care facility
- avoid spontaneous evacuation of unstable patients.
48
Evacuation Procedures: Regulation

Rules:
- victim is in most possible stable condition

- victim is adequately equipped for transfer
- receiving facility correctly informed and ready
- the best possible vehicle and escort available
Victim Flow
- Noria Principle, Spanish word from Arabic-- wheel

WW I Battle of Chemin de Dames, Verdun, France
* conveyor belt flow from first aid to the most
sophisticated care level..
49
Victim Flow : Conveyor Belt Management

Diagram
Triage
3-T
Triage
Tag
Treatment
Evacuation
Treat
and
Transfer
Impact
Zone
Collecting
Point
AMP
TRANSFER
HOSPITAL
50
Victims Flow
Transport Resource Flow
Victim Flow
- Ambulance Traffic Control
Radio Links:
*Transport Officer at AMP
*Hospital Admission / ER Department
*Command Post
*Ambulance Headquarters
Responsibility of Ambulance Driver
*takes order from the Transport Officer
51
Victim Flow
Road Control:
Police Officers ----- crowd and traffic control
Evacuation of Non-Acute Victims

- use available mass transport
- as much as possible, to primary care
centre
52
Field Organization Checklist
Situation Assessment
Report to Central Level
Work Areas Pre-identification
Safety
Primary Area: Impact Zone
Secondary Area Units: CP/AMP/EVAC/TRANSFER
Radio Communications
Crowd & Traffic Control
Search and Rescue
Triage & Stabilization
Controlled Evacuation
53
Fallacy
IT CANT HAPPEN
TO US
54
Incident Command System
Performance Objectives
Discuss the advantages of using the

Discuss the two types of command
Discuss the Incident Command
Process
Discuss Incident Priorities
57
Discuss the components of the

Discuss the Incident Command
System organization
Discuss the use of the Incident
Command checklist
58
Question 1
HOW WILL YOU DIFFERENTIATE A SINGLE
COMMAND FROM A UNIFIED COMMAND ?
Question 2
WHAT IS THE ROLE OF THE INCIDENT
COMMANDER ?
Question 3
WHEN DO YOU TRANSFER COMMAND ?
Developed in the 1970s during the

California wildfires
Business management practices of planning,
directing, organizing, coordinating,
delegating, communicating and evaluating
62
Framework necessary to manage

resources, personnel and equipment
Designed to be flexible and can be used in
large or small incidents
Creates a safe environment for all involved
63
Benefits of Incident Command
Common terminology
Position titles and Chain of
Command for decision making
Responder accountability
64
Basic Command Types

There are two types of
command:
Single Command
Unified Command
65
Single Command
Based on first arriving emergency

units.
Initial Incident Commander begins
assessment of incident
Rescue, Triage, Treatment,
Transport
66
Basic Command Structure

Single Command
IN C ID E N T
C O M M AN D ER
R ESC U E/
E X T R IC A T IO N
T R IA G E
TR EATM EN T
TR AN SPO R T
67
Unified Command
Incidents that involve jurisdictions or

agencies involved in the decision
making and planning process
Ensures plan is communicated and
supported by all resources assembled
68
IN C ID E N T C O M M A N D S Y S T E M
IN C ID E N T
COM M AND
S A F E T Y O F F IC E R
L IA IS O N O F F IC E R
P U B L IC IN F O R M A T IO N
O F F IC E R
O P E R A T IO N S O F F IC E R
F IE L D M E D IC A L C O M M A N D E R
S T A G IN G O F F IC E R
M E D IC A L G R O U P
S U P E R V IS O R
P L A N N IN G O F F IC E R
TRANSPO RT G RO UP
S U P E R V IS O R
RESO URCES
A D M IN IS T R A T IV E O F F IC E R
L O G IS T IC S O F F IC E R
S E R V IC E
SUPPO RT
S IT U A T IO N
TREATM ENT TEAM
LEADER
T R IA G E T E A M
LE AD ER
G R O U N D AM BU LAN C E
PRO CUREMENT
C O M M U N IC A T IO N S
SU PPLY
M E D IC A L
F A C IL IT IE S
FO O D
G RO UND SUPPO RT
D O C U M E N T A T IO N
A IR A M B U L A N C E
TREATM ENT M EM BERS
IM M E D IA T E
DELAYED
T IM E
C O M P E N S A T IO N
T R IA G E M E M B E R S
D E M O B IL IZ A T IO N
CO ST
M O RG UE MANAG ER

M IN O R
69
Overview of Incident Command

Process
Process is based on:
Size up
Setting Incident Priorities
Predicting incident course and harm
Strategic goals and tactical objectives
70
Size Up
Rapid mental evaluation of factors

influencing an incident
Must continue throughout incident
with ongoing evaluation
Incident situation, incident cause
and incident status
71
Incident Situation
May be one or combination of:
Biological
Nuclear
Fire
Chemical
Explosion or natural event
Natural disaster with MCI
72
Incident Cause
Incident Cause is important

because additional or specialized
resources may be needed
The Incident Commander must
determine if the incident was
accidental or intentional
73
Incident Status
Is the incident:
In a somewhat controlled state
or
Does it remain uncontrolled
74
Setting Incident Priorities
After size up of the incident a

course of action is determined
High priority is life safety for the
public and responders
Incident stabilization
Protection of critical systems
75
Estimating Potential Incident Course

and Harm
Responder is making a prediction

on what will likely occur during the
incident
Based on available information
Responders experience
76
Strategic Goals
Broad general statements of desired
outcome of the incident
Example:
mass casualty overturned school bus
- extrication, triage, treatment,
transport
77

Organization
Comprised of two major categories

which assist in organizing functions
into an effective design:
- Command Staff
- General Staff
78
Command Staff
Consists of the :
Incident Commander
Safety Officer
Liaison Officer
Public Information Officer
79
Incident Commander
IN C ID E N T
CO M M ANDER
80
Incident Commander
First person on the scene with

communications capability
Remains in command until
transferred or incident is
terminated
Complete authority and
responsibility
81
Incident Commander
Must assume and announce

command, rapidly evaluate
incident, identify resources on
hand, request additional
resources and establish
incident action plan
82
Incident Commander
Fill command staff and
functional areas
Must approve all information
releases to the media
83
Transfer of Command
Based on the initial responders
experience and comfort level
Higher ranking officer does not
need to assume command
Transfer procedures should be
predetermined
84
Transfer Of Command
Detailed briefing is required
Face to Face is best method
Include: current status, strategies
and tactics employed, progress,
safety, accountability and
resources assigned or needed
85
General Staff
Consists of:
Operations (includes
staging)
Planning
Logistics
Administrative/Finance
86
Operations Section
IN C ID E N T
C O M M AN DER
O P E R A T IO N S
87
Operations Section
Operations officer functions under

direction of the Incident Commander
Deploys tactics to control and
resolve the incident
Responsible for execution of the
incident action plan
88
Operations Section
Makes recommendations for changes

to plan based on incident status
Oversees and is in direct contact
with the staging manager
Task supervisors report to
Operations not Incident Command
89
Planning Section
IN C ID E N T
C O M M AN D ER
O P E R A T IO N S
P L A N N IN G
90
Planning Section
Responsible for collection,

evaluation, distribution and use of
information about the incident
Forecast and develop plans to
contain and resolve incident
Communicates with logistics
section
91
Logistics Section
IN C ID E N T
C O M M AN D
O P E R A T IO N S
P L A N N IN G
L O G IS T IC S
92
Logistics Section
Responsible for providing facilities,

services and materials in support of
incident
Includes equipment, personnel and
associated materials and tools
Support branch and Services branch
93
Administrative / Finance Section

IN C ID E N T
C O M M AND ER
O P E R A T IO N S
P L A N N IN G
L O G IS T IC S
A D M IN IS T R A T IV E
F IN A N C E
94
Administrative/Finance Section
Generally not located at incident

site
Responsible for financial,
administrative and cost analysis
Divided into four units: time,
procurement, compensation/claims
and cost
95
Summary
Incident Command created to deal

with any incident in an organized
manner
Manages resources, personnel and
equipment to mitigate the incident
Builds from first responder
96
Summary
Expandable to manage hundreds

Implementation is critical for safe
and effective operation
Allows for multi-agency operations
and response based on incident
type
97
Thank
98
CRITICAL INCIDENT
MANAGEMENT
99
Discuss critical incident stages

Discuss decision making in a
critical incident
100
Critical Incident Management

Characteristics
Demands a coordinated response

to prevent incident from getting
worse
This includes unresolved element
of danger such as additional bomb,
a threat to citizens and responders
or an unusual incident
101
Critical Incident Management

Characteristics
Often random in nature and

disrupt normal life
Terrorist organizations use
opportunity as a tool for civil
disturbance
A mass casualty is a critical
incident
102

Overview
Produces several patients

As few as six or as many as
several hundred
Affects local hospitals
Patients are greater than resources
of the initial responders
103
Preparation For Mass Casualty
Pre-planning and training are

critical
Establish guidelines and procedures
Early implementation of Incident
Command
First five minutes will determine
next five hours
104
Functional Systems Approach
Three levels of function: strategic,

tactical and task (operation)
Management is strategic
Team leaders are tactical
Resources not involved in
supervision are task
105
Critical Incident Stages

They consist of:
Initial Response
Incident Control using the Six Step
Response
Recovery Stage
106
Initial Response Stage
Ability to establish command and

control
Faced with confusion and panic
Crucial to develop a team and
place a plan in action
107
Initial Response Objectives
Protecting citizens and rescue of

victims
Limit incident growth
Protect arriving responders
Identify ingress and egress routes
108
Initial Response Objectives

As soon as possible:
Gain control of the scene
Restore order
Prevent target opportunities
109
Incident Control Using The

Six-Step Response
The Six-Step response is based on
the Incident Command System. It
includes:
Assume
Command,
Situation Assessment, Identify and
Set
Perimeters,
establish
Command Post, assign Safety
Officer and establish Staging Area
and assign a Staging Officer
110
# 1 Assume Command
Must advise incoming responders

of incident location
Secure tactical frequency
Request supervisory support
111
# 2 Situation Assessment
Size up of the incident that

includes the type of threat,
approximate number of injured,
size of threatened area and
possibility of secondary event.
112
# 2 Situation Assessment
In simple terms the assessment
should describe:
What do you have
What are you doing
What do you need
113
# 3 - Identify and Set Perimeters
Divide the incident into

manageable divisions
(geographical areas)
Allows command to provide
resources where they are needed
114
# 3 - Identify and Set Perimeters
Critical incidents have three

standard perimeters. All
perimeters are divisions
Expand perimeters based on
weather
Perimeters are the hot zone, inner
perimeter and outer perimeter
115
The Hot Zone
Area in which the incident has

occurred
May be a street corner or spread
over a large area
Secured by placing responders in
positions of controlling ingress and
egress
116
Inner Perimeter
Protects responders in hot zone

Uniformed personnel only
Used as decontamination area,
treatment area and evacuation
area for walking wounded
117
Outer Perimeter
Provides last line of defense from

internal incident acceleration
Provides first line of defense from
external acceleration
Secure area for command post,
resources and control of the media
118
Perimeter Placement Illustration
119
# 4 Establish Command Post
Typically begins at first responders

vehicle
Incident dynamics will require
Incident Commander to shift to a
fixed command post
Must be away from hot zone
120
# 4 Establish Command Post
The command post will ensure

support for field personnel, create a
controlled environment and improve
communications
121
# 5 - Establish Safety Officer
Should be filled as soon as

possible
Officer selected on operational
experience and ability to recognize
acceptable and unacceptable risk
Operations can be stopped or
modified
122
# 6 - Establish Staging Area
Effective tool in correct and safe

deployment of resources
Staging Supervisor must track,
rotate and relieve resources as
appropriate
Area established within inner or
outer perimeter. Avoid congestion
123
Inter Agency Planning
Failure to include all agencies

during planning process may
compromise responders
Identify and establish liaisons with
all agencies and coordinate tactical
operations
124
Secondary Incidents
May be more destructive and

damaging than initial incident
World Trade Center crashes were
primary incident with collapse of
the towers as secondary incidents
claiming more lives
125
Recovery Stage
Begun when aggressive threats of

incident are neutralized
Incident is not over when last
patient is transported
Recovery must be managed
aggressively
126
Recovery Stage
Planning Section of incident

command is responsible for initial
recovery
Typically the longest and most
poorly managed part of the
incident
May require months to years
127
Goals in the Recovery Stage
Most important goal is document

collection
Information can assist in Post
Incident Analysis, cost recovery
and tracking responder injuries or
deaths
128
Goals in the Recovery Stage
Provide critical incident stress

management for responders
Collect and properly dispose of
used medical supplies and
biohazard waste from the incident
129
Post Incident Analysis

Critical for operational review.
Benefits include:
Operational performance
Organizational needs
Procedure modification
Additional training
130
Summary
Critical Incident Management can

place a heavy burden on
responders
Requires a coordinated response
from all agencies involved
Mass casualty incident is a critical
incident, terrorist related or not
131
Summary
Identifying critical stages will give

the responder a better chance of
dealing with the incident
Six Step response is a tool for
incident management
Humanitarian Assistance
132
9-11-01
133
TRIAGE
135
QUESTION 1
What is the meaning of Triage ?
What is the basis of triage ?
QUESTION 2
Do you always use Triaging ?
Give conditions.
QUESTION 3
In the MCMS, how many times do you triage
and where ?
Description
This lesson provides participants with
methods of prioritizing care delivery in
mass casualty situations. The decisionmaking process is explored with the goal
being the maximum positive effect for the
greatest number of patients.
Objectives
Describe the basic concepts of sorting and

allocating treatment to patients in a triage
situation
Demonstrate the decision-making process in
determining priority of care
What is Triage ?
French word meaning to Sort

Utilized to identify treatment priorities
Process by which a decision is made on which victim
receives treatment and which does not
Four basic priorities of patient treatment and transport
141
Priorities
Highest Priority
Patients that require immediate care and transportation
Patients receive treatment at the scene for life
threatening injuries
First to be sent to available medical facilities
142
Priorities
Intermediate Priority
Patient treatment and transport

can be delayed
143
Priorities
Delayed or Low Priority
Referred to as walking wounded
Injuries require medical care at
some point
Treatment and transport can be
delayed
Monitor patients and reassess
144
Priorities
Lowest Priority
Patients have either died or are near death
If still alive they have suffered severe or
serious injuries with little chance of survival
When resources are limited, patients must
be ignored
145
Initial Triage Officer
Must size up situation

Ensure safe approach and scene survey
Activate additional resources
Number of victims
Size of the incident
Better off requesting more equipment and
personnel than not enough
146
Simple Triage and Rapid Transport System
This system focuses on three areas :

1. Respirations
2. Pulse Rate and Quality
3. Mental Status
147

System requires first responders to have
tags, ribbons or tape in four colors
Priority One (Highest Priority )
Red Immediate care : Life

threatening injuries
148

Priority Two (Intermediate Priority)
Yellow Urgent care: delay treatment and
transport up to one hour
Priority Three (Delayed or Low Priority)

Green Walking wounded: delay treatment
and transport up to three hours
149
Priority Four (Lowest Priority)

Black No care required: patient is dead or
near death
Hardest priority to deal with emotionally
Necessary for others to survive
150
First Step is to make an announcement

for all people able to get up and walk to
specific area
Allows responder to focus on injured
People who successfully move should be
tagged Green
Tell people to look out for each other
and notify responders of any significant
changes
151
Second step is to conduct an orderly survey

of remaining victims
Decide how to move through area
Perform quick assessment on each person
and label or tag
No more than 10 seconds per patient
152
Correct life threatening : airway or breathing

problem and profuse bleeding
The objective is to: locate, identify and tag
priority one patients who require immediate
care and transportation
153
Patient Assessment
Respiration
Assess breathing rate
Greater than 30 per minute, patient is
priority one and tagged red
Less than 30 per minute, move on to
assessing pulse and mental status
154
Patient Assessment
Not Breathing
Quickly make sure mouth is clear
Open airway with head tilt method
During mass casualty incident, cervical spine
immobilization may not be able to be done
155
Patient Assessment
Open patients airway and position so it

remains open
If patient does not start to breath with
simple airway maneuvers, tag priority four black
156
Patient Assessment
Pulse Rate and Quality

Check radial pulse
No more than 5 second check
Pulse is weak or irregular - Red Tag Priority One
157
Patient Assessment
Pulse Rate And Quality

If pulse is strong, move on to assess mental
status
If there is NO pulse, black tag priority four
158
Patient Assessment
Mental Status
Breathing and pulse should have already been
checked
Have patient respond to simple commands such as
open your eyes or squeeze my hand
159
Patient Assessment
Mental Status
If patient can perform this function, is breathing
and has a pulse, yellow tag priority two
If patient is unresponsive and cannot follow simple
commands, red tag priority one
160
THANK YOU
162

Mass Casualty Management System

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Mass Casualty Management System

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MASS CASUALTY

ROMEO ALMAZAN BITUIN, MD, MHA

1. Kobe Earthquake, Japan

Mass Casualty Incident

Produces several patients

Preparation for Mass Casualty

Pre-planning and training are critical

Response Categories for Mass Casualties

Mass Casualties can occur in a variety of

Response Categories of Mass Casualties

Hazardous materials incidents

Problems in Mass Casualty Incidents

Problems in Mass Casualty Incidents

Perimeter establishment delayed or not done

Establishing a Mass Casualty Management System

Mass Casualty Incident

Establishing a Mass Casualty Management System

Establishing a Mass Casualty Management System