Emergency Medical Responder

First on Scene
TENTH EDITION

CHAPTER

27

Introduction to MultipleCasualty Incidents, the

Incident Command
System, and Triage

Emergency Medical Responder: First on Scene, 10/e

Christopher J. Le Baudour | J. David Bergeron

Copyright 2016, 2011, 2009

by Pearson Education, Inc.
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Objectives
1. Define the following terms:
Incident Command System (ICS)
Incident Commander
JumpSTART pediatric triage system
Multiple-Casualty Incident (MCI)
National Incident Management System
(NIMS)
f. START triage system
g. Triage
a.
b.
c.
d.
e.

continued on next slide

Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron

Copyright 2016, 2011, 2009

by Pearson Education, Inc.
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Objectives
2. Explain the criteria that defines a
Multiple-Casualty Incident.
3. Describe common causes of MultipleCasualty Incidents.
4. Explain the role of the Emergency
Medical Responder in the multiplecasualty situation.

continued on next slide

Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron

Copyright 2016, 2011, 2009

by Pearson Education, Inc.
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Objectives
5. Explain the key principles and
structure of an Incident Command
System.
6. Explain the key principles of triage at a
Multiple-Casualty Incident.
7. Differentiate patient priorities related
to triage.
8. Explain the assessment criteria of the
START triage system.
continued on next slide
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron

Copyright 2016, 2011, 2009

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Objectives
9. Differentiate primary and secondary
triage.
10.Demonstrate the ability to properly
categorize patients of a simulated
multiple-casualty situation.
11.Recognize the importance of patient
priorities during a multiple-casualty
event.

Emergency Medical Responder: First on Scene, 10/e

Christopher J. Le Baudour | J. David Bergeron

Copyright 2016, 2011, 2009

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Topics
Multiple-Casualty Incidents
Incident Command System
Triage

Emergency Medical Responder: First on Scene, 10/e

Christopher J. Le Baudour | J. David Bergeron

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MULTIPLE-CASUALITY
INCIDENTS

Emergency Medical Responder: First on Scene, 10/e

Christopher J. Le Baudour | J. David Bergeron

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Multiple-Casualty Incidents
Multiple-Casualty Incident (MCI)
Any emergency that involves multiple
victims and overwhelms first responding
units
Multiple vehicles
Earthquakes
Floods
Large explosions
Building collapses
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron

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Figure 27.1 Multiple-casualty incidents require the resources of many agencies.

( Edward T. Dickinson, MD)

Emergency Medical Responder: First on Scene, 10/e

Christopher J. Le Baudour | J. David Bergeron

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Multiple-Casualty Incidents
Low-Impact Incidents
Manageable by local emergency
personnel

High-Impact Incidents
Stresses local EMS, fire, and police
resources

Disaster, Terrorism Incidents

Overwhelms regional emergency
response resources
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron

Copyright 2016, 2011, 2009

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Think About It
You respond alone to a serious MVC.
You find two patients. One is bleeding
severely from a neck wound and the
other is complaining of head pain.
Which patient do you treat first?
Would you consider this scene an MCI?

Emergency Medical Responder: First on Scene, 10/e

Christopher J. Le Baudour | J. David Bergeron

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by Pearson Education, Inc.
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INCIDENT COMMAND SYSTEM

Emergency Medical Responder: First on Scene, 10/e

Christopher J. Le Baudour | J. David Bergeron

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Incident Command System

Model tool for command, control,
coordination of resources at scene of
large-scale emergency involving
multiple agencies
Procedures for organizing personnel,
facilities, equipment, and
communications

Emergency Medical Responder: First on Scene, 10/e

Christopher J. Le Baudour | J. David Bergeron

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Incident Command System

Incident Commander
Responsible for all aspects of an
emergency response

Modules in Incident Command System

Command
Operations
Planning
Logistics
Finance
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron

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Figure 27.2 The EMS Branch of a typical ICS organizational plan.

(From Pre-Hospital Emergency Care, 10th Edition by Joseph J. Mistovich, Keith J. Karren, and Brent Hafen.
Published by Pearson Education, 2013.)

Emergency Medical Responder: First on Scene, 10/e

Christopher J. Le Baudour | J. David Bergeron

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Incident Command System

National Incident Management System
Developed so that federal, state, local,
and tribal resources can respond more
efficiently to natural disasters and
emergencies

continued on next slide

Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron

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Incident Command System

National Incident Management System
Teaches unified approach to incident
management, standard command and
management structures
Emphasizes preparedness, mutual aid,
resource management, common
terminology among agencies

Emergency Medical Responder: First on Scene, 10/e

Christopher J. Le Baudour | J. David Bergeron

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Incident Command System

The Medical Branch
Branch of ICS
Designates and coordinates three
functional areas or groups
Triage
Treatment
Transport

Emergency Medical Responder: First on Scene, 10/e

Christopher J. Le Baudour | J. David Bergeron

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Incident Command System

Triage Group
Determines location of triage areas
Conducts primary triage and ensures all
patients are assessed and sorted using
local triage protocol
The triage group leader communicates
resource requirements to the medical
group supervisor.
continued on next slide
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron

Copyright 2016, 2011, 2009

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Incident Command System

Triage Group
Communicates with treatment group
leader to allow for movement of patients
into treatment area for prehospital care

Emergency Medical Responder: First on Scene, 10/e

Christopher J. Le Baudour | J. David Bergeron

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Incident Command System

Treatment Group
Determines treatment group location
Coordinates with triage group to move
patients from triage to treatment areas
Maintains communications with medical
group supervisor

continued on next slide

Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron

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Incident Command System

Treatment Group
Reassesses patients
Conducting secondary triage to match
patients with resources

Directs movement to transport group

Emergency Medical Responder: First on Scene, 10/e

Christopher J. Le Baudour | J. David Bergeron

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Incident Command System

Transport Group
Coordinates transportation of victims to
appropriate facilities for treatment
Manages patient movement and
accountability from scene to hospitals
Works with treatment group to establish
adequately sized, easily identifiable
patient loading area
continued on next slide
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron

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Incident Command System

Transport Group
Designates ambulance staging division
Maintains communication with medical
group supervisor

Emergency Medical Responder: First on Scene, 10/e

Christopher J. Le Baudour | J. David Bergeron

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Incident Command System

Medical Staging
Designates easily located site for
resources to stage near incident area
Determines whether several staging
divisions required
Determines whether staging will need to
be relocated as situation evolves

Emergency Medical Responder: First on Scene, 10/e

Christopher J. Le Baudour | J. David Bergeron

Copyright 2016, 2011, 2009

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Think About It
You are first on scene of a MVC
involving 20 patients who have been
ejected into the median after a bus
overturned.
Should you immediately begin triage?
Do you have other immediate
responsibilities?

Emergency Medical Responder: First on Scene, 10/e

Christopher J. Le Baudour | J. David Bergeron

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TRIAGE

Emergency Medical Responder: First on Scene, 10/e

Christopher J. Le Baudour | J. David Bergeron

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Triage
Method of sorting patients for care and
transport based on severity of injuries
or illnesses
Used in hospital emergency
departments, battlefields, emergencies
when there are multiple victims and
limited medical resources

Emergency Medical Responder: First on Scene, 10/e

Christopher J. Le Baudour | J. David Bergeron

Copyright 2016, 2011, 2009

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Figure 27.3 At the scene of a multiple-casualty incident, triage is the system used to identify victims who are
most in need of immediate medical care.

Emergency Medical Responder: First on Scene, 10/e

Christopher J. Le Baudour | J. David Bergeron

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Triage
EMRs
First on scene
Must be able to triage patients and
initiate care rapidly

Emergency Medical Responder: First on Scene, 10/e

Christopher J. Le Baudour | J. David Bergeron

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Triage
Serious medical or trauma related
problems should be transported quickly.

Heart attack
Shock
Major injuries
Heat stroke

Emergency Medical Responder: First on Scene, 10/e

Christopher J. Le Baudour | J. David Bergeron

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Triage
START Triage System
Simple Triage And Rapid Treatment
Based on rapid assessment of patients
using three criteria
Respirations
Perfusion
Mental status

60 seconds or less per patient

Do not begin treatment during triage.
continued on next slide
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron

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Triage
START Triage System
Patients classified into one of four
categories and tagged with denoted
color-coded tag indicator

Immediate (red)
Delayed (yellow)
Minor (green)
Deceased (black)

Emergency Medical Responder: First on Scene, 10/e

Christopher J. Le Baudour | J. David Bergeron

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Figure 27.4

An example of a standard triage tag, front and back.

Emergency Medical Responder: First on Scene, 10/e

Christopher J. Le Baudour | J. David Bergeron

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Figure 27.5

The START triage algorithm.

Emergency Medical Responder: First on Scene, 10/e

Christopher J. Le Baudour | J. David Bergeron

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Triage
Primary triage
When patient is first identified and
triaged

Secondary triage
When patient is relocated to treatment
area, they will immediately be retriaged by treatment team.

Emergency Medical Responder: First on Scene, 10/e

Christopher J. Le Baudour | J. David Bergeron

Copyright 2016, 2011, 2009

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Table 27.1

Multiple-Casualty Incidents

Emergency Medical Responder: First on Scene, 10/e

Christopher J. Le Baudour | J. David Bergeron

Copyright 2016, 2011, 2009

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Triage
JumpSTART Pediatric Triage System
Specialized pediatric triage system
designed for patients from one to eight
years of age

continued on next slide

Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron

Copyright 2016, 2011, 2009

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Triage
JumpSTART Pediatric Triage System
Assessment categories for JumpSTART
system are the same as for START
system.
Respirations
Perfusion (peripheral pulses)
Mental status (AVPU)

Emergency Medical Responder: First on Scene, 10/e

Christopher J. Le Baudour | J. David Bergeron

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Figure 27.6

The JumpSTART pediatric triage algorithm.

Emergency Medical Responder: First on Scene, 10/e

Christopher J. Le Baudour | J. David Bergeron

Copyright 2016, 2011, 2009

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Triage
Be aware of your mental and physical
stress levels.
Critical Incident Stress Debriefing
(CISD)

Emergency Medical Responder: First on Scene, 10/e

Christopher J. Le Baudour | J. David Bergeron

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Think About It
You respond to an MCI following an
explosion at an outdoor caf. You are
assigned to the triage group and are
given tags. You see significantly injured
patients everywhere. A woman with a
localized ankle fracture screams out to
you for help.
What do you do?
How will you proceed?
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron

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SUMMARY

Emergency Medical Responder: First on Scene, 10/e

Christopher J. Le Baudour | J. David Bergeron

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Summary
While rare, Multiple-Casualty Incidents
(MCIs) can easily overwhelm first
responding units at scene.
First units quickly request additional
resources and begin to establish
command over incident.

continued on next slide

Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron

Copyright 2016, 2011, 2009

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Summary
Incident Command System (Incident
Management System)
Tool used to manage overall control of
large scenes involving many resources
and multiple agencies

continued on next slide

Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron

Copyright 2016, 2011, 2009

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Summary
Triage
Sorting of patients based on severity of
injuries or illnesses
Goal is to save as many patients as
possible using available resources.

continued on next slide

Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron

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Summary
Triage Categories
Immediate
Most critical but salvageable patients

Delayed
Less critical but still in need of care

Minor
Ambulatory at scene

Deceased
No signs of life
continued on next slide
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron

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Summary
START System
Simple Triage And Rapid Treatment
Uses respirations, perfusion, and mental
status assessments to categorize
patients into one of four treatment
categories

continued on next slide

Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron

Copyright 2016, 2011, 2009

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Summary
JumpSTART
Variation of START Triage System
designed specifically for pediatric
patients
Takes into account unique needs and
presentation of pediatric patients

Emergency Medical Responder: First on Scene, 10/e

Christopher J. Le Baudour | J. David Bergeron

Copyright 2016, 2011, 2009

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REVIEW QUESTIONS

Emergency Medical Responder: First on Scene, 10/e

Christopher J. Le Baudour | J. David Bergeron

Copyright 2016, 2011, 2009

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Review Questions
1. What are the criteria that define a
Multiple-Casualty Incident?
2. What are common causes of MultipleCasualty Incidents?
3. What is the role of the Emergency
Medical Responder in the multiplecasualty situation?

continued on next slide

Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron

Copyright 2016, 2011, 2009

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Review Questions
4. What are the key principles and
structure of an Incident Command
System?
5. What are the key principles of triage at
a Multiple-Casualty Incident?
6. What are the assessment criteria of
the START triage system?
7. What is the difference between
primary and secondary triage?
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron

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