MCM Participant's Manual

Participants Manual
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Mass Casualty Management

Participants Manual
Participants Manual
page 3
INTRODUCTION: HEMS IN PERSPECTIVE

The Department of Health-Health Emergency Management Staff (DOH-HEMS)
is the countrys prime mover in responding to emergencies and disasters. It is
composed of technical experts and practitioners in health emergency
management who have been lauded for the way they have prepared for and
managed handled national and international emergencies and disasters.
DOH-HEMS is committed to making the entire country prepared for any
emergency and disaster; to make effective management and response a way
of life. Towards this end, DOH-HEMS conducts training programs committed to
the thrust Capacitating the mind and body (Training beyond training). Over
the last 4 years, DOH-HEMS has been developing, conducting, evaluating, and
refining training programs on various areas in health emergency
management for the purpose of multiplying the critical mass of technical
experts as well as equipping the public to adequately respond to and manage
health emergencies. Since 2007, DOH-HEMS has conducted 17 courses for a
total of 21,314 trainees ranging from managers, leaders, responders,
operation center staff, trainers, and lay individuals or community members.
To refine and professionalize the training programs, DOH-HEMS is currently
collaborating with the academe in developing training packages specifically
on the following courses:
1. National Public Health and Emergency Management in Asia and the Pacific
(PHEMAP 1)
2. Sub-National Public Health and Emergency Management in Asia and the
Pacific
(PHEMAP 2)
3. Health Emergency Response Operations (HERO)
4. Basic Life Support - Training of Trainers (BLS-TOT)
5. Emergency Medical Technicians Basic Training (EMT-B)
6. Nutrition in Emergencies - Basic Training and Training of Trainers
7. Water, Sanitation, and Hygiene (WASH) in Emergencies - Basic Training
and
Training of Trainers
8. Essential Emergency Surgical Skills Training (EESST) for District Hospitals
9. Standard First Aid (SFA) - Basic Training and Training of Trainers
10. Mass Casualty Management (MCM)
This particular training program deals with Mass Casualty Management
(MCM). It is composed of the manuals for facilitators, trainees and the
corresponding references. The manual was derived from the existing MCM
program of HEMS and accorded the basic principles of adult education
adapted for HEMS trainees. It is composed of training objectives, topics,
teaching-learning activities like exercises, drills, and case discussions, and
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assessment plans. It also includes explicit instructions on what roles the

trainers and facilitators will play so that the training program itself serves as
an avenue for institutional strengthening through team building, strategic
planning, post incident evaluation, and program implementation and review.
After the conduct of MCM training and the rest of the DOH-HEMS training
programs, it is expected that a critical pool of trainers can replicate the
program in their own catchment areas, and the general public equipped and
empowered to implement MCM program components during actual strikes of
emergencies.
The MCM training follows a framework that is consistent with basic principles
of adult learning primarily the immediate application of their learning to their
job assignments and their established habits and accumulated rich
experiences. Minimal lectures are featured in the training and complimented
immediately by problem solving, case discussions, games and other practical
exercises actually handled and experienced by participants. The trainers are
content and technical experts of various areas in MCM and had completed
training as trainers and facilitators. Through the extensive experience of the
trainors/instructors working Beyond Training, the multi-hazard perspectives
are considered to help the population develop self-reliance and heightened
level of capacities for survival during disasters and emergencies.
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PREFACE
This training manual for Mass Casualty Management is one among 10
manuals developed by HEMS that cover every aspect of emergencies and
mass casualty incidents. There is Nutrition in Emergencies, Health Emergency
Response Operation (HERO), Water, Sanitation and Hygiene in Emergencies
(WASH), Essential Emergency Surgical Skills, Basic Life Support, Standard First
Aid, Training for Emergency Medical Technician and Public Health and
Emergency Management in Asia and the Pacific for national and local settings.
The contents of this manual were developed based on previous experiences
and inputs from front-liners and key players, review of available literature,
and previous trainings received from various agencies in the country and
abroad.
The processes and approaches were designed to fit the Philippine setting and
the training manual is specific for health emergency managers at all levels of
the health sector. Each manual can exist on its own but it can also
complement the other manuals mentioned above.
I hope you will find all ten manuals very useful for your training activities, in
responding during emergencies and providing support during the recovery
and rehabilitation phase. I also hope that every user of this manual will
eventually become a contributor to its improvement and further development
with the changing time.
CARMENCITA A. BANATIN, MD, MHA

Director III
Health Emergency Management Staff
Department of Health
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ACKNOWLEDGMENTS
The Health Emergency Management Staff of the Department of Health (DOHHEMS) thanks the following team members who developed the Mass Casualty
Incident Training Manual:
Carmencita A. Banatin, MD, MHA
Director III
Health Emergency Management Staff, Department of Health
Romeo Almazan Bituin, MD, MHA
Medical Specialist III
Dr. Jose Fabella Memorial Hospital
Arnel Z. Rivera, MD, FPAFP, MHA, IDHA
Chief, Response Division
Marilyn V. Go, MD, MHA
Chief, Preparedness Division
Nemuel S. Fajutagana, MD, MHPEd
Professor, National Teacher Training Center for the Health Professions
University of the Philippines Manila
Eden C. Mendoza, MD, MIPH
Associate Professor, National Teacher Training Center for the Health
Professions
University of the Philippines Manila
Appreciation is also extended to Assistant Professor Maria Elizabeth M.
Grageda, PTRP, MHPEd as well as to Supervising Administrative Officer and
Officer in Charge of the Office of the Director, Information, Publication, and
Public Affairs Office, UP Manila Ms. Cynthia M. Villamor for assisting in the
editing and final preparation of this manual. NTTCHP University Research
Associate Ms. Claire D. Pastor, and NTTCHP Audio-Visual Supervisor
Armando B. Cervantes helped in the final technical editing and printing of
this manuscript.
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TABLE OF CONTENTS
INTRODUCTION: HEMS IN PERSPECTIVE...............................................
PREFACE............................................................................................
ACKNOWLEDGMENTS.........................................................................
TABLE OF CONTENTS..........................................................................
COURSE DESCRIPTION......................................................................
GLOSSARY........................................................................................
COURSE ORGANIZATION....................................................................
TRAINING GROUND RULES................................................................
MASS CASUALTY MANAGEMENT (MCM) FRAMEWORK..........................
MODULE DESCRIPTION......................................................................................................
MODULE OBJECTIVES........................................................................................................
MODULE ORGANIZATION....................................................................................................
SESSION 1......................................................................................................................
OVERVIEW OF MASS CASUALTY MANAGEMENT SYSTEM............................................................
Session Description.........................................................................................................
Session Objectives...........................................................................................................
Session Content:..............................................................................................................
SESSION 2......................................................................................................................
ESTABLISHING A MASS CASUALTY MANAGEMENT SYSTEM.........................................................
Session Content...............................................................................................................
MODULE 2........................................................................................
HOSPITAL IN MASS CASUALTY MANAGEMENT.....................................
SESSION 1......................................................................................................................
ROLE OF HOSPITAL AND PHYSICAL INFRASTRUCTURE DEVELOPMENT...........................................
Session Content...............................................................................................................
SESSION 2......................................................................................................................
SURGE CAPACITY..............................................................................................................
At the end of this session the participants will be able to:...............................................
Session Content:..............................................................................................................
MODULE 3........................................................................................
THE INCIDENT COMMAND SYSTEM (ICS).............................................
SESSION 1......................................................................................................................
ICS CONCEPTS AND PRINCIPLES..........................................................................................
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Session Content...............................................................................................................
INCIDENT BRIEFING.........................................................................................................
SESSION 2......................................................................................................................
OVERVIEW OF INCIDENT COMMAND SYSTEM..........................................................................
Session Content...............................................................................................................
SESSION 3......................................................................................................................
ICS FACILITIES.................................................................................................................
Session Content...............................................................................................................
MODULE 4........................................................................................
CRITICAL INCIDENT MANAGEMENT.....................................................
SESSION 1......................................................................................................................
CRITICAL INCIDENT MANAGEMENT........................................................................................
Session Content...............................................................................................................
SESSION 2......................................................................................................................
THE SIX-STEP RESPONSE...................................................................................................
Session Content...............................................................................................................
MODULE 5........................................................................................
TRIAGE, TREATMENT AND TRANSPORT SYSTEM..................................
SESSION 1......................................................................................................................
TRIAGE CONCEPTS AND PROCESS........................................................................................
SESSION DESCRIPTION......................................................................................................
Session Content...............................................................................................................
Instructions......................................................................................................................
SESSION 2......................................................................................................................
Session description..........................................................................................................
Session objectives...........................................................................................................
Session Content...............................................................................................................
SESSION 3......................................................................................................................
TRANSPORT SYSTEM..........................................................................................................
Session Content...............................................................................................................
INTEGRATION EXERCISES..................................................................
INTEGRATION EXERCISE 1: TABLE TOP EXERCISE: INCIDENT COMMAND WORKSHOP (5 HOURS).......
EXERCISE DESCRIPTION:....................................................................................................
EXERCISE OBJECTIVES:.................................................................................................... 100
APPENDICES...................................................................................103
INCIDENT COMMAND JOB ACTION SHEETS........................................104
INCIDENT COMMAND SYSTEM FORMS..............................................121
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REFERENCES..................................................................................130
COURSE EVALUATION FORM............................................................131
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COURSE DESCRIPTION
Consider the following situation: A bombing incident was received by your
emergency response center and an alarm was immediately relayed to all
available responders. You happen to be nearest to the impact site so you
immediately responded. When you arrived you realized that you are not the
first responder to arrive on the scene. You noticed that the other responder
is already setting up what seems to be an incident command center.
However, you feel like he is doing it in a different way or perhaps the wrong
way.
This scenario may not be unusual. Responders from different agencies may
have been introduced to a different perspective of the Incident Command
System (ICS) which may result to confusion, affecting the overall
management of the mass casualty incident.
This module hopes to develop responders with common understanding of
mass casualty incident management and mass casualty management
highlighting the incident command.
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GLOSSARY
Agency
An agency is a division of government with a specific function,

or a non-governmental organization (e.g. private contractor,
business, etc,) that offers a particular kind of assistance. 9
Agency
Representa
tive
An individual assigned to an incident from an assisting or

cooperating agency who has been delegated authority to
make decisions on matters affecting that agencys
participation at the incident. Agency Representatives report
to the Incident Liaison Officer. 3
Allocated
Resources
Resources dispatched to an incident that have not yet

checked in with the Incident Commander.
Assignment
s
Tasks given to resources to perform within a given operational

period, based upon tactical objectives in the Incident Action
Plan.3
Base
The location at which primary logistics functions for an

incident are coordinated and administered. There is only one
Base per incident. The Incident Command Post may be
collocated with the Base.3
Camp
A geographic site, within the general incident area, separate

from the Incident Base, equipped and staffed to provide food,
water and sleeping and sanitary facilities to incident
personnel.3
Capacity
An assessment of ability to manage an emergency

The combination of all the strengths, attributes and resources
available within a community, society or organization that can
be used to achieve agreed goals.
Community
People, property, services, livelihoods and environment i.e.

the elements exposed to hazards
Cooperatin
g Agency
An agency supplying assistance other than direct tactical or

support functions or resources to the incident control effort
(e.g. Red Cross, telephone company, etc.). 3
Coordinatio
n
The process of systematically analyzing a situation,

developing relevant information, and informing appropriate
command authority of viable alternatives for selection of the
most effective combination of available resources to meet
specific objectives. The coordination process (which can be
either intra- or inter-agency) does not involve dispatch
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actions. However, personnel responsible for coordination may

perform command or dispatch functions within the limits
established by specific agency delegations, procedures, legal
authority, etc.3
Crisis
The impact on an organization and its ability to cope with or

respond to an extraordinary incident or event.9
Delegation
of Authority
A statement provided to the Incident Commander by the

Agency Executive delegating authority and assigning
responsibility. The Delegation of Authority can include
objectives, priorities, expectations, constraints, and other
considerations or guidelines as needed. Many agencies
require a written Delegation of Authority to be given to
Incident Commanders prior to their assuming command of
larger incidents. 3
Deputy
A fully qualified individual who, in the absence of a superior,

could be delegated the authority to manage a functional
operation or perform a specific task. In some cases, a Deputy
could 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. 3
Disaster
A serious disruption of the functioning of a community or a

society involving widespread human, material, economic or
environmental losses and impacts, which exceeds the ability
of the affected community or society to cope using its own
resources. A disaster may be short-term, long-term, manmade or natural. Also referred to as a catastrophe. 9
Disaster
risk
The potential disaster losses, in lives, health status,

livelihoods, assets and services which could occur to a
particular community or a society over some specified future
time period.
Disaster
risk
manageme
nt
The systematic process of using administrative directives,

organizations, and operational skills and capacities to
implement strategies, policies and improved coping capacities
in order to lessen the adverse impacts of hazards and the
possibility of disaster.
Disaster
risk
reduction
The concept and practice of reducing disaster risks through

systematic efforts to analyze and manage the causal factors
of disasters, including through reduced exposure to hazards,
lessened vulnerability of people and property, wise
management of land and the environment, and improved
preparedness for adverse events.
Dispatch
The implementation of a command decision to move a
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resource or resources from one place to another. 3

Emergency
A sudden and usually unforeseen event that requires

immediate action by the transit agency to minimize
consequences.9 An actual threat to public safety and/or public
health
Emergency
managemen
t
The organization and management of resources and

responsibilities for addressing all aspects of emergencies, in
particular preparedness, response and initial recovery steps.
Emergency
Medical
Technician
(EMT)
A health-care specialist with particular skills and knowledge in

pre-hospital emergency medicine.3
Emergency
Operations
Center
(EOC)
A pre designated facility established by an agency or

jurisdiction to coordinate the overall agency or jurisdictional
response and support to an emergency. 3
Hazard
Any potential threat to public safety and/or public health

A dangerous phenomenon, substance, human activity or
condition that may cause loss of life, injury or other health
impacts, property damage, loss of livelihoods and services,
social and economic disruption, or environmental damage.
Managemen
t by
Objectives
In ICS, this is a top-down management activity which involves

a three-step process to achieve the incident goal. The steps
are: establishing the incident objectives, selection of
appropriate strategy(s) to achieve the objectives, and the
tactical direction associated with the selected strategy.
Tactical direction includes selection of tactics, selection of
resources,
resource
assignments,
and
performance
3
monitoring.
Multiagency A generalized term which describes the functions and

Coordinatio activities of representatives of involved agencies and/or
n (MAC)
jurisdiction who come together to make decisions regarding
the prioritizing of incidents and the sharing and use of critical
resources. The MAC organization is not a part of the on-scene
ICS and is not involved in developing incident strategy or
tactics.3
Prevention
The outright avoidance of adverse impacts or hazards and

related disasters.
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Response
The provision of emergency services and public assistance

during or immediately after a disaster in order to save lives,
reduce health impacts, ensure public safety and meet the
basic subsistence needs of the people affected
Resources
Personnel and equipment available, or potentially available,

for assignment to incidents. Resources are described by kind
and type (e.g., ground, water, air, etc.) and may be used in
tactical support or overhead capacities at an incident. 3
Risk
The exposure or probable likelihood of a hazard (accident,

crisis, emergency, or disaster) occurring at a system. Risk is
measured in terms of impact (criticality to people or the
system) and vulnerability.9
Risk
Assessment
A comprehensive study of a transit agency to identify

components most vulnerable t criminal activity, including acts
of terrorism and quasi-terrorism, and to assess the impact of
such activity on passengers, employees and the agency. 9
Risk
managemen
t
The systematic approach and practice of

uncertainty to minimize potential harm and loss.
Size-up
Includes information developed by the first person at the

scene of an emergency and is basic information transmitted
to the communication center, and then conveyed to other
agency elements concerned with the control of the event. 9
Task Force
A combination of single resources assembled for a particular

tactical need with common communication and a leader. 3
Unity of
Command
The concept by which each person within an organization

reports
to
only
one
designated
3
person. _ENREF_3_ENREF_3_ENREF_3_ENREF_3_ENREF_3_ENR
EF_3_ENREF_3
Vulnerabilit
y
Factors which increase the risks arising from a specific hazard

in a specific community
Vulnerable
groups
Those who because of constraints of an economic, social

ethnic, biological, physical or geographical nature are less
able to cope with the impact of hazards than other members
of their community or society.
managing
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COURSE OBJECTIVES
At the end of this course the participants will be able to:
1. Discuss Mass Casualty Incident Framework,
2. Organize an Incident Command System,
3. Set-up and manage an Advance Medical Post, and
4. Perform the following roles:
a. Field Incident Commander,
b. Triage Officer during an MCI,
c. Treatment Officer, and
d. Transport Officer.
COURSE ORGANIZATION
Module 1: Mass Casualty Management Framework
This module serves as the introductory module. It aims to strengthen and
unify the participants understanding of the Mass Casualty Management
(MCM) framework and concepts, the rescue chain and the role of Mass
Casualty Management System (MCMS).
Module 2: The Hospital in Mass Casualty Management
This module focuses on the hospital as part of the MCM framework. The aim
of this module is to strengthen and unify the participants understanding of
the role of hospitals during mass casualty incidents. It will also present the
hospital functions that are critical to managing the volume of patients and
their various cases.
Module 3: Incident Command System
This module provides an in-depth discussion of the Incident Command System
(ICS), focusing on the concepts and principles of ICS, its organizational
structure, and the facilities needed.
Module 4: Critical Incident Management
The last module provides the participants an overview of Critical Incident
Management. It describes its characteristics and various stages, including
the factors or consideration in decision making in a critical incident.
Integration Exercises
The integration exercises will provide the participants opportunities to apply
the concepts learned in all the modules. In varying levels, the exercises allow
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the participants to experience the different roles and tasks to be performed in

MCM, through simulation using paper cases and human actors.
Time
Module
2 hours 30 Module 1:
mins
Mass Casualty Management
Framework
1 hour
mins
45 Module 2:
Hospital in MCM
4 hours
mins
15 Module 3: Incident
Command System
1 hour
mins
30 Module 4:
Critical Incident Management
10 hours
Module 5:
Triage, Treatment and
Transport
16 hours
Integration Exercises
Sessions
Session 1: Overview of Mass
Casualty
Management
System
Session 2: Establishing MCM
System
Session 1: The Role of
Hospitals and
Physical
Infrastructure
Development
Session 2: Surge Capacity
Session 1: ICS Concepts
and Principles
Session 2: Overview of ICS
Session 3: ICS Facilities
Session 1: Introduction to
Critical Incident
Management
Session 2: Incident Control
Using the Six-Step
Response
Session 1: Triage System
Session 2: Treatment
Session 3: Transport
System
Table Top Exercise
Compartmentalized Practical
Exercise
Field Exercise
TOTAL 37 hrs
TRAINING GROUND RULES

1) You are expected to be in the training venue on time according to the
schedule set. This will facilitate efficient time management throughout
training.
2) Observe respect by listening to others when they are speaking and
waiting for your name to be acknowledged by the facilitator before
speaking.
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3) Issues that arise during training that is beyond the scope of the training
objectives and content shall be placed in the Parking Lot. The
parking lot is a manila paper posted at one area in the training venue
where unresolved issues shall be written down. These shall be
documented and may be considered in future discussions when
appropriate.
4) Utmost participation is expected from everyone. You are highly
encouraged to maximize this learning opportunity.
5) You shall be divided into Host Teams and will be assigned to handle
host team duties on an assigned training day. Each host team will have
the following responsibilities:
Provide a recap of the previous day at the start of the next
training day
Conduct ice breaker activities throughout the day
Assist the Chief Facilitator in ensuring that all the participants
are in the training venue in time for the activities
The facilitators shall be giving a prize and award of Best Host
Team to the host team that performs their responsibilities
efficiently and effectively. This shall be given on the last day of
training.
6) There is a prize and award to the team that performs their
responsibilities efficiently and effectively.
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Module 1
MASS CASUALTY MANAGEMENT (MCM) FRAMEWORK
Module Description
This module serves as the introductory module. The aim of this module is to
strengthen and unify participants understanding of MCM framework and
concepts, the rescue chain and the role of Mass Casualty Management
System (MCMS).
Module Objectives
At the
1.
2.
3.
end of this session the participants will be able to:

Discuss the MCM framework,
Explain the Rescue Chain, and
Explain the process involved in establishing
Management System.
Mass
Casualty
Module Organization
Time
2 hrs
30
mins
60 min
Session # and Title

Content
T L Activities
Module 1: Mass Casualty Management (MCM) Framework
Session 1: Overview
of
Mass
Casualty
Management System
Introduction to Mass
Casualty Management
90 min
Session
2:
Establishing
Mass
Casualty
Management System
Mass
Casualty
Management
Approach
Activities at Various
levels of response
Elements of MCMS
Lecture on important
terms in MCM
Discussion on the
MCMS and the steps
involved in preparing
for a mass casualty
incident
and
establishing a MCMS
Lecture
and
discussion on the
different
approaches to mass
casualty incident.
Discussion of the
activities at various
levels of response.
Lecture
on
the
elements of MCMS
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Session 1
Overview of Mass Casualty Management System
Session Description
This session will provide the participants with the opportunity to compare
their understanding of the basic concepts with other participants. The main
focus of this session is the establishment of a Mass Casualty Management
System.
Session Objectives
At the end of this session the participants will be able to:
1. Define the following terms:
a. Mass Casualty Incident,
b. Mass Casualty Management,
c. Emergency Medical Services,
d. Health Care Services,
e. Mass Casualty Management System, and
f. Rescue Chain
2. Explain Mass Casualty Management System,
3. Discuss the steps involved in preparing for mass casualty incident, and
4. Describe the steps involved in establishing a Mass Casualty
Management System.
Session Content:
Definition of mass casualty incident and other important terms and concepts
that will be used in this course.
Mass Casualty
Incident
Emergency
Services
Health Care
Services
Mass Casualty
Management
Any event resulting in a number of victims large

enough to disrupt the normal course of emergency
and health care services.
Those services which are specifically designed to
respond on a daily basis to emergency situations:
Police, Fire Service, Ambulance Services, Accident and
Emergency Department
All services which are providing health care to any
kind
of
patient:
Hospital,
Polyclinic,
Health
Center/Clinic, and Ambulance Service. In many
countries these services are regulated by the Ministry
of Health
The group of units, organization and sectors which
work jointly, through institutionalized procedures, to
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System
minimize disabilities and loss of life in a mass

casualty event through the efficient use of all existing
resources
Figure 1. Mass Casualty Management Conceptual Framework
Response Categories of Mass Casualties:
Hazardous materials incidents

Civil disturbances
Natural disasters
Major fires
Terrorist attacks
The following are the top 5 hazards in the world and in Asia. From this list, you
can see that mass accidents are usually the most commonly occurring at
32.8% in the world and 37.2% in Asia, respectively
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The following are the most common problems when managing Mass Casualty
Incidents.
Who is in command of the incident?

Location of the Command Post
Lack of communication between agencies leading to conflicting priorities
and orders
Perimeter establishment delayed or not done at all
Large crowds of people
Media involvement
Political involvement
Inadequate resources
Mass Casualty Management Framework is composed of pre-hospital and

hospital rescue chain. The pre-hospital component of the rescue chain consists
of where the mass casualty incident occurred; search and rescue operation;
first aid; triage; evacuation and transport. The hospital component consists of
the management of mass casualty victims in the hospital.
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Figure 1. Mass Casualty Management Framework
Session 2
Establishing a Mass Casualty Management System
Session Description
This session will provide participants with an overview of the various activities
at various levels of responses from the impact zone to the hospital. Detailed
discussions of these activities will be in the later modules.
Session Objectives
1. Discuss the different approaches to Mass Casualty Incident,
2. Explain the activities at various levels of responses, and
3. Discuss
a. Field management, (components of field organization)
b. Management of victims
c. Concept of triage
d. Advance Medical Post
e. Transfer organization
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Exercise 1: Interactive Session

The facilitator will flash a slide and ask you the following questions.
1. In your area of responsibility was there a major event or incident that
has led to mass trauma/casualty situation?
2. Who were involved in responding to the event?
3. Can you describe the handling of the response?
4. What problems were encountered in process?
Session Content
In Mass Casualty Management, there are considerations to be made such as:
Pre-planning and training are critical
Establish guidelines and procedures
Early implementation of Incident Command
First five minutes will determine next five hours.
Basic Approach
A "scoop and run" method is used most commonly to deal with accident
victims. This approach does not require specific technical ability from the
rescuers. While this method can be justified for the management of small
numbers of victims in certain circumstances (e.g., when an accident occurs in
the immediate proximity of available emergency care services), the same
approach in a mass casualty situation will result in the transfer of the problem
from the incident site to the hospital, overwhelming and disrupting the care
capacity of the health facility
Classical Care Approach
In the "classical care approach", first responders are trained to provide victims
with basic triage and field care before evacuation to the nearest available
receiving health care facility. This approach juxtaposes two organizations that
are working independently with only weak linkages:
The field organization (often involving non-health sector responders), and the
receiving health care organization which is often totally divorced from the
pre-hospital problem. In a mass casualty situation, this approach will
quickly result in chaos.
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Mass Casualty Management Approach

Mass casualty management, the most sophisticated approach, includes preestablished procedures for resource mobilization, field management and
hospital reception. It is based on specific training of various levels of
responders and incorporates links between field and health care facilities
through a command post. However, this is very dependent on the availability
of large number of human and material resources.
Mass Casualty Management Approach requires the establishment of the
Mass Casualty Management System. The MCMS is based on:
Pre-established procedures to be used in daily emergency activities and
to be adapted to meet demands of a major incident;
Maximization of the use of existing resources;
Multi-sectoral preparation and response;
Strong pre-planned and tested coordination.
This System is developed in order to accelerate and amplify daily procedures
in order to maximize the use of the existing resources; establish a coordinated
multi-sectoral rescue chain; prompt and efficiently bring disrupted emergency
and health care services back to routine operation.
The health sector is present in all aspects of the mass casualty
management system rescue chain.
Figure 2. Mass Casualty Management Framework showing Rescue Chain
The Rescue Chain is the essence of Mass Casualty Management System

and involves several sectors.
The chain starts at the disaster site where activities like initial assessment,
command and control, search and rescue, and field care are undertaken.
The chain will continue with the proper transfer of victims to appropriate
health facilities and ends when patients have been received and stabilized in
a health care facility.
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KEY POINTS: MCM System has a pre-hospital and hospital component.

The implementation of the rescue chain requires the existence of:
An efficient Admission and Emergency Department
A basic radio communication network
Coordination procedures among all sectors involved
Skilled multi-sectoral rescue team.
Problems in Developing MCM
Limited human resources
Limited material resources
o facility
o transport
o communication
Poor communication
o topography
o isolation
Political
These problems are the things that one should anticipate and address in
developing a Mass Casualty Management System.
The general framework of Mass Casualty Management System. It shows that
Mass Casualty Management has pre-hospital and hospital component. It also
shows that triage has a 4th level and this is done in the hospital.
Figure 2. Mass Casualty Management System
Sequence of activities at different levels of response. Again, the pre-hospital

and hospital components are emphasized here.
Pre-Hospital Component
Hospital Component
Mass casualty incident site
Field hospital may be established
if there is no hospital around or
Search and rescue
the hospital is too far from the
First triage
Participants Manual
page 26
Collection Point for unstable

location
AMP
Tag (2nd Triage)
Treat
Transport (3rd Triage)
impact site
4th Triage at the ER
Definitive treatment
The following are a list of the different activities at various levels of response.
Alerting process
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 management & command system
Components of Field Management System
Alerting process - The core of the alerting process is the dispatch
center: a communications center that receives all warning messages and
is linked by radio and phone to all services involved in emergency
management (e.g., "117").The dispatch center must have the capacity to
mobilize a small assessment team ("flying team"), composed of personnel
from police, fire or ambulance services, in order to confirm a warning
message when necessary.
Initial Assessment is part of the alerting process. This involves

identifying the following (shown in bullets in the slide) in order to know
exactly what is happening and what could happen; to mobilize adequate
resources and to correctly organize the field management.
Pre-identification of field areas -The first to arrive on the scene

(Command Team) should perform a pre-identification of field areas. Preidentification of field areas will allow various incoming resources to reach
their specific areas rapidly and efficiently. It constitutes the initial part of
the on-site deployment.
Safety/security it is important to make sure that no additional

people will be added to the list of victims (including responders).
Command Post- should be set up at the very beginning of the rescue

operation. As more and more sectors become involved in the incident, it is
paramount that their actions are well coordinated otherwise there would
be chaos, affecting the efficient management of victims and resources.
Search and Rescue - The first stage in management of victims is
Participants Manual
page 27
Search and Rescue. Search and rescue teams work in the strictly restricted
area (impact zone) under the command of a fire officer or, in specific
situations, of specialized personnel. Depending on the risk (e.g., toxic
smoke, hazardous materials), rescue teams will utilize special protective
clothing and equipment. In exhausting working conditions, a quick turn
over of rescue teams must be implemented.
Activities in Search and 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.
Field Care - during MCI, management of patients may have to be done

in the field. This would require responders trained to provide emergency
health services.
Evacuation Dont transfer chaos/problem in the scene to the

hospital.
(EMC) Emergency Management Center
TRIAGE is an important process under Management of Victims. Triage, in a

capsule, is a technique developed to facilitate quick identification of victims
needing immediate stabilization for life saving measures and surgery. The
three levels of triage are: on-site, medical, evacuation/transport. This part is
the pre-hospital stage and that there are 3 levels of triage for this part. More
comprehensive discussion will be in Module 5 Session 1.
When needed, First Aid (FA) will be provided to MCI victims on-site. This
module will not cover development of FA skills although general protocols will
be presented in the Module 5 Session 2.
The remaining process in Management of Victims is Transfer Organization.
This is a procedure used to ensure that victims of a Mass Casualty situation is
safely, quickly and efficiently transferred by appropriate vehicles to the
appropriate and prepared facility. There are two kinds of facilities: single
reception facility and multiple reception facilities.
Mass Casualty Incident requires coordinated response and this can be
achieved through a Mass Casualty Management System.
Participants Manual
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MODULE 2
HOSPITAL IN MASS CASUALTY MANAGEMENT
Module Description
This module tackles the other half of Mass Casualty Management System
which is the hospital setting. The aim of this module is to strengthen and
unify participants understanding of MCM framework in a holistic manner.
Module Objectives
At the
1.
2.
3.
end of this session the participants will be able to:

Discuss the hospital component of the MCM framework,
Explain the Hospital Emergency Incident Command System,
Gain a good understanding of the process involved in establishing Mass
Casualty Management System in the hospital.
Module Organization
Time
1 hr
45
mins
45 mins
60 min
Session # and
Content
T L Activities
Title
Module 2: Hospital in Mass Casualty Management
Session 1: Role of
Hospital
and
Physical
Infrastructure
Development
Session 2: Surge
Capacity
Role of the hospital in Lecture on the

MCM
important role
of the hospital
in MCM
Discussion
of
Triage and physical set the
different
up in the ER
areas
and
patient
care
stations in the
hospital
Surge Capacity
Lecture
on
surge capacity
and the core of
surge capacity
planning using
Hospital
Emergency CST.
Incident
Command Lecture
and
System
discussion
on
the HEICS and
its
prescribed
organizational
Participants Manual
page 29
Time
Session # and
Title
Content
T L Activities
structure
for
command,
control
and
coordination
Session 1
Role of Hospital and Physical Infrastructure Development
Session Description
This session covers the hospital component of MCM. It emphasizes the role of
the hospital during a mass casualty incident and how to arrange the physical
set up in the emergency room during a mass casualty event.
Session Objectives
1. Explain the Hospital Mass Casualty Management (HMCM), and
2. Discuss the Physical Infrastructure Development.
Session Content
The hospital can be a responding facility, receiving facility or both. This depends
on the classification, designation and capability of the hospital. 1
As a responding facility, the hospital must have competent response team
always available and ready to be dispatched. The hospital should have a team
that is capable of undertaking the following:
Incident command system
Rapid health assessment
Triaging
Life support
Proper communication
Proper coordination
Establishment of emergency operation center on-site
Evaluation and provision of medical/health care to victims

The response team is composed of:
Physician
Nurse
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EMT
Trained non-medical staff

Ambulance driver with equipped ambulance
As a receiving facility, the hospital should have the following capacities: 1
ER equipped for emergency care to handle all types of MCI victims
Equipped critical areas to accommodate and provide necessary

definitive care to the casualty victims (e.g. OR, Recovery Room, Burn
Unit, Trauma Unit, Morgue, etc.)
Competent staff to provide definitive care to victims
Pre-identified rooms or ward to accommodate influx of patients

Response
In-Hospital Response Team
Provides the definitive medical care to MCI victims who are brought in
or walked in the hospital
Composed essentially of the following:
ER department
Admission area as frontline
Other hospital personnel on duty
At the minimum, should consist of the following key staff:
Head of ER department
Triage officer and team
Treatment officer and team
OR personnel
On-Scene Response Team
Small group deployed to the emergency/disaster site

outside the hospital for external emergencies
Inside the hospital for internal emergencies
Responsible for the management of field/on-site activities from
assessment, triage, treatment, evacuation and transport
Coordinates with the Command Post
Coordinates with:
Hospital Operation Center
Receiving hospital facility
HEMS Operation Center
Composed of:
On-scene Response Officer
Surgeon/Anesthesiologist
Internal Medicine
Nurse/EMT
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First Aiders/Helpers
Ambulance Driver
It is important that certain areas in the hospital be designated for specific

functions during a MCI. There should be a plan covering the following: 1
Functions of designated areas
Staffing requirements
Basic supplies to be utilized
Ventilation
Alternative sources of energy
Communication
Waste disposal
The following are service areas in the hospital that should be ready during MCI.
ER - should be set up when patients from MCI arrive at the hospital. It
shows the various patient care stations and where they should be set up.
Must
have the following:

Reception area/Admission
Triage Area
Decontamination Area
Patient care stations
Figure 3. Patient Care Stations in the ER
Admission Pre-surgical Holding - Most trauma patients stabilized in

the Red Area (emergency department) will be sent to the Admission Presurgical Holding Area
Operating Room - The number of OR that can be staffed is the rate
limiting factor in the provision of definitive care. Most senior surgeon
available must take the responsibility to prioritize and assign cases as
Participants Manual
page 32
rapidly as possible
ICU
Coronary
Medical
Surgical
Special Units
Burn
Toxicology
Infectious
Disability
Accommodation for Responders
Ancillary Units
Laboratory
X-ray/other Radiologic Services
Blood Bank
Psychosocial Care Area - designated in the outpatient department; for
individual and group consultations; people (patients, relatives, visitor,
staff) who are extremely disruptive to hospital disaster operations shall
be placed in a separate isolated area
Morgue - Must be able to expand in cases of large fatalities; other
places such as church or outside facilities may be transformed into
temporary morgues if hospital morgues capacity is full
Family Waiting Area - pre-designated for family members seeking info;
previous experiences have shown that families and friends of victims
converge en masse to hospital seeking info; can seriously interfere with
hospital operations to respond effectively
Social Worker Office - Area designated to allow prompt, systematic and
compassionate technical assistance for families inquiring about and
seeking access to support from government and NGO resources
Media Room area to hold and brief the media. It should be located
in an area not too near the patients. A provision should be in place to
allow for a regular conduct of press conference or press release about
the mass casualty incident and about the victims admitted in that facility.
The reception area should be available in short notice to receive multiple

casualties for registration and admission.
Triage area is for rapid assessment of all incoming casualties, the assignment
of priorities for management, and distribution of patients to various other
patient care.1 The triage area should have direct access from the ambulance
offloading area.
Decontamination area is located before the entrance of the ER. This is for
security and privacy of patient, bathing of patient, disposal of contaminated
clothing, contaminated water disposal, draping of decontaminated patient.
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Used only if there is a high index of suspicion for biological, chemical and
radionuclear.
Patient care stations should be designated by color tags of the patients arriving
at the ER.
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Session 2
Surge Capacity
Session Description
This session covers the hospital functions critical to the maintenance and
creation of surge capacity. Methods will mostly be using didactic and
interactive lectures.
Session Objectives
1.
2.
3.
4.
Define disaster,
Discuss incident management and its importance in surge capacity,
Discuss command, control, communication and coordination, and
Identify hospital functions critical to the maintenance and creation of
surge capacity.
Session Content:
What is a disaster?
Any actual threat to public safety and/or public health
Local government and the emergency services are unable to meet the
immediate needs of the community,
Event is managed from outside the affected communities.
Two aspects to hospital hazard and vulnerability assessment
Vulnerability of the catchment area
Vulnerability of the hospital as a service provider
Hospital Emergency Planning

Three Basic Scenarios
Internal emergency disrupts ability of the hospital provide its normal
services but does not cause harm to the community 1
External emergency causes harm to the community requiring increased
health/medical services, but does not disrupts the ability of the hospital to
provide medical services1
Internal/external emergency causes harm to the community requiring
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increased medical services, and that also disrupts the ability of the hospital to
provide medical services.1
The following are causes of internal emergencies. These emergencies can
cause external emergencies (as shown in the diagram in the lower portion of
the slide). Hence, the internal emergency initially can become both internal
and external.
Fire
Explosion
Hazardous material
Food contamination
Loss of electricity supply, water supply or other service
Key goal of planning and incident management:
Get the right resources to the right place at the right time to prevent an
incident from becoming a disaster.
What is surge capacity?
1. Health care systems ability to rapidly expand beyond normal services to
meet increased demand for qualified personnel, medical care and public
health in the event of large-scale public emergency or disaster.
2.
3. Capacity vs. Capability
4.
5. This distinction is important capacity is about volume, capability is about the
ability to manage specialized patients for example burn patient or smallpox,
or chemical contamination. A much smaller volume of patients can overwhelm
capability even when the institutional capacity is large. Both must be
accounted for in planning.2
The following is the core of surge capacity planning: C, S, T, are acronyms that
help us organize our thinking about surge capacity. Getting all Cs is the first
thing that needs to be done when an incident occurs.
6. The 4 Cs
7.
Command
Control
Communications
Coordination
* Surge capacity CANNOT occur if8.
you dont get all Cs
9.
The 4 Ss
Space
Staff
Stuff
Special
The 3 Ts
Triage
Treat
Transport
4 Cs
Need to make assignments early and firmly to get control of the situation
early.
Address the Cs right away.
Participants Manual
page 36
Command
Pertains to Incident Command. This will be discussed in greater detail in the
next module. The figure below is the structure of the Hospital Emergency
Incident Command System (HEICS).
The HEICS is the prescribed
organizational structure for command, control and coordination as stated in
AO 168 s. 2004. It is a system which employs a logical management structure,
defined responsibilities, clear reporting channels, and a common
nomenclature to help unify hospitals with other emergency responders. 1
Figure 4. Hospital Emergency Incident Command System
ICS is a management system used in responding to an incident. There are 2

types: Single Command involving only one agency and Unified Command
involving several agencies responding to the incident.
Generic nomenclature applicable to any facility. If the facility is a hospital
where all responders are coming from the same agency, it is a single
command type of ICS.1
Hospital Emergency Incident Command System (HEICS) Organizational Chart
Participants Manual
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Figure 5. HEICS Organizational Chart
Tools
in the HEICS
Job Action Sheets
Position recommendations
Incident Planning Guides
Incident Response Guides
Forms
Activation of the HEICS

The following steps should be followed to activate HEICS.
Step
Assume command. Someone should immediately assume command
1
Step
Assess situation. Assess magnitude of the incident from sources and
2
the network
Step
Identify
critical
areas.
These
include
emergency
rooms,
3
decontamination, triage, treatment, security, media, etc
Step
Activate or identify the Operations Center. Coordinate with HEMS
4
OpCen; assign staff and ensure communication system is in place.
Step
Identify the Safety Officer. The Safety Officer is the one to go around
5
the compound to ensure safety of the staff, the hospital and patients
Step
Secure the hospital and critical areas. Identify area for ambulances,
6
points of ingress and egress
Participants Manual
page 38
Coordination and Communication

Look OUTSIDE your facility for partners.
Emergency Management Services (EMS)
Emergency Management
Public Health
Public Safety/Law enforcement
Hospitals and Healthcare Systems
Jurisdictional legal authorities
These will vary depending on the disaster and where it happened. Think that
there are partners that you need to engage. Think of possibilities where each
agency near you can help you.
Coordinate surge capacity across more than one institution. Identify sources
that can provide hospital needs when necessary. They can act as the broker
for transfer of patients so that the facilities dont have to do this in isolation,
duplicating efforts and consuming valuable time.
We have just finished discussing the 4 Cs of surge capacity. We will now
discuss the 4 Ss.
Space
Prioritize patients in the ED.
Can clinics cancel elective and some other appointments? Is there some
criteria that the ED and clinic could agree upon in advance about
patients that the clinic could take in referral from the ED? (small soft
tissue injuries, sprains/strains, etc).
A discharge holding area is important since there is no time to go
through the normal process (getting meds, arranging transport, etc) and
they will need somewhere to be that is quiet and supervised prior to
their actual discharge.
No time? Then put them in chairs in the hall while you fill beds with
victims. Identify areas of the building that could be used for patient care
(eg: lobby areas for triage, flat space gym or conference rooms for cots,
procedure center for trauma care/isolation area).
Convert your step-down beds to ICU beds by allowing more stable ICU
patients to be on vents or med drips there.
Procedure rooms and OR space space can serve as temporary ICU areas
as well. Communicate well as you plan, you dont want to designate the
same space for a morgue and family room
Staf
Ensure that all staff knows their obligations and that they are reachable
during their off-hours.
Free up clinical staff for assessments. Consider what work they normally
do that could be done by other people.
In a pandemic 90% of care will be done by a family member, whether in
hospital or not
Dont forget the support staff! Disaster response cant happen without
Participants Manual
page 39
food!2
Changing the roles of some staff - nurses dont have to
feed/bathe/provide personal cares or even do vitals. Change from
individual nursing to team nursing.2
Find non-healthcare providers or family members to do the personal
cares / feeding. Make sure if you do bring in outside staff to assist that
they are paired with an appropriate mentor from your facility that can
orient and supervise them.2
See if you can oblige your staff to come in during off hours. 2
Stuf
These are the four basic categories of supplies.
Provider protection - check if protective equipment is available such as
masks, lab gowns, etc. Are there antidotes or anti-virals available in
cases of chemical explosion or epidemics? Consider re-using materials if
they can be recycled and determine the duration of use.
General patient care supplies - make sure that you have stocks of the
following and that they are enough for unexpected disasters.
Airway disposable intubation blades, bag/masks
Surgical chest tube trays
Medications Morphine, Valium, Atropine
Other disposables catheters, dressings, linens
Durable beds, vents, IV pumps, BP cuffs
Specialty patient care supplies (ex. For burn patients)

Adaptic dressings
Bacitracin
Kerlix dressings
50% BSA burn needs 14 liters LR/NS in 1st 24h, MS 250mg/24h)
Support supplies
- Food
- Water
- Office supplies
- Utilities
- Communications
- Oxygen supply
Everyone may be busy saving lives but dont forget food and water for staff
and patients. Communication, office supplies, utilities and oxygen supplies
are sometimes neglected during disaster management in the hospital.
Special Areas
Ensure that there are areas designated for these specific areas.
Burn
Chemical / Decontamination
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Isolation
Pediatric
Blast injury / mass trauma
After the 4 Cs and 4 Ss, its time for the 3 Ts. Triage, Treatment and
Transport elements are both found in the pre-hospital and hospital
component of MCM Framework.
The 3 Ts of hospital operations is quite different from that of field
management.
Triage can be divided into hospital triage which is the 4 th level as previously
described and Mass Casualty Triage composed of 3 levels. Triage is all about
the following:
1. Where do they go?
2. Whether they live or die
These are difficult decisions but important especially when there are limited
resources and the hospital is overwhelmed with victims.
Specify location of the triage area. This should be located near the admission &
emergency department (ED).
Triage officer should have options clinics, lobby, ED waiting area
This was discussed in detail in the previous session.
Take a different approach: Examples: 2
Splint fractures for now, (no x-rays),
Bandage (dont suture) the wound
Get a chest x-ray only to rule out the life-threats but defer additional
imaging in stable patients.
Worry about the unstable and those that have potentially lifethreatening injury.
Figure out ahead of time how you do nursing orders and medical recordkeeping during a disaster - these are areas that will fall apart if theres
not a plan.
Keep all greens in the lobby
Look for alternatives to ambulances - wheelchair vans, buses, other
alternatives as ambulances are in short supply. 2
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MODULE 3
THE INCIDENT COMMAND SYSTEM (ICS)
Module Description
This module will provide in depth discussion of the Incident Command
System. Topics to be covered will include the following: ICS definition,
Organizational Structure, Elements and Functions, Job Action Sheet, Single
versus Unified Command, and Transfer of Command among others.
Module Objectives
At
1.
2.
3.
4.
the end of this module the participants will be able to:

Define Incident.
Discuss the Incident Command System.
Explain the features of ICS.
Describe the functions of Incident Commander, Command and General
Staff
5. Utilize Job Action Sheets in assigning a responder to the most appropriate
position as member of the Incident Command Staff.
Module Organization
Time
4 hrs
15 mins
165
minutes
Session # and Content

T-L Activities
Title
Module 2: WATER SUPPLY IN EMERGENCIES
Session1:
Common Terminology
ICS Concepts and Modular Organization

Principles
Integrated communication
Unified
vs.
Single
Command
Incident Action Plan
Incident Objectives
Interactive
Lecture on the
ICS
concepts
and principles.
Group exercises
utilizing
discussion
of
cases
on
expanding the
function of the
ICS
structure,
unified
command, and
the
development of
incident
objectives and
Participants Manual
page 42
60
minutes
Session
2:
Overview of the
Incident Command
System
30
minutes
Session
Facilities
3:
ICS
incident action
plan
Definition of Incident
Interactive
The Incident Command Lecture on ICS,
System
its
processes,
Incident
Command and
Process
organization
ICS organization
Exercise on ICS
organization
Incident Command Post
Interactive
Casualty Collection Point
Lecture on the
Staging Area
ICS facilities
Base
Camp
Session 1
ICS Concepts and Principles
Session Description
This session covers the key concepts and principles of ICS. This will help the
participants understand the reason why ICS works during a mass casualty
incident. It also introduces the important terms that participants need to
know to function in an ICS structure.
Session Objectives
1. Discuss the different ICS concepts and principles,
2. Discuss the command process,
3. Develop an incident objectives, and
4. Prepare an Incident Action Plan.
Session Content
ICS concepts and principles
These concepts and principles have been tested and proven over timein
business and industry and by response agencies at all governmental levels.
ICS training is required to ensure that all who may become involved in an
incident are familiar with ICS principles. In this section you will find how the
application of these concepts and principles makes ICS work. 3
Participants Manual
page 43
Major organizational functions, facilities, and units are pre-designated and

given titles. ICS terminology is standard and consistent among all of the
agencies involved. Common terminology is essential in any emergency
management system, especially when diverse or other than first-response
agencies are involved in the response. When agencies have slightly different
meanings for terms, confusion and inefficiency can result. 3
Using common terminology helps to define:
Organizational functions
Incident facilities
Resource description
Position titles
Common Terminology in ICS
Position Titles
Officer
Chief
Director
Supervisor
Resources
Common
names
by department
Classified by type
Classified by size
Classified
by
capabilities
Facilities
Incident
Command
Post
(ICP)
Base
Staging Areas
Camps
A modular organization develops from the top-down organizational structure

at any incident. Organization structure is based on: size, type, complexity off
the incident, specific hazards created by the incident, incident objectives and
planning process. Top-down means that, at the very least, the Command
function is established by the first arriving officer who becomes the Incident
Commander. As the incident warrants, the Incident Commander activates
other functional areas (i.e., sections). In approximately 95 percent of all
incidents, the organizational structure for operations consists of command and
single resources (e.g., one fire truck, an ambulance, or a tow truck). If needed,
however, the ICS structure can consist of several layers. 3 (See figure below)
Figure 6. Modular Organization of the ICS Structure
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Integrated communications is a system that uses a common

communications plan, standard operating procedures, clear text, common
frequencies, and common terminology. Several communication networks may
be established, depending on the size and complexity of the incident. 3
Within the ICS, the command function may be conducted in two general ways:
Single Command and Unified Command.
Single Command is the concept by which each person within an organization
reports to only one designated person. 3 Single Command comes from only one
organization or agency.
Figure 7. Single Command ICS Structure
Depending on the number of initial responders from one agency, the most
competent of them can assume the position of an Incident Commander while
the rest can be in charge of the other areas of the command system.
A single command can shift into a unified command as the mass casualty
incident unfolds and as the number of people and agencies responding to the
incident increases. It also depends whether the person assuming the Incident
Commander in the Single Command transfer the command to another person
with better skills or with higher authority or not.
A unified command allows all agencies with responsibility for the incident,
either geographic or functional, to manage an incident by establishing a
common set of incident objectives and strategies. Unified command does not
mean losing or giving up agency authority, responsibility, or accountability. The
concept of unified command means that all involved agencies contribute to
the command process by:
Determining overall objectives.
Planning jointly for operational activities while conducting integrated
operations.
Maximizing the use of all assigned resources. 3
This is just to show you a fully expanded Incident Command Structure.
Participants Manual
page 45
Figure 8. Expanded ICS Structure
Incident Action Plan

Every incident must have an Incident Action Plan (IAP) that:
Specifies the incident objectives
States the activities to be completed
Covers a specified time frame, called an operational period
May be oral or written
Every
IAP must have four elements:

What do we want to do? (e.g. extricate, triage, treat, transport)
Who is responsible for doing it?
How do we communicate with each other?
What is the procedure if someone is injured?
IAPs describe response goals, operational objectives, and support activities.

The decision to have a written IAP is made by the Incident Commander. ICS
requires written plans whenever:
Resources from multiple agencies are used.
Several jurisdictions are involved.
The incident is complex (e.g., changes in shifts of personnel or
equipment are required).3
The following are the documents that comprise an Incident Action Plan.
Top cover sheet
ICS 205
ICS 202
ICS 206
ICS 203
Area map of the incident
Participants Manual
page 46
ICS 204
showing division of work areas
The Incident Action Plan is prepared by the Planning Section Chief with input
from the appropriate sections and units of the Incident Management Team. It
should be written at the outset of the response and revised continually
throughout the response.4
The level of detail required in an Incident Action Plan will vary according to the
size and complexity of the response. The plan must be accurate and
completely transmit the information generated during the planning process. 4
The following should be considered for inclusion in an IAP: 5
Incident goals (where the response system wants to be at the end of
response)
Operational period objectives (major areas that must be addressed in
the specified operational period to achieve the goals or control
objectives)
Response strategies (priorities and the general approach to accomplish
the objectives)
Response tactics (methods developed by Operations to achieve the
objectives)
Organization list with ICS chart showing primary roles and relationships
Assignment list with specific tasks
Critical situation updates and assessments
Composite resource status updates
Health and safety plan (to prevent responder injury or illness)
Communications plan (how functional areas can exchange information)
Logistics plan (e.g., procedures to support Operations with equipment,
supplies, etc.)
Responder medical plan (providing direction for care to responders)
Incident map (i.e., map of incident scene)
Participants Manual
page 47
ICS Form 201

INCIDENT BRIEFING
1. Incident Name
2.
Date 3.
Time
Prepared
Prepared
4. Map Sketch
ICS
201
Page 1 of 4
5. Prepared by (Name and Position)
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6. Summary of Current Actions
ICS 201
Page 2
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7. Current Organization
ICS 201
Page 3
Participants Manual
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8. Resources Summary
Resources Ordered
ICS 201
Page 4
Resource
Identification
ETA On Scene Location/Assignm

ent
Participants Manual
page 51
ICS Form 202

1. INCIDENT NAME
INCIDENT OBJECTIVES
2. DATE 3. TIME
4. OPERATIONAL PERIOD (DATE/TIME)

5.
GENERAL
ALTERNATIVES)
CONTROL
OBJECTIVES
FOR
THE
INCIDENT
(INCLUDE
6. WEATHER FORECAST FOR OPERATIONAL PERIOD
7. GENERAL SAFETY MESSAGE
8. Attachments ( if attached)
Organization List
(ICS 203)
Assignment List (ICS
204)
Communications
Plan (ICS 205)
9.
PREPARED
SECTION CHIEF)
BY
Medical Plan
206)
Incident Map
Traffic Plan
(PLANNING
(ICS
Weather Forecast
10.
APPROVED
COMMANDER)
BY
(INCIDENT
Participants Manual
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Organization Assignment List, ICS Form 203

ORGANIZATION ASSIGMENT LIST
1. INCIDENT
NAME
POSITION
4. OPERATIONAL PERIOD (DATE/TIME)
NAME
5. INCIDENT COMMAND AND STAFF

INCIDENT
COMMANDER
DEPUTY
SAFETY OFFICER
INFORMATION
OFFICER
LIAISON OFFICER
6. AGENCY REPRESENTATIVES
AGENCY
NAME
2. DATE
PREPARED
9. OPERATIONS SECTION
CHIEF
DEPUTY
a. BRANCH I- DIVISION/GROUPS
BRANCH DIRECTOR
DEPUTY
DIVISION/GROUP
DIVISION/ GROUP
DIVISION/ GROUP
DIVISION/GROUP
DIVISION /GROUP
7. PLANNING SECTION
CHIEF
DEPUTY
RESOURCES UNIT
SITUATION UNIT
DOCUMENTATION
UNIT
DEMOBILIZATION
UNIT
TECHNICAL
SPECIALISTS
8. LOGISTICS SECTION
CHIEF
DEPUTY
a. SUPPORT BRANCH
DIRECTOR
b. BRANCH II- DIVISIONS/GROUPS

BRANCH DIRECTOR
DEPUTY
DIVISION/GROU
P
DIVISION/GROU
P
DIVISION/GROU
P
DIVISION/GROU
P
c. BRANCH III- DIVISIONS/GROUPS
BRANCH DIRECTOR
DEPUTY
DIVISION/GROU
P
DIVISION/GROU
P
DIVISION/GROU
P
d. AIR OPERATIONS BRANCH
AIR OPERATIONS BR. DIR.
AIR TACTICAL GROUP SUP.
AIR SUPPORT GROUP SUP.
HELICOPTER
COORDINATOR
AIR TANKER/FIXED WING
CRD.
3. TIME
PREPARED
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SUPPLY UNIT
FACILITIES UNIT
GROUND SUPPORT
UNIT
b. SERVICE BRANCH
DIRECTOR
COMMUNICATIONS
UNIT
MEDICAL UNIT
FOOD UNIT
PREPARED BY (RESOURCES UNIT)
10. FINANCE/ADMINISTRATION SECTION

CHIEF
DEPUTY
TIME UNIT
PROCUREMENT UNIT
COMPENSATION/CLAIMS
UNIT
COST UNIT
Participants Manual
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Assignment List, ICS Form 204
1. BRANCH
3. INCIDENT NAME
2.
DIVISION/GRO
UP
ASSIGNMENT LIST
4. OPERATIONAL PERIOD
DAT
E
TIM
E
5. OPERATIONAL PERSONNEL
OPERATIONS
CHIEF
BRANCH
DIRECTOR
DIVISION/GROUP
SUPERVISOR
AIR TACTICAL GROUP
SUPERVISOR
6. RESOURCES ASSIGNED TO THIS PERIOD

STRIKE TEAM/TASK
NUMBE
FORCE/
R
RESOURCE
PERSON
DESIGNATOR
EMT
LEADER S
7. CONTROL OPERATIONS
8. SPECIAL INSTRUCTIONS
TRANS.
NEEDE
D
PICKUP
PT./TIM
E
DROP
OFF
PT./TIME
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9. DIVISION/GROUP COMMUNICATIONS SUMMARY

FUNCTION
COMMA
ND
FRE
Q.
SYSTE
M
LOC
AL
REP
EAT
DIV./GROUP
TACTICAL
PREPARED BY (RESOURCE
UNIT LEADER)
CHAN
.
FUNCTION
SUPP
ORT
FRE
Q.
SYSTEM
LOC
AL
REPE
AT
GROUND
TO AIR
APPROVED BY (PLANNING
SECT. CH.)
DATE
TIME
CHAN.
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Incident Communications Plan, ICS Form 205
INCIDENT RADIO COMMUNICATIONS

PLAN
1. Incident
Name
2.
Date/Time
Prepared
3.
Operationa
l Period
Date/Time
4. Basic Radio Channel Utilization

System/Cache
Channel Function
5. Prepared by (Communications Unit)
Frequency/To Assignment
ne
Remarks
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MEDICAL
PLAN
1. Incident
Name
2. Date
Prepared
3. Time
Prepared
4. Operational
Period
5. Incident Medical Aid Station
Medical Aid Stations
Paramedi
cs
Yes
No
Location
6. Transportation
A. Ambulance Services
Paramedi
cs
Yes
No
Name
Address
Phone
B. Incident Ambulances
Paramedi
cs
Yes
No

Name
Location
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7. Hospitals
Name
Address
Travel
Time
Air Ground
Phone
Helipad
Yes No
Burn Center
Yes No
8. Medical Emergency Procedures
Prepared by (Medical Unit Leader)
10. Reviewed by (Safety Officer)
Participants Manual
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A manageable span of controlis defined as the number of individuals one

supervisor can manage effectively. In ICS, the span of control for any
supervisor falls within a range of three (3) to seven (7) resources,
with five being the optimum. If those numbers increase or decrease, the
Incident Commander should reexamine the organizational structure. 3
Figure 9. Minimum Limit for ICS
Figure 10. Maximum Limit for ICS
Designated Incident Facilities

Includes the following:
An ICP at which the Incident Commander and the Command Staff
oversee all incident operations.
Staging Areas at which resources are kept while awaiting incident
assignment.
Other incident facilities may be designated for incidents that are
geographically dispersed, require large numbers of resources, or require
highly specialized resources.
Comprehensive Resource Management
Maximizes resource use.
Consolidates control of single resources.
Reduces the communications load.
Provides accountability.
Reduces freelancing.
Ensures personnel safety.
All resources are assigned to a status condition.
Assigned resources are performing active functions.
Available resources are ready for assignment.
Out-of-service resources are not ready for assigned or available status.
Incident Command System
Utilizes management features including the use of common terminology
and a modular organizational structure.
Utilizes the principles of chain of command, unity of command, Unified
Command, and transfer of command.
Emphasizes effective planning through the use of management by
objectives and Incident Action Plans.
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Supports responders by providing data they need through effective

information and intelligence management.
Helps ensure that resources are ready through accountability and
dispatch/deployment processes.
Ensures full utilization of incident resources by maintaining a
manageable span of control, implementing resource management
practices, and ensuring integrated communications
Exercise 1. Expanding the function of the ICS Structure using the

Single Command
Objectives:
At the end of this exercise, the participants should be able to:
1. Expand the ICS structure using the Single Command.
2. Identify Incident Objectives given a case scenario.
Instructions:
1. Divide yourselves into 8 groups.
2. Read the case scenario as shown by the presentor.
3. Draw the structural organization of the ICS for the scenario given
4. You will be given 10 minutes to work on the case.
5. Draw your output on the manila paper provided.
6. After 10 minutes, present your output to the other groups\
Exercise 2. Unified Command

Objectives:
At the end of this exercise, the participants should be able to:
1. Organize the responders/agencies in the given scenario into a Unified
Command
2. Contract the ICS Command
Instructions:
1. Maintain your grouping.
2. Another case will be shown on a Powerpoint slide.
3. Perform the task as shown on the slide.
4. You will be given less than 10 minutes to work on the first part of the
case.
5. Write your answers in the manila paper provided.
6. After 10 minutes, present you output to the other groups.
7. All outputs will be processed by the facilitator.
8. The second handout will be given to you.
9. Perform the task being asked in the handout.
10.Present your outputs after 10 minutes.
11.All outputs will be processed by the facilitator.
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Exercise 3. Development of Incident Objectives and Incident Action

Plan
Objectives:
At the end of the exercise, the participants should be able to:
1. Develop correct incident objectives given a case scenario
2. Create an Incident Action Plan appropriate for a case
Instructions:
1. Maintain your grouping.
2. You will be given another case (Case 3) and ICS forms to fill up.
3. Fill up the forms provided and develop Incident Objectives for the case
scenario given.
4. Create an Incident Action Plan.
5. After 30 minutes, present your output to the other groups.
6. Facilitator will process outputs after all presentations.
Session 2
Overview of Incident Command System
Session Description
During an incident it is important that it is properly managed so as to ensure
that safety of responders and other stakeholders are ensured, tactical
objectives are achieved, and resources are efficiently managed. In this
session, participants will be introduced to the ICS organization and learn to
expand and contract the ICS organization.
Session Objectives
1. Define an Incident
2. Discuss the Incident Command System according to its:
history
advantages of using the Incident Command System
concept and principles of the Incident Command System
3. Discuss the two types of command

Session Content
Definition of Incident
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An occurrence of an event, natural or man-made, that requires a response to

protect life or property.
Incident Command System (ICS) Overview

The ICS is a standardized, on-scene, all-hazards incident management
approach. It allows integration of facilities, equipment personnel, procedures
and communications operating within a common organizational structure. It
enables a coordinated response among various jurisdictions and functional
agencies, both public and private. The ICS established common processes for
planning and managing resources.
ICS is flexible and can be used for incidents of any type, scope and complexity.
It allows its users to adopt an integrated organizational structure to match the
complexities and demands of single or multiple incidents.
It ensures the safety of responders and others; achievement of tactical
objectives and efficient use of resources.
History of ICS
The ICS was developed in the 1970s by Firefighting Resources of California
Organized for Potential Emergencies (FIRESCOPE). FIRESCOPE identified several
recurring problems involving multiagency responses, such as:
Nonstandard terminology among responding agencies
Lack of capability to expand and contract as required by the situation
Nonstandard and nonintegrated communications
Lack of consolidated action plans
Lack of designated facilities
ICS Benefits
Meets the needs of incidents of any kind or size
Allows personnel from a variety of agencies to meld rapidly into a
common management structure
Provides logistical and administrative support to operation staff
Is cost effective by avoiding duplication of efforts
Incident Command Process:
Size up
Setting incident priorities
Predicting incident course and harm
Strategic goals and tactical objectives
Size Up
A rapid mental evaluation of factors influencing an incident. It is a
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continuous process of evaluation throughout the incident. It should cover

the evaluation of the incident situation, incident cause and incident
status.
An incident situation can be any one or a combination of the following:
o Biological
o Nuclear
o Fire
o Chemical
o Explosion or natural event
o Natural disaster with mass casualty incident
Incident cause
o Finding out the incident cause is important because additional or
specialized resources may be needed.
o The Incident Commander must determine whether the incident
was accidental or intentional.
Incident status
o Determine whether the incident is controlled or remain
uncontrolled
Incident Objectives
Based on overall priorities
Priorities:
o life safety
o incident stabilization
o property preservation
o protection of critical systems
Incident objectives should have the S.M.A.R.T. characteristics: Specific,
Measurable, Action Oriented, Realistic and Time sensitive. Some examples of
correctly written incident objectives are the following:
Provide for the safety of all response personnel for the duration of the
incident
Remove all trapped victims
Provide medical care and transportation of all injured victims
throughout the duration of the incident
Exercise 4. The ICS Organization

1. Divide yourselves into 8 groups and assign each group to a table where they
can work.
2. For every case scenario given, record the agencies that would be involved
in this incident and the resources that each agency can offer.
3. You have 5 minutes to write down your answers for each scenario.
4. Present your outputs every after each scenario.
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The ICS organization

Composed of 2 major components:
Command Staff
General Staff
The Command Staff is composed of the following:
Incident Commander
Public Information Officer
Liaison Officer
Safety Officer
Incident Commander.
Upon arriving at an incident, the higher ranking person will either assume
command, maintain command as is, or transfer command to a third party.
In some situations or agencies, a lower ranking but more qualified
person may be designated as the Incident Commander.
The Incident Commander performs all major ICS command and staff
responsibilities unless the ICS functions are delegated and assigned.
First person on the scene with communications capability
Remains in command until transferred or incident is terminated
Must assume and announce command, rapidly evaluate incident, identify
resources on hand, request additional resources and establish Incident
Action Plan
Roles
of the Incident Commander

Provides overall leadership for incident response.
Delegates authority to others.
Takes general directions from agency administrator/official
Assesses needs for staff.
Establishes incident objectives.
Directs staff to develop the Incident Action Plan
Establish facilities as they are needed.
Responsibilities of Incident Commander

Ensure incident safety
Provide information services to internal and external stakeholders
Establish and maintain liaison with other agencies participating in the
incident.
In some situation, the IC may designate a Deputy Incident Commander (DIC).
The Deputy Incident Commander may be designated to do the following:
Perform specific tasks as requested by the Incident Commander
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Perform the Incident Command function in a relief capacity

Represent an assisting agency that shares jurisdiction
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Figure 11. The Command Staff
The Command Staf.
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page 67
General Staf
Consists of:
Planning
Operations
Logistics
Finance/Administration
These four major components are the foundation upon which the ICS
organization develops.
They apply during a routine emergency, when
preparing for a major event, or when managing a response to a major disaster. 3
In smaller events, the Incident Commander is responsible for planning, but
when the incident is of larger scale, the Incident Commander establishes the
Planning Section.3
Planning Section
The Planning Sections function includes the collection, evaluation,
dissemination, and use of information about the development of the incident
and status of resources. This sections responsibilities can also include creation
of the Incident Action Plan (IAP), which defines the response activities and
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resource utilization for a specified time period. 3 (IAPs will be described in more
detail later in this course.)
Operations Section
The Operations Section is responsible for carrying out the response activities
described in the IAP. The Operations Section Chief coordinates Operations
Section activities and has primary responsibility for receiving and implementing
the IAP. The Operations Section Chief reports to the Incident Commander and
determines the required resources and organizational structure within the
Operations Section.3
Logistics Section
The Logistics Section is responsible for providing facilities, services, and
materials, including personnel to operate the requested equipment for the
incident. This section takes on great significance in long-term or extended
operations. It is important to note that the Logistics Section functions are
geared to support the incident responders. For example, the Medical Unit in the
Logistics Section provides care for the incident responders not civilian victims. 3
Finance/Administration Section
Finance/Administration Section is critical for tracking incident costs and
reimbursement accounting. Unless costs and financial operations are carefully
recorded and justified, reimbursement of costs is difficult, if not impossible. The
Finance/Administration Section is especially important when the incident is of a
magnitude that may result in a Presidential Declaration. This section is
responsible for tracking incident costs and reimbursement accounting.
Changing Commands
As described earlier in this unit, the senior person among the initial responders
to an incident becomes the Incident Commander. As an incident escalates,
however, it may be necessary to transfer command of the incident to a more
experienced personor to an Incident Commander that is designated by local
ordinance or law. When transfer of command is necessary, the transfer must be
made as efficiently as possible and in person, whenever possible.
Command may change to meet the needs of the incident when incident
expands or contracts; change in jurisdiction or discipline; or become more or
less complex.
To transfer command, the person being relieved must brief the incoming
Incident Commander to provide information about: 3
The incident conditions (e.g., the current situation, objectives, priorities,
hazards, resource needs, etc.).
The IAP and its current status.
Safety considerations and concerns.
Deployment and assignment of operating units and personnel.
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Session 3
ICS Facilities
Session Description
Part of organizing the ICS is establishing where to put up the ICS facilities.
Each facility has a specific purpose. This session will describe and introduce
the different ICS facilities; when and where they are established and illustrate
how they support incident operations.
Session Objectives
1. Identify the different facilities required during an incident operation.
2. Explain how these facilities support incident operations.
3. Discuss when and where the facilities are established.
Session Content
Incident Facilities
As mentioned previously, the first responsibility is to establish command. By
establishing command, the Incident Commander also establishes clear lines of
authority and communication for the incident. The key to establishing
command is establishing an ICP at every incident. It is important for the
Incident Commander to establish the ICP in a safe area of the incident.
The following are some guidelines to follow when deciding where to position the
ICP:
Away from the general noise and confusion that are associated with the
incident
Outside the area of present and potential hazards
Within view of the incident when possible
Upwind when the incident involves a chemical or poisonous fume from
the air
Uphill when there are flashfloods
Upstream
NOTE: When the location of the ICP has been selected, the Incident Commander
should ensure that the location is announced to all responders and to dispatch
so that all personnel are aware of its location.
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Figure 12. Field Mass Casualty Management General Organization
The following figures show where the Incident Command Post can be positioned
during a road accident, chemical or fire incident.
Figure 13. Incident Command Post during a Traffic Accident
Wind direction is important in cases of chemical or fire incidents.
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Figure 14. Incident Command Post in a Chemical Explosion
The Incident Commander should also be able to identify an area that will ensure
that the ICP can expand, provide security and be identified clearly and easily by
responders.
Expandable
When the incident escalates, the ICP should be able to expand and occupy a
space large enough so that sufficient working area and other necessary
facilities are available for the potentially large number of individuals who will
be working there.
Provide security
The ICP should be able to provide security and control access. Unauthorized
personnel should not be able to gain ready access to the facility.
Identifiable
The ICP should be readily identifiable to all responders. The ICP should be
identified with a light blue and white flag, lights or other identifiable
marking. The standard symbol for identifying ICPs is shown below.
Casualty Collection Point (CCP) is an area established near but safe from the
impact zone. It should be close to but upwind and uphill from the hazard area.
This is where victims from the impact zone are gathered during onsite triage. 3
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This is established when the incident is unstable.
Figure 15. Location of Casualty Collection Point in Relation with the Advance
Medical Post
Staging Area
Staging areas are established as incidents escalate and additional resources are
required. 3Established to avoid the problems that could result from the
convergence of too many resources and to manage the available resources
effectively.3
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Factors to be considered in selecting the location for the Staging Area:
Proximity to operational assignments

o Staging Areas should be away from the incident but as close to
probable operational assignments as possible.
o Should not be more than 5 minutes away from the incident.
Proximity to possible hazards.
o Staging Areas should be located out of the way of any possible
direct hazards.
Access routes
o Staging Areas must have different access routes for incoming and
outgoing resources. Should have one way direction.
Space
o Staging Areas must be large enough to accommodate available
resources and should be large enough to expand if the incident
escalates.
Security
o Staging Areas must offer security for both personnel and equipment
Staging Officer
Reports to Incident Commander and coordinates with the Operations
Section Chief
Oversee the check-in procedure for personnel and equipment
Respond to requests for resources
Keep the Incident Commander or the Operations Section Chief informed
of the status of resources in the Staging Area
Base
If the incident will continue for an extended period of time and covers a large
area, it will require large number of resources that rotate in and out of
operation assignments. A Base may have to be established to offer primary
services and support activities for an incident.
The standard sign is a circle with B in the middle.
Camp
Camp is a geographic site, within the general incident area, separate from the
Incident Base, equipped and staffed to provide food, water, and sleeping and
sanitary facilities. This is under the responsibility of the Logistics Section.
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Helibases and Helispots

Helibases and helispots are used in incidents requiring air operations. Helibase
is a location in and around an incident area at which helicopters may be parked,
maintained, fuelled and equipped for incident operations. Helispots are
temporary location where helicopters can land and load and offload personnel
equipment and supplies. Air operations are highly specialized and will no longer
be tackled here.
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MODULE 4
CRITICAL INCIDENT MANAGEMENT
Module Description
This module focuses specifically on the critical incident itself and how it is
managed in the impact zone. It is divided into two sessions. This module
emphasizes the importance of acting within the first hour of the incident in
order to prevent the incident from blowing out of unmanageable
proportions. The first session describes the characteristics and different
stages of a critical incident while the second session focuses on the sixstep response which is very important in Critical Incident Management
Module Objectives
1. Discuss the characteristics of Critical Incident Management
2. Describe the stages of critical incident.
3. Discuss decision making in a critical incident.
4. Discus the six-step response to critical incident.
Module Organization
Time
Allotted
90
minutes
45
minutes
Session Title
Topics
45
minutes
The
Six-Step The
Six
Response
Response
Strategies
Module 4: Critical Incident Management

Critical
Incident Characteristics
of Interactive
Management
Critical
Incident Lecture
Management
Stages
of
Critical
Incident
Step Interactive
Lecture
Participants Manual
page 76
Session 1
Critical Incident Management
Session Description
This session will cover different examples of critical incidents and their
characteristics. Preparations and the different stages of response for a
Critical Incident will also be covered in this session.
Session Objectives
At the end of this session, the participants should be able to:
Discuss the characteristics of Critical Incident Management
Describe the stages of critical incident
Discuss decision making in a critical incident
Session Content
What is a critical incident?
Critical incidents are those situations that have the potential to cause injury or
loss of life to the public; major disruptions of regular activities; or property or
environmental damage or loss.
The following are examples of events that may be designated as a critical
incident. These are merely examples and do not constitute a comprehensive list
of possible crisis events.6
Fire, explosion, hazardous substance spill or other damage to property, which
may require closing the site temporarily or permanently.
An incident resulting in or with the potential for fatality or major injuries.
A major demonstration that disrupts the communitys regular functions.
The characteristics of a critical incident management are the following:
Demands a coordinated response to prevent incident from getting worse
Includes unresolved element of danger such as additional bomb, a threat to
citizens and responders or an unusual incident
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
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
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Stages of Critical Incident

They consist of:
Initial Response
Incident Control using the Six Step Response
Recovery Stage
When everyone else is in the state of confusion and panic, it is crucial that
command and control is established, incident team organized, and a plan
put in motion.
Initial response objectives7 should be:
Ability to establish control and command
Crucial to develop a team and place a plan in action
Protecting citizen and rescue of victims
Limit incident growth
Protect arriving responders, and
Identify ingress and egress routes.
As first on the scene, as soon as possible:
a. Gain control of the scene
b. Restore order
c. Prevent target opportunities
Incident Control Using the Six-Step Response
1. Assume command
2. Situation assessment
3. Identify and set perimeters
4. Establish Command Post
5. Assign Safety Officer
6. Establish Staging Area and assign a Staging Officer
Recovery Stage of Mass Casualty Incident
Highlights of Recovery stage:7
Begins when aggressive threats of incident are neutralized
Incident is not over when last patient is transported
Recovery must be managed aggressively
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
Goals in the Recovery Stage
Most important goal is document collection
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Information can assist in post-incident analysis, cost recovery and

tracking responder injuries or deaths
Provide critical incident stress management for responders
Collect and properly dispose of used medical supplies and biohazard
waste from the incident
Post Incident Analysis

This is critical for operational review. The benefits include:
Operational performance
Organizational needs
Procedure modification
Additional training
Session 2
The Six-Step Response
Session Description
Assuming command in a mass casualty incident is very critical. This
session will cover the six-step response that should be followed when
managing mass casualty incidents. These steps are very important and
should be followed because this will prevent chaos and waste of resources
and duplication of efforts during an incident.
Session Objectives
At the end of this session, the participants should be able to:
Discuss the six-step response to critical incident.
Apply the six-step response given a case scenario.
Session Content
Six Step Incident Control
The six-step response is based on the ICS. It provides a framework to
organize and coordinate operations. It includes:
1.
Assume command.
By assuming command, the first responder is providing order to the
incident. This prevents independent action and multiple commands. It
also reassures responders that someone is in charge. You have to
advise incoming responders of incident location, secure a tactical
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frequency and request supervisory support.
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. When assessing the situation, you should be able to answer the
following questions?
What do we have?
What are we doing?
What do we need?
Identify and set perimeters

3.
3. Divide the incident into manageable divisions (geographical
areas). This will allow command to provide resources where they are
needed. Critical incidents have three standard perimeters: hot zone,
inner perimeter and outer perimeter. All perimeters are divisions.
Expand perimeters based on weather
Hot Zone area in which the incident has occurred. May be a street
corner or spread over a large area. This is secured by placing responders
in positions of controlling ingress and egress.
Inner Perimeter - This is established to protect the responders in the
hot zone. Due to the intensity of the incident, only informed personnel
are allowed within this area. The inner perimeter can be used as a
decontamination area, treatment area and evacuation area for the
walking wounded.
Outer Perimeter - The creation of an outer perimeter provides two key
functions during an incident. First, it provides the last line of defense
from internal incident acceleration. Second, it is the first line of defense
from external acceleration. The properly established and maintained
outer perimeter will provide a safe and secure area to make decisions
(Command Post), assemble resources, control the media and support the
incident.
4. Establish Command Post
The command post typically begins in the first responders vehicle.
The dynamics of the incident will require the Incident Commander
to aggressively shift to a fixed command post if available. When
establishing a fixed command post, it must be away from the hot
zone and contain command staff plus the incident commander. The
command post will ensure support for the field personnel, create a
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controlled environment and improve communications.

5. Assign Safety Officer
This position should be filled as soon as possible, based upon
available resources. The Safety Officer should be selected on
operational experience and the ability to recognize acceptable and
unacceptable risk. The Safety Officer ensures that operational
deployment issues, which could conflict or endanger responders,
are stopped or modified.
6. Establish Staging Area
As we discussed in the Incident Command lesson, the Staging Area
is one of the most effective tools for ensuring the correct and safe
deployment of resources. The Incident Commander must assign a
Staging Area Officer to accurately track, rotate and relieve
resources as appropriate. Staging may be established within the
inner or outer perimeter. Failure to stage resources can create
confusion and limited use. If resources are poorly placed, they can
be rendered useless and cause congestion of the area.
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MODULE 5
TRIAGE, TREATMENT AND TRANSPORT SYSTEM
Module Description
During mass casualty incidents, the major challenge to responding health
personnel is making sure that casualties are properly assessed and correctly
prioritized for treatment and transport. The process of sorting out patients is
called triaging. Triaging requires critical decision making skills and
appropriate knowledge and understanding of triage principles and
procedures.
This module aims to develop participants competencies needed in doing
triage during an MCI. The module will start with inputs on basic concepts and
principles of triaging and end with exercises that will test participants
application of these concepts and principles and process. This will be done
through a table top exercises that would test participants decision making
given sets of primary patient data.
Module Objectives
1. Define Triage.
2. Discuss the Principles involved in triaging
3. Describe the basic concepts of sorting and allocating treatment to
patients in a triage situation.
4. Discuss the levels of Triage
5. Explain the procedures used in triaging
6. Using primary and secondary patient data will be able to apply color
coding to patients for a simulated mass casualty incident.
Time
Session
Topics
T L Activities
3
Module 5: Triage, Treatment and Transport
hours
60
Session
1:
Definition and Principles
Interactive
minute Triage
Levels
Lectures
s
Procedures
Color Coding
Jumpstart Triage
60
Session
2:
Basic vs. Standard AMP
Interactive
minute Treatment
Personnel
requirements Lecture
s
of AMP
Design and arrangement
of treatment areas based
on triage colors
60
Session
3:
Interactive
minute Transport
Transport Organization
Lectures
s
Transfer Organization
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Time
Session
Topics
T L Activities
Victim
Flow
(The
Conveyor Belt System)
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Session 1
Triage Concepts and Process
Session Description
During mass casualty incidents, resources are always limited and the
principle of saving as many lives as possible will always be priority. Sorting
and allocating treatment to patients who have higher chances of survival will
be discussed. This session will introduce triage concepts and processes and
the use of an algorithm known as the START triage.
Session Objectives
At the end of the session, the participants will be able to:
Define triage
Discuss the principles involved in triaging
Describe the basic concepts of sorting and allocating treatment to
patients in a triage situation
Discuss the level of triage
Explain the procedures of triaging
Apply color coding to patient for a simulated mass casualty incident
Discuss the advantage of the triage team leader system
Organize a triage team
Session Content
What is Triage?
Triage is a French a word which means to sort. It is utilized to identify
treatment priorities. A process by which decision is made on which victim
receives treatment and which does not.
Three Triage Levels
On-site (where they lie)
On-site categorization of victims or at the collecting point.
Generally performed by first aiders, sometimes EMTs due to limited
medical resources
Expected to identify those victims needing prompt medical attention
(quick transport to the Advance Medical Post) and those who can wait.
Medical ( at Advance Medical Post)
Performed at the AMP by the most experienced medical personnel
available who have extensive skill in triaging.
If possible, the preferred specialist to act as Triage Officer should be an
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emergency physician, followed by an anesthesiologist, then by a

surgeon.
The objective of medical triage is to determine the level of care
needed.
Evacuation (Transport)
The 3rd level of triage is during transport.
Prioritize victims for transfer to adapted and ready-to-receive
health care facilities
The Medical Officer in charge of the AMP will decide, according to
the status of the victims and in liaison with the Command Post
and the hospital, who will be moved first to what destination,
with what type of vehicle and escort
Four Basic Priorities
Remind the participants that the KEY POINT is PRIORITIZATION. This
system is known as the Simple Triage and Rapid Treatment system
(S.T.A.R.T)
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
Intermediate Priority
Patient treatment and transport can be delayed
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
The Initial Triage Officer must do the following at the site of the
incident.
Must size up situation
Ensure safe approach and scene survey
Activate additional resources
o Number of victims
o Size of the incident
o Better off requesting more equipment and personnel than
not enough
Simple Triage and Rapid Treatment (START) System
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This system focuses on three areas:

Respiration > or < 30 respirations per minute
Pulse rate and quality/perfusion radial pulse or capillary refill <
or > 2 seconds
Mental status able/unable to follow simple command
System requires first responders to have tags, ribbons or tape in four
colors and focuses on the 3 areas
Overview of S.T.A.R.T. Procedure

Ensure proper protection of yourself before entering the scene
Ensure scene safety
Ask all people who are able to get up and walk to proceed to specified
area
Conduct an orderly survey of the remaining victims
Correct life-threatening signs and symptoms while categorizing each
patient
Make a triage report
Steps for the S.T.A.R.T. procedure
For those who can stand and walk, ask them to stand and go to a
specified area.
Emphasize that in this step, people/victims should look out for each
other and notify responders of any significant changes among their
fellow victims
Conduct an orderly survey of remaining victims.
Emphasize that responders should spend not more than 10 seconds per
casualty.
Make sure that you correct life threatening signs such as profuse
bleeding and airway or breathing problems while categorizing the
patient
Patient Assessment
RESPIRATION
What to look at
Assess breathing rate
Greater than 30 per minute, patient is
priority one and tagged red
Procedures/Decisions
Not breathing
Quickly make sure mouth is
clear.
Open airway with head tilt
method
During mass casualty incident,
cervical spine immobilization
may not be done
Less than 30 per minute, move on to Open patients airway and position
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assessing pulse and mental status
PULSE RATE AND QUALITY

What to look at
Check radial pulse
No more than 5 seconds
Check pulse is weak or irregular Red
tag, Priority One
Check capillary refill
Capillary refill > 2 sec tag red
Capillary refill < 2 sec proceed to
assess mental status
MENTAL STATUS
What to look at
Have
patient
respond
to
simple
commands such as open your eyes or
squeeze my hand
so it remains open.
If patient does not start to breath
with simple airway maneuvers, tag
priority four-black.
If patient breathes after simple
airway maneuver, tag red.
If pulse is strong, move on to
assessmental status
If there is NO pulse, black tag
priority four
If pulse is strong, move on to assess
mental status
If there is NO pulse, black tag
priority four
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
Evacuation/Transport Triage
RED
To be transferred immediately
Includes victims:
o Needing life-saving surgery
o Needing functions-saving surgery
o For ICU
YELLOW
To be transferred after evacuation of all red victims to tertiary hospital
by ambulance
Includes victims without life threatening problems needing tertiary
hospital care
GREEN
To be transferred at the end of the field operations, to appropriate
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health care facilities by available vehicles

Can be brought to health center or polyclinic
Interactive Session: This is a prelude to a triaging simulation that will be

conducted later.
Procedure:
You will be given a set of four cards (yellow, green, red, and black).
Answer the question projected in the Powerpoint presentation by
raising the appropriate colored tag.
Give your reason for your choice.
Team Triage
Triage done in teams can provide a more efficient response during a

mass casualty incident
This makes the role of the team leader essential to team triage
success
REMEMBER: The goal of the team is to do the greatest good for the
greatest number of people.
Triage Team Leader
Reports to the IC
Determine the location, number and condition of victims
Determine resources needed for triage and communicate needs to IC
Identify walking wounded and move to safe area
Assign team members to begin triage
Determine a treatment area for the victims
Assign addition personnel to triage or to assist in moving patients to
treatment area
Consider establishing initial morgue operations for priority four victims
Provide progress reports to the incident commander
Coordinate activities with Treatment Team Leader
Once triage is complete, provide IC with a triage report
Documentation
The triage team leader must maintain a record of all victims

Include priority status and the medical facility where the patient was
taken
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Triage Team Organization

Triage team leader assigns arriving emergency units & personnel to
triage
Quickly assess area & establish a safe zone
Brief personnel on triage concept
Triage must be performed in a systematic order
Move walking wounded to a safe area (not necessarily a treatment
area)
Continuous communication of triage team members with triage team
leader is essential
Coordinate ambulance staging and loading with the Transportation
Team Leader
Practical Exercise 1: Single Triage (4 hrs)

Exercise Objectives:
At the end of the exercise, participants will be able to:
1. Classify patients according to priority (red, yellow, green or black)
2. Tag patients appropriately with maximum efficiency.
3. Prepare an accurate triage report.
4. Present triage report with accuracy and clarity.
Instructions
1. You will be assigned into a group by your facilitator.
2. In the first part of the exercise, one group will be assigned as patients,
and the other groups as responders. The groups will then exchange
roles in the second part of the exercise. This will give an opportunity for
ALL participants to perform triage.
As patients you are expected to:
Review the symptom card assigned to you
Act out these symptoms as accurately as possible
Refrain from giving clues or prompts to the responder
Act out the patients role according to the given scenario.
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As responders you are expected to:
Ensure proper protection of yourself before entering the scene.

Wear your complete PPE prior to entering the scene.
Ensure scene safety.
Ask all people who are able to get up and walk to proceed to a
specified area.
Conduct an orderly survey of the remaining victims

o
Start triage where you stand
Move from starting point in a systematic manner
Stop at each victim
Spend less than 10 seconds per victim
Check pulse
Count breathing
Check mental status (Check patients reaction to certain

command)
Tag patient appropriately
Correct life-threatening signs and symptoms while categorizing

each patient.
Present an accurate Triage Report
Proceed to the designated area once exercise is completed and

wait for further instructions.
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3. You will be evaluated by the facilitators assigned based on how well

you are able to conduct the START protocol.
Observation Checklist
Single Triage
Name of Participant: __________________________
Name of Observer: __________________________
Instruction to Observer: Please observe the participants performance of
the following tasks. Put a check on the appropriate cell.
Task
Not
Done
Comments
Don correct
(Focus on attitude
e
ly
during
(put
performance)
numbe
r)
Entered the scene wearing complete PPE
Ensured scene Safety
Asked those who can stand and walk to
go to a specified area.
Started triage where he stands.
Moved from starting point in a
systematic manner
Stopped at each victim
Spent less than 10 seconds per patient.
Checked pulse
Counted breathing
Checked mental status. (Checked
patients reaction to certain command.)
Tagged patient appropriately
Presented an accurate Triage Report
4. After the scenario is given, you may gather materials needed and
prepare for the exercise.
5. Be back at the venue in 15 minutes.
Practical Exercise 2: Team Triage (3 hrs)
At the end of the exercise, participants will be able to:
1. Perform triaging systematically
2. Tag all patients appropriately with maximum efficiency.
3. Prepare an accurate team triage report.
4. Communicate team triage report with accuracy and clarity.
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5. Present triage report with accuracy and clarity.

Instructions:
1. Go back to your group as assigned in Single Triage.
2. Assign a triage team leader and plan for triaging for the given scenario.
3. In the first part of the exercise, one group will be assigned as patients,
and the other groups as the triage team. The groups will then
exchange roles in the second part of the exercise.
As
patients you are expected to:

Review the symptom card assigned to you
Act out these symptoms as accurately as possible
Refrain from giving clues or prompts to the triage team
Act out the patients role according to the given scenario.
As
triage team leader you are expected to:

Organize the group before sending the team to triage
Quickly assess the area and establish a safe zone.
Ask those who can stand and walk to go to a specified area
Provide IC with an accurate Triage Report.
As triage team members you are expected to:

Ensure proper protection of yourself before entering the scene.
Wear your complete PPE prior to entering the scene.
Perform triage in a systematic manner
Spend less than 10 seconds per victim
o Check pulse
o Count breathing
o Check mental status (Check patients reaction to certain
command)
Tag patient appropriately

Continuously communicate with team leader
Submit an accurate Triage Report to the triage team leader
Proceed to the designated area once exercise is completed and wait
for further instructions.
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You will be evaluated by the facilitators assigned based on how well your
team is able to conduct Team Triage.
Observation Checklist
Team Triage
Name of Team: __________________________
Name of Observer: __________________________
Instruction to Observer: Please observe the teams performance of the following
tasks. Put a check on the appropriate cell.
Task
Not
Done
Comments
Done
correctl (Focus on attitude
y
during
(put
performance)
numbe
r)
All team members entered the scene
wearing complete PPE
Team leader organized his group
before sending his team to triage.
Quickly assessed area & established
safe zone
Asked those who can stand and walk
to go to a specified area.
Performed triage in a systematic
manner
Spent less than 10 seconds per
patient.
Checked pulse
Counted breathing
Checked mental status. (Checked
patients reaction to certain
command.)
Tagged all victims appropriately
Team members continuously
communicated with team leader
Team members submitted a triage
report to team leader
Team leader provided IC with an
accurate Triage Report
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After the scenario is given, you may gather materials needed and prepare for
the exercise. Be back at the venue in 15 minutes.
Session 2
Treatment
Session description
This session covers the management and design of the AMP or
treatment area, assigning doctors to triaged patients, arranging patients and
changing tags after initial treatment or after the patients have been
stabilized. This session will be conducted through interactive lecture.
Session objectives
1. Discuss the purpose and role of the Advance Medical Post in Mass
Casualty Management,
2. Describe the basic concepts of sorting and allocating treatment to
patients in a triage situation,
3. Differentiate a basic AMP from standard AMP, and
4. Discuss the guidelines of providing emergency care to patients in the
AMP.
Session Content
Advance Medical Post
Purpose:
Reduce loss of life & limb - save as many as possible in the context of
existing & available resources/ situation
Convert red to yellow category as maybe possible
The chance of survival depends on the victims status and resources

Role:
Provide medical triage
Effective stabilization for victims of a MCI/Situation
3Ts (Tag, Treat, Transfer)
The 3 Ts of AMP involves tagging which is basically triaging and categorizing
patients into different priorities was discussed earlier. In the AMP, this is
where treatment and stabilization of patients are conducted before they are
transferred to tertiary hospitals.
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Figure 16. Schematic Diagram for Triaging
Field stabilization care that involves intubation, tracheostomy, chest drainage,

shock management, analgesia , fracture immobilization, fasciotomy, control
external bleed & dressing.
Organize patient transfer to designated care facility/ties
Location:
The location of the AMP should be at a safe distance from the Impact Zone. It
should have a direct access to the evacuation road and to the command post.
It should also have clear radio communication. If the incident is a fire or
chemical spill ensure that the AMP is found at the upwind location.
Ideally, the figure below shows how the AMP should be organized but the green
can be accommodated in a safe place other than the AMP. The black victims
may be place in a temporary morgue and no longer included in the AMP to
avoid crowding the area.
It has one entrance.
A treatment area divided into:
Red and yellow this will be the largest area
One exit
Figure 17. Patient Flow in AMP
The AMP should have the following personnel:
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Triage Area
Yellow and Red
o Triage officer most experienced physician
o Assisted by either a nurse, an EMT or a first aider
o Administrative clerk for registration (clerk/nurse/first aider)
Green
o Triage officer most experienced nurse, paramedic or EMT
o Assisted first aider
o Administrative clerk
Treatment Area
Is headed by Medical Officer.
Preferably skilled paramedic or EMT experienced in disaster organization
Experienced physician
Guidelines for Managing the AMP
Patients in the treatment area should be positioned head to toe, with

two to three feet of space between victims. This system will facilitate
efficient use of space and effective use of available personnel.
Treatment teams should treat first those needing immediate care
(priority 1) and arrange for their immediate transport.
Multiple teams can be formed to treat as many patients as possible.
Give stabilizing care based on triage priority (red, then yellow, then
green) whichever is applicable
Assign providers, equipment, and supplies to patients based on triage
priority
Consider use of special procedures teams to perform common
treatments (airway, IV, splinting, etc.)
Continuously reevaluate (re-triage) patients and move to other
treatment areas as necessary.
Move patients who died to the temporary morgue
Select patients to transport based on color tag.
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Session 3
Transport System
This session will focus on developing participants competencies with regard
to making decision about transport. The roles and functions of transfer
organization (TO) will be discussed and also using table top exercises will be
asked to make decisions about prioritizing patients for transport.
Session Objectives
At
1.
2.
3.
the end of the session, the participants will be able to:

Define transport.
Discuss the Principles involved in transport
Explain the procedures used in transport triaging
Session Content
Transfer Organization
Transfer organization refers to the procedures used to ensure that victims
of amass casualty situation is safely, quickly and efficiently transferred by
appropriate vehicles to the appropriate and prepared facility.
Reception Facilities
Single reception facilities are usually found in provinces where there

are no other hospitals.
Multiple reception facilities are areas with multiple hospitals are
available. The following should be considered when transferring
victims to different hospitals.
o
Type of vehicle required
o
Type of escort required
o
Destination
The evacuation officer reporting to the medical officer should do the
following prior to transfer:
Assess patients status: vital signs, ventilation/hemostasis
Check security of equipment & accessories
Ensuring efficiency of immobilization measures
Ensure triage tags: secure& clearly visible
Strict control of the rate/destination of evacuation is necessary to avoid
overwhelming the health facilities.
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There should be coordination between the Transport Officer and the Medical
Officer in the Treatment Area and also with the receiving hospital.
One of the roles of the first responding team arriving on the scene will be to
stop spontaneous evacuation organized by witnesses. This unmanaged
transport in unsafe, uncontrolled conditions to any unprepared health care
facility will endanger the lives of victims and disrupt the implementation of the
Mass Casualty Management Systemthus endangering the lives of those to
follow.
No victim may be removed from AMP to health care facilities before the
following:
Victim should be as much as possible in a stable condition
Ambulance is adequately equipped for transfer
Receiving facility correctly informed and ready
The best possible vehicle and escort--available
The victim may be transferred as soon as possible and be stabilized in transit
especially if the distance between the incident and the receiving facility is
very short.
Patient movement (whether by walking, by stretcher, by vehicle) must be in a
"one way" direction and without any crossing. From impact zone site to
collecting point, from collecting point to AMP entrance, from AMP entrance to
treatment area, from treatment area to evacuation area, from evacuation area
to hospital receiving area, from hospital receiving area to appropriate care
area, the victims will be on a kind of one-way "conveyor belt," taking them
from a basic first aid care level to sophisticated care level 8
Figure 18. Flow of transport of victims from impact zone to hospital
Ambulance Traffic Control.

Smooth and efficient ambulance traffic requires the following:
Radio links
o Transport officer at AMP
o Hospital Admission/ER Department
o Command Post
o Ambulance Headquarters
Responsibility of ambulance driver
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o Takes order from the transport officer

Guidelines for Transferring Patients
Setup a one-way in / one-way out round robin ambulance
loading zone at the exit of the treatment area.
Notify the hospital as soon as possible.
Assign patients to ambulances and helicopters based on severity
and most appropriate vehicles available.
Move minors (green) as soon as possible to vehicles such as buses
Have porter teams move patients from treatment to the
ambulance loading zone
Load patients head first into the ambulance and direct
ambulance to the appropriate hospital
Remind ambulance driver not to drive backwards when loading
patients.
The driver should just go around and follow the victim flow.
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INTEGRATION EXERCISES
Integration Exercise 1: Table Top Exercise: Incident Command Workshop (5
hours)
Exercise Description:
This exercise provides the participants with an opportunity to practice in a
controlled classroom environment the processes presented on Mass Casualty
Management.
At the end of this exercise, the participants will be able to:
1. Discuss the decision making process in establishing the Incident Command
System and the functions of Triage, Treatment and Transport.
2. Discuss resolving classroom problems dealing with mass casualties and mass
fatalities.
Instructions:
1. Divide yourselves into 3 groups.
2. Assign a team leader.
3. You will be given a scenario from which you will report the following:
a. Strategic goals (may include tactical or specific goals)
b. Organization chart, positions and people assigned
c. Total resources who responded/ used
d. Sketch map of the scene and the perimeter set including positioning
of the command post and other areas identified
e. Number of patients seen (color coded) including the course of
action done
f. 6 step response for critical incident management and your
justification
4. You will be given 30 minutes to present your work. Be read to answer
clarificatory questions from members of other groups.
Integration Exercise 2: Compartmentalized Exercise
Exercise Description:
This exercise will serve two functions, as an integration exercise and as Post
Training evaluation. As in integration exercise, participants will be given the
opportunity to process and apply what they have learned through a practical
exercise using a paper trail. This is similar to the Field Exercise but instead of
being in the field, the exercise will be held indoors utilizing different rooms which
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represent the different field areas. Each participant will write down his/her
actions or plans on a paper as the case unfolds.
At the end of this exercise, the participants will be able to:
1. Set up an Incident Command System in a simulated mass casualty incident.
10.Manage the following during a mass casualty incident:
a. Incident command
b. Triage
c. Treatment
d. Transport
11.Perform the following functions during a mass casualty incident:
e. Incident commander
f. Triage Team Leader
g. Treatment Team Leader
h. Transport Group Supervisor
Instructions:
1. You will be divided according to the following teams:
a. ICS team
b. Triage team
c. Treatment team
d. Transport team
e. Hospital team
2. Proceed to your designated rooms or areas. Each team will be given a
radio communication set with a common assigned frequency. The drill
officially starts when they receive a radio signal or report of a mass
casualty incident.
3. The first team to arrive in the scene will automatically assume the incident
command team therefore would be responsible for giving responsibilities
to members of arriving teams.
4. Each team is expected to perform the following:
a. ICS team
ICP
o IC organized his team
o IC assigned the following positions/jobs
Safety Officer
Security Officer
Triage Team Leader
Treatment Team Leader
Transport Team Leader
o Command Staff organized and assigned jobs to different
team leaders
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Assumed command
Assessed the situation
Set perimeters/work areas
Established a command post
Did the group establish an ICS organization?
What communication system was they used?
Established a communication system
o Assigned a Safety Officer
o Set up staging and designated a Staging Officer
o Location
Triage Area
Treatment Area
Transport Area
b. Triage team
Triage Team Leader
o Is the team leader identifiable?
o Scene survey done
o Divided the work area into quadrants or grid
o Performed triage
o Proper transport of patients from the scene to the
treatment area/AMP
Red transferred to treatment area first
Followed by yellow
Followed by green
Black left behind but properly accounted for or
brought to the morgue
o Recorded report of triage team
o Relayed report of triage to Advance Command Post
How many were tagged according to the following
o Red
o Yellow
o Green
o Black
c. Treatment team
o Organized treatment teams and gave assignments
o Set up color coded treatment areas
o Filled up patient record form/victim form
o Reported the number and type of cases treated in the
treatment area to ACP.
o Coordinated transfer of patients to ACP and Transport
Team Leader
o Recorded all cases seen and their receiving hospitals
o
o
o
o
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o Reported last case out of the treatment area to ACP

o Took attendance of treatment personnel
o Conducted clean up of the area
d. Transport team
o Ensure that Transport Team Leader is readily
identifiable
o Transport Team Leader identified the ingress and
egress route of the vehicles
o Recorded the cases transported including the receiving
hospital
o Submitted report to ACP
Evaluation Checklist for Compartmentalized and Field Exercise Drill
ICS TEAM
Don
Not
e
done
IC organized his team
IC assigned the following positions/jobs
Safety Officer
Security Officer
Triage Team Leader
Command Staff organized and assigned jobs to different team
leaders
Assumed command
Assigned a Safety Officer
Set up staging and designated a Staging Officer
Location
Triage Area
Treatment Area
Transport Area
TRIAGE TEAM
Triage Team Leader
Is the team leader identifiable?
Scene survey done
Divided the work area into quadrants or grid
Performed triage
Proper transport of patients from the scene to the treatment
area/AMP
Followed by yellow
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Followed by green
Black left behind but properly accounted for or brought
to the morgue
Recorded report of triage team
Relayed report of triage to Advance Command Post
Red?
Yellow?
Green?
Black?
TREATMENT TEAM
Organized treatment teams and gave assignments
Treatment area identifiable
Set up color coded treatment areas
Filled up patient record form/victim form
Reported the number and type of cases treated in the
Coordinated transfer of patients to ACP and Transport Team
Leader
Recorded all cases seen and their receiving hospitals
Reported last case out of the treatment area to ACP
Took attendance of treatment personnel
Conducted clean up of the area
TRANSPORT TEAM
Ensure that Transport Team Leader is readily identifiable
Transport Team Leader identified the ingress and egress route
of the vehicles
Identified hospital services offered and capacity
Recorded the cases transported including the receiving
hospital
Submitted report to ACP
Integration Exercise 3: Field Exercise / Drill

Exercise Description
This final exercise will serve two functions, as an integration exercise and as Post
Training evaluation. As in integration exercise, participants will be given the
opportunity to process and apply what they have learned in a simulated
situation. As an evaluation, complicated but commonly occurring scenarios were
developed which participants will attempt to work on individually and as member
of a responding group. As a group they will be evaluated on how they set up the
Incident Command, Triage, Transport, and staging area. Individually, the will be
assessed on how they perform the function that was assigned to them by the
incident commander.
At the end of this exercise the participants will be able to:
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2. Set up an Incident Command System in a simulated mass casualty

incident.
3. Manage the following during a mass casualty incident:
Incident command
Triage
Treatment
Transport
Staging
Morgue
4. Perform the following functions during a mass casualty incident:
Incident commander
Triage Team Leader
Transport Group Supervisor
Staging Officer
Morgue Manager
As an assessment method, this exercise hopes to:
1. Test Unified Structure in a mass casualty situation.
2. Assess the management skills of first responders to manage situation in
the different areas of the mass casualty incident such as Incident
Command, Triage, Treatment, Transport, Staging, Morgue, etc.
3. Evaluate skills in tagging, and treatment in a pre-hospital setting.
Running Time: 8 hours
2 hours preparation
4 hours Drill
2 hours Post Exercise Evaluation
Instructions:
1. Divide yourselves according to the following teams:
a. ICS team
b. Triage team
c. Treatment team
d. Transport team
2. Manage the given case scenario according to your assigned role.
3. Apply all the principles and concepts of mass casualty management
Evaluation Checklist for Compartmentalized and Field Exercise Drill

ICS TEAM
IC organized his team
Don
e
Not
done
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IC assigned the following positions/jobs

Safety Officer
Security Officer
Triage Team Leader
Command Staff organized and assigned jobs to different team
leaders
Assumed command
Assigned a Safety Officer
Set up staging and designated a Staging Officer
Location
Triage Area
Treatment Area
Transport Area
TRIAGE TEAM
Triage Team Leader
Is the team leader identifiable?
Scene survey done
Divided the work area into quadrants or grid
Performed triage
Proper transport of patients from the scene to the treatment
area/AMP
Followed by yellow
Followed by green
Black left behind but properly accounted for or brought
to the morgue
Recorded report of triage team
Relayed report of triage to Advance Command Post
Red?
Yellow?
Green?
Black?
TREATMENT TEAM
Organized treatment teams and gave assignments
Treatment area identifiable
Set up color coded treatment areas
Filled up patient record form/victim form
Reported the number and type of cases treated in the
Coordinated transfer of patients to ACP and Transport Team
Leader
Recorded all cases seen and their receiving hospitals
Participants Manual
page 106
Reported last case out of the treatment area to ACP

Took attendance of treatment personnel
Conducted clean up of the area
TRANSPORT TEAM
Ensure that Transport Team Leader is readily identifiable
Transport Team Leader identified the ingress and egress route
of the vehicles
Identified hospital services offered and capacity
Recorded the cases transported including the receiving
hospital
Submitted report to ACP
Participants Manual
page 107
APPENDICES
Participants Manual
page 108
INCIDENT COMMAND JOB ACTION SHEETS
Participants Manual
page 109
INCIDENT COMMANDER
Mission:
Qualifications
Performs overall direction for the field operations and

if needed, authorize evacuation
Must be an Emergency Manager/Local Chief Executive or

his
Preferably has experience in handling "on-scene" Mass

Casualty Incident Management situations
Must possess good communication skills
Must have leadership qualities.
Must be a good coordinator, good command and control

abilities
Functions and
Responsibilitie
s
Identification
Initiate the Incident Command System (ICS) by assuming

the role of the Incident Commander and put any
identification mark.
Designate a Command Post to include required logistical
needs.
Carefully assess the situation and the magnitude of the
casualties
Secure the area, preventing entry of unauthorized people
and designate staging and transport area
Depending on the number of responders and the
magnitude of the emergency, fill-up the organization
assignment list, the needed positions relevant to the
situation.
In major MCI the following should be filled up: Safety
Officer, Liaison Officer, Public Information Officer,
Operations Manager, Triage Officer, Treatment Officer,
Staging Officer, Transport Officer and Morgue Officer
The Planning Officer, Logistic Officer and Administrative
Officer complements and completes the positions in severe
MCI necessitating the support of major agencies and
requiring long period of operations.
Announce an action plan meeting and identifies the
general objective of the operations including alternatives,
and the incident communication plan Assign someone as
Documentation, Recorder/Aide.
Authorize resources as needed or requested by managers
Designate routine briefings with managers to receive
status reports and update the action plan regarding the
continuance and termination of the action plan.
Authorize resources as needed or requested by managers
Designate routine briefings with managers to receive
status reports and update the action plan regarding the
continuance and termination of the action plan.
Communicate status to higher authority
Approve media releases
Proper signages (hard hat with mark of Incident
Participants Manual
page 110
Commander or a vest)
Participants Manual
page 111
SAFETY AND SECURITY OFFICER

Position assigned to:
Your report to:
Incident Commander
Command Post
Telephone/Cellphone:
Mission
Qualifications
Functions
and
Responsibilities
Identification
Monitor and have authority over the safety of rescue

operations and hazardous conditions. Organize and
enforce scene/facility protection and traffic security.
Knowledgeable on safety precautions, procedures.
Preferably with various training in emergencies relating to

bombing,
fire,
hazardous
materials,
structural
assessment, security procedures and safety of responding
personnel
Had experiences in emergencies and disasters
Good decision making abilities.
Have sound knowledge in evacuation procedures.
Obtain appointment and briefing from the Incident

Commander
Implement the emergency lockdown policy and personnel

identification policy
Establish Security Command Post
Remove unauthorized persons from restricted areas.
Establish ambulance entry and exit route in cooperation

with Transportation and Staging Officers.
Secure the Command Post, Advance Medical Post, Triage

and Treatment areas including the Morgue Area and all
other sensitive or strategic areas from unauthorized
access.
Fully understand the importance of his roles especially in

the safety of the responders
Secure and post non-entry signs around unsafe areas.
Always alert to identify and report all hazards and unsafe

conditions to the Incident Commander
Secure areas evacuated to and from, to limit unauthorized

personnel access.
Initiate contact with fire, police agencies through the

Liaison Officer, when necessary.
Advise the Incident Commander and others immediately

of any unsafe hazardous or security related conditions.
Confer with Public Information Officer to establish areas

for media personnel.
Establish routine briefings with Incident Commander.
Provide vehicular and pedestrian traffic control.
Secure food, water, medical, and blood resources.
Document all actions and observations.
Can order stoppage of operation if unsafe
Use of any identification hat or vest
Participants Manual
page 112
PUBLIC INFORMATION OFFICER (P.I.O)

You report to:
(Incident Commander)
Command Post:
Mission
Provide Information to the Public and the Media
Qualifications
Knowledgeable on communication aspects especially in
collating relevant
information needed
Knowledgeable in media handling
Preferably with experience in emergencies and disasters
Preferably with understanding of Mass Casualty Management
Good communication skills and interpersonal relationships
Sensitive on restrictions in contents of news and patient care

activities.
Functions and
Responsibiliti
Commander
es
Ensure that all news releases have the approval of the

Incident
and for media releases; obtain progress reports from

respective areas as appropriate
Issue an initial incident information report to the news media

especially on the casualty status and the actions being done
Schedule press conferences on a regular basis
Inform on-site media of the physical areas, which they have

access to and those which are restricted.
Coordinate with Safety and Security Officer.
Contact other at-scene agencies to coordinate released

information
Direct calls from those who wish to volunteer to Liaison

Officer. Contact Operations to determine requests to be made
to the public via the media.
Identification
Proper signages (hard hat with a mark of Public

Information Officer or a vest)
Participants Manual
page 113
LIAISON OFFICER
Your report to:
Incident Commander
Command Post
Mission
Function as incident contact person for representatives

from other agencies (government or private).
Qualifications
Preferably with experience in liaison procedures and
coordination
Good or excellent public relations skills
Preferably with understanding of Mass Casualty Management
Understands the bureaucracy and working relationships of

the different government as well as private agencies
responding to emergencies and disasters
Good grasp of patient care and management in mass

casualty situations; informed on inter-hospital emergency
communication network, municipal operation centers and/or
province, region or national as appropriate.
Knowledge on the inventory of resources available in the

area/country
Understands municipal (provincial, regional, national)

organizational charts to determine appropriate contacts and
message routing,
Functions and
Responsibiliti
Commander.
es
In coordination with the Public Information Officer should

always be knowledgeable on the following:
o The number of "Immediate" and "Delayed" patients
that can be received and treated immediately
(Patient Care Capacity); also the status of all other
victims especially in mass dead situations
o Any current or anticipated shortage of personnel,
supplies, etc.
o Number of patients transferred to hospitals.
o Any resources, which are requested by each area
(i.e., staff, equipment, supplies).
Establish contact with liaison counterparts of each assisting

and cooperating agency.
Keeping appropriate agency Liaison Officers updated on

changes and development of response to incident
Request assistance and information as needed through the

different network of government and private organizations
responding to emergencies and disasters.
Respond to requests and complaints from incident personnel

regarding inter-organization problems.
Prepare to assist Labour Pool with problems encountered in

the volunteer credentialing process.
Identification Use of any identification (hat or vest)
Participants Manual
page 114
Participants Manual
page 115
LOGISTIC SECTION CHIEF

Position Assigned To:
You report to:
Logistics Command Post:
Telephone:
Mission:
Qualification
s
Organize and direct those associated with maintenance of

the physical environment, and adequate levels of food,
shelter, supplies and other resources needed to support
the objectives of the incident
Preferably with experience in logistics management

Preferably with experience in emergencies and disasters
Understands the bureaucracy and working relationships of the
different units in government especially in procurement and
emergency purchases.
Good grasp of procurement procedures; knowledgeable in
accessing supplies, medicines and equipment needed during
emergencies
Good coordination with pharmaceuticals, companies and
suppliers and knowledgeable on database of available
resources in the market
Functions &
Responsibilit
ies

Commander.
Establish Logistics Section Center in proximity to the
Command Post
Brief all his staff on current situation; outline action plan and
designate time for next briefing.
Attend
damage
assessment
meeting
with
Incident
Commander
Coordinate with companies regarding stock level, available
supply and equipment
Anticipate needed logistical requirement.
Obtain information and updates regularly; maintain current
status of all areas;
Communicate
frequently
with
Emergency
Incident
Commander.
Obtain needed supplies with assistance of the Finance Section
Chief, and Liaison Unit Leader.
Identificatio
n
Proper signages (hat or vest)
Participants Manual
page 116
PLANNING SECTION CHIEF

You report to
:(Incident Commander)
Planning Command Post:
Telephone:
Mission:
Qualifications
Organize and direct all aspects of Planning Section

operations.
Ensure
the
distribution
of
critical
information/data. Compile scenario/ resource projections
from all areas and efect long range planning. Document
all activities'
Preferably a senior official with adequate knowledge in

planning and decision making
Had experiences in emergencies and disaster situation in
addition to crises management
Adequate knowledge on the government bureaucracy and the
role of the different government entities responding to
emergencies and disasters
Good coordination and networking skills
Functions &
Responsibilities

Commander; have regular updates as appropriate.
Brief members of the staff after meeting with Incident
Commander.
Provide for a Planning/Information Center
Recruit a documentation aide from the labor Pool. Appoint
Planning Unit Leaders; Situation Status Leader, Labor Pool
and other appropriate positions as needed. Ensure that all
appropriate agencies are represented in this section.
Ensure the formulation and documentation of an incidentspecific action plan. Distribute copies to Incident Commander
and all areas'
Call for projection reports (Action Plan) from the Planning Unit
Leaders for scenarios 4,8,24 and 48 hours from time of
incident onset. Adjust time for receiving projection reports as
necessary.
Instruct staff to document update status reports from all
areas for use in decision-making and for reference in postdisaster evaluation and recovery assistance applications.
Schedule planning meetings to include Planning Section Unit
Participants Manual
page 117
Identification
Leaders, Section Chiefs and the Incident Commander for

continued update of the Action Plan.
Coordinate with the Liaison Officer and Labor especially with
regards manpower requirements
Proper signage (hat or vest)
Participants Manual
page 118
FINANCE SECTION CHIEF

You report to:
Finance Command Post:
Telephone:
Mission:
Monitor the utilization of financial assets. Oversee the

acquisition of
supplies and services necessary to carry out the
objective of the
incident. Supervise the documentation of expenditures
relevant to the emergency incident.
Qualifications
Preferably a senior official with adequate knowledge in

financial management.
Had experiences in emergencies and disaster situation
Adequate knowledge on the government bureaucracy and
the role of the different government entities responding to
emergencies and disasters.
Good resource manager; knowledgeable on tapping other
resources
Functions
&
Responsibiliti
es
Identification

Commander.
Appoint members of his staff preferably the following: Time
Unit Leader,
Procurement Unit Leader, Claims Unit Leader, Cost Unit
Leader and other appropriate positions as he desires.
Establish a Financial Section Operations Center. Ensure
adequate documentation/recording personnel. His station
need not be within the area of incident.
Confer with Unit Leaders after meeting with Incident
Commander and develop an action plan.
Approve a "cost-to-date" incident financial status report
eight hours summarizing financial data relative to
personnel, supplies and miscellaneous expenses.
Obtain briefings and updates from Incident Commander as
appropriate.
Relate pertinent financial status reports to appropriate
chiefs and unit leaders.
Schedule planning meetings to include Finance Section
unit leaders to discuss updating the section's incident
action plan and termination procedures.
Participants Manual
page 119
Participants Manual
page 120
OPERATIONS SECTION CHIEF

You report to:
Command Post:
Telephone:
Mission:
Organize and direct aspects relating to the operations.

carry out directives of the Incident Commander.
Qualifications
Knowledgeable on operation procedures; understands

well the
organizational chart in MCI
Preferably has experience in handling " on-scene"
Mass Casualty Incident with varied knowledge of all
types of operations (Search and rescue , ",
Medical etc.)
Must be a crisis manager and with leadership skills
Good communicator and can stand pressures
Must know capabilities of people for proper
assignments
Functions &
Responsibilities
Identification

commander.
Responsible for all specific sections of the operations:
ex. Medical, Search and Rescue, Fire suppression and
others depending on the incident
Establish Operations Section in the Command Post
preferably with the Incident Commander.
Brief all Operations Officers on current situation and
develop the section's initial plan.
Designate times for briefings and updates with all
Operations Officers to develop/ update sections action
plan.
Ensure that all areas are adequately staffed and
supplied.
Brief the Emergency Incident Commander routinely on
the status of the operations section especially on the
status of all patients, problems encountered,
resources needed etc.
Ensure that all actions and decisions are documented.
Observe all staff and personnel for' signs of stress and
inappropriate behaviour and report concerns to
Psychosocial supervisor. Ensure rotation of all
personnel to prevent burnt out among personnel.
Participants Manual
page 121
Participants Manual
page 122
TREATMENT TEAM LEADER

You report to:
(Field Medical Commander)
Treatment Area:
Telephone:
Mission:
Responsible for the management of the Treatment Area and
assigning of responsible supervisor for specific areas (Red,
Yellow and Green subsections). Assure treatment of
casualties according to triage categories. Provide for a
controlled patient discharge and transfer to appropriate
hospitals.
Preferably
a
general
surgeon/Trauma/Emergency
Physician/Anaesthesia/Family Medicine
Knowledgeable on Mass Casualty Management and the
organization staff in field care and field operation.
Skilled in emergency procedures especially life sustaining and
stabilization of patients
Good in personnel management especially in stress situations
Qualifications
Functions &
Responsibiliti
es
Receive
appointment
and
briefing
from
Incident
Commander/Operations Chief Field Medical Commander
Organizes the treatment area assigning all members of their
specific assignments and responsibilities. In cases of WMD,
treatment area should be at the cold zone. Appoint unit leaders
for the following treatment areas in pre-established locations:
Second Triage; Immediate Treatment (Red); Delayed Treatment
(Yellow); Minor Treatment (Green); Discharge.
Supervise the receiving of patient from the Initial Triage from
the site, re-triage the victims and institute measures to
stabilize the victims; ensure that all victims are continuously
monitored.
Assess problems, treatment needs and customize the staffing
and supplies in each area.
Receive, coordinate and forward requests for personnel and
supplies to the Field Medical commander and/or Staging officer
Contact the Safety and Security Officer for any security needs
in the Area.
Establish 2-way communication (radio or runner) with Field
Medical Commander,
Triage, Transport and Staging Officers
Coordinate with Transport Officer, decides on the order of
transfer of victims, the mode of transport, escort and place of
transfer
Document everything with regards every individual patient
brought to the area using the individual treatment form.
Regularly report to the Field Medical Commander
Observe and assist any staff that exhibits signs of stress and
fatigue. Report any concerns to Psycho Supervisor. Provide for
staff rest periods and relief'
Participants Manual
page 123
Identification
Participants Manual
page 124
TRIAGE INITIAL TEAM LEADER

You report to:
Triage Area:
Telephone:
Mission:
Sort casualties at the site according to priority of injuries,
and transfer (according to tagging priorities) to the
treatment area.
Qualifications
Any of the following:

o Doctor of medicine preferably trained in emergency
medical care. and triaging
o Nurses, paramedic with appropriate training in
emergency, medical care and basic triaging.
Knowledgeable on mass casualty management and had

experience in "on-site" mass casualty incident; skilled in field
care and field operations
Duties &
Responsibilitie
s
Receive appointment and briefing from the Field Medical

commander or as previously designated by the Incident
commander
Assess first the safety in entering the incident area; note
abnormalities
in
the
surrounding,
any
untoward
manifestations of the victims and approximate number of
casualties and the type of injuries
Protect self by using the appropriate Personal Protective
Equipment (PPE)
In cases of WMD, ensure that decontamination is present
before entering the incident site
Report first to authority and request for additional help before
proceeding to actual triaging.
Quickly brief members of the Triage Team and assign areas
for triaging
Tag the appropriate color to every patient as follows:
RED - immediate stabilization necessary
YELLOW - close monitoring' care can be delayed
GREEN - minor; delayed treatment or no treatment
BLACK - dead or almost dead
Document important things to consider in the site for
purposes of evidence by use of camera, by mapping or
sketching etc.' especially in WMD'
Ask first all walking wounded to an identified place'(only for
bleeding and respiratory problems)
Bring patients to the Treatment Area according to priority
number and types of casualties, equipment needs
Assess problem, triage treatment needs relative to specific
incident
Identify a Morgue Manager and a Morgue Area for black
patients.
Contact the Safety and Security Officer of security and traffic
flow needs in the Triage Area.
Ends his services once all patients are out of his area and
Participants Manual
page 125
Identification
receives another assignment

Commander
from
the
Field
Medical
Participants Manual
page 126
TRANSPORT GROUP SUPERVISOR

You report to:
Transport Area :
Telephone:
Mission:
Coordinate the transfer of patient received from the

Treatment Area to the appropriate hospitals
Qualifications
Duties &
Responsibilities
Identification
Preferably a paramedic, nurse or doctor with basic

training in Basic Life support
Experienced and knowledgeable in Mass casualty
Management
Skilled in ambulance traffic control; skilled in radio
communications
Sound
knowledge
of
countrys
transportation
resources
sound knowledge of access routes to Health care
facilities
Familiar with terrain, road maps, alternate routes
Has sufficient knowledge in the return time of the
ambulance
Receives appointment and briefing from the Incident
Commander/ Field Medical Commander
Establish immediately an ambulance loading zone
observing principles on way traffic flow; identifies
access routes and communicates traffic now to
drivers; Coordinates and supervises transport of
victims from the Treatment Area
Ascertain all information relating to receiving hospital
(as to type of facility, bed availability, hospital
capability, contact ER medical officer etc...)
supervises all available ambulance drivers; using
appropriate vehicle in accordance with status of
patients
Receives requests for transportation; Maintains a log
of the whereabouts of all vehicles under his control
Ensure all patients transferred are tagged and with
their treatment form Brief ambulance crew as to the
Condit-ion or in patient, care required, access routes,
traffic flow, location of the receiving hospital and the
previous in the endorsement of the patient
Coordinate regularly with the Treatment ream
Leader/staging officer and report all patients
transferred and when the last patient is transported.
Document all activities in his area including a
complete record of all patients.
Participants Manual
page 127
Participants Manual
page 128
STAGING OFFICER
You report to:
Staging Area:
Mission:
(Operations Section Chief)
Qualifications
Telephone:
Coordinate all resources arriving at the scene. For
manpower resources referring them to appropriate
area of assignment. For transportation resources
organizing them and dispatching them as required
At least a Paramedic or an EMT
Duties &
Responsibilities
Receives appointment and briefing from the Incident

Commander/
Operations Section Chief
Identify suitable place for the Staging Area usually away
from the incident
Organize, classify all transportation resources
Coordinates with Transport Supervisor

Dispatch appropriate vehicle as requested by Transport
Supervisor
Coordinate with appropriate agencies with regard traffic
flow and access routes within the site.
Direct all incoming responding teams to the Field
Medical Commander
Document all resources
Identification
Any identification mark (hats or vests)
Participants Manual
page 129
FIELD MEDICAL COMMANDER

You report to:
(Operations Section Chief
Advance Medical Post (AMP)
Telephone:
Mission
Organize, prioritize and assign officers under its

jurisdiction to areas where medical care is being delivered,
Advise the Operations Section Chief incident Commander
on issues related to handling of the victims.
Qualifications
Must be a Doctor of Medicine

Must possess managerial skills in disaster
Preferably with training and experience in MCI management

situations
Knowledgeable in the hospital capability and networking;
sound knowledge of country's health resources
Skilled in pre-hospital care; skilled in radio communications
Skilled in staff management; skilled in logistical operations
Duties &
Responsibilitie
s
Identification
In the absence of the above the first who arrives at the scene
preferably coming from the following:
a. Municipal Health Officer, City Health Officer, any
Emergency Health Physician
b. Emergency Critical Nurse (in the absence of an MD)
c. Private MD with experience in emergency care
Can first assume the position and later endorse (face to face)
providing an orderly transfer of command to the next
incoming qualified medical personnel
Receives
appointment
from
the
Incident
Commander/Operations Section Chief Officer, Treatment
Officer, Transport Officer, Mortuary Officer
Responsible that all the needed medical resources be

mobilized and available likewise attend meetings and press
conferences
Ensures the welfare and safety of the medical team including

relief and sustenance (decking, scheduling, pull back etc.)
Conducts regular meeting with his designated officers in the

area
Anticipates other concerns and regularly confer with the

Operations Chief / Incident Commander
Responsible that all the necessary recording of the events be

done and all required reports to all the authorities be
submitted on time
Evaluate the whole activity and make the necessary

recommendations to
improve future responses
Coordinates and regularly reports to the Medical controller of

the DOH
Participants Manual
page 130
Participants Manual
page 131
MORGUE MANAGER
You report to:
Morgue Area:
Mission:
(Triage Officer / Treatment Officer)

Telephone:
Collect, protect and identify deceased patients
Qualifications
Doctor of Medicine aided with a social worker, a

psychosocial support officer
For medico-legal cases forensic experts from the PNP
Crime Laboratory or the National bureau of
Investigation will be part of the team
Duties &
Responsibilities
Identification
Receives appointment and briefing from the Triage

Officer / Field Medical Commander
Identifies and establish the Morgue Area; coordinate
with the Triage Officer and Treatment Officer
Maintain master list of deceased patients with time of
arrival
Assure all personal belongings are kept with deceased
patients and are secured.
Assure all deceased patients in Morgue Areas are
covered, tagged and
identified where possible
Provide a system or procedures for identifying and
endorsing the body of the deceased to authorized
members of the family
In medico-legal cases consult with PNP and NBI with
regards procedures necessary for proper identification
and for evidence collection and preservation
Keep Triage Treatment officers apprised of number of
deceased.
Contact the Safety and Security Officer for any
morgue security needs.
Arrange for frequent rest and recovery periods as well
as relief for staff.
Schedule meetings with the Psychological support
Unit Leader to allow for staff debriefing.
Observe and assist any staff that exhibits signs of
stress or fatigue. Report any concerns to the
Treatment Areas Supervisor.
Review and approve the area documenter's recording
of action/decisions in the Morgue Area.
Participants Manual
page 132
Participants Manual
page 133
MEDICAL CONTROLLER
You report to:
(Director HEMS/OSEC)
DOH Central/Regional Operation Center
Telephone:
Mission:
Coordinate all activities of the Department of

Health/Health Sector in response to the Mass Casualty
Situation
Qualifications
Doctor of Medicine/Nurse familiar with the Operation

Center (Central or Regional)
Good knowledge of the DOH organization as well as
members of the Health Sector responding to
emergencies and disasters
Good resource mobilize
Knowledgeable on the manpower resources, hospital

capabilities, dispatching and radio communications
Articulate and good spokesperson
Excellent coordinator
Duties &
Responsibilities
Identification
Designated by the office and assume the position in case

of Mass Casualty Situations
Supervises the Operation Centre and make all decisions
in relation to the dispatch and subsequent fielding of
additional teams
Assists in the scheduling of rotation of the medical teams
at the site in the event of prolonged operations in
coordination with the Field Medical Commander
Coordinates with the different receiving hospitals to
prepare their facilities
Coordinates with other agencies, DCC agencies,
response units etc.'
Review resources not only within the DOH OPCEN but of
the other facilities of the DOH; likewise mobilize
resources if need be
May respond to queries by officials, media in relation to
DOH response
Update superiors especially the Secretary of Health
Document and record the event
Evaluate the proceedings and make some necessary
input for policy amendments or recommendations
Schedule and lead post-mortem evaluation within one
week of the event for the Health Sector
Participants Manual
page 134
INCIDENT MEDICAL COMMANDER

You report to:
Command Post:
Telephone:
Mission:
Represents the Department of Health in the Command

Post
and
coordinates
all
treatment
activities/requirements in cases of Regional
Emergencies/ Disasters
Qualifications
Highest official designated by the Regional Health Office

Sector responding to emergencies and disasters; sound
knowledge of the region's health resources
Knowledgeable on Mass Casualty Management and it's
organization
Skilled in logistical operation and staff management
Knowledgeable in both public health and pre- hospital
care
Duties &
Responsibilities
Identification
Designated by the Regional office and assume the

position in case of Mass Casualty Situations
Reports to the Incident commander in the Command
Post. Usually will be part of the Planning Committee
In constant coordination with the Field Medical
Commander and the Medical Controller
Anticipates other concerns such as public health
concerns (sanitation, nutritional needs, needs of
evacuees) or Psychosocial concern especially in
situations of Mass Dead
Leads in public health information and the needed IEC
materials
Organizes all reports coming from the Field Medical
Commander and attend all press briefings and
conferences
Document and make his/her own evaluation of the
incident.
Participants Manual
page 135
INCIDENT COMMAND SYSTEM FORMS
Participants Manual
page 136
INSTRUCTIONS FOR COMPLETING THE INCIDENT OBJECTIVES

Item
Numbe
r
1.
2.
3.
4.
5.
6.
7.
Item Title
Incident Name
Date Prepared
Time Prepared
Operational
Period
General
Control
Objectives
(Include
alternatives)
Weather Forecast
for
Operational
Period
General
Safety
Message
8.
Attachments
9.
Prepared By
10.
Approved By
Instructions
Note: Incident Objectives form serves only as a cover
sheet and is not considered complete until attachments
are included
Print the name assigned to the incident.
Enter date prepared (month, day, year)
Enter time prepared (24-hr clock)
Enter the time interval for which the form applies. Record
the start time and end time and include date(s).
Enter short, clear, and concise statements of the
objectives for managing the incident, including
alternatives. The control objectives usually apply for the
duration of the incident.
Enter weather prediction information for the specified
operational period.
Enter information such as known safety hazards and
specific precautions to be observed during this
operational period. If available, a safety message should
be referenced and attached.
The form is ready for distribution when appropriate
attachments are completed and attached to the form.
Enter the name and position of the person completing
the form (usually the Planning Section Chief)
Enter the name and position of the person approving the
form (usually the Incident Commander).
Participants Manual
page 137
Participants Manual
page 138
INCIDENT ASSIGNMENT LIST

Purpose: The Organization Assignment List provides ICS personnel with
information on the units that are currently activated and the names of
personnel staffing each position or unit. It is used to complete the Incident
Organization Chart which is posted on the Incident Command Post display.
Preparation: The list is prepared and maintained by the Resources Unit
under the direction of the Planning Section Chief.
Distribution: The Organization Assignment List is duplicated and
attached to the Incident Objectives form and given to all recipients of the
Incident Action Plan.
Participants Manual
page 139
Participants Manual
page 140
Participants Manual
page 141
Participants Manual
page 142
Participants Manual
page 143
REFERENCES
Participants Manual
page 144
1. Guidelines for health emergency management. In: DOH, editor. 2nd ed.
Manila: Health Emergency Management Staff, Department of Health,
World Health Organization; 2008.
2. Dodge B, Helget V, Medcalf S. Healthcare Surge Capacity in Disasters
[unpublished lecture]. lecture given
3. Basic Incident Command System Independent Study [database on the
Internet]. Federal Emergency Management Agency, Emergency
Management Institute. [cited 9 Nov2011].
4. Critical Incident Management Plan. University of Virginia2010.
5. Ali P. Critical Incident Management [unpublished lecture]. Ministry of
Health, Fiji; lecture given (no date)
6. Establishing a Mass Casualty Management System. Washington, D.C.:
Pan American Health Organization, Pan American Sanitary Bureau,
Regional Office of the World Health Organization; 2001.
7. Knotts KE, Etengoff S, Barber K, Golden IJ. Casualty collection in masscasualty incidents: a better method for finding proverbial needles in a
haystack. Prehospital and Disaster Medicine 2006;21(6):459-64.
8. The Hospital Emergency Incident Command System. In: Services
SMCDoH, Agency EMS, Authority CEMS, editors. 3rd ed1998.
9. Boyd A, Caton J. Critical Incident Management Guidelines. In: Center
VNTS, editor.1998.
10. Incident Command System. In: FIRESCOPE, editor. California1994.
Participants Manual
page 145
COURSE EVALUATION FORM

For participants to accomplish after the Final Plenary and Post-Training
Assessment Exercise. Kindly check the appropriate column for your
feedback. Then submit the accomplished form to your Chief Facilitator.
Particulars
1.
The training objectives were clear

and relevant to my work situation
2. The training stimulated my
interest in the subject matter
3. The previous
knowledge/experiences prepared
me adequately for the training
4. The handouts/audio-visual aids
facilitated my understanding of
the subject matter
5. The lectures were effective in
facilitating my understanding of
the subject matter
6. I had ample opportunity to ask
questions and participate in the
discussions
7. The facilitators provided valuable
information and directions
8. The activities were effective for
the training objectives
9. The content of the workshops was
appropriate for my needs
10. The avenue is conducive to
training
11. The meals were adequate
12. I am fully satisfied with the output
of this training
Ratings of Participants
Strongly
Agree
Disagree Strongl
Agree
y
Disagre
e

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Participants Manual

Mass Casualty Management

INTRODUCTION: HEMS IN PERSPECTIVE

assessment plans. It also includes explicit instructions on what roles the

CARMENCITA A. BANATIN, MD, MHA

An agency is a division of government with a specific function,

An individual assigned to an incident from an assisting or

Resources dispatched to an incident that have not yet

Tasks given to resources to perform within a given operational

The location at which primary logistics functions for an

A geographic site, within the general incident area, separate

An assessment of ability to manage an emergency

People, property, services, livelihoods and environment i.e.

An agency supplying assistance other than direct tactical or

The process of systematically analyzing a situation,

actions. However, personnel responsible for coordination may

The impact on an organization and its ability to cope with or

A statement provided to the Incident Commander by the

A fully qualified individual who, in the absence of a superior,

A serious disruption of the functioning of a community or a

The potential disaster losses, in lives, health status,

The systematic process of using administrative directives,

The concept and practice of reducing disaster risks through

The implementation of a command decision to move a

resource or resources from one place to another. 3

A sudden and usually unforeseen event that requires

The organization and management of resources and

A health-care specialist with particular skills and knowledge in

A pre designated facility established by an agency or

Any potential threat to public safety and/or public health

In ICS, this is a top-down management activity which involves

Multiagency A generalized term which describes the functions and

The outright avoidance of adverse impacts or hazards and

The provision of emergency services and public assistance

Personnel and equipment available, or potentially available,

The exposure or probable likelihood of a hazard (accident,

A comprehensive study of a transit agency to identify

The systematic approach and practice of

Includes information developed by the first person at the

A combination of single resources assembled for a particular

The concept by which each person within an organization

Factors which increase the risks arising from a specific hazard

Those who because of constraints of an economic, social

the participants to experience the different roles and tasks to be performed in

TRAINING GROUND RULES

end of this session the participants will be able to:

Session # and Title

Any event resulting in a number of victims large

minimize disabilities and loss of life in a mass

Figure 1. Mass Casualty Management Conceptual Framework

Response Categories of Mass Casualties:

Hazardous materials incidents

Who is in command of the incident?

Mass Casualty Management Framework is composed of pre-hospital and

Figure 1. Mass Casualty Management Framework

Exercise 1: Interactive Session

Mass Casualty Management Approach

Figure 2. Mass Casualty Management Framework showing Rescue Chain

The Rescue Chain is the essence of Mass Casualty Management System

KEY POINTS: MCM System has a pre-hospital and hospital component.

Figure 2. Mass Casualty Management System

Sequence of activities at different levels of response. Again, the pre-hospital

Collection Point for unstable

Initial Assessment is part of the alerting process. This involves

MCM Participant's Manual

MCM Participant's Manual