Region X

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Region X

• Multiple Patient Management Plan
• 2008

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An accident has occurred.
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Rescue crews arrive on the scene.
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The patients may all require transportation to a
hospital, but sometimes there are simply too
many patients to be cared for at a single
facility.
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The revised Region X Multiple Patient Management
Plan offers clear guidelines for the
transportation of multiple patients.
Region X MULTIPLE PATIENT MANAGEMENT PLAN
Effective May 1, 2008
Last Revised April 2008 (Formerly known as
Region X Multiple Victims and Mass Casualty
Plan)
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The purpose of the plan is to safely move
patients from the field to the most appropriate
hospital in an efficient and cooperative manner.
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A Brief Review of the Basics
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REGION X
There are over one million people living in
Region X.
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A pre-established communication system links
all of the hospitals located within Illinois.
ILLINOIS DEPARTMENT OF PUBLIC HEALTH (IDPH)
POD HOSPITAL
RESOURCE HOSPITAL
ASSOCIATE HOSPITAL
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MABAS
Region X
MABAS stands for Mutual Aid Box Alarm System.
Divisions I, III, and IV are located within
Region X
Illinois is a national leader in
pre-established agreements between fire
departments. Many other states are
following their example.
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INCIDENT MANAGEMENTSYSTEM ORGANIZATION
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The Revised Plan
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The revised plan is presented in an improved
format.
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This Patient Management Plan is based on four
different classes.
Business as Usual
Note that the line between the third and fourth
columns is darker
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The specifics for each class are clearly
identified in a table format.
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Classifying an Incident
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CLASS 1
Business as Usual
During a Class 1 Multiple Patient Incident field
providers are able to provide their normal level
of care.
In a Class 1 Incident EMS providers now contact
their CLOSEST HOSPITAL
A few areas make Class 1 unique.
Hospitals MAY NOT divert ambulances transporting
from a multiple patient incident.
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IN REVIEWContacting the closest hospital
during a Class 1 incident to discuss patient
disbursement is a new approach in Region X.
Business as Usual

• In the past.
• EMS
• Resource Hospital
• Receiving Hospitals
• Resource Hospital
• EMS

• Now.
• EMS
• Closest
• Hospital

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CLASS 1
This is the most unique addition to the Region X
plan.
Business as Usual
1
2
3
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Occasionally, situations may arise during a Class
1 incident when field personnel want to take more
than two patients to the same hospital.
Two patients in this car have been classified as
Category I trauma patients.
Three patients in this car have been classified
as Category III trauma patients. They are a
mother and two small children.
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What if EMS is on the scene of a auto accident
with two Category 1 trauma patients. A Level Two
is 8 minutes away. A Level One is 15 minutes
away. WHICH HOSPITAL SHOULDBE CONTACTED BY
FIELD PERSONNEL?
Two Patients Both Category I Trauma Patients
8 min
15 min
LEVEL ONE TRAUMA CENTER
LEVEL TWOTRAUMA CENTER
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CLASS 2
During a Class 2 Multiple Patient Incident,
field providers are UNABLE to meet their
normal level of care.
In a Class 2 Incident, EMS providers contact
their RESOURCE HOSPITAL.
Because resources and information will likely be
limited, providers give the hospital an
estimated number of patients and their levels
of acuity.
During a Class 2 Incident, providers will
communicate to their Resource Hospital
using traditional triage colors of red, yellow
and green based on the START Triage Method.
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It is important to compare the difference in
communication between Class 1 and Classes 2 or 3.
CLASS 1
CLASSES 2 and 3

Business as Usual
FIELD COMMAND
FIELD COMMAND
RESOURCEHOSPITAL
RESOURCEHOSPITAL
CLOSEST HOSPITAL
POTENTIALRECEIVING HOSPITALS
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Communication Structure Class 2 and Class 3
SCENE COMMAND
RESOURCE
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CLASS 3
During a Class 3 Multiple Patient
Incident responders are OVERWHELMINGLY unable to
meet the normal level of care.
The POD Hospital may be activated for
assistance with communication
Transporting ambulances will not have
any communication with receiving hospitals.
NO PATIENT CARE REPORTS
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A Class 3 incident could involve an enormous
number of patients.
Outdoor Concert
Amusement Park
Political Rally
College Stadium
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EMERGENT EVACUATIONOF HEALTHCARE FACILITY
It is important to include the administration
of the facility in making some decisions.
Charity Hospital New Orleans
Note the different types of triage.
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WHAT IS REVERSE TRIAGE?
Patients that are able to exit the building on
their own are removed first. Patients that
require assistance in a wheelchair are
next. Patients that are extremely ill and
require intensive manpower to move are moved last.
A small fire occurs in the electrical room of a
large hospital. Only a few patients have been
injured, but the hospital needs to be evacuated.
As the patients arrive at a collection area,
the process is reversed. The most critical
patients are transported first. The patients
requiring a moderate amount of care are sent
next. Patients requiring minimal medical care
leave the facility last.
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Typical Scenario EMERGENT EVACUATION OF
AHEALTHCARE FACILITY
Hospitals
Patients injured in fire.
Community Center
Ambulatory nursing home residents not affected by
fire.
A FIRE OCCURS IN ONE WING OF A NURSING HOME
Bed-ridden nursing home residents not affected
by fire.
Alternate Nursing Home
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An After-Action Report should be generated
following any activation of the Region X
Multiple Patient Plan.
A copy of this form is found in the plan.
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TRIAGE
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The State of Illinois has adopted the START
triage method in partnership with the SMART
Incident Command System as a state-wide standard.
SMART Tags to be used when doing START Triage.
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START TRIAGE
RED Light Sticks are found in each pack to
visually identify critical patients in a dark
environmental
ADULTS
Pediatric Patients Under 32 kg
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(No Transcript)
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All ambulances in Illinois have receiveda SMART
Triage Pack.

• Components of the Triage Pack
• Folding SMART Triage Tags
• Mini-light sticks to identify
• RED patients at night
• DEAD tags
• SMART Tape
• (to prioritize injured or sick
• children up to 32 kg)
• Triage prompt card
• (to prioritize adults)
• Dynamic record of casualties
• already triaged
• Pencil

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SMART equipment is also being given to
hospitals, fire departments and MABAS Divisions.

• SMART MCI Bag
• Includes
• Four SMART Triage Packs
• One SMART Command Board

Command Board
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The Region X Multiple Patient Plan includes other
important information.

• Summary of OHare Disaster Plan
• Summary of State Disaster Plan
• Summary of National Disaster Plan
• Training guidelines
• Guidelines for sending medical personnel to the
  scene of a disaster
• Post-incident recovery services (CISM)
• After-action Report Forms
• Hospital / Field log forms (template)

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Putting the Plan to Work

• Scenarios

Business as Usual
OR
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Truck Driver 57 year old male Complains of Chest
Pain prior to accident Denies trauma, able to
ambulate Pale, cool and diaphoretic Respirations
32/min
Car 1 - Driver 25 year old male Ambulatory at
the scene Air bags deployed / seat belt
worn Complains of wrist pain with deformity
Car 2 Driver 84 year old male Unresponsive,
Respirations 24/min Bilateral femur
fractures Car 2 Passenger 82 year old
female Laceration to forehead Respirations
32/min Deteriorating mental status
-What Class? -Which hospital do you call? -Where
should the patients be transported?
-Specifics
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The owner of this house has called to report that
he returned home from work to find his family
unresponsive and his carbon monoxide alarm going
off.

• Patient 1 50 year old unresponsive female
• Patient 2 20 year old unresponsive female
• Patient 3 17 year old unresponsive male
• Patient 4 16 year old unresponsive female
• Patient 5 15 year old unresponsive male

-What Class? -Which hospital do you call? -Where
should the patients be transported?
-Specifics
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10-12 patients 4 Red 5 Yellow 1-3 Green All
adults All trauma patients
-What Class? -Which hospital do you call? -Where
should the patients be transported?
-Specifics
3
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Patient 1 24 year old male Ambulatory at the
scene Driver of this car Appears stable
Patient 2 20 year old male Unresponsive Thrown
from a vehicle
This picture is a simulation.
Patient 3 18 year old male Front seat passenger
unrestrained Unresponsive
-What Class? -Which hospital do you call? -Where
should the patients be transported?
-Specifics
Patient 4 18 year old female Back seat
passenger - restrained Unresponsive
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An earthquake has occurred in Illinois. This
building is located in Region X and contained
over 100 people. Many other buildings have been
damaged.
The New Madrid Fault line runs through Illinois.
An 1811 earthquake involving this fault line was
the most destructive in U.S. history. The
Mississippi River actually ran backwards. Some
researchers contend that a mega-quake of this
fault is long overdue.
-What Class? -Which hospital do you call? -Where
should the patients be transported?
-Specifics
5
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Patient 1 Driver 18 year old
male Unresponsive Still restrained
Patient 2 Front Seat Passenger 18 year old
female Crying in pain Open Skull Fracture
-What Class? -Which hospital do you call? -Where
should the patients be transported?
-Specifics
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Patient 1 Driver FATAL INJURY (in accordance
with Region X guidelines) No transport
Patient 2 Back Seat Passenger Still
restrained Denies Complaints No trauma noted
Patient 3 Front Seat Passenger Thrown from
vehicle Unresponsive
-What Class? -Which hospital do you call? -Where
should the patients be transported?
-Specifics
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This is a small nursing home. Eight elderly
people and two caregivers live here.
It is 230 a.m. The temperature is below zero.
-What Class? -Which hospital do you call? -Where
should the patients be transported?
-Specifics
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QUESTIONS?
We welcome your questions Jill Ramaker, RN,
EMT-P Chairman Region X DMSC EMS Coordinator,
Evanston Hospital 847-570-2166 jramaker_at_enh.org