Mass Casualty Incidents SFFD

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Mass Casualty IncidentsSFFD

• Presentation to the California Fire
  Chiefs-Communications Section
• November 29, 2006

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Review and Primer on MCI Management

• Two car MVA - 3 to 4 patients
• SF Muni Bus vs. Cable Car 20 to 35 patients
• Definition of a Mass Casualty Incident

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MCI Defined

• According to EMT textbooks, more than 3 patients
• Situation placing great demand on available
  equipment
• SF EMS Agency Policy 8000 Level I is activated
  when 6 or more Immediate Category Patients or 10
  patients of any category.

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The Medical Branch or Group

• Serves under the Operations Section Chief
• Medical Group Supervisor
• Triage
• Treatment
• Transportation

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Objective

• Identify and triage all patients/victims
• Treat patients and victims based on triage level
• Transport patients to appropriate medical
  facilities
• Properly document and track patient flow and care

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How Does SFFD Handle MCIs?

• Close Coordination with several elements
• The I.C.
• The Communications Center (ECD)
• Area Hospitals

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Training

• All entry level recruits (firefighters) are
  trained on START Triage.
• SFFD Ambulance Personnel have MCI Roles and
  Responsibilities Training
• SFFD Rescue Captains (paramedic supervisors) have
  extensive ICS and MCI Management Training

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Declaration of MCI

• Red Alert or Yellow Alert
• Activated by any member in the field
• Activated by any member in the ECD

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Yellow or Red Alert

• Hospitals report status on EM Systems
• Ancillary or Auxiliary ambulance providers report
  status to ECD and hold or suspend non emergency
  ambulance operations

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Communications is KEY!!!

• Command Talk Group
• Incident Tactical Talk Group
• Medical Branch Talk Group
• Other communications may be needed CalCord, Fire
  White, Inter-Agency in SF.

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SFFD Suppression Resources

• 43 Engine Companies (13)
• 19 Truck Companies (14)
• 2 Heavy Rescue Squads (13)
• 9 Battalion Chiefs
• 2 Division Chiefs

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SFFD EMS Resources

• Ambulances transitioning from statically deployed
  to dynamically deployed. 21 peak scheduled.
• 4 Rescue Captains
• 22-24 ALS Engines of the 43.

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Equipment Resources

• Mass Casualty Unit
• 2 MCU Response Vans (being outfitted)
• San Francisco Muni Bus (special request)

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MCI Response

• Actions of the responding units in the first 5
  minutes dictate the relative success of the
  Medical Branch to satisfactorily mitigate the MCI.

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Actions

• Institution of COMMAND (ICS)
• Scene Size Up
• Need for additional resources
• Access and egress for units (Staging ?)
• Assignment of ICS roles and responsibilities
• Identification of treatment areas

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Actions (cont.)

• All tactical actions in coordination with or
  approved by I.C.
• Tactical actions must be communicated to
  communications center (ECD) so that future
  responding units can be properly updated.

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Actions (cont.)

• After initial Triage of patients
• Patients treated
• Patients treated and re-Triaged based on
  secondary criteria.
• Patients identified for transport to Trauma
  Centers outside of primary service area.

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Transport Group

• Responsible for dispersing patients to area
  hospitals based on pre-arranged mechanism.
• Initial 4 Immediate patients to SFGH
• Each subsequent hospital receives 2 Immediate
  patients
• Does not overwhelm single hospital-Share the
  wealth

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What about special transport needs?

• Patients that need Trauma Center care beyond the
  4 handled by SFGH will go to Regional Trauma
  Centers
• Transport by ground ambulance or aero medical
  helicopter.

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Aero Medical Operations

• LZ at incident scene or closest approved LZ
• Need SFFD engine crew at LZ with SFPD Security
  element.
• May need ground ambulance shuttle from incident
  to LZ.

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Aero Medical Communications

• CalCord is preferred frequency
• Problematic for SF at times
• Patch of CalCord to Fire White has been recent
  work around

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Regional Resources

• Types according to FIRESCOPE
• Non Transport and Transport
• Type 1 ALS
• Type 2 BLS
• ALS can be EMT Paramedic or two paramedics.

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Ambulance Strike Teams

• Type 1 Transport AST 5 Type 1 ambulances and 1
  AST Leader
• Type 2 Transport AST 5 Type 2 ambulances and 1
  AST Leader
• Classes for AST Units and AST Leader have been
  ongoing through CA State EMS Authority and John
  Hancock College

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Access to resources

• Two pathways
• Traditional Fire route asking for fire ambulance
  resources via CA OES Region 2
• SF EMS Agency MHOAC
• CA Region 2 RDHMC

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Which one should I use?

• Using the local Agency MHOAC and the RDHMC allows
  the operational needs of each constituent county
  or Local EMS Operating Area to be properly
  coordinated.
• Remember not all ambulances in the system are FD
  ambulances.

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Future State of the Art

• EPCR has a MCI Module in the SFFD
• SF EMS Agency has a grant for portable patient
  care tracking at an MCI Symbol Technologies.

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Hand Held Patient Tracking
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Wi-Fi networked Patient Flow

• Accurate patient tracking and flow recording has
  been Achilles heel of MCI Management for years.
• MGS and all subordinate groups can network
  laptops to show real time hospital status and
  patient destinations using technology