How to avoid relocating the MCI to a hospital?
Patient tracking and destination management is essential to not relocating the MCI to a hospital. Second, obtain all transportation group equipment. Each ambulance should be equipped with the equipment and supplies to serve in the role of the transportation group.
How does the MCC decide which hospital to transport a patient?
The MCC briefly stops the crew and asks them what the triage color is for their patient. The MCC then reviews their form and informs the crew which hospital can accept the patient. The MCC makes a tick mark on the sender side to document the patient has been transported to that hospital.
Is your MCI plan flexible enough to work for all incidents?
MCI plans should be flexible enough to work for both large- and small-scale incidents. When should an MCI plan be put into effect? Who is responsible at a multiple-casualty incident for initially setting up a command post?
Why do EMS providers need to know MCI thresholds?
Because MCI identification differs for every EMS service, each provider must know the MCI threshold for their system.
Which MCI patients should receive treatment and transport first priority?
4.9 Patients categorized as immediate are the first priority for treatment and/or transport, followed by patients categorized as delayed and minimal. Patients categorized as expectant should be provided with treatment and/or transport as resources allow.
Which patient should be triaged first?
START Triage First responders delegate the movement of injured victims to a designated collection point as directed by using four main categories based on injury severity: BLACK: (Deceased/expectant) injuries incompatible with life or without spontaneous respiration; should not be moved forward to the collection point.
What is the first thing to do in a MCI?
On arrival at a large MCI, the key is to immediately begin scene size-up, establishment of command, an initial triage sweep and the coordination and assigning of incoming resources. The speed with which these things are accomplished sets the tone.
What determines the order in which patients are relocated?
"Triage is used to determine the order in which patients will receive medical care and transport." The EMT correctly defines a multiple-casualty incident (MCI) when he states: "It is any event that places an excessive demand on rescue personnel and equipment."
Which casualty should you treat first?
If someone is not breathing then they should be treated first. As a general rule, the "quiet" casualty is more in need of help compared to the casualty with a serious cut who is screaming in agony. Whilst this is distressing - the unconscious casualty should take priority.
What is Priority 3 patient?
Priority 3 (Green) "Walking-wounded" Victims who are not seriously injured, are quickly triaged and tagged as "walking wounded", and a priority 3 or "green" classification (meaning delayed treatment/transportation).
Can a patient consent to transport but not treatment?
The correct answer is: A. A patient can consent to transport but can legally refuse to be treated.
What is the nurse's role in emergency and MCI preparedness?
Nurses are critical thinkers and can make decisions necessary in emergency situations. Nurses with advanced education and experience in trauma or critical care can fill more advanced triage, diagnostic, and treatment roles on the scene of an MCI.
What are the 3 categories of triage?
TriageImmediate category. These casualties require immediate life-saving treatment.Urgent category. These casualties require significant intervention as soon as possible.Delayed category. These patients will require medical intervention, but not with any urgency.Expectant category.
Is your most important priority when responding to any MCI?
The most important scene management priority is scene safety. The emergency scene may contain hazards for the original victim, bystanders, and rescue personnel who are operating at the scene. The command system allows Incident Command to review the emergency operation in its entirety and prioritize areas for safety.
What are the three criteria for assessing patients during start triage?
The START triage system classifies patients as red/immediate if the patient fits one of the following three criteria: 1) A respiratory rate that's > 30 per minute; 2) Radial pulse is absent, or capillary refill is > 2 seconds; and 3) Patient is unable to follow simple commands.
What is the first step in the salt field triage system?
The first EMS unit to arrive on the scene will perform the initial scene assessment. Once a triage officer has been identified for the incident, this triage officer can initiate a request for additional resources to manage the triage efforts at the incident.
When should an incident command notify ambulances?
Notify incident command once the exact location has been identified. Incident command and the communication center should make an announcement to all ambulances about where the PEP is located.
How many people can be in a transportation group?
Although two people can operate effectively as the transportation group, three is more effective. If a third person is riding in the unit, the roles can change slightly based on experience and training. The officer can assume the role of transportation group supervisor. A transportation group supervisor can monitor the radio, help funnel ambulance crews, and troubleshoot issues while the MCC and TR check out patients. On large MCIs, it’s essential to staff the transportation group supervisor position.
What is the role of the transport recorder in EMS?
Although several roles fall under the transportation group, two essential roles are the medical communications coordinator (MCC) and the transport recorder (TR). (See Figure 1, below.) The MCC is responsible for obtaining the capacity of hospitals and deciding where each patient is transported. The TR is the gatekeeper, recording the destination of each patient. In our system, the driver of the first arriving EMS unit assumes the TR role and the officer or attendant-in-charge assumes the MCC role.
How long does it take for a RHCC to provide bed capacity?
The RHCC should provide the MCC with the local bed capacity in less than 10 minutes.
What is the TR on a disaster tag?
Simultaneously, the TR pulls the transportation stub off the disaster tag. The TR checks to see that this portion is complete because it’s essential for patient tracking. The TR then places the adhesive disaster tag stub on the transport recorder form for the appropriate hospital. If an electronic patient tracking technology is also utilized, this is the appropriate time to scan the bar code on the disaster tag stub.
What happens if EMS is not performed well?
If it’s not performed well, critical patients may be sent to non-trauma centers, hospitals may become overloaded, and patients may be delayed care or family reunification. Because it must be established early in the incident, one of the first arriving EMS transport units should serve in this role.
Where should the transportation group be located?
The transportation group should position at a funnel point where every patient leaving the scene must pass . This is known as the patient exit point (PEP). This may be between the treatment areas and the location where the ambulances are being loaded. As patients are moved from a treatment area to a waiting ambulance, they can be contacted by the transportation group. (See Figure 2, below.)
Which point do immediate patients move forward to?
Immediate patients move forward to the casualty collection point first.
Where should patients move their tags?
As patients receive their tags from the SALT process, they should move forward to a casualty collection point. Patients continue to move forward from there to a treatment area and eventually to an ambulance for transport to a receiving facility..
How many breaths should an ALS patient take?
If that patient is a child or infant, consider giving them two breaths. If you are an ALS provider, it may be appropriate to provide needle decompression, auto-injector chemical toxin antidotes or other lifesaving interventions that take less than a minute to administer and do not require you to stay with the patient.
When you assess and find a life threat, should you provide a lifesaving intervention?
When you assess and find a life threat you should provide a lifesaving intervention as long as it does not take longer than a minute and does not require you or another EMS provider to stay with the patient. For example, if you find that a patient has massive hemorrhage, provide rapid bleeding control with a tourniquet.
What to say to patients who remain in place?
To the patients who remain in place say, "If you need help, wave your arm or move your leg and we will be there to help you as soon as we can."
What are some examples of expectant patients?
Examples of expectant patients include head injury with exposed brain matter, carotid artery hemorrhage or burns to 90 percent of the total body surface area.
When needs outstrip resources, is it appropriate to call for help?
When needs outstrip resources it is appropriate to call for help, but rather than to wait for the resources to come to you, EMS providers can use SALT to move patients forward to resources .
How to determine which triage category a patient falls under?
To determine which triage category these patients fall under, we begin by assessing the respirations of the remaining victims. If they are not breathing we can reposition their airway, but if breathing does not begin spontaneously, the victim is tagged as "deceased."
What is the purpose of the simple triage and rapid transport method?
The Simple Triage and Rapid Transport method assesses respirations, perfusion and mental status to identify the most critical patients
What does triage mean in EMS?
Triage means "to sort" — to figure out which patients need immediate care and which patients can wait.
What is the first step in triage?
The first step in triage is to clear out the minor injuries and those with low likelihood of death in the immediate future . The best way to do this is to direct in a loud voice (with public address or loudspeaker assistance) for anyone that is injured and needs medical assistance to move to a designated area, a casualty collection point. The walking wounded patients are initially tagged as "green" or "minor." While it is possible that these patients may have serious injuries, if they are able to listen, understand directions and get up and walk on their own to a casualty collection point, the chances of them dying in the next hour is low. As soon as enough medical resources arrive on location, the "green" or "minor" injury patients will need to be re-triaged to look for more serious conditions.
What does it mean when a patient breathes 30 times a minute?
If the patient is breathing, and breathing over 30 times per minute, they are tagged "red" or "immediate." If their respiratory rate is fast they may be in shock, or be in respiratory distress.
When can treatment begin on the most serious victims?
Once you have triaged the patients, treatment can begin on the most serious victims.
Should EMS use triage tags?
Whether to use triage tags or not is debatable. While most agencies will use a triage tag of some sort, there have been some EMS leaders that have questioned whether we should deviate from our usual practice just when the situation is becoming more volatile and chaotic. It may be more beneficial to do things as close to normal as possible. Certainly follow local protocol, but understand the weaknesses of both the use and lack of use of the triage tag. It is my opinion that the benefits of a tag outweigh the drawbacks, especially for accountability purposes.
What is MCI triage?
This addendum covers mass casualty incident (MCI) triage and is not to be confused with individual trauma field triage as outlined by the Centers for Disease Control and Prevention
What is the MUCC criteria?
MUCC was created to address the issues inherent in mass casualty incidents that cross jurisdictional lines, where responders may be using different triage systems. As Lerner et al. (2011) write, “for operational simplicity, communication interoperability, and clinical efficiency, it is preferable for all of the responders at a given incident to use the same triage system, or at the very least operate from some common elements.”1
What is the only way to transport a patient to the hospital?
Ambulances are the only way to transport a patient to the hospital.
What should an EMS provider know?
EMS providers should be familiar with the Incident Management System and their responsibilities within the system.
When is an ambulance call considered complete?
An ambulance call is considered complete when patient care is transferred to the hospital staff.
Do ambulance operators need special training?
Some states require ambulance operators to attend special training.
What is the only way to transport a patient to the hospital?
Ambulances are the only way to transport a patient to the hospital.
What should an EMS provider know?
EMS providers should be familiar with the Incident Management System and their responsibilities within the system.
When is an ambulance call considered complete?
An ambulance call is considered complete when patient care is transferred to the hospital staff.