Transcript 15 January 2015 Mass Casualty Management

MASS CASUALTY
MANAGEMENT
DERICK D. NYASEBWA M.D, Fel HSM
EMERGENCY DEPARTMENT
BUGANDO MEDICAL CENTRE
Mass Casualty Management is the one that,
because of the number and severity of casualties,
properties damaged or its location requires special
arrangements such as information management,
safety measures, dispatch of teams, and activation of
the contingency plan, scene management, triage,
evacuation, code of conduct and debriefing.
Factors for consideration at all levels are available
resources, magnitude of the incident, location, and
distance from the health facilities and possibilities of
other incidents happening.
Examples of major incidents include: health threats
like cholera epidemics, major accidents like marine
accidents, road traffic accidents, major explosions etc.
INTRODUCTION
Scene Management: is a command system
established immediately at the scene of an incident to
assure the coordination of multiple responding
agencies and provides safety measures of all
responders; it enables assessment and determines the
magnitude of the incident where complex scenes can
be split into tiers of command, thus simplifying rescue
operations and coordination at the scene or incident. It
also describes duties and responsibilities of each
responding agency.
Learning objectives:
At the end of this lesson learners will be able to:
• To learn the Tiers of Command in Scene
management
• To understand the elements of Scene Control
• To understand Scene Organization
AIMS OF RESPONDING HEALTH
WORKERS
 To save life
 To limit worsening of the condition
 To promote recovery
Definition of Terms:
Tiers of Command – these are the three levels
represents command structure at the scene or incident
describes responsibilities, namely Bronze Command
cordon), Silver Command (outer cordon) and
Command(at vicinity of scene).
which
which
(inner
Gold
Command Post – The joint post where authority and
responsibility of all emergency responders reports for
coordination, directives and actions plans made.
Incident Commander - The officer having overall
responsibility for managing the incident and dictating
tactics and resource management.
Ambulance Loading Area - This is the point through which all casualties
requiring hospital treatment pass through, ensures a free flow of ambulances
and assists by collating the numbers of casualties and their destination and
ensuring records are kept.
Marshalling area – A location in the vicinity of an incident or scene prepositioned storage site where arriving emergency vehicles, personnel,
equipment and accompanying supplies are reassembled and prepared for
onward movement.
Casualty Clearing Area – is the area at the scene of an incident which is the
part of the casualty evacuation chain to facilitate movement of casualties from
the inner cordon, before transferred on to the health facilities.
Survivor Reception Area - All uninjured survivors will be directed to the area
where details are collected this ensures a record of everybody involved in such
incident or scene is kept.
Tiers of Command in Scene Management (Command levels)
are:
Gold Level (Strategic) – is usually located at remote into necessarily within the
scene or incident area, it represents the highest level of command for the
incident. It involves the local authorities’ administrative powers and decision
making on how to manage the scene or incident with resources.
Silver Level (Tactical) – is the outer cordon area is the entire scene within the
incident with all responding agent’s representation. It gives all tactical
approaches on operations and rescue. The outer cordon is established in order
to prevent anybody who is not involved in responding to the incident to keep
away from the site for their own personal protection and also to allow the
responding services the necessary space to carry out their duties effectively.
Bronze Level (Operational) –is the inner cordon area is the area of immediate
hazard and casualty rescue. Only those personnel who are responsible for
immediate rescue operations enter this cordon area and keeping record of who
goes in and out of it.
Each command level has a Leading Commander at each cordon.
PROCEDURES

RECEIVING AN ALARM / EMERGENCY CALL

RESPOND TO THE SCENE / INCIDENT AREA(Maintain scene
control, Initiate response actions/plans, Ref info & sources)

SAFETY MEASURES FIRST(Personal, Scene, Casualties)

INIATE OTHER EMERGENCY SERVICES FROM EOC /
CONTROL CENTRE(Police, Army, Local Authorities etc)

REPORT THE INCIDENT IN 5 –W`s sequence
(WHO,WHERE,WHAT HAPPENED,WHEN,HOW)

PROTECT YOURSELF FROM HAZARDS – P.P.E (Helmets, Filter
masks, Chemical respirator's, Aprons, Clinical suits, Safety
boots etc).
PROCEDURES cont.`
Ensure;
 TRIAGE,PRIMARY ASSESSMENT,SECONDARY ASSESSMENT
& TRANSFER TO DEFINITIVE CARE
 FLEET MANAGEMENT(Bikes,Motorcycles,Vehicles,Air
Ambulances)
 DEPLOY RELIABLE EQUIPTMENTS/ MONITORS
 COMMAND POST / CASUALITY HOLDING POINTS
 RECORDS FOR POST-INCIDENT DEBRIEF
SCENE ORGANISATION
The following three elements of immediate
incident control are;
Confirm – the nature if the incident and any hazards.
Clear – the area of bystanders and walking casualties.
Cordon – the area to control crowd / unauthorized entries
and prevent further casualties.
MASS CASUALTY INCIDENTS
A Mass Casualty incident is one that, because of the number and
severity of live casualties, properties damaged or its location,
requires special arrangements to be implemented by the Local /
Emergency Services authorities.
Factors for consideration are: Available resources ( man-power, equipments and financial
support).
 Number of casualties and types of injury.
 Location and distance from definitive care hospitals.
 Accessibility.
 Possibility of further incidents happening
RESPONSE TEAMS IN TANZANIA
TRAIN ACCIDENT
RESPONSE TEAMS
FIRST RESPONDER ASSESSING VICTIMS
IDENTIFICATION OF VICTIMS
UNIVERSAL PRECAUTIONS
Before beginning the scene assessment, always consider the
need for universal precautions. “Your Primary responsible is your
own Safety”. Protect yourself from possible injuries and blood /
fluids contamination.
 Wear protective Gloves (how to put them on and take
them off without contaminating yourself).
 Wear Goggles – for eye protection.
 Wear filter masks – prevent smoke / fumes inhalation.
 Wear Helmets – protection for possible head injuries.
METHANE REPORT
M–
My call sign, or name and appointment.
(Major Incident Standby & Declared )
E–
Exact Location.
T–
Type of Incident.
H–
Hazards, Present & Potential
A–
Access to scene and exit route.
N–
Number & Severity of causalities.
E–
Emergency services, present and required.
LEVELS OF INCIDENT
COMMAND
GOLD
SILVER
BRONZE
STRATEGY
TACTICS
OPERATIONAL
TASKS OF COMMAND
STRUCTURE
GOLD
What we intend to do
SILVER
How we intend to do it
BRONZE
Do it
INCIDENT AREA - 1
OUTER CORDEN – GOLD
INNER CORDON – SILVER
BRONZE
TIERS OF COMMAND
BRONZE
The Bronze area is the area of immediate hazard & casualty rescue.
The boundary of the Bronze area is the inner Cordon.
Each department / Service provider may designate a Bronze Commander.
There can be more than 1 Bronze area ( and set of Bronze Commanders)
within an incident.
INCIDENT AREA - 2
OUTER CORDEN – GOLD
INNER CORDON – SILVER
BRONZE
TIERS OF COMMAND
SILVER
The Silver area is the entire scene.
The boundary of the Silver area is the Outer Cordon.
Each department / Service provider will provide Silver Commander.
There is only one Silver area for an incident (Exception, for example
earthquake with multiple “Major Incidents”)
INCIDENT AREA - 3
OUTER CORDEN – GOLD
INNER CORDON – SILVER
BRONZE
TIERS OF COMMAND
GOLD
Gold represents the Highest Level of Command for the incident.
Gold is remote from the scene.
Gold maybe identified by a Local Authority, Regional, State or National
Boundary.
SCENE ORGANISATION
+ ----------------- (OFFSCENE MARSHALLING AREA)
ENTRANCE
MEDIA / LIAISON POINT
Ambulance Parking Area
SILVER AREA
Command Post
Incident Commander
Patients
INNER CORDON
Casualty
Clearing
Station
BRONZE
INCIDENT
Survivors’
Reception
Survivors
EXIT
Area
Ambulance
Loading
Point
RESPONSIBILITIES OF THE HEALTH WORKER
RESPONDER
 Maintain communication with control/ communication centre
 Identify and activate the resources as needed
 Ensure appropriate mobilization of all subsequent resources
e.g. Police, Fire & Rescue services, Ambulance service etc.
 Do not cause a delay in mobilization by treating patients
 Risk-evaluation
Be aware of the potential hazards in large industrial plants, docks,
airports, motorways, public offices etc.
RESPONSIBILITIES OF THE HEALTH WORKER
RESPONDER - 2
The following are main considerations when managing Mass Casualty
scenario;
 Do not become a victim yourself. Address potential safety
threats to the crew / fellow workers and patients immediately
upon arrival at the scene (Protect the health and safety of all
personnel at the scene).

Assist the extraction of, triage, treat and stabilize casualties
 Transport / Evacuate all casualties without delay to an
appropriate facility.
CODE OF CONDUCT
HAVE HIGH PERSONAL STANDARDS

Personal hygiene & cleanliness.

Personal appearance.

Effectiveness & Efficiency

Fitness & Health
CONDUCT & BEHAVIOUR TOWARDS PATIENTS & OTHERS

Honesty – do remember that you’re in a position of trust.

Maintain the ethics of patient confidentiality.

Always be respectful & avoid over-familiarity.

Cooperate with other services, patients relatives/friends or others who are
concerned. Liaise with emergency services.

Sense of responsibility
- Self discipline.
- Maintain a record of events.
- Be identifiable – distinctive clothing (Reflective Jackets)
- Be in a safe & Prominent position.
- Have access to reliable communication
REMEMBER
At first there can be a great deal of confusion at a Mass Casualty
Incident. How quickly, order and efficiency are established may
depend on your prompt response and strict adherence to
instructions given.
Finally remember that ;
MAINTAIN CALMNESS,EARLY STABILIZATION /
EVACUATION AND RAPID TRANSFER TO HOSPITAL
IMPROVES OUTCOME OF CASUALITIES.
Introduction to TRIAGE :
It is conducted to facilitate identification of injured
persons according to their severity to ensure that they
are transported to an appropriate hospital or trauma
center. It also minimizes scene time for rapid
assessment of casualties and prioritizes transportation
requirement and treatment.
At the end of this lesson learners will be able to:
• To learn categories and color’s codes of TRIAGE
• To understand need to perform Triage
Definition of Terms in TRIAGE:
Mass Casualty – is any incident in which emergency medical services
resources, such as personnel and equipment, are overwhelmed by the number
and severity of casualties.
Evacuation – is an operation whereby all or part of a particular population is
temporarily relocated, whether individually or in an organized manner, from an
area in which a disaster or emergency is imminent or has occurred.
Priority – the state or quality of being earlier in time,occurrence,order,ank etc.
Triage Sieve - is a tag which first responders and medical personnel use
during a mass casualty incident with the aide of the triage tags, the first-arriving
personnel are able to effectively and efficiently distribute the limited resources
and provide the necessary immediate care for the victims until more help
arrives.
Categories for Triage and Color codes:
•PRIORITY 1 - Any serious ABCD problem, (Red label, immediate
treatment and evacuation).
•PRIORITY 2 - No ABCD problem, but potential or actual other
serious injury, (Yellow label, urgent but may be delayed treatment
and evacuation).
•PRIORITY 3 – Walking wounded, (Green label, non-urgent
delayed treatment and evacuation).
•PRIORITY 4 – Dead, no treatment to be evacuated after all
injured people cleared (White / Black label).
Keep re-assessing and re-triage as necessary as possible.
Evacuate and treat patients in strict triage priority order.
Need for Triage?
• It aids to identify injured persons with potential
serious injuries to ensure that they are
transported to an appropriate hospital or trauma
center.
• Minimizing scene time for rapid assessment of
casualties
and
prioritize
transportation
requirement and treatment
TRIAGE
TOP
PRIORITY
2ND
DEAD
PRIORITY
WALKING
WOUNDED
EVACUATIONS :
Casualty Evacuation should be dynamic, because mode of transport,
evacuation priority and final destination will be influenced by triage and
treatment decisions.
• Extricate, assist and stabilize injured people
• Provide ambulances, medical staff, equipment and resources
• Establish effective triage points and systems
• Provide a central point for medical resources
• Provide communication facilities
• Alert receiving hospitals
• Provide transport for medical teams and their equipment
• Arrange transport for injured people
• Make a flood kit: medications, warm clothing, sealed food,
blankets, matches, candles, flashlights, portable radio, spare
batteries, rubber gloves, personal documents etc.