Adoption of January 31, 2020, Mass Casualty Incident Plan as Annex to Comprehensive Emergency Management Plan BEFORE THE BOARD OF COUNTY COMMISSIONERS
LEWIS COUNTY, WASHINGTON
IN THE MATTER OF: RESOLUTION NO. 20-162
ADOPTION OF THE JANUARY 31, 2020, MASS
CASUALTY INCIDENT PLAN AS AN ANNEX TO THE
LEWIS COUNTY COMPREHENSIVE EMERGENCY
MANAGEMENT PLAN
WHEREAS, Lewis County maintains a Comprehensive Emergency Management Plan
(CEMP) as a set of guidelines for coordinating countywide disaster mitigation,
preparedness, response, and recovery in compliance with RCW 38.52.070; and
WHEREAS, the Lewis County Division of Emergency Management has completed the
Mass Causality Incident (MCI) Plan dated January 31, 2020, as an Annex to the
Emergency Support Function of Public Health and Medical Services within the CEMP;
and
WHEREAS, the MCI Plan has been presented for review to the Board of County
Commissioners as a set of guidelines for responders to treat and save the greatest
number of patients possible under extreme conditions; and
WHEREAS, the Board has reviewed the MCI Plan, and it appears to be in the best
interest of the public to adopt the plan for Lewis County.
NOW THEREFORE BE IT RESOLVED the January 31, 2020, Mass Casualty Incident
Plan is hereby adopted and approved as an Annex to the Lewis County Comprehensive
Emergency Management Plan by the Board of County Commissioners, Lewis County,
Washington.
DONE IN OPEN SESSION this 18th day of May, 2020.
APPROVED AS TO FORM: BOARD OF COUNTY COMMISSIONERS
Jonathan Meyer, Prosecuting Attorney LEWIS COUNTY, WASHINGTON
Amber Smith Gary Stamper
By: Amber Smith, Gary Stamper, Chair
Deputy Prosecuting Attorney
ATTEST: •'�°"-�Tr,lv,7•
OF' Edna J J . Fund
•pRD .y�
'"e;Edna J. Fund, Vice Chair
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Rieva Lester '•qs� Robert C. Jackson
Rieva Lester, Robert C. Jackson, Commissioner
Clerk of the Lewis County Board of County
Commissioners
Acknowledgements
The Lewis County Emergency Medical Services(EMS) providers that collaborated in the development of
this plan include the following:
Medical Program Director LC FD#18-Glenoma
LC FD#1-Onalaska Cowlitz-Lewis FD#20-
LC FD#2-Toledo Riverside Fire Authority
LC FD#3-Mossyrock Chehalis Fire Department
LC FD#4-Morton American Medical Response
LC FD#5-Napavine Lewis County Medic One
LC FD#6-Chehalis Providence Centralia Hospital
LC FD#8-Salkum Morton General Hospital
LC FD#9-Mineral Elected Official
LC FD#10-Packwood Consumer
LC FD#11-PeEll Law Enforcement
LC FD#13-Curtis Government Agency
LC FD#14-Randle Physician
LC FD#15-Winlock Prevention Specialist
LC FD#16-Doty Airlift NW
LC FD fit 17-Ashford Life Flight Network
Promulgation
Lewis Co mergency anagement Deputy Director:
Andy Ca well • Date
Lewi n Medical Program Director:
6//t
Dr. Peter McCahill Date
Lewis Co - Fire Chiefs Association:
gg Peterson, Chair Date
Lewis County Emergency Medical Services (EMS) Council:
Doug Fosburg, Chair Date
Lewis Co my Board of County Commissioners:
Gary Stamper, Cha Dat
;.r
Lewis County
,��--� :f � Y : ,: Fire Services & EMS Council
LEWIS COUNTY
Mass Casualty Incident
( MCI ) Plan
January 31 , 2020
Reformatted: 2001; Revised: July, 2006, 2019
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Annex to:
Lewis County CEMP -
ESF # 8 Health, Medical and Mortuary Services
Prepared by: Division of Emergency Management
351 NW North Street, Chehalis, WA 98532
Created: 2001 Final Revised January,2020 Page#i
Lewis County Lewis County CEMP-ESF#8 Health,Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
Lewis County Mass Casualty Incident
(MCI) Plan
Annex to:
Lewis County CEMP — ESF # 8 Health, Medical and Mortuary Services
Suggested Operating Procedures
For Responding EMS Units to Mass Casualty Incident
Using SALT Triage
January 31, 2020
(Replaces: Reformatted: 2001, Revised: July 2006)
Level I Up to 6 patients Medically oriented incident that exceeds the
capabilities of the initial responding agencies.
Level II 7-12 patients Medically oriented incident possibly requiring
the activation of the Emergency Operations
Center. May require out-of-county resources
and the distribution of patients to multiple
medical facilities.
Level III 13 or more patients EOC personnel will be notified. Local EMS
agencies and medical facilities may require out-
of-county assistance.
Created: 2001 Final Revised January 31,2020 Page# i
Lewis County Lewis County CEMP-ESF#8 Health,Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
Acknowledgements
The Lewis County Emergency Medical Services (EMS)providers that collaborated in the development of
this plan include the following:
Medical Program Director LC FD#18-GIenonta
LC FD ft 1-Onalaska CowlitI•Lewis FD 4 20-
LC FD if 2-Toledo Riverside Fire Authority
LC FD fr 3•Mossyrock Chehalis Fire Department
LC FP It 4-Morton American Medical Response
LC FD N 5-Napavine Lewis County Medic One
LC FD tr 6-Chehalis Providence Centralia Hospital
LC FD N 8-Salkum Morton General Hospital
LC FD N 9-Mineral Elected Official
LC FD k 10-Packwood Consumer
LC FD N 11-PeEtl Law Enforcement
LC FD N 13-Curtis Government Agency
LC FO N 14•Randle Physician
LC FD N 15-Winlock Prevention Specialist
LC FDN 16-Doty AirhftNW
LC FD N 17-Ashford Life Flight Network
Promulgation
Lewis Coynty Emergency Management Deputy Director.
Andy C `a`l'6well j Date
Lewi t Medical Program Director:
f)ti 6/i?
Dr. Peter McCahill Date
Lewis Co Fire Chiefs Association:
• 2-6 -2d1'
Gregg Peterson. Chair Date
Lewis County Emergency Medical Services (EMS) Council.
.,..i4€&-.".......''L-: ,i— -.494P/, ,
Doug Fosburg, Chair Date
Lewis County Board of County Commissioners:
Gary Stamper, Chair Date
Created: 2001 Final Revised January 31,2020 Page# ii
Lewis County Lewis County CEMP-ESF 48 Health, Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
Plan Distribution List
CD Plan Agency Staff Title Date
Issued
BOCC Clerk of the Board
Risk Management Administrator
X E911 Director
X LC DEM Manager
X Chehalis EM Liaison
X Mossyrock EM Liaison
X Morton EM Liaison
X Napavine EM Liaison
X Pe Ell EM Liaison
X Toledo EM Liaison
X Vader EM Liaison
X Winlock EM Liaison
X LC Coroner Coroner
X LC Sheriff Sheriff
X American Red Cross Coordinator
X AMR Supervisor
X Salvation Army Administrator
X Providence Hospital Asst.Admin. Patient
X Morton Hospital Director
X ; Lewis County Medic One Supervisor
X Riverside Fire Authority#1 (Centralia) Chief
X Riverside Fire Authority#2(Harrison) Chief
X Chehalis Fire Department Chief
X Lewis County FD# 1 -Onalaska Chief
X Lewis County FD#2-Toledo Chief
X Lewis County FD#3 -Mossyrock Chief
X Lewis County FD#4-Morton Chief
X Lewis County FD#5 -Napavine Chief
X Lewis County FD#6-Chehalis Chief
X Lewis County FD#8-Salkum Chief
X Lewis County FD#9-Mineral Chief
X Lewis County FD# 10-Packwood Chief
X Lewis County FD# 11 -Pe Ell Chief
X Lewis County FD# 13 -Curtis Chief
X Lewis County FD# 14 -Randle Chief
X Lewis County FD# 15 -Winlock Chief
X Lewis County FD# 16-Doty Chief
X Lewis County FD# 17-Ashford Chief
X Lewis County FD# 18-Glenoma Chief
X Lewis County FD#20-Cowlitz/Lewis Chief
X Washington State Patrol Sergeant
X Chehalis Police Department Chief
X Morton Police Department Chief
X Mossyrock Police Department Chief
X Napavine Police Department Officer in Charge
X Pe Ell Marshal's Office Marshal
X Toledo Police Department Chief
X Vader Police Department Chief
X Winlock Police Department Chief
X EMS Medical Program Director
X Airlift NW EMS Representative
X Life Flight Network EMS Representative
X Washington State EMD Plans Division Manager
Created: 2001 Final Revised January 31,2020 Page 4 iii
Lewis County Lewis County CEMP- ESF#8 Health,Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
Record of Changes
NOTICE TO PLAN HOLDERS: In order to maintain a current Lewis County Mass Casualty
(MCI) Plan, changes will be issued periodically by the Lewis County Division of Emergency
Management. Please make those changes upon receipt,and record them on this page. If a
previous change number shows no entry,you may not have an up-to-date version of this
plan.
CHANGE DATE LOCATION/PAGES(S) CHANGED INITIALS
1 July, Revision of 2001 plan, complete replacement
Feb,
2 2020 Complete replacement,based on SALT
Created: 2001 Final Revised January 31,2020 Page# iv
Lewis County Lewis County CEMP-ESF#8 Health, Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
Lewis County Mass Casualty Incident Plan
(MCI)
TABLE OF CONTENTS
Acknowledgements ii
Promulgation ... . ii
Distribution List iii
Record of Changes iv
Table of Contents v -vii
I. Lewis County Triage System Philosophy 1
II. Executive Summary and Planning Assumptions 1 —3
SALT/ MCI Overview 4
III. Definitions & Acronyms 5- 9
A. Definitions 5 -10
B. Acronyms 10 - 11
IV. MCI Concept of Operations 11 - 22
A. Disaster Medical Coordination Center DMCC 11 - 12
B. Lewis County 911 Communications Center 12
C. Lewis County MCI Run Card 13
D. Fire Coordinator Contact Process 14
E. First Arriving Units 14
F. Incident Commander 14
G. Next Arriving Units 15
H. Size Up 15
I. Initial Actions & Reports 15 - 16
J. Removal of Patients 16
K. Recon Group, if needed 16 - 17
L. Progress Reports 17
M. Tactical Benchmarks 17
N. Off-site Communications 18
O. Scene Security 18 - 19
1. Hazard Zones (Hazmat) 18
2. Crowd Control 18
3. Bystanders 18 - 19
P. Staging 19
Q. Transportation Corridor 19 - 20
R. Triage Area 20
S. Treatment Area 20- 21
1. Field Treatment Site 21
T. GREEN Area 21 - 22
U. Communications 22—23
Created: 2001 Final Revised January 31,2020 Page# v
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Mass Casualty Incident Plan(MCI)
V. Patient Disposition 23 -28
A. Rescue 23 - 24
1. Removal 24
2. Extrication 24
B. Decontamination 25
C. Patient Sheltering 26
D. Patient Care —Transport Coordination —Medical Control & DMCC 26 -27
E. Patient Count and Tracking 27
F. Documentation 27 - 28
1. Medical Incident Report Forms
(MIRFs) 27
2. Unique Number with Transporting Agency 27- 28
G. Transportation 28
VI. Medical Branch -Overview 28 -31
A. Medical Branch (Group) 28 - 29
1. Treatment 29 - 30
2. Transportation 30
B. Rescue 31
Field Checklists
Incident Commander Field Checklist (2 pages) 32 - 33
Medical Branch Director Field Checklist 34
Safety Officer Field Checklist 35
Staging Manager Field Checklist 36
Staging Manger Field Log Sheet 37
Transport Group Supervisor Field Checklist 38
Transport Group Supervisor Field Log Sheet 39
GREEN Area Manager Field Checklist 40
GREEN Area Manager Field Checklist Log Sheet 41
Treatment Group Supervisor Field Checklist 42
Treatment Group Supervisor Field Log Sheet 43
Treatment Group Supervisor— Field Patent Release Form 44
Triage Group Supervisor Field Checklist 45
Communications Field Checklist 46
Triage & Tagging Process Help Sheet 47
Officer Responsibilities Field Reference 48
Clipboard Distribution Chart 49
Recommended Contents for Mass Casualty Incident (MCI) Bags 50
Created: 2001 Final Revised January 31,2020 Page#vi
Lewis County Lewis County CEMP-ESF#8 Health,Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
ATTACHMENT SECTION
Attachment A— MCI Run Cards 51
Attachment B —Options for Consideration in Agency Run Cards 52
1. Notifications 52
2. Additional Resources Notifications 52
Attachment C —Area Hospital Contacts and Directions (2 Pages) 53 -54
Attachment D —SALT Triage System Overview (MCI) 55 -59
Attachment E — ICS Chart—FULL 60
Attachment F —Mass Casualty Triage Diagram —SALT 61
Attachment G —Tagging Chart 62
Attachment H —Triage Tag 63
Attachment I — Primary Duties—Authorities Chart 64
Attachment J — MCI Triage Bag Inventory Recommendation 65 - 66
Created: 2001 Final Revised January 31,2020 Page#vii
Lewis County Lewis County CEMP-ESF#8 Health, Medical, and Mortuary Services
Mass Casualty Incident Plan(MCI)
I. LEWIS COUNTY TRIAGE SYSTEM PHILOSOPHY
The intent (philosophy) of this plan is to treat and save the greatest number of patients
possible under extreme conditions. Responders must remember that this is not a
routine response; otherwise you would not be using the MCI Plan and triage system.
Key to the success of a multi casualty response is the standardization of response
procedures for sorting, treating and transporting patients. Responders must learn to
recognize when circumstances are present that warrant a shift from normal response
procedures to the MCI procedures. Dependent upon the size and complexity of the MCI,
the Incident Commander will be tasked with determining what elements of the plan need
to be employed to bring the response to a satisfactory conclusion. Incident
Commanders must remain situationally aware to stay ahead of the incident
development curve while avoiding the pit fall of building too large an ICS structure that
exhausts precious resources.
When responders are overwhelmed in an MCI, in-depth patient care does not typically
occur until the patient arrives at a treatment area or they are placed inside a transport
unit. Treating patients where they are found, like in a routine response, slows the
system down for the other patients. When dealing with large numbers of victims, it is
very likely that the standard of medical care will be less than what would normally be
expected so adjustments in expectations must be made to match the situation.
Out of necessity, well intentioned civilians and the walking wounded may be used to
assist with patient care. Other responders including Law Enforcement and Public
Works with little formal medical training are encouraged to learn how they can fill a role
in the MCI disaster response.
Proficiency comes with repeated exercise of these plans and procedures; therefore,
response agencies expecting to use this system are encouraged to regularly review and
train in its use and whenever possible involve their partner agencies and responders.
II. EXECUTIVE SUMMARY and PLANNING ASSUMPTIONS
When responders encounter overwhelming numbers of patients all at once they must
quickly recognize that their treatment decisions for individual patients must be adjusted
to the benefit of the many. While we always strive to provide the best medical care, we
must recognize that certain circumstances will warrant changes in the standard of
medical care. This predictably will occur when there are more patients in need than
there are response resources on a scene.
The "Golden Hour" of emergency medicine is a well-accepted concept which states that
patients of trauma need to have surgery within one hour of the insult or injury to
Created: 2001 Final Revised January 31,2020 Page# 1
Lewis County Lewis County CEMP-ESF#8 Health,Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
maximize survivability. In today's world we must recognize that the same principals will
apply to non-trauma, medical emergencies involving mass respiratory distress and
decontamination cases. Therefore, in all MCI's regardless of the cause, rapid transport
to definitive care centers is the best way to increase survivability for as many patients as
possible.
This plan seeks to reduce the number of unnecessary actions and to streamline efforts
to reduce the time it takes to remove all patients from the scene. Important features of
the plan include:
• Use of the SALT triage system to quickly sort patients.
• Use of color-coded flagging tape and triage tags to classify patients.
• Limiting initial care during triage to essential lifesaving intervention and
expanding care as time, equipment, and resources allow.
• Providing scalable instructions for first arriving units depending on the level of the
MCI encountered.
• Encouraging the establishment of geographic divisions at larger incidents to
speed triage and removal;
• Scaling patient tracking and documentation with the size and complexity of an
incident.
This plan differs from previous Lewis County MCI plans in several ways.
• A transportation corridor should now be established and secured early in the
incident to facilitate rapid patient transport.
• The use of flagger tape and triage tags remains the preferred triage tool.
Patients will be "Global Sorted" into three categories where found. Walking
wounded patients, GREEN (minimal), will be removed from the impact area to be
assessed last. Patients with "Purposeful Movement" will be assessed second,
and those "Still/Obvious Life Threat" will be assessed first.
In the "Initial" triage, the "Still/Obvious Life Threat" patients will be assessed
(using flagger tape) either RED (Immediate)/YELLOW (Delayed), GREY
(Expectant) or BLACK (Dead).
RED (Immediate) and YELLOW (Delayed) patients will be moved to treatment
areas as quickly as possible by members of the Removal Team and subsequent
arriving responders. During the assessment, responders may perform the four
Life Saving Interventions (LSIs) as needed. Each victim must be triaged as
quickly as possible.
Once this has been accomplished, Removal Teams should return to locate the
GREY patients for movement to the CCP or appropriate Treatment area.
BLACK/Dead patients will not be moved, unless it is necessary to access live
patients or for responder safety reasons.
Created: 2001 Final Revised January 31,2020 Page#2
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Mass Casualty Incident Plan(MCI)
• Patients marked for decontamination that are not at the decontamination area
may now be moved to the decontamination area and then triaged and taken to
the corresponding treatment area once decontamination is complete.
Extrication priorities will be dynamic based on severity, access, and resources. It may
be prudent to remove some YELLOW (Delayed) patients before RED (Immediate)
patients. Situations such as extended extrication times, YELLOW (Delayed) patients
blocking the access of RED (Immediate) patients, physical barriers, or a shortage of
staffing may necessitate altering extrication priorities.
The Casualty Collection Point (CCP) to the treatment area may be used to upgrade or
down grade triaged patients being transported to the RED/YELLOW treatment areas.
The color-coded flagging tape should be left in place when the triage tag is applied to
the extremity. When the CCP is no longer staffed, the triage tags may be applied in the
Treatment area, or for sure at the Transport area. If a patient is being directly
transported without going to a Treatment area, a tag will be placed on the patient by the
Transport Group Supervisor prior to transport.
MCI's can be as small as a few patients or as large as hundreds and our responders
must be trained to recognize the difference. Flexibility is integrated into this plan to
accommodate all sizes of incidents. The extent of which the MCI plan, tools and
procedures are used can and will be driven by the size of the MCI. Use as much of the
plan as is needed to handle the incident and to stay ahead of the incident curve. Over
commitment to the plan could place limited response resources in assignments that are
unnecessary. Issues related to a fractured or geographically challenging incident are
also addressed within the plan. Federal and regional disaster levels were used to help
determine MCI incident sizes and the appropriate procedures for each level.
This plan is intended to be integrated with local, state, and federal governmental
agencies and interagency cooperation shall be in accordance with the National Incident
Management System (NIMS). In recognition of known resource limitations and the
ingenuity of our responder's, dependent upon the size and complexity of an MCI,
multiple ICS positions may be assigned to a single individual or not at all. MCI positions
are named within the plan, but radio designators are left to be determined at the
incident.
Created: 2001 Final Revised January 31,2020 Page#3
Lewis County Lewis County CEMP-ESF#8 Health,Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
SALT/ MCI OVERVIEW
1. Tagging and Initial Triage:
• Move as quickly as possible, but don't neglect the processes (triage, allocation of patients to
hospitals, command etc.).
• Perform Global Sort and separate GREEN (Minimal) patients and move them out of the
impact area. Appoint a GREEN/ INC Area Manager, if necessary.
• Begin individual assessment with patients that are RED (Immediate) "Still, obvious life
threat".
• Initial triage tagging (on the right wrist or uninjured arm) is done with flagger ribbons, placing
a small piece in your pocket for later count matching. Perform LSI as necessary:
o Control major hemorrhage
o Open airway(if child 2 rescue breaths)
c Chest decompression
• Indicate contaminated patients with ORANGE polka dot ribbons. (Always notify hospital of
contaminated patients and— mark "DECON" has been performed on the Triage Tag placed
after DECON is completed).
• Triage personnel should return to the CCP to reconcile their ribbon pieces with the Triage
Group Manager. This number will be reported to the Medical Branch Director to determine
the number of RED (Immediate), YELLOW (Delayed), and BLACK (Dead) patients. Triage
personnel will then be available for reassignment duties such as removal or treatment teams.
• Depending on the incident size or the need, some GREENs (Minimal) and "Involved, Non-
Casualties" (INC) could be assigned to stay with patients until EMS personnel are available.
2. Patient Removal and Reconnaissance Teams:
• If the incident is large enough, assign a team to conduct reconnaissance and report to the
IC.
• Assemble patient removal teams from subsequent arriving units and personnel finishing
triage.
• Setup the Casualty Collection Point (CCP) near the entrance to the RED and YELLOW
Treatment Areas. Assign a responder to the CCP to Perform Secondary triage and apply
triage tags- care should be taken to not slow down patient distribution to treatment
areas at the CCP.
• Patient Removal Teams should remove RED (Immediate) patients first, then YELLOW
(Delayed) patients. Once both RED (Immediate) and YELLOW(Delayed) patients have been
removed, the Removal Teams should re-triage the GREY (Expectant) patients or transfer
contaminated patients to Decon.
3. Treatment
• Set up treatment areas near the transportation corridor. Mark them with flagger tape: RED
(Immediate) and YELLOW(Delayed).
• The Treatment Group Manager will coordinate patient evacuation with the Transport Group
Manager.
• The Treatment Group Manager will report the number of patients no longer needing transport
to the Medical Branch Director.
• The Transport Group Manager will report the number of patients transported to the Medical
Branch Director.
Created: 2001 Final Revised January 31,2020 Page 4 4
Lewis County Lewis County CEMP-ESF 48 Health, Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
III. DEFINITIONS & ACRONYMS:
A. DEFINITIONS:
Term Definition
Alternative Care Facility (ACF) Location, preexisting or created, that serves to expand the
capacity of a hospital in order to accommodate or care for
patients when an incident overwhelms local hospital
capacity. In an MCI, patients will be triaged and
transported to the hospital not the ACF for definitive care.
ALS: Advanced Life Support Invasive emergency medical services requiring advanced
medical treatment skills as defined in chapter 18.71 RCW.
ALS/BLS Transport Corridor Designated parking area for patient transport vehicles.
Operators and attendants will not leave their vehicles.
Apparatus Level I Staging: Staging at incident address, a block away or otherwise in
the immediate area. (Primarily a short term action).
Apparatus Level II Staging: Staging away from incident, usually for larger events and
at a set location with other apparatus.
Base Station (Hospital) Hospital term for local Medical Control. See page 8.
Basic Life Support (BLS): ! Non-invasive emergency medical services requiring basic
medical treatment skills as defined in chapter 18.73 RCW.
Casualty Collection Point Also known as "Triage Funnel," or"Choke Point". An area
(CCP): designated by the Triage Group Supervisor that every
patient filters through prior to movement into the
Treatment area. The CCP is usually located at the
entrance to the Treatment area. All patients will receive a
triage tag at the CCP. .
Color Identifiers A color-coded identification system used to designate
(Flagging Ribbons/Triage medical priority of patients during a mass casualty incident.
Tags/Tarps): • RED (immediate)
• YELLOW (delayed)
• GREEN (minimal)
• GREY (expectant)
• BLACK (zebra stripe) (dead)
• ORANGE with polka dots (used in addition to the
above ribbons to indicate potential hazardous
material contamination)
Decon: To decontaminate a person or persons. Decontamination
resources: Joint Base Lewis McChord Fire and
Emergency Services has a 300-person Decon Trailer.
Regionally Decon resources are available on site at
Capital Medical Center, Providence St. Peters and
Centralia Hospitals.
Disaster Medical Control Center Disaster Medical Coordination Centers are designated
(DMCC): hospitals where trained medical personnel gather to help
coordinate patient movement during an incident that may
See Page 10 overwhelm the healthcare community. DMCCs are
Also SEE: Pages 26-27 responsible for supporting EMS and the healthcare
Created: 2001 Final Revised January 31,2020 Page#5
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Mass Casualty Incident Plan(MCI)
Term Definition
community by identifying available beds and placing
patients at the most appropriate facility, based on their
Also See: Medical Control (local) injuries or illness, as quickly as possible. For the purpose
of the plan, Providence St. Peter Hospital will be the
primary DMCC for Lewis County with Good Samaritan
Hospital as backup. (See pages 53 & 54 attachments for
Charge Nurse telephone numbers).
Emergency Medical Services Medical treatment and care which may be rendered at the
(EMS): scene of any medical emergency or while transporting any
patient in an ambulance to an appropriate medical control,
including ambulance transportation between medical
facilities.
Patient Removal Team Team that moves patients out of the impact area to the
casualty collection point (CCP) and then to the treatment
and transport areas.
Extrication The process of removing a patient from an entrapment.
Field Treatment Site (FTS) Area designated or created by emergency officials for the
congregation, triage, medical treatment, holding, and/or
evacuation of casualties following a multiple casualty
incident.
Field Triage The process of rapidly categorizing a large number of
patients according to their severity of injury in order to
prioritize their extrication and/or removal to the treatment
area. Various forms of triage are used to determine the
severity of a patient's injuries and condition. Lewis County
uses the following SALT system:
• Lewis County Mass Casualty Triage SALT:
Algorithm/System (Sort, Assess, Lifesaving
Interventions, Treatment/Transport).
Funnel Out-dated terminology, now called "Casualty Collection
Point (CCP), for the area all patients in a mass casualty
incident pass through to ensure patient count, triage
tagging, and entry into a Treatment Area to await transport
based upon their level of injury.
GREEN Area An area dedicated for congregation, treatment, and care of
patients with minimal injuries. Designated as a separate
area from Treatment due to the large number of potential
patients and the special considerations they may need
such as shelter, food and restroom facilities. Depending
on the type of incident they may also be considered
witness/suspects and require police presence.
GREEN Area Manager A functional IMS position designed to manage the
GREENs (Minimal) at an MCI. The GREEN Area
Manager is responsible for assuring patients in this area
are re-triaged to decrease the original numbers down to
just those needing medication attention and transmit that
number to Treatment Group Supervisor.
Created: 2001 Final Revised January 31,2020 Page#6
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Mass Casualty Incident Plan(MCI)
Term Definition
Initial Triage The SALT process of applying flagging ribbons to patients
at the scene of a mass casualty incident to rapidly classify
those injured and report preliminary patient counts to the
IC and hospitals and prepare for transport to hospitals.
Intermediate Life Support A person certified to provide mobile intravenous therapy
(ILS) and advanced airway procedures as defined in RCW
18.71.200.
Involved, Non-Casualty Involved, non-casualty (INC) are those from the incident
(INC) who are not in need of medical attention. It is important to
remove those not going to the hospital(s) from the patient
count in order to provide receiving agencies with a more
realistic number of patients that will be transported.
Levels of Life Support ALS-Advanced Life Support; BLS-Basic Life Support;
Intermediate Life Support.
Lewis County Comprised of Lewis County Sheriff's Office deputies and
Search & Rescue volunteers. By statute, administered by the Sheriff's
(LCSAR): Office. Teams include the following: ATV Team of
searchers with All Terrain Vehicles; Dog Team trained for
scent tracking; Rope Rescue Team, trained in low and
high angle rescues; and a Snow Mobile Team. Most
members are also trained in ground searches for people
as well as evidence searches. Activated by request
through the 911 Communications Center.
Lewis County The Lewis County Technical Rescue Team consists of
Technical Rescue Team Fire Service and Law Enforcement personnel. The team
(LC TRT): is trained and equipped for both water rescue (including
swift water) and rope rescue (both low and high angle
rescue). The TRT Team is activated via request through
the 911 Communications Center.
MCI Bags: There are two types of bags: the Command MCI bag and
the First Responder MCI Bag. The Command MCI Bag
contains ICS vests, materials for establishing a medical
branch, limited protective supplies, various check lists and
writing materials. The First Responder MCI Bag is limited
to a belt with the triage-system colored flagging tapes to
be used in Initial triage field tagging. See page 50 for MCI
Ba• contents list.
Mass Casualty Incident Any medically oriented incident that overwhelms the initial
(MCI) EMS response. An incident resulting from man-made or
natural causes with associated illness or injury to a large
number of people. The effect is that patient care cannot
be provided immediately to all and resources must be
managed. An MCI is categorized into three levels:
■ Level I involving Up to 6 patients:
o Medically oriented incident that exceed the
capabilities of the initial responding
agencies.
• Level II involving 7-12 patients:
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Term Definition
o Medically oriented incident possibly
requiring the activation of the Emergency
Operations Center. May require out-of-
county resources and the distribution of
patients to multiple medical facilities.
• Level III involving 13 or more patients:
EOC personnel will be notified. Local EMS
agencies and medical facilities may require out-of-
county assistance.
MCI Response Varied level of resources dispatched to an incident
dependent upon the nature of the incident, the number of
patients, and their severity of injury.
MCI Unit: A mobile unit, which contains large quantities of medical
supplies that can be dispatched to a scene of an MCI.
Medical Command Post Medical command functions are executed at this location.
The medical command post may be co-located or proximal
to the Incident Command Post.
Medical Control A term used in the local EMS community to identify the
base station hospital that can be used as a resource or to
See: Page 26 gain concurrence with the action plan. The Medical
Control can also provide the protocol to follow for patient
Also See: Disaster Medical care. East County uses Morton General Hospital as their
Control Center (DMCC) Medical Control and West County uses Providence
Centralia Hospital. NOTE: Hospital personnel continue to
refer to this as "Base Station" hospital.
Medical Direction Physician direction over pre-hospital activities. Also
includes written policies, procedures, and protocols for
pre-hospital emergency medical care and transportation.
Medical Program Director This position is certified by and appointed by the
(MPD) Washington State Department of Health, and operates
under the direction and protection of the state. In this role,
the MPD is responsible for the education, certification, and
quality assurance for the care provided by all emergency
medical services in Lewis County. Thus, all emergency
medical services personnel in Lewis County work under
his/her state license.
Medical Group/Branch Ensures that Triage, Removal, Treatment, Transportation,
GREEN Area, Medical Staging, and Morgue Team
functions are performed; establish positions as necessary
Medical Supply Area Medical supplies are cached at this location. The medical
supply area should be located proximal to the treatment
area to facilitate re-supply of the individual treatment
areas.
Off-Site Communications Radio, cell or data communications with contacts not at
the emergency scene or command post. Off-Site
Communications must be routed thorough the Incident
Commander, except transportation (through the Transport
Group Supervisor).
•
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Term Definition
Personal Protective Equipment Refers to protective clothing, helmets, goggles, or other
(PPE) garments or equipment designed to protect the wearer's
body from injury or infection. The hazards addressed by
protective equipment include physical, electrical, heat,
chemicals, biohazards, and airborne particulate matter.
Recon The act of gathering information to support the operation
or function being performed.
Rescue Group/Branch In larger or more complex incidents Rescue Branch will
oversee Groups/Teams for the removal and extrication of
patients.
Run Cards Pre-designated response plans filed with Communications.
SALT Lewis County Mass Casualty Triage Algorithm/System
(Sort, Assess, Lifesaving Interventions,
Treatment/Transport)
Secondary Triage A patient evaluation that occurs following the initial patient
assessment and sorting. This activity may occur in the
Casualty Collection Point (CCP), in the Treatment Areas
or during the transportation phase.
Size-up The initial evaluation phase of the emergency situation, to
include description of what is seen, resources needed,
initial actions, and safety considerations. The size-up shall
be reported by the first arriving unit or Incident
Commander and updated as need throughout the
situation.
Staging Area Locations where incident personnel and equipment are
assigned on an immediately available status. There are
two "Staging Levels" as follows:
Level I Staging:
Following the arrival of the first EMS/FIRE unit(s)—
initial units will stage in their direction of travel,
uncommitted, approximately one (1) block from the
scene until assigned by Command.
Level II Staging:
Level II Staging is utilized for large events when
Command desires to maintain a reserve of resources
on-scene, and when the need to centralize resources
is required. Level II Staging places all reserve
resources in a central location and automatically
requires the implementation of a Staging Manager.
Technical Rescue Team A Lewis County Multi-Disciplinary Technical Rescue
Team.
Transport Area All patients are moved to this designated area following
treatment to be loaded and transported to a medical
facility.
Treatment Area The designated area for the collection and treatment of
patients. The same color flagging tape or flags that are
found on the triage tags identify the treatment area.
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Term Definition
• RED (Immediate): an area where patients require
immediate assistance
• YELLOW (Delayed): an area where patient
injuries are serious (delayed) but not immediately
life-threatening
• GREEN (Minimal): an area where patients with
minimal injuries are kept.
Triage The sorting of patients into categories based upon their
need for treatment and probability of survival.
Triage Tag A tag that is affixed to each patient's extremity before
entering the treatment area that is color-coded to indicate
the patients triage level. The tag contains an area for basic
patient information and unique identifying numbers for
patient tracking purposes.
Secondary Triage A patient evaluation that occurs following the initial patient
sorting and assessment. This activity may occur in the
Casualty Collection Point (CCP), in the Treatment Area or
during the transportation phase.
Unified Command Unified Command is a unified team effort which allows all
agencies with jurisdictional responsibility for the incident,
either geographical or functional, to manage an incident by
establishing a common set of incident objectives and
strategies.
Unique Identifier Number Number preprinted on a band, tag (METTAG®) or bracelet
to assist in tracking patient throughout the incident from
initial entry to final disposition.
Zones Operating zones that define areas of an incident and
(Hot, Warm, Cold, Exclusion) provide for a safe working area for responders. These
Zones are used in response to Fire/EMS Response to
Hazardous Materials incidents or Large— Scale Violent
Incidents involving threats or acts of violence in
cooperation and coordination with responding Law
Enforcement Agencies found in the Appendixes.
B. ACRONYMS:
Acronyms Definition
ACF Alternative Care Facility
ALS Advanced Life Support
BLS Basic Life Support
CAN Conditions, Actions and Needs Report
CCP Casualty Collection Point
DMCC Disaster Medical Control Center See pages: 11, 26-27
EMS Emergency Medical Services
FTS Field Treatment Site (page 20)
GN GREEN (Minimal)
GY GREY (Expectant)
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HM Hazard Materials
ILS Intermediate Life Support
LC SAR Lewis County Search & Rescue
LC TRT Lewis County Technical Rescue Team
MCI Mass Casualty Incident
MIRFs Medical Incident Report Forms
MPD Medical Program Director
MSO Medical Services Officer
PPE Personal Protective Equipment
R RED (Immediate)
RPM Respirations, Pulse, Mentation
SALT Sort, Assess, Lifesaving Interventions, Treatment/Transport
SORT Special Operations Rescue Team
START Simple Triage and Rapid Treatment
Y 1 YELLOW (Delayed)
IV. MCI CONCEPT OF OPERATIONS
A. Disaster Medical Coordination Center DMCC
(Also See Pages 26-27 for Medical Control duties / processes.)
A DMCC is activated following an incident that may overwhelm the healthcare
system such as a Mass Casualty Incident (MCI) or hospital evacuation. An
activation request typically comes from Fire/EMS at the scene. A DMCC is
operated by trained emergency department staff that may consist of doctors,
nurses, technicians, administrative personnel and/or EMS partners.
DMCCs are task with:
• Gathering information from the field
• Making initial notification to area hospitals; requesting bed availability and
ability to receive patients
• Coordination or assistance with patient placement with hospitals,
Fire/EMS and other DMCCs
When gathering information from the field, DMCCs seek five key points of
information:
1. Location of incident 2. Number of patients (adults & pediatrics)
3. Types of injuries 4. Mechanism of injury
5. Any contamination or exposure concerns
In large events (greater than 10 patients), a DMCC will notify its partners to assist
with other support needs such as family reunification, and/or any resource
requests. Partners include: other healthcare facilities, the Northwest Healthcare
Response Network, Department of Health, local and/or county public health, city
and/or county emergency management. Incidents near county lines require
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notification to neighboring regional DMCCs to potentially assist with patient
placement.
The DMCC for Lewis County is Providence St. Peter Hospital, Olympia (West
District).
B. Lewis County 911 Communications Center
Lewis County 911 Communications Center (911 Communications) is the
answering point and dispatch center for all law enforcement, fire services, and
emergency medical services in Lewis County. The 911 Communications Center
has put in place a matrix and/or a run card to activate an MCI and dispatch the
proper resources to the scene of the incident. All requests for MCI upgrades and
Mutual Aid are coordinated through 911 Communications Center. Any EMS, Fire
Service, Law Enforcement or other qualified individual en route to or on the
scene of the emergency is authorized to declare the Level of MCI and request
activation of the Emergency Operations Center (EOC) if necessary. If the
dispatcher calls for one, they will notify the IC to let them know why. Following
are the patient numbers/responders needed guidelines for calling an MCI:
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C. MCI Run Card
Lewis County MCI Run Card
MCI Resources Staffing Guidelines
*MCI Level # Patients Responders Chiefs Comments
Needed Needed
Level I Up to 6 13 1 3—2 Person
Engine Co.
2—2 Person
Medic Units
3—2 Person
*Aid Units
*Aid Units staffed
with 1 Driver and
FF EMT
Level II 7-12 26 2 6—2 Person
Engine Co.
4—2 Person
Medic Units,
6—2 Person
*Aid Units
*Aid Units staffed
with 1 Driver and
FF EMT
Level III 13 or More 30+ 3 9—2 Person
Engine Co.
6—2 Person
Medic Units,
All available
*Aid Units
*Aid Units staffed
with 1 Driver and
FF EMT
Note: Staffing of the Aid Units would be by 1 Driver and 1 EMT pulled from the Engine
Personnel for Transport.
*Level I—Consider notifying AMR-Seattle; Level II — Notify AMR—Seattle
For all MCI activations, the Lewis County Communications Center shall notify the Lewis County
Fire Mobilization Coordinators (by Spillman Page).
If you are the Incident Commander, Fire Chief, or designee; request 911
Communications to notify the County Fire Coordinator of the incident.
Coordinator 1ST Alternate 2nd Alternate
Jeff Jaques Doug Fosburg Kevin VanEngdom
Fire Chief, Lewis Co FD 14 Fire Chief, Lewis CO FD 3 Lewis Co FD 5
County Fire Coordinator Alternate County Fire Coordinator Alternate County Fire Coordinator
(360) 508-0133 (360)880-3262 (360) 304-0768
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D. Fire Coordinator Contact Process
1. All resources requests for either County, Regional, State or Federal response
will be activated through the County Fire Coordinator.
2. The IC or Fire Chief contacts the County Coordinator via 911
Communications Center and requests activation of LC Mobilization Plan and
leaves a contact number.
It is highly recommended that, all agencies utilize the alarm levels in their
response plans and that at a second alarm, 911 Communications Center is
directed to notify the County Fire Coordinators, via "Spillman Paging," of the
incident. The 911 Communications Center will strive to notify the County Fire
Coordinator of any second alarm incident or any level MCI.
3. This notification will give the County Fire Coordinator an opportunity to
contact county agencies to see what staffed apparatus would be available for
response and/or move up to support the incident. It is advised that units be
selected to ensure that no large holes in coverage are left in any area of the
county.
E. First Arriving Units
The first responding unit will establish the Incident Commander, who will
accomplish the Incident Commander Help Sheet.
Upon arrival the initial unit officer will broadcast the initial report over the radio,
including the following in the report:
• Unit identifier
• The location, or corrected location
• Initial basic impression
• Initiate command with name
• Initiate command post location
As with any fire or rescue response, the initial unit is also responsible to give an
initial CAN (Conditions, Actions and Needs) report. These reports give 911
Communications Center and all incoming units a "picture" of what the initial unit
is seeing.
F. Incident Commander
If no Incident Commander is at the scene, the most qualified responder/officer
will assume Incident command until relieved. The Incident Commander shall be
responsible for the management of operations at the scene of the incident. The
Incident Commander may appoint an aide to assist with the task list to prevent
being overwhelmed.
I
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G. Next Arriving Units
Initial units will stage in their direction of travel, approximately one block from the
sign as directed by Command. In large incidents, additional responders will
proceed directly to the Level II Staging Area and check in with the Staging
Manager, unless directed to go to the scene. EMS personnel shall not leave the
staging area or transport zone without the permission of the Staging Manager or
Transport Group Supervisor.
NOTE: When responding to mass casualty incidents, responders shall keep
radio communications to a minimum on 911 Communications Center and
operations frequencies.
H. Size Up
As soon as possible, the Incident Commander will give a size-up report to the
Lewis County 911 Communications Center including:
1. Initiate the Command Designator and Command Post location
2. Designate Command frequency.
3. Description of the scene.
4. Number of patients:
5. Determine and direct the initial actions
6. Identify dispatch and operations frequencies to be used.
7. Designate the Transportation Corridor
8. Determine Level I and Level II staging areas.
9. Identify safety concerns.
As the incident proceeds, the IC will provide additional reports to the Lewis
County 911 Communications Center that will include the following:
1. Briefly describe an impression of the scene, including known hazards
2. Cause of the incident if known
3. Updates of the initial patient count
4. Initial actions and assignments
5. Determine and request any needed additional resources
I Initial Actions & Reports
The initial actions of the first arriving unit officer are critical to ensuring a
successful outcome. Depending on the size and complexity of the incident, the
initial unit may be able to fill many roles, or handle only a few assignments.
Critical Initial Unit Actions:
• Initial and size-up reports
• Establish and secure the transportation corridor
• Give assignments to incoming units (to include staging)
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Assignments to be handled by initial units:
• Begin Recon and Triage according to SALT procedures, as soon as
possible
• Perform a risk assessment and begin reducing the immediate danger to
patients, rescuers, or the public
• Designate a GREEN area and have all GREENs moved to that location
• Begin removal and treatment of patients as able
J. Removal of Patients
To be completed with emphasis on the following:
• First move RED (Immediate)-YELLOW (Delayed)
• GREENS (Minimal) —designate responder or GREEN (Minimal) to move
those able to a GREEN Area. Those going to the GREEN area are tagged
there.
• BLACK (Dead) stays where found
• GREY (Expectant) moved only after REDS (Immediate)/YELLOWS
(Delayed), if then
• Recon group and next arriving units help staff triage and removal teams
K. Recon Group, if needed
Depending on the size and complexity of the incident, a rapid reconnaissance of
the entire MCI site is essential to establish the scope and scale of the incident.
This may require a Recon Group consisting of multiple teams. The overriding
factor should be speed as opposed to specificity to ensure that the information
reaches the IC in a timely manner.
Recon should identify the following:
• Equipment needs
• Levels of PPE that will be required. (Note: Differing levels may be
required in different areas.)
• Estimate the number and condition of patients involved so that the
appropriate MCI response can be initiated through the IC
• Hazards
• Cause of the incident
• Any physical barriers preventing easy access between areas in the hazard
zone. If so, identify areas for multiple treatment and transportation areas
Recon teams should consider using an elevated platform to help form an overall
picture of the incident. This can include nearby buildings, aerial ladders, or
geographical highpoints. Helicopters may also be considered for Recon. If
MEDIVAC is being considered, Recon should evaluate any restrictions to landing
zone locations. Additionally, consider the possibility of implementing temporary
flight restrictions to news helicopters and other aircraft that may be operating
over the emergency scene. Recon reports directly to Operations (example next
page).
Created: 2001 Final Revised January 31,2020 Page if 16
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L. Progress Reports
Progress reports are required any time there is a change of the Incident
Commander and every 10 minutes.
The progress reports should include the following:
• Current estimated total patient count
• Update transportation corridor location as needed
• Numbers of RED (Immediate), YELLOW (Delayed), GREEN (Minimal),
and BLACK (Dead) patients when known
• Number of patients remaining to be removed
• Number of patients transported
• Progress of hazard mitigation
• Additional resources needed
M. Tactical Benchmarks
• All patients removed
• All RED (Immediate) and YELLOW (Delayed) patients transported
• All patients transported/clear of incident
• Any tactical benchmarks appropriate for hazard mitigation
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N. Off-site Communications
Off-site communications is defined as radio, cell or data communications with
contacts not at the emergency scene or command post. Off-Site
Communications must be routed through the Incident Commander, except
transportation (through the Transport Group Supervisor).
O. Scene Security
Scene security will be the responsibility of law enforcement, but Fire and EMS
personnel must stay alert to potential security issues including but not limited to:
• Secondary Devices
• Crowd control
• Traffic control
The situation may cause the delay of certain operations while law enforcement
clears the hazard area. Clear and consistent communication between Fire,
EMS, and Law Enforcement is critical to maintain security.
1. Hazard Zones (Hazmat)
Initial units need to clearly establish appropriate operational zones for the
incident. The zones must be clearly communicated to all on-scene
responders, including law enforcement. The hazard zone locations should
be broadcast over the all frequencies to inform all incoming units even if
coordination with law enforcement is handled face to face. Fire scene
tape should be used to clearly mark the exclusion zone (outer perimeter)
of an incident when possible. Larger sites may need to be secured by law
enforcement. See Hazardous Materials Appendix I for a list of the
established zones
2. Crowd Control
Care must be given to crowd control, but total exclusion of bystanders
may not be possible or practical as patients of the incident may have been
separated from friends, or family members, and will experience even
greater anxiety when dealing with the unknown.
If at all possible, reunification may help in this effort as needed or
appropriate. If exclusion is impossible or impractical, attempts should be
made to moderate the risk to both bystanders and rescue personnel with
the help of law enforcement.
3. Bystanders
MCI incidents may draw bystanders with varying levels of skill and
expertise. These bystanders can be helpful if utilized in a safe and
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organized way, but if they are ignored, they can hinder efforts and
increase the risk to both themselves and personnel.
It is recommended that bystanders may be assigned appropriate tasks
according to their self-claimed knowledge, skills, and abilities as long as
the risks associated with these tasks are minimized. It may be difficult or
impossible to verify the claims of expertise by bystanders and care should
be taken to place them in supervised roles. It is important to remove or
replace bystanders as resources become available.
P. Staging
Two separate staging areas may be considered based on the size and
complexity of the MCI. Level I staging area should be for personnel or
equipment immediately available for use. A location providing a maximum of
possible tactical options regarding access, direction of travel, water supply, etc.,
should be selected. At no time should units self-assign. Level I staging occurs
in the initial operations of small events, and ends quickly as new resources are
directed to the Level II Staging area with a larger capacity.
In large scale incidents, there may be a Level II Staging Area when warranted.
In the Level II Staging area, personnel are not to leave their vehicles. The
locations of various apparatus should be arranged to ensure ALS/BLS units can
get out as needed.
Level II Staging should be considered for any declared MCI or other incidents in
which Command desires to centralize resources, or simply to park apparatus in
a central, designated location. Units which are already staged (Level I) or en-
route to Level I Staging, will stay in Level I unless otherwise directed by
Command. All other responding units will proceed to the Level II Staging Area.
When activating Level II Staging, Command will give an approximate (named)
location for the Staging Area and request a separate radio channel for the
Staging area.
The Level II Staging Area should be some distance away from the Command
Post and the emergency scene to reduce site congestion, but close enough for
prompt response to the incident site. A Staging Manager should be appointed
with a Level II incident.
Q. Transportation Corridor
The first arriving unit is responsible for defining and determining a transportation
corridor. The Corridor must be kept clear. The corridor must be maintained
until law enforcement takes over the security of the corridor. If the initial unit
cannot commit a member, they will assign that task to another unit from the initial
response.
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The transportation corridor must be established early and clearly communicated
by the first arriving unit during the initial size-up. The exact street, entry point,
exit point, and direction of flow must all be determined and communicated. Law
enforcement will clear and protect the designated corridor; all other apparatus
should keep this location clear. Large incidents may require law enforcement to
extend the protected corridor all the way to the hospitals.
The member controlling the corridor should anticipate requirements for treatment
and decontamination areas, and a patient loading area adjacent to the
designated corridor.
All apparatus operators must keep the transportation corridor clear.
R. Triage Area
It is understood that all patients should be triaged where found, with the
exception of GREENs (Minimal). However, depending on the variables of the
scene, triage may be accomplished by: a Triage Team, Removal Teams, or
after safely leaving the area (this pertains to GREEN (Minimal) who are moved
out of the area to be tagged separately or perhaps not at all if they self-release
and are not be transported—local hospitals should be notified of possible influx
of walk-ins).
Triage will be dynamic, but will be a collective and ongoing effort to constantly
evaluate patients at every step in the MCI process. SALT triage standard will be
used to evaluate patients.
S. Treatment Area
The patient treatment area will be established in conjunction with the
transportation corridor. It should be adjacent to the transportation corridor to
facilitate communication, tracking, and patient transfer. If the treatment area and
transportation corridor are unable to be co-located, they should be located as
close as possible with a clear path between the two.
The treatment area will be the responsibility of the Treatment Group Supervisor,
typically, a senior ALS member appointed by the Medical Branch Director.
Removed patients will be delivered directly to the treatment area through the
CCP (funnel) unless diverted to the transport corridor by the Treatment Group
Supervisor.
Every effort should be made to only have one area for each treatment color.
Large incidents may necessitate large treatment areas with separate areas and
staff for RED (Immediate) and YELLOW (Delayed) patients. Multiple treatment
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areas with corresponding transportation corridors may be needed. Treatment
Group Supervisor needs to request enough staff to handle care for the expected
number of patients that may be present.
The level of treatment performed in the treatment area may vary according to the
situation, but rapid patient stabilization will be the priority. The level of care will
be determined by the Treatment Group Supervisor in accordance with Lewis
County EMS Protocols, Policies, Procedures, Guidelines and/or direction from
DMCC I Medical Control.
1. Field Treatment Site
When circumstances dictate that EMS resources must continue to hold RED
(Immediate) patients, the Medical Branch Director should consider
establishing a Field Treatment Site (FTS). An FTS may be as simple as
extended use of the treatment areas created at the incident or as complex as
translocating patients to an Alternate Care Facility that has been opened to
EMS. In some cases local agencies and jurisdictions will predetermine where
EMS might naturally establish an FTS. Ad-hoc FTSs may be established
wherever the IC can rally enough resources to effectively care for patients.
EMS may need to establish an FTS for any of the flowing reasons:
• Transport resources are inadequate
• Transport cannot keep pace with removal
T. GREEN Area
The Triage Team(s) at an MCI will direct those who can walk to a designated
area of refuge, or GREEN Area. These patients will be initially classified as
GREENs (Minimal). As soon as possible, a GREEN Area Manager should be
designated.
Law enforcement is critical in establishing and maintaining the GREEN area. Law
enforcement will likely want to interview and document GREENs (Minimal) for
investigation purposes. Security in the GREEN Area may be necessary.
The GREEN Area Manager will liaison with law enforcement and is responsible
for the following:
• Documentation. Triage and tag all patients (including GREENs [Minimal]).
GREENs will be included in the overall patient count.
• Perform secondary triage as necessary. When necessary, upgrade
patients to RED (Immediate) or YELLOW (Delayed) as needed and move
those patients to the indicated treatment area(s).
Created: 2001 Final Revised January 31,2020 Page#21
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• Patient Tracking. Remove tags from GREENs (Minimal) as they are
released from the scene. Deduct any GREEN (Minimal), "Injured, Non-
Casualty" (INC) not needing transport to hospitals from the patient count.
Verify remaining count with the Treatment Group Supervisor.
• Contain patients as needed (liaison with law enforcement for interviews)
• Provide basic medical care
• Provide information as it becomes available to the GREENs (Minimal)
• Victim Assistance and Family Reunification
o Consider comfort needs such as restroom facilities, water, blanket, etc.
o Consider the need for emotional support including the chaplains, family
members, or outside counseling support. (Many of the GREENs
(Minimal) may have been separated from friends, or family members,
and will experience even greater anxiety when dealing with unknown
factors.)
o Coordinate transportation of the GREENs (Minimal) to the appropriate
facility for treatment or family reunification center (Emergency
responder should accompany GREENs (Minimal) during transport).
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U. Communications
A single tactical radio channel may be adequate for a small MCI. Large or
complex MCIs may quickly overwhelm a single radio channel, hampering critical
communication. Therefore, maintain radio discipline as required. The Incident
Commander should forecast incidents and with the assistance of the 911
Communications Center, may designate multiple radio channels for the incident.
Possible radio channel assignments are:
Created: 200I Final Revised January 31,2020 Page#22
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• Command
• Fire
• Logistics
• Ground-Air Rescue (VTAC 11)
• Hazard Materials
• Medical
• Transportation
• Staging
Disaster Medical Control Center (Medical Control) to include:
• Establishing communications from scene to DMCC/Medical Control via
cell phone
• Transportation
Radio communication may be further affected by many factors including:
• Areas of reduced radio signals
• Damage to radio/cell tower infrastructure
• System overload/outages
V. PATIENT DISPOSITION
A. Rescue
Patient removal from the hazard zone will be prioritized based on the patient's
condition and difficulty of removal. In larger incidents, Rescue will supervise
Removal as well as Extrication if needed.
Large or complex incidents may require the hazard zone to be divided into
geographical divisions. Supervisors should be alert to recon their assigned area.
Geographical recon includes:
• Number of patients in their area
• How many of those patients are RED (Immediate), YELLOW (Delayed),
GREY (Expectant) and BLACK (Dead)
• Removal needs, including number of patients and complexity
• Hazards inside their area
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Lewis County Lewis County CEMP-ESF#8 Health,Medical, and Mortuary Services
Mass Casualty Incident Plan(MCI)
1. Removal
Removal Teams will be composed of one or more pairs of personnel and will
report to Medical or Rescue, depending on incident size, for the purpose of
patient removal (harvesting) and delivery to the patient treatment area.
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' Removal ! Extrication
2. Extrication
Disentanglement and technical rescue may be handled by extrication teams
under direction of Rescue. When trapped patients are located, the extrication
teams will be sent to assist with the technical removal of those patients.
Extrication teams must prioritize their operations to remove as many viable
patients as possible in the shortest amount of time.
In smaller incidents it is appropriate for patient removal teams to be assigned
to Medical versus their own group under Operations.
Finance Planning Logistics Operations
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Created: 2001 Final Revised January 31,2020 Page#24
Lewis County Lewis County CEMP-ESF#8 Health,Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
B. Decontamination
Any MCI, natural or intentional, may include the release of hazardous materials
(hazmat). Rescuers will need to evaluate the potential need for a hazmat
response and decontamination procedures. If a hazmat release is known or
suspected, a hazmat response should be requested if not already dispatched.
Primary tasks of the initial units include: wear the appropriate level of PPE,
isolate the area and deny entry, consider a larger evacuation zone, and start
emergency decontamination procedures.
Removal, treatment and/or transport of any patient cannot occur until the patient
has gone through emergency decontamination.
It may be difficult to determine in the field if a patient is completely
decontaminated, therefore patient contact should be limited to essential
procedures in the field and during transport.
Tyvek suits should be used for patients after gross decon when their clothing has
been discarded.
Decontamination procedures will occur in the warm zone.
If decontamination procedures are required, the IC must ensure that a large
enough footprint has been established for both gross and technical Decon.
Patients in need of decontamination should have an ORANGE/POLKA DOT
ribbon tied next to the initial triage ribbon and that tag and ribbon should not be
removed. After Decon, mark the triage tag that decon has been completed, add
a white ribbon to indicate Decon has been performed and move the patient to the
treatment area.
Advise receiving hospitals that grossly decontaminated patients are being
transported from the scene in time for them to initiate their own decontamination
processes.
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Fire Ops Decon Fire Ops
Created: 2001 Final Revised January 31,2020 Page#25
Lewis County Lewis County CEMP-ESF#8 Health,Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
C. Patient Sheltering
Every attempt should be made to provide shelter for the patients in the patient
treatment and GREEN areas. The shelter should provide protection from the
hazards, weather, media, and the public.
Shelters of opportunity, or existing buildings, should be considered first. Priority
will be given to structures with bathroom facilities, running water, and buildings
with access that can be easily controlled. If no existing buildings are easily
accessible or adjacent to the transportation corridor, then temporary shelters may
be used.
Possible temporary shelters include:
• Tents from gross Decon Units
• Public/School transportation
• MCI Bus (if available)
When choosing a shelter, the possibility for an expanding incident needs to be
considered, ensuring patients are not placed into an existing or future hazard
zone.
D. Patient Care —Transport Coordination — Medical Control & DMCC
In general, personnel will treat RED (Immediate) patients first, YELLOW
(Delayed) patients only as time allows, and GREY (Expectant) patients only after
assuring that all patients from the RED (Immediate) and YELLOW (Delayed)
categories are stabilized. Note: Deceased patients will not be moved, unless it is
necessary to access a live patient. Depending on acuity and number of patients,
it may be necessary to transport ALS patients in BLS units without the oversight
of ALS personnel.
In a small incident, patient care protocols and transport may be managed by the
local Medical Control. East County uses Morton General Hospital as their
Medical Control and West County uses Providence Centralia Hospital. Once
contact has been made with Medical Control the connection shall not be
disconnected.
NOTE: Hospital personnel continue to refer to this as "Base Station" hospital.
In a large scale incident, notification of the local Medical Control is done first,
then the region DMCC is notified. Providence St. Peter Hospital (page 53) shall
serve as the primary DMCC for Lewis County. If less than 6 patients (Level I),
consider not activating DMCC. Good Samaritan Hospital (page 54) shall serve
as back up DMCC.
Created: 2001 Final Revised January 31,2020 Page#26
Lewis County Lewis County CEMP-ESF##8 Health, Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
If neither primary nor back up DMCC is able to coordinate patient destination,
Harborview Medical Center shall serve as the third option. Transport shall notify
the receiving hospital of patient numbers and triage status prior to patient
transport if possible. Individual transporting units will not routinely communicate
to hospitals unless directed to do so. (Also See: Page 11 for DMCC Concepts of
Operations.)
E. Patient Count and Tracking
Patient count and tracking are important aspects of an MCI, especially when the
incident is large and complex. An attempt will be made to count and track every
patient who is cared for at an incident. The level of tracking may have to be
scaled to an individual incident. Factors such as environment, severity of
injuries, hazards, number of patients, and available responders will dictate the
level of tracking. At no time will these activities be priorities above patient care
and transport.
Patient count and tracking will be the responsibility of Transportation in
coordination with Treatment. An attempt will be made to attach a unique
identifier to each individual patient. Transportation will attempt to keep track of
the number of RED (Immediate), YELLOW (Delayed), and GREENs (Minimal) as
they are transported.
Any first responder may be assigned to Transportation as an aide to assist in
patient count and tracking.
F. Documentation
1. Medical Incident Report Forms (MIRFs)
Patient documentation is important; however, documentation should never
delay patient care or transport. Individual MIRFs should be attempted at
every incident, however, as an incident grows in size and complexity MIRFs
may not be reasonable to complete. Incidents may have segments when
MIRFs may be completed and other segments that circumstances prevent
usage of MIRFs. At a minimum, a photograph of all command and control
boards, MCI position sheets (Reference Guides, Job Aides) shall be taken
and filed with the incident report or official record.
2. Unique Number with Transporting Agency
When a patient is received by a transporting unit, personnel will document the
unique identifier that is attached to the patient onto their agency's MIRF. If a
unique identifier has not been assigned to the patient, then the transporting
Created: 2001 Final Revised January 31,2020 Page#27
Lewis County Lewis County CEMP-ESF#8 Health,Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
unit's personnel will do so. Every effort will be made to give a copy of the
unique identifier to Transport.
G. Transportation
Transport will assign patients to transporting units as those resources arrive.
Constant communication between Transport and Treatment is important to
ensure that patients are ready to be transported. Constant communication
between Transport and Staging is important to ensure transport units are
available and move into position when needed. Transportation will communicate
patient loads and receive transport unit destination assignments from the DMCC.
Larger incidents may require non-traditional assets. If non-traditional assets
without emergency signal devices are used, consideration should be given to
using law enforcement escorts to aid during travel. Containing bio-hazardous
material in non-traditional assets may be difficult, but tarps, plastic, or other
resources should be used to limit the spread of this material.
If a GREEN (Minimal) is not transported e.g. the patient has been reunified with
friends or family, their name should be documented on the Transport Unit Patient
Log.
VI. MEDICAL BRANCH - OVERVIEW
A. Medical Branch (Group)
One of the first arriving EMS members should assume the role of Medical
Branch, until relieved by a more senior member. The role of Medical Branch,
while initially filled by one of the first arriving EMS members, should be assumed
by a senior EMS member, likely a Medical Services Officer (MSO), when
possible. Intimate knowledge of the plan is necessary for the Medical Branch.
Medical Branch is responsible for the following tasks:
• Transportation
• Treatment
• Triage
• Extrication and patient removal in the absence of a Rescue Branch
• Consider activation of the DMCC (Medical Control)
• GREEN Area management
Medical Branch may handle most or all of the responsibilities in smaller incidents.
Larger or complex incidents will require Medical Branch to be proactive in
forecasting the incident and begin assigning roles as soon as possible. The use
Created: 2001 Final Revised January 31,2020 Page#28
Lewis County Lewis County CEMP-ESF#8 Health,Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
of Aides or Assistants will be needed particularly in complex incidents.
Circumstances may dictate a large number of ALS and BLS personnel where:
• ALS personnel need to be prioritized to treatment due to a high patient
count;
• Patient removal from the hazard zone will require a large amount of BLS
personnel and/or complex coordination.
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Finance Planning Logistics Operations
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1. Treatment
Medical Branch may designate a senior EMS member to be Treatment
Group Supervisor. (Note: Smaller incidents may allow Medical Branch to
retain this role). Treatment is responsible for the following:
• Receiving patients from Removal
• Supervising treatment of patients
• Managing Treatment Personnel
• Coordinating with Transportation
• Prioritizing patients for transport
The level of treatment performed in the treatment area may vary according to
the situation, but rapid patient stabilization will be the priority. The level of
care will be determined by the Treatment Team Leader.
Treatment, with input from Transportation, may elect to have patients
delivered directly to the transportation corridor for transport.
Treatment should request adequate personnel and resources to care for the
expected number of patients.
The use of Aides or Assistants will be needed particularly in complex incidents.
Created: 2001 Final Revised January 31,2020 Page#29
Lewis County Lewis County CEMP-ESF#8 Health,Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
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2. Transportation
Transportation should be designated early by Medical. Smaller incidents may
allow Medical to retain this role. Transportation should be a senior EMS
member capable of performing a wide range of duties including:
• Communication with DMCC (Medical Control)
• Keeping a total patient count of all transported patients (may be
delegated to one or more Aides)
• Coordination with Treatment
• Coordination with law enforcement to clear the transportation corridor
• Liaison with transportation resources
• Liaison with Staging to maintain transportation resources
• Initiate tracking if unique identifier not already assigned
Incidents that require multiple transportation corridors must have multiple
personnel assigned to Transport. They may act independently of each other.
Transportation will contact the DMCC independently for patient destinations
and be responsible for patient count and tracking.
The use of one or more Transportation Group Aides will be needed,
particularly in complex incidents.
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Created: 2001 Final Revised January 31,2020 Page#30
Lewis County Lewis County CEMP-ESF#8 Health, Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
B. Rescue
Rescue should be considered when:
• ALS staffing needs to be prioritized to patient treatment and transport
• Any part of patient removal from the hazard zone will require a large
amount of BLS resources
Rescue may be in charge of triage and removal of all patients from the hot zone
into the patient treatment areas.
Technical Rescue Teams will report to Rescue to serve as technical advisors,
and participate in extrication as needed.
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Created: 2001 Final Revised January 31,2020 Page#31
Lewis County CEMP—ESF#8 Health,Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
INCIDENT COMMANDER FIELD CHECKLIST
First on-scene,unless passed: the most qualified responder/officer will assume Incident Command until relieved
Radio Frequency: 0 REDNET 0 V-TAC (12-13) 0 LERN 0 Other
V-TAC 11 Reserved for Air Opps
1. Establish Command Done ❑
2. Complete size-up, inform 911 Communications Center: Done 0
0 a. Name Incident: Location:
❑ b. Describe the scene.
❑ c. Estimate number of patients:
❑ d. Determine and direct initial actions
❑ e. Designate radio frequencies
Command: Fire: Transportation: Rescue:
Logistics: Medical: Hazmat:
❑ f. Establish Personnel Accountability System
❑ g. Determine Level 2 staging area location
❑ h. Determine transportation corridor
❑ i. Notify Emergency Management
El j. Identify safety concerns
0 k. Consider additional resource needs
3. Relay size-up information to E911 Communications. Done ❑
4. Don"Incident Commander"vest,assign positions/checklists: Done ❑
0 a. Medical Branch Director
Elb. Triage Group Supervisor
c. Treatment Group Supervisor
D d. Transport Group Supervisor
❑ e. Staging Manager
El f. Safety Officer
5. Ensure Medical Control/DMCC are notified of situation: Done ❑
❑ a. Type of incident
El b. Estimated patient count
❑ c. Special considerations(Hazardous Material)
6. Determine MCI level from the Triage Group Supervisor tag count: Done ❑
❑ Level I: Up to 6 patients
❑ Level II: 7 to 12 patients
El Level III: 13 or more patients
7. Request 10-minute status updates from all officers Done ❑
8. Consider other needs: law enforcement,mass transportation, morgue,chaplains, rehabilitation,
debriefings. Done ❑
9. Check patient and responder accountability. Done n
10. Appoint Public Information Officer(PIO)as media liaison. Done ❑
11. Coordinate officer demobilization actions. Done ❑
All duties remain the responsibility of the IC unless delegated to another!
Created: 2001 Final Revised January 31,2020 Page#32
Lewis County CEMP—ESF#8 Health,Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
Incident Commander Field Status Report
Patient Total:
Triage Breakdown:
RED (Immediate): YELLOW(Delayed): GREEN (Minimal):
GREY(Expectant): BLACK (Dead): HAZMAT:
Officers assigned/Areas established: Done ❑
Medical Branch Director: Transport Group Supervisor:
Triage Group Supervisor: Staging Manager:
Treatment Group Supervisor: Safety officer:
Morgue Established: ❑ Yes ❑ No Done ❑
Total patients transported:
Reminder: Appoint an Aide before you are overwhelmed!
Created: 2001 Final Revised January 31,2020 Page#33
Lewis County CEMP—ESF# 8 Health,Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
MEDICAL BRANCH DIRECTOR FIELD CHECKLIST
Radio Frequency: ❑ REDNET ❑ V-TAC (12-13) ❑ LERN 0 Other
V-TAC 11 Reserved for Air Opps
Takes Direction from Incident commander and is responsible for directing all medical operations.
Also responsible for accountability tracking of the medical group officers:
-Triage Group Supervisor—Treatment Group supervisor—Transport Group Supervisor'—Staging Manager
If Medical Branch Director is not appointed, Incident Commander completes this.
1. If delegated by the Incident Commander, immediately conducts size-up including: Done ❑
❑ Name the incident ❑. Describe scene.
❑ Estimate number of patients: ❑ Determine/direct initial actions
❑ Identify dispatch and operations frequencies E Establish Command Post location
❑ Establish staging area location. E Establish Transportation Corridor
❑ Identify safety concerns. ❑ Consider need for additional resources
2. Provide the size-up information to the Incident Commander Done ❑
3. Don "Medical Branch Director"vest. Done ❑
4. If designed by the Incident Commander, relay the following information
to the Medical Control/DMCC Done ❑
❑Providence (360) 330-8515 ❑Morton General (360) 496-6866 ❑DMCC (360) 493-0202
❑ a. Type of incident.
❑ b. Estimated patient count.
❑ c. Special considerations (Hazardous Material).
5. Ensure placement of Medical Supply Area(s), if needed: Done ❑
6. If asked by the IC, appoint the following: Done ❑
❑ Triage Group Supervisor,Name:
❑ Treatment Group Supervisor,Name:
❑ Transport Group Supervisor,Name:
7. Obtain patient counts from Triage Group Supervisor/Green Area Manager Done ❑
8. Relay patient count to Incident Commander. Done ❑
9. Obtain additional resources needed, requesting them through the IC. Done ❑
10. Benchmarks: Done ❑
❑ All Patients removed ❑ All RED (Immediate)patients transported
❑ All patients transported/clear of incident ❑ Any hazard mitigation
Created: 2001 Final Revised January 31,2020 Page#34
Lewis County CEMP—ESF# 8 Health, Medical, and Mortuary Services
Mass Casualty Incident Plan(MCI)
SAFETY OFFICER FIELD CHECKLIST
Radio Frequency: ❑ REDNET ❑ V-TAC (12-13) ❑ LERN ❑ Other
V-TAC 11 Reserved for Air Opps
The Safety Officer takes directions from Incident Commander and is responsible for:
• Participating in planning meetings
• Identifies hazardous situation associated with the incident
• Reviews the Incident Action Plan for safety implications
• Exercises emergency authority to stop and prevent unsafe acts
• Investigates accidents that have occurred within the incident area.
• Assigns assistants as needed
• Reviews and approves the medical plan
❑ Don "Safety Officer" vest. Receive briefing from IC.
❑ Obtain radio frequencies:
Command: Fire: Transportation: Rescue:
Logistics: Medical: Hazmat:
❑ Check Personnel Accountability System
❑ Yes, a personnel accountability system is in place
❑ No. Immediately recommend modifications to the IC
❑ Consider the abandonment signal; if used, communicated to all teams
❑ Complete a scene survey & report back to IC
Check potential hazards including:
a. Utility status c. Collapse zones e. Hazardous materials
b. Traffic d. Citizens f. Other hazards
❑ Yes, team integrity(teams of two or more) is being maintained.
❑ Yes, proper PPE is in use.
❑ Yes,additional safety officers are needed.
❑ Yes,the Incident Action Plan needs to be revised.
❑ Y• es,equipment is being used appropriately
❑ Y• es,decontamination is being provided.
❑ No, decontamination is needed and hasn't been provided.
❑ Yes,a critical incident stress debriefing is needed.
Remember: Request Additional Safety Officers As Needed
Created: 2001 Final Revised January 31,2020 Page#35
Lewis County CEMP—ESF#8 Health,Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
STAGING MANAGER FIELD CHECKLIST
Radio Frequency: ❑ REDNET 0 V-TAC (12-13) 0 LERN 0 Other
V-TAC 11 Reserved for Air Opps
The Staging Manager takes direction from the Medical Branch Director and is responsible
for:
• Manages the Level II staging area in two sections, see Item#2 below
• Groups apparatus/resources to accommodate easy facilitation to assignments
• Receives minimum resource numbers from the Medical Branch Director
• Directs transport units to loading area as requested by the Transport Group
Supervisor
• Notifies the Medical Branch Director when transport vehicle numbers fall
below the number set by the Medical Branch Director
• May communicate directly with the Transport Group Supervisor
1. Don "Staging Manager" vest and receive briefing from Medical Branch Director.
Done ❑
2. Develop a two-part staging area: Done ❑
❑ Part One: Consists of patient transport units. (Stage one (1) block away)
Transport Unit personnel will be advised to stay with their unit.
Part Two: Consists of single resources. (Stage 3 to 5 minutes from scene)
Extrication crews should stay together.
3. Group apparatus/resources to accommodate easy facilitation to assignments Done ❑
4. Direct transport units to transport area as requested by the Transport Group Supervisor
Done ❑
5. Notify the Medical Branch Director when transport vehicle numbers fall below set number
Done ❑
In-coming units report to a staging area so that resources are assembled in one place.
If possible,staging should be within eyesight of the transport zone.
Created: 2001 Final Revised January 31,2020 Page#36
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Mass Casualty Incident Plan(MCI)
TRANSPORT GROUP SUPERVISOR FIELD CHECKLIST
Radio Frequency: 0 REDNET 0 V-TAC (12-13) 0 LERN 0 Other
V-TAC 11 Reserved for Air Opps
Takes direction from the IC or Medical Branch Director and is responsible for:
• Reconcile patient count by removing INC (involved, non-casualty) number
• Obtain patient destinations from Medical Control/DMCC
• May communicate directly with the Staging Manager
• Receives patient injuries, needs information from Treatment Group supervisor and relays
same to Medial Control/DMCC
• Supervise patient loading activities
• Maintain traffic flow routes
• Accountability tracking of transport group personnel
1. Don "Transport Group Supervisor" vest, obtain briefing from Medical Branch Director
Done ❑
2. Develop patient loading zones. Done n
3. Coordinate entrance/exit routes with Medical and Staging Managers Done ❑
4. Contact Staging Manager to request transport units move into loading zone Done E
5. Coordinate with law enforcement to maintain transportation corridor Done E
*6. Work closely with Treatment Group Supervisor to provide Medical Control/DMCC with
required patient counts, classifications of injuries, and patient routing information.
(Removes INC from numbers and estimates of likely POV transports). Done ❑
7. Direct loading of transport vehicles Done ❑
8. Transport GREENs to Reunification Point Done n
9. ❑ Complete Transport Group Supervisor Log. Done n
❑ Obtain destinations from Medical Control/DMCC.
n Relay destinations to waiting transport units.
10. Collect tag stubs. Done n
11. Match tag stubs Done ❑
❑ Match with Treatment Group Supervisor
❑ Report findings to Medical Branch Director
*12. Confirm number of patients and destinations with Medical Control1DMCC Done n
Communicates direct with Medical Control/DMCC
**If patients are diverted due to nature of their injuries,
the Transport Group Supervisor must be notified.
Created: 2001 Final Revised January 31,2020 Page# 38
Lewis County CEMP—ESF#8 Health,Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
TRANSPORT GROUP SUPERVISOR
LOG SHEET
The Transportation Group Supervisor will confer with the Treatment Group Supervisor to provide patient
information to Medical Control/DMCC. Medical Control/DMCC will require:
• Reconcile patient count by removing INC (involved, non-casualty) number
• Patient counts
• Classifications of injury
• Routing information (destination recommendation from on-scene officer)
• Collect tag stubs and reconcile them with the Treatment Group Supervisor
DO NOT
• Overload ambulances
• Place too many serious patients in the same unit or direct too many patients to any single
receiving facility
• Send local transport units on out-of-area transports. Direct these requests to out-of-area
mutual aid units
TAG # Triage Class DESTINATION Unit # Time Out
Gn Red Bk
Y Gy Hm
Gn Red Bk
Y Gy Hm
Gn Red Bk
Y Gy Hm
Gn Red Bk
Y Gy Hm
Gn Red Bk
Y Gy Hm
Gn Red Bk
Y Gy Hm
Gn Red Bk
Y Gy Hm
Gn Red Bk
Y Gy Hm
Gn Red Bk
Y Gy Hm
Gn Red Bk
Y Gy Hm
Gn Red Bk
Y Gy Hm
Gn Red Bk
Y Gy Hm
Gn Red Bk
Y Gy Hm
Gn Red Bk
Y Gy Hm
Gn Red Bk
Y Gy Hm
Created: 2001 Final Revised January 31,2020 Page#39
Lewis County CEMP—ESF#8 Health, Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
GREEN AREA MANAGER FIELD CHECKLIST
Radio Frequency: 0 REDNET 0 V-TAC (12-13) 0 LERN 0 Other
V-TAC 11 Reserved for Air Opps
The GREEN Area Manager takes direction from the Treatment Group Supervisor. The GREEN Area
Manager is responsible for:
• Gathering all ambulatory or non-injured patients together and move away from the scene
• Tag GREENs(Minimal) use flagging tape.
• Perform an initial triage.
• Responsible for tracking non-injured who self-release(using Patient Release Form).
• Provides GREEN(Minimal) count(and any self-released)to the Treatment Group
Supervisor.
• Performs periodic ongoing triage.
• Liaisons with Law Enforcement for interviews as necessary.
• Provides for GREEN group transportation to hospital or Reunification Center.
• If conditions deteriorate,re-tags patients and moves to YELLOW(Delayed) or RED
(Immediate)Treatment Area.
• Considers comfort needs and provides available information to patients.
1. Receives Treatment Group Supervisor briefing. Done _
2. Gathers all GREENs/INCs and moves away from initial scene to GREEN Area
Done ❑
3. .Documents Patients Done ❑
❑ Triage and tag patients(with flagging tape if triage tags are in short supply).
❑ Record patients' status on the GREEN Area Manager Log Sheet
❑ Liaison with Law Enforcement to arrange necessary interviews.
❑ Complete Patient Release Forms for those uninjured or refusing transport
❑ Coordinate transport to hospital or Family Reunification Center as appropriate.
❑ Provide patient counts/updates to Treatment Group Supervisor
4. Periodically provide Secondary Triage. Done ❑
❑ If patient condition degrades,re-triage and escort to appropriate YELLOW or RED area
5. Provide information updates to GREENs as it becomes available. Done ❑
Created: 2001 Final Revised January 31,2020 Page#40
Lewis County CEMP—ESF# 8 Health, Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
GREEN AREA MANAGER FIELD
LOG SHEET
The GREEN Area Manager takes direction from the Treatment Group Supervisor. The GREEN Area
Manager is responsible to:
• Performs an initial triage and tags patients with flagger tape
• Documents all patients on a Log Sheet to account for INC (Involved,Non-Casualty) (for Law
Enforcement interviews), group transportation to hospital or Reunification Center, and those
who self-release
• Reconciles patient count by removing INC (Involved, non-casualty) number that are not
injured or refuse transport (AMA) and forwarding number for transport to Treatment Group
Supervisor.
• If patient conditions deteriorate, re-tag and move to YELLOW (Delayed) or RED (Immediate)
Treatment Area and notify Treatment Group Supervisor of change in numbers.
• Arranges for transportation, and or comfort needs
• Provides available information to patients
NAls'IE/Tag# Triage Class DESTINATION Law Self-Release
Interview AMA
1 Gn Red Y Hm
2 Gn Red Y Hm
3 Gn Red Y Hm
4 GnRedYHm
5 Gn Red Y Hm
6 Gn Red Y Hm
7 Gn Red Y Hm
8 Gn Red Y Hm
9 GnRedYHm
10 Gn Red Y Hm
11 Gn Red Y Hm
12 Gn Red Y Hm
13 GnRedYHm
14 Gn Red Y Hm
15 Gn Red Y Hm
Created: 2001 Final Revised January 31,2020 Page#41
Lewis County CEMP—ESF# 8 Health, Medical, and Mortuary Services
Mass Casualty Incident Plan(MCI)
TREATMENT GROUP SUPERVISOR FIELD CHECKLIST
Radio Frequency: 0 REDNET 0 V-TAC (12-13) ® LERN 0 Other
V-TAC 11 Reserved for Air Opps
Takes direction from the Medical Branch Director and is responsible for:
• Supervises treatment areas: RED, YELLOW, GREEN
• Ensures patient care documented on the triage tags: vital signs,treatment done,
time and patient name, if known
• Confers with Transport Group Supervisor regarding patient injuries, needs and
destinations
• Responsible for tracking injured released at scene (not transported)
• Establishes Medical Supply, re-supply through Medical Branch Director
• Accountable for treatment group personnel
• Periodically conducts Secondary Triage
1. Don "Treatment Group Supervisor" vest and receive Medical Branch Director briefing.
Done ❑
2. Develop treatment teams from available personnel Done l
3. Develop treatment areas (mark with flagger tape): Done ❑
n RED: Immediate
❑ YELLOW: Delayed
❑ GREEN: Minimal
4. Supervise patient care: Done ❑
❑ Chart patient vitals on triage tag
Chart patient treatment in the RED and YELLOW (GREEN if not delegated) Areas
_ Periodically conduct Secondary Triage
5. Confers with GREEN Manager regarding triaged patients upgraded to Treatment/Transport
Done ❑
6. Works with Transportation Group Supervisor to provide Medical Control/DMCC with the following
information:
Done ❑
❑ Patient counts
❑ Classifications of injuries
❑ Patient routing information.
7. Relay patient injuries to Transport Group Supervisor for patient evacuations Done ❑
8. Maintain treatment area medical supply. Works through Medical Branch Director for resupply.
Done ❑
NOTE: Periodically Conduct Secondary Triage ! !
Non-medical bystanders can be very useful in helping identify or track where patients are transported.
Limit treatment to: airway control,oxygen,severe bleeding control, and necessary fluid therapy.
Created: 2001 Final Revised January 31,2020 42
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Lewis County CEMP—ESF# 8 Health, Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
TRIAGE GROUP SUPERVISOR FIELD CHECKLIST
Radio Frequency: 0 REDNET 0 V-TAC (12-13) 0 LERN 0 Other
V-TAC 11 Reserved for Air Opps
Takes direction from the Medical Branch Director.
The Triage Group Supervisor is responsible for:
• Development of triage tagging teams
• Development of patient removal teams
• Establishing triage Casualty Collection Point (CCP) [Funnel]
• Triaging patients
• Matching torn triage tag stubs with Transport Group Supervisor
• Accountability tracking of triage group personnel
1. Don "Triage Group Supervisor"vest. Done ❑
2. Assign triage tagging teams. Place ribbons on uninjured arm of patients Done n
Tear piece and put in pocket for count and later matching.
3. If necessary, assign a GREEN Manager and designate a GREEN location. Done ❑
4. Reassign taggers and additional crews to patient removal teams to move RED (Immediate)
and YELLOW (Delayed) patients to the CCP (Funnel) for secondary triage. Done ❑
5. Establish the triage CCP (Funnel). Mark with flagging tape. Done ❑
6. Triage the patients at the CCP (Funnel). Apply triage tag mark the correct color.
Keep a tag stub for accountability. Done ❑
7. Direct patient removal teams to/through CCP and
into treatment areas. Done ❑
8. After tagging is complete, count the number of stubs and/or flagging pieces.
This is the total patient count. Done ❑
9. Report total patient count to: Done ❑
a. Medical Branch Director, or Done ❑
b. If no Medical Branch Director,to Incident Commander Done ❑
10. Match torn triage tag stubs with Transport Group Supervisor. Done ❑
Created: 2001 Final Revised January 31,2020 Page#45
Lewis County CEMP—ESF#8 Health,Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
COMMUNICATIONS FIELD CHECKLIST
Keep radio communications to a minimum on dispatch and operations frequencies.
• If no Incident Commander is at the scene, the most qualified responder/officer will assume Incident Command
until relieved and immediately accomplish the Incident Commander Help Sheet.
• Initial dispatch and incident command communications will be conducted on:
• Fire-1: Chehalis/West, South and
Central County areas 154.190 rx/csq 154.190 tx/p1123.0
• Fire-2: Riverside Fire Authority/Cent 154.9725 rx/pl 123.0 159.0725 tx/ pl 123.0
• Fire-3: Randle area 156.105 rx I csq 155.805 tx/p1131.8
• Fire-4: Packwood area 156.105 rx/csq 155.805 tx/ pl 88.5
• Fire-5: Mineral area 154.190 rx/csq 159.315 tx l pl 118.8
• Dispatch will advise of staging area location. Respond directly to the Staging Area and check in with the
Staging Manager, unless directed to go to the scene. Do not abandon your unit unless approved by
command.
• The Incident Commander will assign the event an operations frequency, either:
❑ (REDNET) 153.830 ❑ VTAC 12 154.4525 ❑ VTAC 13 158.7375 ❑ VTAC 14 159.4725
• (VTAC 11 reserved for Air Ops)
• Dispatch will advise to switch to the operations frequency upon arrival at the scene or staging area.
• Radio instructions given on scene should be repeated back to assure accurate message.
• Medical Control/DMCC communications will be on:
❑ Cellular Phone or ❑ HEAR 155.340
Law Dispatch (360) 740-1105 24 Hr-Numbers
Enforcement Lewis County Sheriffs Office (360) 748-9286 or
(360) 740-1266 (360) 740-1105
DEM Division of Emergency Mgmt (360) 740-1151 (360) 740-1105
Hospitals Providence-Centralia ER (360) 330-8515/ 8516
St. Peter- Olympia ER (360)493-0202
St. Johns/Peace Health -Longview ER (360)423-1530
Morton General ER (360)496-6866
Clinics Steck -Chehalis (360) 748-0211
Woodland - Centralia (360) 736-9822
Woodland - Chehalis (360) 748-9822
Pe ElI Clinic- Pe ElI (360)291-3232
Napavine Medical Clinic (360)262-3990
Randle Clinic- Randle (360)497-3333
Shoestring Valley- Onalaska (360) 978-6888
Valley View Hlth Ctr-Chehalis (360) 330-9595
Valley View Hlth Ctr-Centralia (360)669-0335
Valley View Hlth Ctr-Morton (360)496-5101
Valley View Hlth Ctr-Onalaska (360) 978-6600
Valley View Hlth Ctr- PeEll (360)291-3232
Valley View Hlth Ctr-Toledo (360) 864-4400
Valley View Hlth Ctr-Winlock (360) 785-9400
Dispatch will only record en route time and available time. The Responder shall record all other times.
Created: 2001 Final Revised January 31,2020 Page 4 46
Lewis County CEMP—ESF 4 8 Health, Medical, and Mortuary Services
Mass Casualty Incident Plan(MCI)
TRIAGE & TAGGING PROCESS HELP SHEET
TRIAGE PERSONNEL - Reports to the Triage Group Supervisor.
Triages patients and assigns them to appropriate treatment areas.
1. Obtain situation briefing from Triage Group Supervisor / check into personnel
accountability system.
2. Don position identification vest (if available).
3. Report to designated on-scene triage location, generally at the CCP.
4. Secure adequate supplies of triage tags and flaggers tape.
5. Assess situation for safety concerns.
6. Triage and tag injured patients. Classify patients using SALT while noting injuries and
vital signs if taken.
7. Direct movement of patients to proper Treatment Areas.
8. Provide appropriate medical treatment to patients prior to movement as incident
conditions dictate.
PATIENT MOVEMENT / TRANSPORT PERSONNEL. - Reports to Triage Group Supervisor
1 . Obtain situation briefing from Triage Group Supervisor I check into personnel
accountability system.
2. GREENs (minimal) should be moved to the care of the GREEN Area as soon as
possible.
3. Individual responders may be assigned to remove ambulatory patients from the scene.
4. Assemble teams of two or three personnel for non-ambulatory patient removal.
5. Locate the backboard and patient mover supply cache and pickup needed materials.
6. Locate ''Casualty Collection Point (CCP)"" and try to locate and remove RED
(Immediate) patients first, followed by Yellow (Delayed) patients by passing through the
CCP.
7. When all RED (Immediate) / YELLOW (Delayed) patients have been removed. check with
the Triage Group Supervisor to confirm next assignment that may involve GREY (Expectant)
or DECON patients.
Created: 2001 Final Revised January 31,2020 Page;#47
Lewis County CEMP—ESF#8 Health,Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
OFFICER RESPONSIBILITIES REFERENCE
Incident Commander • Establish Command;Conducts Size-up,or delegates to Medical Branch Director
• Provides Size-up information to 911 Communications
• Appoints ICS officer positions. Assumes responsibilities for all duties for positions not filled
• Notifies Medical Control/DMCC of MCI situation;Determines level of MCI incident
• Notifies Lewis County Emergency Management as needed
• Serves as or appoints PIO as media liaison
• Requests status updates from officers every 10 minutes,adjusts response as necessary
• Considers other needs:transportation,chaplains,rehabilitation,morgue,debrief,demobilization,EOC
• Coordinates officer demobilization actions
• Responsible for patient and responder accountability
Medical Branch Director • Takes direction from Incident Commander;if delegated,provides Size-up information to IC
• If asked by IC,appoints Triage,Treatment,and Transportation Group Supervisors
• If needed,ensures placement of Medical Command Post and Medical Supply Area(s)
• If delegated,obtains initial triage patient count from Triage Group Supervisor;relates count to
IC/Medical Control/DMCC
• Determines need for additional resources and requests from IC
Triage Group Supervisor • Takes direction from Medical Branch Director
• Assigns GREEN Area Manager and designates a GREEN location,if necessary
• Develops triage tagging teams;Develops patient removal teams
• Establishes Casualty Collection Point(CCP);Triages patients at the CCP
• Reports total patient count to IC and/or Medical Branch Director
• Match torn triage tag stubs with Transport Group Supervisor
• Accountability tracking of triage group personnel
Treatment Group • Takes direction from Medical Branch Director;Develops treatment teams;Supervises treatment areas
Supervisor • Confers with GREEN Manager regarding triaged patients upgraded to Treatment/Transport
• Ensures patient care is documented on triage tags;Periodically conducts Secondary Triage
• Coordinates with the Transport Group Supervisor for patient counts and loading.
• Responsible for tracking injured released at scene(not transported)
• Establishes Medical Supply
• Match tag stubs with Transport Group Supervisor;report findings to Medical Branch Director
• Accountability tracking of personnel assigned to treatment group
GREEN/INC Area • Takes direction from the Treatment Group Supervisor.
Manager • Gathers all ambulatory patients and moves them to GREEN area.
• Triage,tag,and record patients on Log sheet;Liaison with Law Enforcement for interviews.
• Completes Release Forms for INCs or any refusing transport,updating patient count to Treatment
Group Supervisor.
• Coordinates,comfort needs,patient info,group transport to hospital or Family Reunifications Center.
Transport Group • Takes direction from IC or Medical Branch Director
Supervisor • Communicates directly to Medical Control/DMCC;may communicate directly to Staging Manager
• Receives patient injury information from Treatment Group Supervisor
• Obtains patient destinations from Medical Control/DMCC
• Supervise patient loading activities,maintains traffic flow routes
• Accountability tracking of transport personnel,matches tag stubs w,Treatment Group Supervisor.
Staging Manager • Takes direction from the Medical Branch Director;Manages the two-part staging area
• May communicate directly with the Transport Group Supervisor
• Groups apparatus/resources to accommodate easy facilitation to assignments
• Notifies Medical Branch Director when transport vehicle numbers fall below number set by the
Medical Branch Director
• Directs transport units to loading area as requested by the Transport Group Supervisor
Medical Control/DMCC • Coordinate patient destinations based upon patient condition and hospital availability
• Assist EMS with patient care protocols
Safety Officer • Takes direction from the Incident Commander and participates in planning meetings
• Identifies hazardous situation associated with the incident
• Reviews the Incident Action Plan for safety implications
• Exercises emergency authority to stop and prevent unsafe acts
• Investigates accidents that have occurred within the incident area.
• Assigns assistants as needed
• Review and approves the medical plan
Created: 2001 Final Revised January,2020 Page#48
Lewis County CEMP—ESF# 8 Health, Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
CLIPBOARD DISTRIBUTION CHART
*All checklists remain the responsibility of the Incident Commander
for any Officer positions not appointed.
1. Incident Commander(8 sheets)
Incident Commander Field Checklist
Incident Commander Status Report
Triage System Procedures
Communications Field Checklist (2)
Officer Responsibilities Reference (2)
Hospital Contacts and Directions (2 pages back-to-back)
2. Medical Branch Director (2 sheets)
Medical Branch Director Field Checklist
Triage System Procedures
3. Safety Officer (2 sheets)
Safety Officer Field Checklist(2)
4. Staging Manager (3 sheets)
Staging Manager Field Checklist
Staging Manager Field Log Sheet (2)
5. Transport Group Supervisor (5 sheets)
Transport Group Supervisor Field Checklist
Transport Group Supervisor Field Log(3)
Hospital Contacts and Directions (2 pages back-to-back)
6. Treatment Group Supervisor (6 sheets)
Treatment Group Supervisor Field Checklist
Treatment Group Supervisor Field Log Sheet (3)
Patient Release Form (2)
7. Triage Group Supervisor(2 sheets)
Triage Group Supervisor Field Checklist
Triage System Procedures
8. GREEN Area Manager(2 sheets)
GREEN Area Manager Field Checklist
GREEN Area Manager Log Sheet(4)
Created: 2001 Final Revised January 31,2020 Page#49
Lewis County CEMP—ESF# 8 Health, Medical,and Mortuary Services
Mass Casualty Incident Plan (MCI)
RECOMMENDED CONTENTS FOR
MASS CASUALTY INCIDENT (MCI) BAGS
Any unit that has the potential to be dispatched to an MCI should consider having a MCI
bag onboard. There are two recommended MCI bags. Command MCI Bag and First
Responder MCI Bag.
Command MCI Bag
Each agency should have enough Command MCI Bags on hand to ensure at least one
is available at the scene. Recommended items include:
• Checklists: MCI procedures/tasks and job descriptions.
• Tags: No less than three packages of 10.
• Flagging Tape:
1 Roll GREEN
1 Roll YELLOW
1 Roll RED
1 Roll GREY
1 Roll BLACK (zebra stripe)
1 Roll ORANGE with polka dots
1 Roll WHITE
1 Roll Fire Line-Do Not Cross
• Vests Set (7):
Incident Commander, Medical Branch Director. Staging. Triage, Treatment,
Transport. and Safety
• Clipboards: 1 for each position and patient logs
• Writing Utensils: Pens, pencils, all-weather markers (such as grease
pencil)
• Face Masks: (6) Barrier protection for any artificial respirations
• Protective gloves: 3 sets each S M L XL
• Eye Protection: At least six
First Responder MCI Bag
The First Responder MCI Bag should be available on every apparatus. Recommended
items include:
• Belt holding the following Flagging Tape:
1 Roll GREEN
1 Roll YELLOW
1 Roll RED
1 Roll Grey
1 Roll BLACK (zebra stripe)
1 Roll ORANGE with polka dots
Created: 2001 Final Revised January 31,2020 Page# 50
Lewis County CEMP—ESF#8 Health,Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
Attachment A:
MCI RUN CARDS
Lewis County Run Cards for MCI —
Suggested MCI resource needs to be considered by individual agencies to establish
Communications Center Run Cards:
Lewis County MCI Run Card
MCI Resources Staffing Guidelines
*MCI Level # Patients Responders Chiefs Comments
Needed Needed
Level I Up to 6 13 1 3—2 Person
Engine Co.
2—2 Person
Medic Units
3—2 Person
*Aid Units
*Aid Units staffed
with 1 Driver and
FF EMT
Level II 7-12 26 2 6—2 Person
Engine Co.
4—2 Person
Medic Units,
6-2 Person
*Aid Units
*Aid Units staffed
with 1 Driver and
FF EMT
Level Ill 13 or More 30 3 9—2 Person
Engine Co.
6—2 Person
Medic Units,
All available
*Aid Units
*Aid Units staffed
with 1 Driver and
FF EMT
Note: Staffing of the Aid Units would be by 1 Driver and 1 EMT pulled from the Engine
Personnel for Transport.
*Level I—Consider notifying AMR-Seattle
Level II— Notify AMR— Seattle
For all MCI activations, the Lewis County Communications Center shall notify the Lewis
County Fire Mobilization Coordinators (by Spillman Page).
4
Created: 2001 Final Revised January 31,2020 Page# 51
Lewis County CEMP—ESF# 8 Health, Medical, and Mortuary Services
Mass Casualty Incident Plan(MCI)
Attachment B:
Options for Consideration in Agency Run Cards
1. Notifications
Notified By To Be Notified
Lewis County Communications Center Medic/AID Units, Responders
Medical Branch, From the Scene Disaster Medical Control Center(DMCC)
(Medical Control):
Providence St. Peter Hospital
Good Samaritan is the backup
Responding Agency Private Ambulance & BLS Transport
Providers
Incident Commander Delegated PIO
IC & Response Plan/Countywide Paging Chief Officer Notification
(Spillman)
Local, Regional, State Fire Coordinators Predetermined Out of Area ALS Strike
Team, EMS Task Force, Engine Strike
Team, Structural Task Force
IC & Response Plan Intercity Transport and School District
Buses
IC & Response Plan MCI Units, Trailers etc.
Lewis County Communications Center Thurston County SORT
Lewis County Communications Center HazMat
notification of WSP
Lewis County Communications Center Lewis County Coroner's Office
Lewis County Communications Center Lewis County Emergency Management
Lewis County Communications Center Lewis County Public Health
Lewis County Communications Center Area Law Enforcement
2. Additional Resources Notifications
Consider the following if MCI is larger than MCI — Ill. The request for the resources
below would be attained through the Lewis County Communications Center.
Jurisdiction Resource Requesting Party
Regional Resources Out of County Structural Task Regional Coordinator
Forces
Out of County Engine Strike Regional Coordinator
Teams
Out of County EMS Task Forces Regional Coordinator
Out of County ALS Strike Teams Regional Coordinator
Thurston County SORT Team Regional Coordinator
State Resources HazMat Team & Decon for up to State Coordinator
300 (JBLM F&ES)
Mass Casualty Unit (JBLM) State Coordinator
Created: 2001 Final Revised January 31,2020 Page## 52
Lewis County CEMP—ESF# 8 Health, Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
Attachment C:
Area Hospital Contacts and Directions
Hospital Address City Phone Directions
Local
Providence Centralia 1820 Cooks Hill Centralia 360-330-8515 Heading North on 1-5: Take exit 81. Follow(H)
signs. Turn Left onto Mellen Street. Keep Right.4
Hospital Rd. mi.on Cooks Hill Rd. turn Left on Scheuber Rd. Go
.02 mi to West parking lot Emergency Department
on left.
Heading South on I-5: Take Exit 82 Harrison Ave.
Go straight cross Harrison Ave. Follow frontage
road signage(H)to Cooks Hill Rd. Turn Right at
Mellen Street. Follow(H)signs over bridge.Keep
right on Cooks Hill rd.04 mi. Turn Left on
Scheuber Rd. Go.02 mi to West parking lot.
Emergency Dept.will be on the left.
Morton General 521 Adams Morton 360-496-6866 Take Exit 68 off 1-5
Hospital Take Hwy 12 East to Morton
` Left on 7th
Right on Adams St.
North
St. Peters Hospital 413 N Lilly Olympia 360-493-0202 Take 1-5 N to exit 107
Turn Right on Pacific. Turn Left on Lilly,
Left on Ensign, to Hospital
Capital Medical 3900 Capital Olympia 360-956-2590 Take I-5 to exit 104
Center Mall Dr. Follow Hwy 101 to Black Lake Blvd Exit
Right on Black Lk Blvd
Left on Cooper Pt Rd.
Left on Capital Mall Blvd to Hospital
Summit Pacific 600 E. Main St. Elma 360-495-3244 I-5 to exit 88.
Medical Center Left on Hwy 12 into Elma
Left to stay on Main St.to Hospital.
Madigan Army 9040A Jackson JBLM 253-968-1396 Call ahead and give rig#so guard shack
Medical Center Ave lets you in. Take I-5 N to Jackson Ave,
JBLM, WA 98431 Turn Right, Right on Gardner Loop Rd.
St. Clare Hospital 11315 Bridgeport Lakewood 253-588-2255 Take I-5 to Exit 125
Wy Turn North on Bridgeport to Hospital
St. Joseph's Hospital 1718 S "I" St Tacoma 253-426-6769 Take I-5 to Exit 132 (Hwy 16)
Take Sprague Exit North on Sprague
Turn Right on 19th Avenue
Left on "J" Street
Tacoma General 315 S "K" St Tacoma 253-627-8500 Take 1-5 to Exit 132 (Hwy 16)
Hospital Take Sprague Exit(north)
Angle to Right to Division Street
Turn Right on "J" Street to Hospital
Created: 2001 Final Revised January 31,2020 Page 4 53
Lewis County CEMP—ESF# 8 Health, Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
Area Hospital Contacts and Directions - (Continued)
Hospital Address City Phone Directions
North (Continued)
Allenmore S. 19th & Union Tacoma 253-596-5114 Take l-5 to Exit 132(Hwy 16)
Take Sprague Exit N on Sprague
Turn Left on 19th Avenue to Hospital
St. Anthony's 11567 Gig Harbor 253-530-2000 1-5 North. Take exit 132 for Hwy 16 towards
Hospital Canterwood Blvd. Bremerton/Gig Harbor.Take exit for Burnham
Dr NW.Stay in left lane as you enter
roundabout.Take 3rd exit onto Canterwood
Blvd. Pass 15t hospital entrance,turn right at
the 2nd hospital entrance.
Good Samaritan 407 14th SE Puyallup 253-848-0465 Take 1-5 to Exit 127
Hospital Go East on Hwy 512 to S. Meridian
Turn Right onto Meridian
Turn Left on 14th Ave SE
Mary Bridge 311 S "K" Tacoma 253-403-1476 Take 1-S to Exit 132(Hwy 16)
Children's Hospital Take Sprague Exit, (North)
Angle to Right to Division Street
Turn Right on "1"Street to Hospital
St. Francis Hospital 34515 9th Ave S. Federal 253-835-8100 1-5 North. Take exit 142E for S.348th St
Way toward WA-99. Merge onto WA-18. WA-18
becomes S.348th St.
Turn right onto 9th Ave. Turn left at the last
hospital entrance.
Auburn 20 2nd NE Auburn 253-735-7561 1-5 to Exit 142B(Hwy 18)
Regional Medical East on Hwy 18 to Auburn Wy
Center Go North on Auburn Wy
Left on Main
Right on Auburn Ave. Go Left on 2"c.
Harborview 325 9th Ave Seattle 206-731-3074 Take 1-5 to Exit 164A
Medical Center Take the James St Exit
Turn Right on James Street
Right on 9th Street to Hospital
South
St. John's Longview 1614 E Kessler Longview 360-636-4818 Take 1-5 to Exit 36
Blvd West on Hwy 432
Right on 15ththen Left on Kessler.
Salmon Creek 211 NE 139th St. Vancouver 360-487-1400 Take 1-S to Exit 7. Merge onto 1-205 S.
Medical Center Take NE 130 St exit.
Keep left toward WSU.
Left on 134th St. Left on 20th.
Right on 139'h to the hospital.
Southwest 400 NE Mother Vancouver 360-514-2000 Take I-5 to Exit 7
Washington Medical Joseph Place Take I-205 to Exit 28
Center Right onto Mill Plain
Right on Mother Joseph Place
Created: 2001 Final Revised January 31,2020 Page# 54
Lewis County CEMP—ESF# 8 Health,Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
Attachment D:
SALT TRIAGE SYSTEM OVERVIEW (MCI)
Taken from the Model Uniform Core Criteria for MCI Triage
Federal Interagency Committee (FICEMS) on EMS
The SALT (Sort, Assess, Life-Saving Intervention, Treatment/Transport) triage system
was developed by the Centers for Disease Control and Prevention (CDC) to address
limitations in START and other triage systems. It has been endorsed by numerous
national EMS groups. It is designed to reduce triage time and has an additional triage
category to better utilize resources, and CDC has proposed SALT as the national
standard for MCI triage.
Use SALT triage to assess any significant number of victims rapidly. It can be used
easily and effectively by all EMS personnel.
INITIAL AND SECONDARY TRIAGE PRIOR TO TRANSPORT
Initial Triage
• Use triage ribbons (color-coded strips), not triage tags, during initial triage. One
should be tied to an upper extremity in a VISIBLE location (on the right wrist, if
possible).
o RED — Immediate
o YELLOW — Delayed
o GREEN — Minimal
o GREY — Expectant
o BLACK — Dead (both ribbons and triage tags use a black & white zebra
stripe rather than black for easier visibility in low light).
o ORANGE and polka dot ribbon - used in addition to one of the above
ribbons to indicate victim has been contaminated with a hazardous
material. The dots are to make the Orange easier to distinguish from Red.
• Move as quickly and safely as possible, making quick decisions. Remember that
the victim may be re-triaged, probably multiple times, and the category will be
revised, up or down, whenever needed.
• Over-triage can be as harmful as under-triage. If everyone is tagged red, those
who are truly red will receive delayed treatment, delayed transport, and delayed
definitive care.
o NOTE: Expectant does NOT mean dead.
• It means the patient is unlikely to survive given the current resources.
• Treatment and transport should be delayed until more resources, field
or hospital, are available. If there are delays in the field, consider
Created: 2001 Final Revised January 31,2020 Page# 55
Lewis County CEMP—ESF# 8 Health, Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
requesting orders for palliative care, e.g., pain medications if time and
resources allow.
Secondary Triage
• Secondary Triage must be performed on all victims prior to transport.
• Treatment Area may also be the Casualty Collection Point (CCP), or the CCP
may be separate.
o Patients should be reassessed periodically, including when moved to a
CCP, or when their condition or resources change.
• Utilize Triage Tags and complete pertinent and available information on the tag.
o Affix the tag to the victim using the triage ribbon. This is not done at the
initial triage site, but after patients enter the Treatment Area or by the
Transport Group if patient is being directly moved without going to
Treatment Area.
o Tags are applied after patients enter the Treatment Area or CCP, or by
Transport Group if the patient is being directly removed without going to the
Treatment Area.
• Orange Ribbons (indicating contaminated patients) are not removed during
Decon.
o EMS always has responsibility for performing primary decontamination
prior to transport, however, the hospital must be aware of both
contamination and decontamination.
o When contaminated patients are discovered, each of those patients
initially receives two ribbons: one with a triage category (Red, Yellow,
Green, Gray, or Black (zebra), and the other an Orange polka-dot ribbon.
o Move ribbons to Decon under them.
o After patients are Deconned, add a white ribbon to the patient and be sure
to note "Decon" on the Triage Tag Intervention and note the time. (That
way the hospital know the patient has had field Decon, but may still be
somewhat "dirty")
o Notify hospitals of an MCI involving victim contamination
• Priority for transport is determined in the Treatment Area or by the Transport
Group.
• Patient allocation, that is, distribution of patients among various hospitals, is one
of EMS' most crucial tasks.
Created: 2001 Final Revised January 31,2020 Page# 56
Lewis County CEMP—ESF#8 Health,Medical, and Mortuary Services
Mass Casualty Incident Plan(MCI)
SORT, ASSESS, LIFE-SAVING INTERVENTION, TREATMENT/TRANSPORT
PROCESS
S — Sort
• Global Sorting: Action 1
o Action: "Everyone who can hear me please move to [designated area] and we
will help you" (use loudspeaker if available)
o Goal: Group ambulatory patients using voice commands
o Result: Those who follow this command — last priority for individual
assessment (Green)
o Assign someone to keep them together (e.g., PD, FD, a bystander) and notify
Incident Command or Medical Branch Director of number of patients and their
location. Do not forget these victims. Someone must re-triage them as soon
as possible.
o In smaller incidents, such as a motor vehicle crash with a few victims where
you do not want any of them to move on their own, skip Action 1, and go to
Global Sorting Action 2
• Global Sorting: Action 2
o Action: "If you need help, wave your arm or move your leg and we will be
there to help you as soon as possible"
o Goal: Identify non-ambulatory patients who can follow commands or make
purposeful movements
o Result: Those who follow this command —second priority for individual
assessment
• Global Sorting: Result
o Casualties are now prioritized for individual assessment
• Priority 1: Still, and those with obvious life threat
• Priority 2: Waving/purposeful movements
• Priority 3: Walking
• Begin assessing all non-ambulatory victims where they lie, performing the four
Life Saving Interventions (LSIs) as needed, but only within your scope of
practice, and only if the equipment is readily available.
• Each victim must be triaged as quickly as possible.
Assess:
• Is the patient breathing?
o If not, open the airway. In children, consider giving two rescue breaths.
Created: 2001 Final Revised January 31,2020 Page# 57
Lewis County CEMP—ESF#8 Health,Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
o If the patient is still not breathing, triage them to BLACK, using a zebra-
striped ribbon. Do not move the patient except to gain access to a living
patient.
o If patient is breathing, conduct next assessment.
• Assess for the following:
o Can the patient follow commands or make purposeful movements?
o Does the patient have a peripheral pulse?
o Is the patient not in respiratory distress?
o Is hemorrhaging under control?
• If the answer to any of those questions is no and the patient Is likely to
survive given current resources, tag them as RED (Immediate).
• If the answer to any of those questions is no and the patient is Not likely
to survive given current resources, tag them as GREY (Expectant).
• If the answer to all of those questions is yes but injuries are not minimal
and require care, tag patient as YELLOW (Delayed).
• YELLOWs have serious injuries and need care, though not as
urgently as REDs. On secondary triage, some YELLOWs will need
higher priority transport than others.
• If the answers to all of those questions is yes and the injuries are minor,
tag patient as GREEN (Minimal).
• Two mnemonics for the four Assess Questions:
o CRAP:
• C — Follows Commands
• R — No Respiratory Distress
• A — No (uncontrolled) Arterial bleeding
• P — Peripheral Pulse Present
o A second mnemonic is the use of good or bad. Don't be confused by the
double negatives in two of the questions. Instead, think of the questions in
terms of"bad" or "good". If the answer to the questions is "bad" (i.e., cannot
follow commands, absent peripheral pulse, respiratory distress, or
uncontrolled hemorrhage are all "bad"), then the patient is tagged either RED
or GREY.
Created: 2001 Final Revised January 31;2020 Page#58
Lewis County CEMP-ESF# 8 Health,Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
Life Saving Interventions:
• Only correct life-threatening problems during triage.
o Control major hemorrhage
o Open airway (if child, consider giving two rescue breaths)
o Needle chest decompression
o Auto injector antidotes
Treatment/Transport:
• Transport/treatment priority is typically given to RED (Immediate), YELLOW
(Delayed), then GREEN (Minimal).
• GRAY (Expectant) patients should be treated/transported as resources allow.
• Patients should be reassessed periodically, including when moved to the CCP, or
when their condition or resources change.
Special Considerations:
• When using Triage Tags, if the patient's condition or the triage priority changes,
indicate that on the tag. If necessary, add a new tag to identify the new triage
priority, and if time permits, the reason for the change.
SALT Mass Casualty Triage
Walk
,a,s Ord
I-Sort: wave!Purpoeeld Movement
Global sorting_: Assess 2nd
Still/Obvious Lite Throat
Assess 1st
j Stop 2-,Assess:
j Individual Assessment
LSI: __ -_—,
C,�irct mop h�a.H�wp• commends se m ew .------__l
• "I(614 �Yin
cau.dw 2 iKan WN�b i —•,3wat/ril 6••Na PWipigem racer 1• hhmn , Minimal
,awl a„�y , i •PIO•i spralnrydiem:, only
•AMa rricw•.diaokv 1-NO •Mslc"wnbriwi►K carsc,kd+ Delayed
• Any No
Dead
U>wiywww.e7wn Ytt immediate
axon vivo,*
D
Expectant
•
Created: 2001 Final Revised January 31,2020 Page# 59
,
Lewis County CEMP—ESF#8 Health,Medical, and Mortuary Services
Mass Casualty Incident Plan(MCI)
Attachment E:
ICS Chart - Full
Liaison
PIO
IC
Safety
• I — Reconi
Finance Planning Logistics Operations —
Medical Rescue Hazard
Branch J ` Branch Mitigation
• Medical Group Medical Group Division Division Fire Ops Hazmat Decon
Supervisor Supervisor Group 1 Group 2
. 1
Triage Green Pts. 1 Treatment Transport Removal Extrication
This is the org chart for a large scale incident. As with other incidents, multiple
roles may be filled by one individual as span of control and need allow. (e.g.
' Medical Group Supervisor may fill the roles of GREEN Area Manager, Treatment
and Transport Group Supervisor. Geography and work volume may alter this).
THIS CHART IS NOT INTENDED TO IDENTIFY ALL ASPECTS OF ICS AT A LARGE
INCIDENT.
Created: 2001 Final Revised January 31,2020 Page#60
Lewis County CEMP—ESF#8 Health,Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
ATTACHMENT F
Mass Casualty Triage Diagram - *SALT
Walk
Assess 3rd
Step 1: Sort: Wave / Purposeful Movement
Global Sorting Assess 2nd
, Still / Obvious Life Threat
Assess 1st
Step 2 - Assess:
Individual Assessment
Lifesaving
Interventions:
• Control major hemorrhage
• Open airway (if child N°
consider 2 rescue breaths) Breathing? Dead
• Chest decompression
Yes
V
• Obeys commands or makes All
purposeful movements? Yey_ Minor Yes
• Has peripheral pulse? injuries
• Not in respiratory distress? only?
• Major hemorrhage is controlled?
No
Any No
Delayed
Reassess:
considering Likely to survive Yes
patient conditions, given current its- Immediate
resources, resources?
scene safety
No
Expectant
V
Step 3 -
Treatment and/or Transport
*Recommended SALT Triage, National Association of EMS Physicians(NAEMSP)&National Registry of EM
Technicians(NREMT)
Created: 2001 Final Revised January 31,2020 Page#61
Lewis County CEMP-ESF#8 Health,Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
ATTACHMENT G
Tagging Chart
f
Triage Group Supervisor
l Tears ribbon pieces
I M PACT
Initial Triage
Tag With GREEN/INC Area
Flagger ZONE Process:
Ribbons 1. Tag with flagger
ribbons
2. Triage
Processing Steps: --ts�...._ 3. Interview
4. Self Release or
1. RECON—Global Sort Mass Transit to
2. Assess-GREENs moved out Medical or
2. LSI-Triage—Tag with ribbons Reunification
3. REDS then YELLOWS to CCP Center
4. CCP Secondary Triage&Triage tag f
5. RED-YELLOW To Treatment Areas ! ^Try
6. RED-YELLOW To Transport GREEN / INC
7. Process GREY/ DECON Area
8. Corner match reconciliation
Use flagging tape
V
--
Secondary Triage
Triage Tag CASUALTY COLLECTION POINT (CCP)
Torn to Color \
i.
Treatment Group
Supervisor tears RED YELLOW
"Destination" Corner
j
a LOADING Transportation Group
e
` Supervisor tears
AREA "Transport" Corner
Count Reconciliation
By Treatment & / - iv N
Transportation Group
Supervisors Transportation Corridor
Created: 2001 Final Revised January 31,2020 Page#62
Lewis County CEMP—ESF#8 Health,Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
ATTACHMENT H
Triage Tag
Transportation Group Supervisor corner
Treatment Group Supervisor corner
V 1
`„`Otc 11111.11111 lHIll Il lli 111 1IIIEI1111I1ll
` `.,,I, N1675876 MEDICAL``•
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•
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S, l` .`�jO ,i
n ,'
i . ,Q •
`• ,' EMTx •�•
Time Date / /
J
❑ Male ❑ Female Age Weight
Notes TIME INTERVENTION
1015 _ DECON
Destination
Major Injuries _
Name
Time [ BP Pulse Resp. Responsiveness Address
A V P City State
A V P U Phone ��II EfNAxrusAuRmoRs
1T
A V P U 800-425-5397 mettag.com MT-SO1 o 2eM6`Au.PoDMS RESERVED
Not Breathing DEAD DEAD 1M11111767IIN
N166755876
of likei to ury've • I L P i_T
®1�IIIIfIIIIM
•
g 'to survive givel current IMMEDIATE
I MMEDIAT: I®M,IIIIIMI11MM
. FS ; N1675876
Obeys commands or makes
purposeful movements
II1ital,ii;!Iii+1111ili
AND Has peripheral pulse DELAYED DELAYED N1675876
AND Not in respiratory distress
AND Major hemorrhage controlled
Minor injuries only MINIMAL MINIMAL IIIIII�IIIIIj
N1675876 <
Created: 2001 Final Revised January 31,2020 Page#63
Lewis County CEMP—ESF## 8 Health, Medical, and Mortuary Services
Mass Casualty Incident Plan(MCI)
ATTACHMENT I
Primary Duties - Authorities Chart
Incident Commander(IC)
• Establishes Command,calls MCI Level Safety Officer
• Appoints Medical Branch Director or assumes
those duties • Identifies hazards
• Notifies Medical Control/MMCC/DEM I* • Reviews IAP for safety
• Appoints Safety Officer concerns
• Appoints Staging Manager • Prevents unsafe acts
• Serves as or appoints PIO • Investigates accidents
• Requests status updates every 10 minutes
• Coordinates demobilization
Green Area Manager
Medical Branch Director
• Reports to Treatment Group
■ Conducts Size up, provides to IC Supervisor
• Appoints Triage,Treatment and Transportation • Gathers& removes all
Group supervisors ambulatory, non-injured
• Submits patient counts to IC. patients
• Performs initial triage
• Tracks self-released persons
Triage Group Supervisor Provides GREEN count&self
i • released to Treatment Group
• Establishes Tagging/Removal Teams Supervisor
• Establishes Casualty Collection Point(CCP)
• Performs ongoing triage
• Submits Patient count to Medical Branch Director • Liaisons with Law for
• Appoints Green Area Manager, if necessary interviews
• Match torn triage ribbon stubs with Transport Group Supervisor • Provides transport to hospital
or Reunification Center
• Retags and moves
Treatment Group Supervisor deteriorated patients to
YELLOS/RED areas
4
• Supervise RED,YELLOW, and GREEN Areas • Considers comfort needs&
• Ensures patient care documentation provides information to
— ■ Conducts Secondary Triage
• Tracks injured released at scene(not transported)
• Establishes Medical Supply
• Communicates with Transportation Group Supervisor Staging Manager
regarding patient injuries and destinations
• Matches Tag Tags with Transportation Group Supervisor • Takes direction from Medical
Branch Director
•
Transportation Group Supervisor Manages Level II staging area
■ Communications with Transport
— • Establish Transportation Corridor Group Supervisor
•
• Track patient numbers/destinations Notifies Medical Branch Director
• Communications with Staging for resources when there is insufficient
• Maintains communications with Medical Control/DMCC transport vehicles pending
• Matches Triage stubs with Treatment Group Supervisor
Created: 2001 Final Revised January 31,2020 Page#64
Lewis County CEMP—ESF# 8 Health, Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
ATTACHMENT J
MCI Triage Bag Inventory Recommendation
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Created: 2001 Final Revised January 31,2020 Page#65
Lewis County CEMP—ESF#8 Health,Medical,and Mortuary Services
Mass Casualty Incident Plan(MCI)
ATTACHMENT J
MCI Triage Bag Inventory Recommendation — Page 2
• SALT-triage algorithm inserts
• Survey ribbon:
o Green
o Yellow
o Red
o Grey
o black and white striped
o orange with polka dots
o white
• Several pairs of large gloves (90% of EMS providers can function in this size)
• 3-4 of the most common sized NPA's and OPA's
• 3-4 hemostatic gauze pads or 4x4's
• 2-3 tourniquets
• A face mask or shield
• 2 occlusive dressings
• Heavy duty medical tape
• Flashlight or headlamp
• Trauma shears
• Grease pen and or permanent marker
• 10 triage tags with attached cordage
• 2- 10g-14g catheters for chest decompression
Created: 2001 Final Revised January 31,2020 Page#66
BOCC AGENDA ITEM SUMMARY
Resolution: BOCC Meeting Date: May 18, 2020
Suggested Wording for Agenda Item: Agenda Type: Deliberation
Adoption of the January 31, 2020, Mass Casualty Incident Plan as an Annex to the Lewis County
Comprehensive Emergency Management Plan
Contact: Andy Caldwell Phone: 3607401157
Department: DES - Emergency Management (Dept. of Emergency Services)
Description:
Adoption of the January 31, 2020, Mass Casualty Incident Plan as an Annex to the Lewis County
Comprehensive Emergency Management Plan
Approvals: Publication Requirements:
Publications:
User Status
Josh Metcalf Pending
PA's Office Approved
Additional Copies: Cover Letter To: