# MCI & Triage



## mikie (Apr 1, 2008)

*I tried a search and yielded nothing, so if this is already out there, my apologies*

What was the largest MCI you've been involved with?  How many people?  What happened?  Your role?  

Just curious.

Also, this might be branching off but...(and you don't have to answer if you just want to post the stuff mentioned above)

I have yet to 'work' one, but I was wondering, how do you move on from patients?  I guess I was just taught to tag and move on (if not critical), but how do you just leave if you think they need far more assessing, even if they could be considered 'green' (ie- minor bleed but suspicious of other injuries) .  Hope that made sense...

Thanks!


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## firecoins (Apr 1, 2008)

mikie333 said:


> *What was the largest MCI you've been involved with?  How many people?  What happened?  Your role?


A nursing home as evaculated due to a small fire.  Helped move residents to a different a school for shelter.  

I did a riot at the US Chinese embassy by Tibetan protesters.  We were the ALS bus.  All the injuries were minor, mace or hit with batons.  FDNY EMS supervisors were in charge.  Other BLS ambulances positioned to transport if necessary. 

Indirectly....my suburban vollie ambulance corp was ready to go into NYC and take normal 911 calls in the week after 9/11 so FDNY EMS could move resources downtown.  Never happaned.  So we wern't involved but were ready to be.



> have yet to 'work' one, but I was wondering, how do you move on from patients?  I guess I was just taught to tag and move on (if not critical), but how do you just leave if you think they need far more assessing, even if they could be considered 'green' (ie- minor bleed but suspicious of other injuries) .  Hope that made sense...
> 
> Thanks!



you just do that.   You do a very quick assement and move on.  To much will be going for you to care about individual.  You will have your hands full.  If your tagging people, your the triage officer so make sure you got ambulances coming to take care of people.


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## Grady_emt (Apr 2, 2008)

First In, Last Off...
Get additional resources rolling early!!!  It's much easier to cancel them if not needed than to need them and they be tied up on another call already. 

Basically, if you get onscene and start triaging, you should never load a pt in your unit unless it is the last patient to leave the scene.  The most critical and still viable pt should be put in the second/third/fouth due units.

       Personally Ive been first in on a CO poisoning in a nursing home (32 assessments, 21 transports)
       First in at an Escalator collapse/failure in a public transist station on New years eve last year, 28 assessments, 7 transports (2 critical-1 pelvis frac, 1 bilat compoind femurs)
       Many many MVCs that required multiple units (we dont fly being an inner-city service with a level 1 trauma center)

As the first in unit, usually my partner and I will split up.  My partner will grab the bag and start basic treatments and triaging pts.    I'll start to get a Pt count, make sure there are no hazards, and establish command while staying near the truck.   Staying at the truck has many purposes, if my partner needs any equip then I can get it, I'll tell other responding units to report to our truck with stretcher/LBB/jump bag etc, and the side of our trucks is a great surface to use as a white board with a dry erase marker to keep track of pts, trucks, and what hospitals are accepting pts.  I keep a dry-erase marker in my bag for this purpose.


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## Jon (Apr 2, 2008)

I think it depends on the scope of the incident... an MCI is often defined as any incident where the number of patients is more than the number of availible units. If you have a multi-vehicle accident, with, say 5 "actually injured" patients... then you might have an MCI... and at the least, you are overwhelmed until additional units arrive. HOWEVER... you probably don't need to pull out the triage tags and you and your partner can just work to treat the most seriously injured. In fact, once other units arrive, you and your partner might just grab the most serious patient and head for the TC or the LZ (depending on your system... you might head for the TC/LZ with someone else as your driver, and your partner riding a different patient in).

We had one a few years ago on the PA Turnpike where a smaller passenger van lost its front axle while cruising at approx. 70mph... they were in the passing lane and the driver's side went into the Jersey Barrier at high speed. Single vehicle... with 8 or 9 occupants. 1 BLS and 1 ALS fly car onscene at first. We called for the "medical box" which gets us 5 Transport units, 2 ALS fly cars, and an Engine or Rescue. The medic had me dig out his triage tags and tag all the patients... Driver was a yellow/red tag... hyperventilating, chest pain, spidered windshield and ??? seatbelt. I think we had 5 greens and 2 yellows in the back of the van... most were kids, and all had to be immobilized. After Fire got the driver's door open, the driver came out and went to the L.Z. ALS (He bought himself a whirlybird ride to the TC). We transported everyone in 4 rigs - In fact, as we were a combination paid/vollie FD/EMS agency...my ambulance left without me, with someone off the fire engine at the wheel. I went back to station on the Engine.

Anyway... in short... at an MCI, most of the "normal" way we do things goes out the window. We do what needs to be done to treat the patients. If it is a REALLY big incident... your rig will be stripped for the treatment sector while you try to find and triage all the patients. If it is smaller... then you might still transport.


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## rayemtjax77 (Apr 2, 2008)

Largest MCI was a 14 car MVA.  I was one of the first rescues on scene.  Did a rapid trauma assessment on everyone.  called in extra resources.  noone was "critically injuried" So we did quick basic first aide then sent them on.  Its not really hard to deal with if U are only with them for a few seconds.. maybe a minute.  its when you are with them for 30-45 minutes during either a long transport or even a long extrication.


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## BossyCow (Apr 2, 2008)

The point of moving on from someone that is too severely injured for your help is because there are others who need your time. Generally speaking, in this situation, you are going to be so busy working on those you can help, I don't think those you can't are going to be much of an issue.


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## AZFF/EMT (Apr 2, 2008)

Largest started as a single vehicle rollover with ejections (2patients) and 9 other patients who self extricated. While responding to the scene 4 other cars were involved in an accident at the scene. All minor/delayed patients in the second accident but total of 7 more. So 18 total patients. 

Immediates-2 grounded to level 1's and 3 flown(st.Joe's). 4 other delayed patients grounded. The remaining were refusals.


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## Airwaygoddess (Apr 2, 2008)

*Fire!*

Painted Cave Fire in Santa Barbara, Ca.  So much smoke and a Very fast moving fire.  Came very close to evacuating the whole central wing of the main hospital due to air ducts almost failing.......That was one wild 36 hours...-_-


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## certguy (Apr 3, 2008)

Multiple large MVA's ( over 10 vehicles ) over the years due to fog/rain and cranial/rectal inversion causing confusion about which pedal the boneheads should push till impact . First in on at least 3 that I can remember . Hotel fire - downtown San Diego . Unknown total number of pts. 27 transported , we took 4 . Border patrol bus crash in San Ysidro , 77 pts. 7 or 8 transports . ( first in BLS rig , no radio contact with ALS till we got there , thought I was gonna wind up medical IC ) 

In an MCI , step back for a second , take a deep breath , and think about what you need to do . Safety first . Is it safe for you and your crew ? Start triage where you stand and follow a systematic route . It should take about 30 seconds per pt. Life saving care only is your goal . Triage , open the airway if needed ( 2 attempts , if not breathing , tag dead and move on ) , control major bleeds and keep moving . Transport teams will be following you to take the pts. to treatment . As a general rule , if they're screaming thier heads off , you know they're conscious and have a good airway . It's the silent ones you need to worry about , thier airway status is unknown . CPR is too labor intensive when you're low on manpower and if you tie up on one pt. who is clinically dead , you will lose others who would've been saveable . Don't be afraid to use green tags to help out ( keeping airways open , direct pressure for bleeding control , babysitting confused head injuries , etc. As triage officer , your function is evaluation only .


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## certguy (Apr 3, 2008)

Also , dispatched for Tecate bull ring collapse in Mexico and the Normal Hieghts fire in San Diego .


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## Grady_emt (Apr 3, 2008)

Heard a rumor the other day that they are changing the "Dead" portion of the triage tag from black to blue, has anyone else heard/seen this?  Why change something that is so easy to comprehend to anyone, black = bad


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## Jon (Apr 3, 2008)

I saw a orange vs. blue addition to the triage tag for "contaminated and salvageable" and "contaminated and gonna die" at EMS Today... can't remember which vendor.. but it was an add-on to the start of the SMART triage algorithm. I also saw a tag that had a "White" option for "uninjured but tracked"... makes sense.


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## Ridryder911 (Apr 3, 2008)

I was one of the triage officers at the OKC Bombing (> 200 patients) as well as many other MCI's (tornadoes, school exposions, MVC's). 

MCI planning is great, but they call it a disaster for a reason. Each case is separate. 

R/r 911


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## BossyCow (Apr 3, 2008)

We had 14 mexican Salal pickers in one van wreck. 2 spoke some english, several self extricated and left the scene... I can't imagine why..


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## Jon (Apr 3, 2008)

BossyCow said:


> We had 14 mexican Salal pickers in one van wreck. 2 spoke some english, several self extricated and left the scene... I can't imagine why..


Just to be non-offensive... I think you meant to say "Hispanic migrant agricultural workers" - is that correct?  BTW... as I live near the "Mushroom capital of the world" we have similar populations including communications barriers and the desire by some of the population to, umm, _avoid _legal involvement.

And I want to ask how many seatbelts did the van have?... but that would be off-topic, and I'd have the Forum Moderators give me a hard time.



PS.. Rid... Any tips/tricks? Anything work well?


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## Ops Paramedic (Apr 3, 2008)

This is one of those situations where you get thrown in the deep end!  No matter what they teach you in school or you learn from a book, you can only apply some of the basics.  The rest you will have to come up with as you move along in the scene and as you are exposed to more and more of these incidents.

There is, as mentioned, a difference between multiple casualties and mass casualties, the latter bordering more toward the disaster side.Resources are not just a phone call for us, and we have to manage them very carefuly.  Hence, sometimes we have to clear c-spine prehospital.  It is alarming, but we might have to stick up to six patients in a ambo.

The way we normally do them is that the first highest medical qualified person takes charge of the patients and triage them, until an higher qualified can take over.  We don't use the tags system, but rather something along the lines of (when triaging):  If you can walk, or is standing = Code green.  If you can't walk, but can talk = Code Orange/yellow.  If you don't walk or talk = Code red (until proven otherwise or death is obvious).  The only treatment we give during traige is to turn the red code patients lateral.

I go to Multiple casualties on a weekly base, up to 30 patients.  Some from the archives...  43 Code blue/black at a stampede at a soccer game and only 3 code yellow, of which 2 was flown due to not bieng able to get in or out of the stadium, 72 odd kids with food posioning at some event (Has anyone else worked on a medical multiple casualty??), train accident with 40 or so minor injuries...


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## BossyCow (Apr 3, 2008)

Jon said:


> Just to be non-offensive... I think you meant to say "Hispanic migrant agricultural workers" - is that correct?  BTW... as I live near the "Mushroom capital of the world" we have similar populations including communications barriers and the desire by some of the population to, umm, _avoid _legal involvement.
> 
> And I want to ask how many seatbelts did the van have?... but that would be off-topic, and I'd have the Forum Moderators give me a hard time.
> 
> ...



Right after this incident we got those spanish phrase books for each of our rigs! We also called ahead for a translator to meet us in the ER. 

Actually the Salal pickers are generally independent contractors who get a license to harvest Salal which is used for greens in floral arrangements. So not technically agricultural workers. Also, not migrants, they live here full time, since Salal is an evergreen.


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## emtwacker710 (Apr 4, 2008)

Our last big one that I was on was in December of '07, me and another guy were at our building and our tek had the medic truck and we get dispatched to a restaurant I used to work at, (The Log Jam for anyone from this area) for a female unresponsive, breathing confirmed, our squad building is at exit 18 of I-87 so as we are getting off exit 20 we hear the FD first responders calling the county for additional ambulances and full fire response for a possible CO leak in the building, so after about 10 minutes of toning mutual aid companies we have 2 fire companies, 3 county EMS and fire coordinators and 7 ambulances on the scene, the rig I was on (1st due) pulled out our MCI kit and started triaging the people we could find, it was one of our 1st MCI's in a while and honestly I have to say it was a clusterf*ck, but eventually we transported 3 pt.'s that got flown to a hyperbaric chamber, my rig had the worst pt. and then we went back and us and another local rig each took 10 pt.'s to the ER, there were also about 7-8 pt.'s that signed off and drove themselves to the ER...that was a fun night...Dennys afterwords though^_^


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## paramedix (Apr 4, 2008)

Ops Paramedic said:
			
		

> I go to Multiple casualties on a weekly base, up to 30 patients. Some from the archives... 43 Code blue/black at a stampede at a soccer game and only 3 code yellow, of which 2 was flown due to not bieng able to get in or out of the stadium, 72 odd kids with food posioning at some event (Has anyone else worked on a medical multiple casualty??), train accident with 40 or so minor injuries...



I can second that... three or more MCI's per week is nothing out of the ordinary. The problem comes in with resources and unfortunately we do not have those resources available and we implement a demand and supply scenario.

You can have the best triage officer on scene or all the resources to your disposal, but communication plays the biggest role in the whole scenario. If you do not have an effective communication system in place, those resources and patients will stay as is.

Generally the first vehicle or crew that arrive on scene take control and have to relay as much information as possible to the control center. Allocate a specific channel for that scene and avoid radio interference. The call center needs to be updated regularly - thus further resources can be dispatched and other services can be notified.

The downside to our MCI's are that we sometimes have to many chiefs and no indians... everyone wants to be in charge...

The key is to work together by utilizing time effective and efficiently with excellent communication.


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## certguy (Apr 5, 2008)

BossyCow said:


> We had 14 mexican Salal pickers in one van wreck. 2 spoke some english, several self extricated and left the scene... I can't imagine why..



Working in San Diego , we used to get wrecks like that too , but these were mostly coyotes that wrecked , and you'd have mostly non - english speaking pts. everywhere . 

When we went on the border patrol crash ( greyhound sized bus with 77 illegals and 2 agents aboard that rolled on it's side during a nasty storm )  , I don't think any of them spoke english , but we had a lot of BP and FD that could on scene . BP did a great job of improvised stabilization , using 3 of thier blazers to keep the bus from sliding further downhill .


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