ALS Role at MCI in a targeted system

[FiremanMike]

Why? was it because no one was following their MCI plans? did no one know what the MCI plans were? were there issues with the MCI plans? Is triage disorganized because the scene is chaotic, or because everyone is trying to treat and triage, and no one is actually setting up a plan to handle an incident? Was everyone freelancing before an incident commander started to assign tasks to specific people?
So what should we do? just do what the cops did at the aurora shooting, pull up, throw a bunch of people in the back of the car and take them to the local hospital?

There is an old saying: "those who fail to plan, plan to fail." All the experts from the boston bombing said their MCI plan worked pretty well, because it was a planned MCI. Many of the concerts I've worked have been the same. Where we end up with major CF is those unplanned MCIs, normally because we lack sufficient EMS resources to manage the scene, and people don't follow the established plan for how we will handle said MCI.

I'd love to see the presentation to see exactly they said could be done better.I am confident that your crews can triage without the tags, but your missing their point (other than proving a cheat sheet for those who forgot the algorithm): numbers, documentation and accountability.

The very nature of Eagles is that the presentations are short and they give you bullet points to consider to cause you to whet your appetite for more, so they didn't go extremely in depth as to the why's, but with that said, the themes seemed to be as follows;

1. Chaotic scenes. No matter how much we try to make MCI training realistic, it just isn't. It never is. When real people are hurt/dying/dead, it's a whole new ballgame.

2. Tags don't work from their standpoint for a few reasons, including but not limited to the fact that the actual triage color of a patient can change rapidly and by the time you get done triage tagging, it's basically time to start all over again. Additionally, they have noticed that folks are changing their tags or stealing other folks tags because they think they'll get transported out quickly.

3. They did not specifically speak to the incident command structure/freelancing, but IMHO the likelihood of the troops showing up at the same time as the IC and it all working smoothly without quickly overwhelming the incident command post are both fallacies. Real life scenes are extremely dynamic and it is unlikely that anyone could keep track of everything that's going on. Case in point, in Las Vegas, cops and Uber transported the majority of the patients and there was no accountability as to how or how many were being transported via those means.

4. I don't think it's fair to compare the Boston bombing to anything for a few reasons. First and foremost, this was a highly concentrated scene. Two blasts a block apart with all the patients in a very small area. Additionally, you had hundreds of cops/firemen/EMS who were ALREADY on scene and who were ALREADY dialed in to the idea of a mass casualty. This is NOT the norm of active aggressor scenarios, which happen at random times and in random places and result in responders coming in from random locations and at random times. Boston is not a fair comparison to anything.

Once the slides come out, I'll review through them to see if I missed anything and bring it back to this thread.