MCI Resources

[EpiEMS]

While MCI resource needs depend on the scale and type of the MCI, I'd like to pose a question: What do *you* want, at a minimum, for the MCI response that you perceive as most likely and impactful (think number of critical patients times probability of the event) for your response area?

Here's the silly article from JEMS that prompted my thinking.

 

[DesertMedic66]

Most likely MCI for us is a car accident and we have had several. The most recent one was a bus vs semi with 13 DOAs and 30 injured.

What I would like on scene? A qualified IC, a qualified MedCom, qualified triage leader, qualified transport leader. We don't always get those...

Let's use a 40 patient MCI (our most recent MCI). I would like a minimum of 10 ALS engines (the majority of engines are staffed with 3 crew members all being at least EMTs. So that makes 30 fire/EMTs. A BC from the fire department (usually have the most training for MCIs), and a PIO. As far as ambulances if I had unlimited numbers I would like to have a 1:1 for critical patients. Can transport several delayed in the same ambulance and maybe some minors. Can transport all the minors in a city bus with 2 EMTs.

So if there was 10 reds, 10 yellows, 20 greens I would like a total of 15 ambulances and a city bus.

I may also consider airships depending on distance to trauma centers.

 

[EpiEMS]

I think my most likely MCI is a bus accident along those lines, as well. Can't help but think that this is true for most of the country (where road transport by bus is common).

My biggest worry is a commuter train accident - 500 passengers on a single train plus limited access to the tracks means I'll likely need more rescue staff than I can get for extrications.

 

[NysEms2117]

@EpiEMS Albany had a pretty big "MCI" a few weeks ago, a car(ford f350 super duty, quad wheels all that crap) into a building (injuring 20 something people, i want to say 24). It's quite hard to get an MCI in a major city, just due to the large amount of resources we have... However all of what desert said was basically there. Both CCT rigs were called, 6 additional ALS rigs, 10 transport vanbulances(From mohawk*private*). The sheriffs office had the undersheriff there(in charge of the EMS unit), public officer, 8 squad cars from albany PD (set up a fantastic perimeter and staging area i may add). They also had a on-site communications "expert" *i dont know qualifications so i won't call them an expert*, and the CCRN's from one of the CCT rigs were the triage folks.

My biggest worry is a commuter train accident - 500 passengers on a single train plus limited access to the tracks means I'll likely need more rescue staff than I can get for extrications.

For this, NYS has something in place already, called New York Task for 2 (they handle the rest of the state, literally anything other then NYC.) the one exception was 9/11. NYTF1 is city. They have a ton of people available (i think they can deploy up too 100 people in under an hour +travel time ect), in reserves and active. Since you like sources: http://www.dhses.ny.gov/ofpc/ny-tf2/index.cfm
Its kind of cool how they work because the military will let them onto bases in NY and military pilots will fly them if a "heavy" deployment is deemed necessary.. In conjunction with NYSP. Albany county itself has a USAR team, so those 2 together gives you about 120-140 people?
The structure of NYTF2 is here: http://www.cdutsara.org/organization_chart.html

As well as Albany Med has helicopters stationed at it, so if need be for flight (i cant see why, but who knows.) that can happen. Albany med also has a neato program in my opinion, it asks doctors voluntarily to be put on a list in case of a MCI on a massive scale (bomb, building collapse, anything that could be +100 severe injuries), and if they get the call they come in **clock in to get paid for it**, and work, Just so you have more doctors available, and since it's voluntary, it would be safe to assume if they get called they will come, unless they are not in the area, ect. I just think that bit is really cool. **Source: trauma surgeon at Albany med current volunteered on that list**

 

[EpiEMS]

Albany Med has helicopters stationed at it, so if need be for flight (i cant see why, but who knows.) that can happen

I've never really heard of a major city flying patients out to outlying hospitals, but it seems possible. I know that during 9/11, hospitals outside NYC emptied out ERs, etc. so they could bring in the anticipated casualties from Lower Manhattan, so I suppose you could fly folks if need be. I would think burn patients, among others that need critical specialists that may not be available in an affected area, could potentially be flown?

 

[DrParasite]

http://www.nj.gov/health/ems/documents/special_services/njemstf_overview.pdf

http://www.wakegov.com/ems/about/operations/pages/fleet.aspx

 

[NysEms2117]

I've never really heard of a major city flying patients out to outlying hospitals, but it seems possible. I know that during 9/11, hospitals outside NYC emptied out ERs, etc. so they could bring in the anticipated casualties from Lower Manhattan, so I suppose you could fly folks if need be. I would think burn patients, among others that need critical specialists that may not be available in an affected area, could potentially be flown?

I meant more of Leave from albany med, come back to albany med... When i say there really is no other capable trauma hospital close... i actually mean that. I'd venture to say Westchester Hospital (south an hour- hour and 15 mins driving 100 L&S *in an LE car*) Or Crouse hospital in Cuse' (north about 2 hours going 100+) Unless you want to organize emergency flights into the city, which i sure don't, because that **** will be near impossible.
http://www.health.ny.gov/professionals/ems/state_trauma/trauma2.htm

 

[EpiEMS]

When i say there really is no other capable trauma hospital close... i actually mean that. I'd venture to say Westchester Hospital (south an hour- hour and 15 mins driving 100 L&S *in an LE car*) Or Crouse hospital in Cuse' (north about 2 hours going 100+)

I'm thinking more like, say you've got X number of severely burned patients in Albany, and you've got enough helicopters to fly a portion to Syracuse and a portion to Westchester (I don't think Albany has a burn center), so you go ahead and do that to improve care/free up ICU beds in Albany? I dunno if that make sense.

I do see your point for ground transport for sure.

 

[NysEms2117]

I'm thinking more like, say you've got X number of severely burned patients in Albany, and you've got enough helicopters to fly a portion to Syracuse and a portion to Westchester (I don't think Albany has a burn center), so you go ahead and do that to improve care/free up ICU beds in Albany? I dunno if that make sense.

I do see your point for ground transport for sure.

In all honesty my ground transport times where just a reference for you, but i could see it happening, especially NYSP, maybe stick a paramedic with an ALS back in the passenger seat and wing it?? Albany med does have a burn center, a small one, and i dont know if it is even state recognized, but its under 15 beds. I think thats the only thing albany med does not have.. They just got awarded peds TC if im correct as well. Westechester has absolutely everything i know that for sure.

 

[EpiEMS]

especially NYSP, maybe stick a paramedic with an ALS back in the passenger seat and wing it?

Maybe - but it's probably hard to do much care when you're in a Taurus's back seat!

Albany med does have a burn center, a small one, and i dont know if it is even state recognized, but its under 15 beds. I think thats the only thing albany med does not have.. They just got awarded peds TC if im correct as well. Westechester has absolutely everything i know that for sure.

Ah, that explains why I didn't see it - I was looking at the DOH list. Gotcha, thanks!

 

[NysEms2117]

Maybe - but it's probably hard to do much care when you're in a Taurus's back seat!

Charger* but the point remains the same. Could always pull over? maybe? tbh at that point it's a last ditch kind of thing.