Lawrence-Douglas County Fire Medical 210.40 Procedure Mass ... · 156 - Patient Triage: Use START Triage, jumpSTART for pediatrics. Initial triage can be 157 indicated with colored

Lawrence-Douglas County Fire Medical Procedure 210.40 Title:

Mass Casualty Response Effective Date: 07/03/2019 Page 1 of 15 Supersedes – SOP II-358 Date(s): 04/02/2018

1 PURPOSE 1

2

This plan establishes structure and guidelines for the management of operations in a multi-3

casualty emergency situation. This plan will integrate into the overall Incident Command 4

System. 5

6

2 SCOPE 7

8

The scope of this procedure applies to department members. 9

10

3 ACCREDITATION REFERENCE 11

12

5G Technical Rescue 13

14

4 PROCEDURE 15

16

INTRODUCTION 17

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The first arriving unit(s) of a large scale emergency with multiple casualties may well find 19

themselves overwhelmed with minimal resources to act. It is imperative that they utilize 20

strong and effective communication to establish an operational structure to deal with the 21

incident at hand and to bring rapid, effective, and efficient care to the largest number of 22

victims possible. 23

24

MASS CASUALTY INCIDENT (MCI) LEVELS 25

26

MCI Levels are based on the number of estimated patients, and are used by Dispatch centers 27

and area hospitals for coordinating resources. Thus, early determination of the MCI Level is an 28

important part of size-up at an MCI. 29

30

Level V: 5 – 10 patients 31

Level IV: 10 – 25 patients 32

Level III: 25 – 50 patients 33

Level II: 50 – 100 patients 34

Level I: 100+ patients 35

36

FIRST ARRIVING UNIT 37

Establish a strong visible command; 38

- Perform size-up and provide an initial report. 39

- What type of incident (i.e. building collapse, bus accident, tornado, etc.)? 40

- Perform rapid safety assessment. 41

- Estimated number of victims and MCI. 42

- Upgrade alarm and/or request mutual aid. 43

If the incident is a chemical, biological, radiological, nuclear or explosive (CBRNE) mass 44



casualty event, treat it as a hazmat scene. Immediately request the appropriate hazmat 45

response if not already dispatched. 46

- Time permitting, notify local medical facilities and advise them on potential 47

decontamination needs. 48

Establish access and egress and identify a staging area with easy access for apparatus and 49

resources. 50

Establish a casualty collection area for ambulatory victims. 51

Establish work zones and hazard control zones (if applicable). 52

Initiate triage using START/jumpSTART. 53

Maintain command and control of incident until relieved. 54

55

INCIDENT COMMAND SYSTEM (ICS) FUNCTIONS AT AN MCI 56

57

As additional resources arrive, the Incident Commander will expand the operational structure 58

as needed. 59

60

Most commonly, an MCI will require the Incident Commander to establish a Medical Branch. 61

Under the Medical Branch will be the Triage Group, the Treatment Group, and the Transport 62

Group. Each of the above Groups will have specialized teams working under them. 63

64

Non-medical ICS roles that will frequently be created at an MCI include a Staging Group and a 65

Landing Zone Group (which may be combined into the Logistics Branch at larger incidents). 66

67

Other ICS roles may be created at an MCI to handle specific needs or hazards. A major 68

tornado might require a Rescue Branch with USAR, Structural Collapse, and other technical 69

rescue functions. An incident involving hazardous materials release will likely need a HAZMAT 70

Branch for entry, isolation/containment, and decontamination. 71

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Figure 78

1: Sample ICS chart at an MCI 79

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INCIDENT COMMANDER

RESCUE BRANCH

MEDICAL BRANCH

Triage Group

Triage Team 1

Triage Team 2

Treatment Group

Minor (Green)

Delayed (Yellow)

Immediate (Red)

Uninjured (White)

Transport Group

Medical Control

Transport Teams

Ambulance Coordinator

LOGISTICSBRANCH

Safety Officer

PIO



ICS POSITION RESPONSIBILITIES 84

85

Incident Commander (IC) 86

Assume command from initial IC. 87

Use the radio designation “COMMAND”. 88

Establish a strong visible command. 89

- Don the appropriate vest, and use green command light on vehicle 90

Perform initial size-up as well as an ongoing evaluation of changing conditions. 91

Establish operational structure and groups to manage resources. 92

- Review available/incoming resources, and request additional as needed. 93

Consider EOC and the Mass Casualty Trailer 94

Consider mutual aid requests 95

- Ensure regional hospitals and Emergency Management Control Centers (EMCC) are 96

notified to initiate their mass casualty plans. 97

This will be the responsibility of the Transport Group, once it is established. 98

Consider need for additional radio channels, request them early. 99

100

Public Information Officer (PIO) 101

Use radio designation “PIO”. 102

- Don appropriate vest. 103

Reports to COMMAND. 104

Monitor situation to be able to answer public questions/concerns. 105

Established designated media briefing areas & times as needed. 106

Craft press releases and social media statements to convey public safety messages. 107

108

Safety Officer 109

Use radio designation “SAFETY”. 110



Monitor situation and emergency operations for unsafe practices or plans. 113

Delegate additional safety officers as necessary. 114

- Example: Incident Safety Officer is at Unified Command Post for over-all view of incident 115

operations. If USAR Operations are being conducted in the Hot Zone, the Incident 116

Safety Officer establishes a dedicated USAR Group Safety Officer. 117

118

Medical Branch 119

Use radio designation “MEDICAL BRANCH”. 120



Establish/supervise Medical Branch (Triage, Treatment, and Transport Groups). 123

Ensure patient accountability procedures are followed. 124

Coordinate, direct, and request resources as needed for Medical Branch Groups, and make 125

requests via the chain of command. 126

Liaison with other Branches as needed (ex: work with Rescue Branch to ensure coordinated 127

operations during USAR). 128



129

Triage Group 130

Use radio designation “TRIAGE”. 131


Reports to MEDICAL BRANCH Director. 133

Supervise one or more Triage Teams. 134

- Consider requesting separate tactical channel. 135

Maintain over-all understanding of conditions in Hot Zone, including: 136

- Total number of patients 137

- Totals in each triage category 138

- Approximate locations of patients 139

- Special hazards or needs 140

- Estimated time to access/remove patients 141

Coordinate Triage Team(s) movement of patients to Treatment Group. 142

- Priority to most critical and easiest removed patients. 143

Collect and retain triage tag slips as patients are moved to Treatment Group. 144

- Track which Triage Team brought which patient out of the “Hot Zone”. 145

Release assigned members for other functions (e.g., Treatment Group) as they become 146

available. 147

148

Triage Team(s) 149

Use radio designation “TRIAGE TEAM 1”, “TRIAGE TEAM 2”, etc. 150

Reports to TRIAGE Group Supervisor. 151

- Number/location/severity of patients 152

- Obstacles/special hazards 153

Typically 2-4 responders per Triage Team. 154

Responsible for medical operations in the “Hot Zone”. This includes: 155

- Patient Triage: Use START Triage, jumpSTART for pediatrics. Initial triage can be 156

indicated with colored ribbon strips. Triage tags should be applied at time patient is 157

being moved to Treatment Group. Save one of the tear-off slips from each triage tag, 158

and provide them to the TRIAGE GROUP Supervisor when possible. 159

- Immediate Treatment: These will be rapid BLS interventions only (airway opening, 160

wound packing, tourniquet application). Use supplies from Mass Casualty/Active 161

Shooter kits. 162

- Victim Removal: Moving patients to Treatment Group. Applies to non-technical removal 163

only (stretchers/backboards) for patients who can be accessed and removed without 164

delay. Operations that involve technical rescue, Hazmat, or other specialized skills will 165

have Groups/Teams from appropriate branches coordinating work with Triage Group 166

Multiple teams at larger incidents should be coordinated. Options include: 167

- Using multiple entry points simultaneously 168

- One team enters, other team(s) move patients to Treatment Group 169

- Two teams “leap-frogging”: 170

Triage Team 1 enters, proceeds to triage/treat until supplies exhausted. 171

Triage Team 2 enters, meets w/Triage Team 1, and continues from where they left 172

off. 173



Triage Team 1 exits, removing most critical victim(s) to Treatment Group, resupplies, 174

then re-enters to meet with Triage Team 2 and repeat cycle. 175

176

Treatment Group 177

Use radio designation “TREATMENT”. 178



Supervise Treatment Teams (described below). 181

Establish safe location for treatment area. 182

- Minimize distance to incident scene and to transport area 183

- Outside of Hot Zone 184

Consider requesting tactical channel. 185

Monitor allocated personnel/equipment for each treatment area, redirect as necessary. 186

Maintain awareness of supply levels, request resupplies early through the chain of 187

command. 188

Coordinate patient transport priorities with TRANSPORT GROUP Supervisor. 189

Maintain patient accountability. 190

- Collect triage tag slips as patients are moved to Transport Group. 191

- Utilize the Mass Casualty Patient Accountability equipment provided. 192

193

Treatment Teams 194

Treatment Teams are the personnel assigned to each treatment area. 195

Provide care for the patients in their area until they are transported from the scene. 196

Determine which patients need to be transport priorities. 197

Monitor patients for signs of increasing/decreasing severity. 198

- Move patients to other Treatment Teams as dictated by symptoms. 199

Example: a patient initially placed in Delayed (YELLOW) area who is no longer AxOx4 200

should be moved to Critical (RED) area. 201

- Note any re-triage on the patient’s triage tag. 202

Team size determined by needs – GREEN TEAM may only need 1 person to maintain 203

accountability, while RED TEAM may need a dozen to provide adequate care. 204

205

Critical (RED) Team 206

- Use radio designation “RED TEAM”. 207

Leader should don appropriate vest. 208

- Reports to TREATMENT Group Supervisor. 209

- Provide care for most critical patients: 210

Patients in this area will be breathing spontaneously, but may need airways 211

maintained, and will have one or more of the following: 212

RR>30 213

Absent radial pulse OR cap refill >2 secs 214

Altered LOC 215

- Collect any personal property removed from patients and attach personal property tag. 216

- Patients in this area will require the most attendants and supplies. 217

- Determine which patient(s) is the most critical when transport capabilities are limited. 218



Consider both severity of injuries and likelihood of expedited transport having a 219

significant impact on patient outcome. 220

Report order in which patients are to be transported to TREATMENT Group 221

Supervisor. 222

223

Delayed (YELLOW) Team 224

- Use radio designation “YELLOW TEAM”. 225



- Provide care for non-critical patients: 228

Patients in this area will have the widest range of severity in terms of injuries, but 229

common factors will be: 230

Unable to walk 231

AxOx4 232

Pulse, perfusion, and respirations within normal limits 233

- Collect any personal property removed from patients and attach personal property tag. 234

- Patients in this area may require care at scene for prolonged periods before transport, 235

while critical patients are being transported. 236

- Monitor patients for deterioration and re-triage as necessary. 237

238

Minor (GREEN) Team 239

- Use radio designation “GREEN TEAM”. 240



- Provide care for ambulatory patients. 243

- Monitor patients for deterioration and re-triage as necessary. 244

- Patients in this area may require transport to a hospital via ambulance, but may also be 245

appropriate to transport via passenger vehicle, or be treated and released at scene. 246

Keep ambulatory patients in this area to prevent loss of accountability or 247

overwhelming closest hospitals with patients seeking care in POV. 248

- Alert & oriented patients have the right to decline treatment/transport. 249

If circumstances permit, create an ePCR report for patients to sign refusals. 250

If creating an ePCR is not feasible: 251

Record the patient’s name and other information on their triage tag. 252

Write “refusal” in the comments section of the triage tag. 253

Have the patient write their signature in the comments section. 254

Retain the triage tag for later tracking – patient accountability. 255

256

Uninjured (WHITE) Team 257

- Use radio designation “WHITE TEAM”. 258



- Act as a collection/accountability area for civilians at an incident who are uninjured or 261

decline further medical care. 262

- Not always established, but a good idea in some circumstances: 263



Incidents requiring decontamination or other processing of all people in Hot Zone 264

Incidents with large numbers of uninjured participants 265

- Establish safe exit corridor from scene and release civilians when directed to do so. 266

267

Morgue (BLACK) Team 268

- Use radio designation “BLACK TEAM”. 269



- Acts as a collection area for the bodies of patients who die after being removed from the 272

Hot Zone. 273

Patients who are Dead On Arrival inside the Hot Zone should NOT be removed from 274

the scene to the morgue, but left in place. 275

- Not always established, but should be created if large numbers of patients in the 276

treatments areas are dead or expected to die prior to transport. 277

- Determine a location for this team that is as isolated from view of other treatment areas 278

and onlookers as is reasonably possible under the circumstances 279

- If staffing permits, at least one person should be assigned to this team, to ensure bodies 280

are undisturbed. 281

- Treat bodies with as much respect and dignity as possible under the circumstances. 282

283

Transport Group 284

Use radio designation “TRANSPORT”. 285



Supervise Transport Group teams (described below). 288

Consider requesting tactical channel. 289

Maintain patient accountability. 290

Coordinate patient transport priorities with TREATMENT Group using following process: 291

1. TREATMENT Group Supervisor reports a patient is ready for transport and their triage 292

level (most critical first). 293

2. TRANSPORT Group Supervisor requests an ambulance for transport from AMBULANCE 294

COORDINATOR. 295

3. AMBULANCE COORDINATOR notifies TRANSPORT Group Supervisor when ambulance 296

is available for transport. 297

4. TRANSPORT Group Supervisor orders TRANSPORT TEAM to move patient to 298

designated ambulance. 299

5. TRANSPORT TEAM moves patient from Treatment Area to ambulance, as directed by 300

AMBULANCE COORDINATOR. 301

6. TRANSPORT Group Supervisor notifies MEDICAL CONTOL of patient being prepared 302

for departure. 303

7. MEDICAL CONTROL determines patient destination and informs TRANSPORT TEAMS, 304

AMBULANCE COORDINATOR, and TRANSPORT Group Supervisor. 305

8. AMBULANCE COORDINATOR reports when ambulance/patient depart the scene. 306

9. MEDICAL CONTROL updates patient log. 307

10. TRANSPORT TEAM reports to TRANSPORT Group supervisor for next assignment. 308



309

Ambulance Coordinator 310

Use radio designation “AMBULANCE COORDINATOR”. 311


Reports to TRANSPORT Group Supervisor. 313

Establish ambulance loading areas & ingress/egress pathways: 314

- Safe locations with controlled site access 315

- Minimize need for backing, if possible. 316

Supervise ambulance arrival, loading, and departure from loading area. 317

- Notified by TRANSPORT Group Supervisor when patients are ready for transport from 318

Treatment Areas. 319

- Request ambulances move into loading area from Staging as space permits. 320

Unlike ground ambulances, helicopters will have an LZ in the Staging area and will 321

not be in the loading zone. Instead, patients will be brought to the LZ by Transport 322

Teams. 323

- Inform TRANSPORT Group Supervisor when ambulances are in place in the loading zone 324

(or helicopters are available in the landing zone) and ready to receive patients. 325

- Direct TRANSPORT TEAM assigned to move patient from Treatment Area to assigned 326

ambulance, supervise patient hand-off. 327

Coordinate ambulance destinations with MEDICAL CONTROL. 328

- Receive patient destination from MEDICAL CONTROL 329

- Inform TRANSPORT TEAM(s) of patient destination 330

- Inform MEDICAL CONTROL once patient is transported, including triage & destination 331

Collect transport receipts from patient triage tags from Transport Teams. 332

- Note patient name (if known), triage, destination, and transporting unit 333

334

Transport Team(s) 335

Use radio designation “TRANSPORT TEAM 1”, “TRANSPORT TEAM 2”, etc. 336


Responsible for moving patients from Treatment Area to loading zone or landing zone. 338

Patients may be moved by cot, soft-cot, backboard, stretcher, or other device. 339

Activated by TRANSPORT Group Supervisor after the TREATMENT Group Supervisor and 340

the AMBULANCE COORDINATOR report a patient and ambulance are both ready for 341

transport. 342

Take report from Treatment Area, ensure treatments/vitals are documented on triage tag. 343

Move patient to ambulance. 344

- May be with cot, soft cot, stretcher, Gator, or other means. 345

Provide report and transfer patient care to transporting ambulance crew. 346

Collect transport receipt portion of triage tag at time of hand-off. 347

- Should include patient name (if known), triage, destination, and transporting unit. 348

Deliver transport receipt portion of triage tag to AMBULANCE COORDINATOR. 349

Report to TRANSPORT Group Supervisor once ready for next patient. 350

351

Medical Control 352

Use radio designation “MEDICAL CONTROL”. 353





Determine hospital destination(s) for all patients transported from scene: 356

Hospital bed availability is determined in KC Metro Area by EMResource (web-based 357

software), which is accessed by one of three EMResource Control Centers (EMCC): 358

- Johnson County (KS) Dispatch (913) 432-2121 359

- KCMO Fire Dept. (FD) Dispatch (816) 923-3456 360

- Lee’s Summit FD Dispatch (816) 969-7407 361

- Douglas County Emergency Communications Center (785) 843-0250 362

Determine which EMResource Control Center (EMCC) is handling the MCI alert and 363

coordinate with that EMCC to determine bed availability of area hospitals. 364

Cellular networks may be overwhelmed at major incidents. EMCCs may also be 365

contacted by portable radio (mutual aid frequencies). Hospitals in the KC Metro area 366

may also be contacted directly via MARCER radios in ambulance patient compartments. 367

Track the available beds for each triage level (red/yellow/green) at each receiving hospital. 368

- Keep this information updated as patients are transported, and at longer incidents 369

where availability may change. 370

TRANSPORT Group Supervisor will notify MEDICAL CONTROL when a patient is ready to be 371

loaded/transported. 372

MEDICAL CONTROL will use available beds, patient triage, hospital distance, and special 373

needs of the patient to assign a transport destination. 374

Inform AMBULANCE COORDINATOR, TRANSPORT TEAM, and TRANSPORT Group 375

Supervisor of assigned hospital destination. 376

377

Staging Group 378

Uses radio designation “STAGING”. 379


Supervisor depends on scale of incident – may report directly to COMMAND or may report 381

to LOGISTICS at a larger incident. 382

Establishes a (Level II) staging area for resources to assemble. 383

Ensure that all personnel stay with their vehicles unless otherwise directed. 384

- If personnel are directed to assist in another function, ensure that the keys to the 385

vehicles stay with each vehicle. 386

Maintain a reserve of at least one transport unit. Advise COMMAND when all transport units 387

are depleted. 388

Provide updates on numbers of uncommitted resources via chain of command. 389

May supervise a LANDING ZONE TEAM if air ambulances are in use. 390

391

5 DEPLOYMENT OF REGIONAL MASS CASUALTY INCIDENT CACHES OF SUPPLIES 392

393

The MCI trailer is available for immediate deployment in the Northeast Kansas upon request 394

during a mass casualty or fatality incident. The Incident Commander shall make the request 395

and identify the location the trailer is to be dispatched to. The Douglas County Emergency 396

Communications Center (DGECC) can receive all requests by telephone at 785-843-0250, 397

alternately the Douglas County Emergency Management Agency can be contacted to process 398



the request through DGECC. There are caches of equipment intended for use during MCI 399

located throughout the KC Metropolitan area. Each cache has a capability to treat 400

approximately 50-100 patients. 401

402

Mass Casualty Incident Caches of Supplies (Appendix F; 2015 MARCER 403

Plan) 404

405

There are caches of equipment intended for MCI use located throughout the metropolitan 406

area. Each cache has a capability to treat approximately 50 to 100 patients. Some of the 407

equipment is ALS capable. 408

Caches include the following: 409

410

Western Missouri Fire Chiefs Association MCI Trailer 411

One trailer available: Located at Central Jackson County Fire Protection District Station #4 412

Contact: Fire Mutual Aid to Central Jackson County Fire Protection District or Call (816) 220-413

4005 414

• Capacity to treat up to 50-100 patients 415

• Carries ALS (IV and intubation equipment) and oxygen 416

417

North Kansas City Fire Department 418

One trailer available: Located at North Kansas City Fire Department Station #2 419

Contact: Call (816) 274-6010 or (816) 274-6013 420

• Capacity to treat up to 50 patients 421

• BLS equipped 422

423

Kansas City, Kansas Fire Department 424

One trailer available: Located at Kansas City, Kansas Fire Department Station #6 425

Contact: Call (913) 596-3050 426


• BLS equipped 428

429

Johnson County MED-ACT 430

Two trailers available: One in Mission and one in Olathe 431

Contact: Johnson County Emergency Communications Center at (913) 432-2121 432

• Each trailer has a capacity to treat up to 50-100 patients 433

• ALS and BLS equipped 434

• Multiple oxygen delivery devices 435

436

Kansas City International Airport 437

Note: This truck cannot leave airport grounds 438


440

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Mass Casualty Incident Caches of Supplies (Appendix F, 2015 MARCER Plan) 443

Continued 444

445

KCFD 446

One Trailer at the Eastwood Facility 447

Contact: Call (816) 924-0600 448


• ALS equipped 450

451

Northland Regional Ambulance District 452

One Trailer at NRAD Headquarters 453

Contact: Call (816) 858-4450 454



457

Belton Fire Department 458

One Trailer at Station #1 459

Contact: Call (816) 331-1500 460



463

Lawrence - Douglas County Fire Medical 464

One Trailer at LDCFM Station #2 465

Contact: Call (785) 843-0250 466

467

There is no cost for the use of the equipment, other than the replacement of expended 468

supplies. To request the cache be deployed to an incident, contact the communications center, 469

or listed contact, for each jurisdiction. 470

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APPENDIX A 487

Triage Guidelines 488

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APPENDIX B 528

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Triage Tag 530

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554 Document Initial triage ribbon color here. (applied by Triage Team @ initial contact)

First triage strip (front/back). Triage Team taking patient to

Treatment Area keeps it

Second triage strip (front/back). Removed by Treatment Team once patient is moved to Transport

Group

Transport Receipt (front/back) – removed & retained by Transport Group, to show where patient went & by which ambulance

Ambulance Receipt (front/back) – removed & retained by transporting EMS units for later patient tracking. Remainder of triage tag remains attached to patient for benefit of receiving

hospital

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=imgres&cd=&cad=rja&uact=8&ved=2ahUKEwiP-8eCzc7ZAhUGEawKHRUpB2gQjRx6BAgAEAY&url=https://www.grainger.com/product/DMS-All-Risk-Triage-Tags-38E563&psig=AOvVaw1YcYxAAx2rPaMHMedVehJl&ust=1520113180238991



APPENDIX C 555

556

Mid-America Regional Council Emergency Rescue Committee (MARCER) 557

558

Regional Mass Casualty Incident Plan for Metropolitan Kansas City, June 2011 559

560

Three copies of the document are also provided on the Mass Casualty Trailer. 561

Documents

Lawrence-Douglas County Fire Medical 210.40 Procedure Mass ... · 156 - Patient Triage: Use START Triage, jumpSTART for pediatrics. Initial triage can be 157 indicated with colored