MCI Management Tips

The ability to effectively manage an MCI is entirely dependent on how much effort has gone into building your MCI response capabilities. A well-managed mass casualty event is only possible when it has been front-loaded with adequate preparation, including resources, equipment, policies, procedures, strategic stockpiles, interagency agreements and both initial and ongoing collaborative training.

MCI planning and training have traditionally been based on trying to do the most good for the most injured people. A valid model for communities to use in preparation is to plan for their "most likely" worst-case scenario. Pour resources and planning into preparation for that event, which, in most communities, probably means a crash of some type of high passenger load transportation. Other common possibilities include fire in a high-occupancy building (especially with non-ambulatory occupants) or industrial operations.

Create an action plan to create an effective MCI response capability based on an assessment of your most likely worst-case scenario, an inventory of existing resources and capabilities to meet that challenge, and include a means to close any gaps. Consider your local medical protocols, national best practices or standards, incoming mutual aid resources, likely patient counts, tools, equipment, vehicles and personnel needs, sources and costs, funding and how to package for transportation to the scene.

Involve all potential players in the planning process so they take ownership of the final product and know their roles and responsibilities ahead of time. This can include law enforcement, fire, EMS, medical direction, hospitals, the disaster source itself and mutual aid resources. Don't forget to include the people who fund and oversee the agency. Their buy-in figuratively and literally will be essential.

Develop training that builds on existing skills and equipment, while adding in any new tools, equipment and procedures. Train to the highest risk identified in the action plan. Coordinate and conduct training with of all the players from other agencies who will be at the MCI scene.

Coordinate training evolutions with the source of your anticipated disaster. Familiarize responders with the physical environment, be it a train car, school bus or factory floor. At the same time, let the source know what the operations will include and what command and responders will need from them during the disaster.

Since 9/11, a great deal of thought has gone into managing "extreme" MCIs. In "extreme" mode, your focus changes from keeping the most severely injured alive to keeping your system alive. Harvesting becomes corralling the walking-wounded and worried-well so hundreds or thousands of people don't self-refer to local hospitals and prevent your community's medical system from treating the more seriously injured who will be transported via the EMS system. More seriously injured or contaminated victims who have self-extricated from the scene are captured at choke points, treated on scene and transported to definitive care. The most severely injured victims who cannot self-extricate are left in place so your responders can concentrate on doing the most good for the most people.

Ed Mund began his fire and EMS career in 1989. He currently serves with Riverside Fire Authority, a fire-based ALS agency in Centralia, WA. His writing and photos have been published in several industry publications. He may be contacted at ems@emedstrat.com.