View source for MCI Action List

==STAGE 1 (INITIATE) GOALS==

== '''Needs Assessment''' ==
->estimated time-line
:Now/10min/60min/hours
:Walk-in/Ground Ambulance/Air Transport
->injury types (COBRA/CBRNE)
:Trauma/Burn/Chemical/Radiation/Infectious
->incoming patients
:Children/Adults

== '''Incident situation''' ==
ED/OR/Hosp capacity assessment

Census, Open Beds, Expandable Space

Asset Assignment

Staff - communicate/assign

:Pre-OP - Triage Staging/OR Holding
:OR - Immediate Surgical/Damage Control
:Post-OP - PACU/Minor Procedure/PICU Annes

Stuff - secure/prepare/deliver
:Stretchers/Monitors
:Fluids/Blankets/Triage Intervention
Space - assign/secure
:Consider double stretcher in rooms
:PrepPACU/OR Corridor: stretchers/beds/equipment

== '''Activate Preparation Response (local)''' ==
:<i>(understand basic concepts of Patient Influx Protocols)</i>
::[https://hpo-docs.jh.edu/I8EMHRyj EP318 Patient Influx: Mass Casualty - ED]
::[https://hpo-docs.jh.edu/KxeyOf0y EP317 Patient Influx: Mass Casualty Physician Teams]
::[https://hpo-docs.jh.edu/ZuKVoCVH EP322 Patient Influx: Mass Casualty Bio]
::[https://hpo-docs.jh.edu/1O8qyPQX EP323 Patient Influx: Mass Casualty Chemical]
::[https://hpo-docs.jh.edu/4uVAB1aA EP324 Patient Influx: Mass Casualty Radiation]
::[https://hpo-docs.jh.edu/WlMMKGUN EP333 Patient Influx: Epidemic/Pandemic Respiratory Illness (EPRI) Response Plan]

:Declare/verify appropriate Patient Influx Plan (ED/Hospital)
:Activate local incident command (administration)
:Notify clinical departments: ED, trauma for Peds & Adults, radiology & shift coordinators
:Partial mobilization of staff: ED trauma nurses, radiology, public affairs, EVS, security

'''Activate local reverse triage'''

'''Decide/Assess:''' 
:Define staff, space, stuff needs
:Acquire/Prepare additional supplies
:[partial] mobilization of hospital incident command

'''Activate concepts of Triage'''

==STAGE 2 (RAMP UP) GOALS==

'''Needs Assessment'''
:Situation
::incoming patients
::needs assessment
::estimated ongoing time-line
:Hospital/Local capacity needs assessment

'''Activate Hospital Response'''
:(understand base concepts of code yellow ED vs. code yellow Hospital)
:⁃Declare code yellow HOSPITAL
:⁃Activate Hospital incident command (HICS)
:⁃Notify clinical departments: wards, trauma for Peds & Adults, radiology & shift coordinators
:⁃Stop elective operations (ORs/Clinics)
:⁃Mobilization of staff: Hospital nursing, blood bank, EVS, radiology, public affairs, security, public affairs, facilities
::⁃Call in additional staff
::-Activate hospital-wide reverse triage

Decide/Assess: 
:⁃[partial] mobilization of hospital incident command
:⁃Define staff, space, stuff needs
:⁃Acquire/Prepare additional supplies
:⁃Establish contact with other hospitals
:⁃Go on ED diversion
:⁃Contact materials management for more supplies (eg, PPE)

Activate concepts of Re-Triage

==STAGE 3 (ACTIVE) GOALS==

Triage + Treat Patients
:Immediate interventions
::Airway (oxygen)
::Bleeding (tourniquet)
::Chest tube
::Antidote

Move Patients Around
:- match resources to needs

Expand available space to accommodate more patients
:- repurpose space as necessary

Secure perimeter/crowd control
:-“Protect the House”

Attempt to Resupply
:- Anticipate ongoing needs
:- Consider time-limited resources

==STAGE 4 (CONSOLIDATION) GOALS==

Recursive needs assessment: open ICU/OR beds

Maintain contact with other hospitals
:-borrow supplies
:-re-supply
Media/crowd management

Re-Triage

==STAGE 5 (ON-GOING MANAGEMENT) GOALS==

Staff management – getting more fatigue mitigation; food

Family management

Advanced triage

Definitive Treatment - ICU, OR, Home, Psych Liaison, Morgue

Ongoing security

==STAGE 6 (RESOLUTION) GOALS==

Send excess staff home

Begin elective procedures again

Bring in new staff

De-escalate security

Restock supplies

Laundry/Room Flips