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)

(understand basic concepts of Patient Influx Protocols)

EP318 Patient Influx: Mass Casualty - ED

EP317 Patient Influx: Mass Casualty Physician Teams

EP322 Patient Influx: Mass Casualty Bio

EP323 Patient Influx: Mass Casualty Chemical

EP324 Patient Influx: Mass Casualty Radiation

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