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/Numbers
Incident situation
ED/OR/Hosp capacity assessment
Census, Open Beds, Expandable Space
Asset Assignment
| Location | Phone | Location | Phone | |
|---|---|---|---|---|
| Hospital Incident Command | ACCM Incident Command | |||
| Peds Shift Coordinator | ||||
| ZBOR4 Anes Commander | ||||
| ZBOR4 Surg Commander | ||||
| ZBOR4 Nursing Commander | ||||
| ZBOR4 Pre-Op | 2-5890 | Radiology | ||
| ZBOR OR Desk | 5-6520 | Blood Bank | ||
| ZBOR4 PACU | 5-5722 | Security | ||
| ZBOR4 PICU | 5-5260 | EVS | ||
| Emergency Department | 5-2280 | Facilities |
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
- Personal Protective Equipement
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
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