DISASTER AND MASS

CASUALTY INCIDENT
• The emergency medical service (EMS) provides first-line
medical care in emergency incident and disaster situations.

• An incident is an occurrence, either caused by human or

natural phenomena, that requires response actions to prevent
or minimise loss of life, or damage to property and/or the
environment.

• The linguistic definition of the world disaster is “a sudden

calamitous event bringing great damage, loss, or destruction”.

• The World Health Organization (WHO) defines an event as a

disaster when “normal conditions of existence are disrupted,
and the level of suffering exceeds the capacity of the hazard-
affected community to respond to it.”

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• While a disaster by definition overwhelms response
capabilities, a Mass Casualty Incident (MCI) occurs more
commonly and is defined as a situation that places a
significant demand on medical resources and personnel on
hand or equipment on hand.

• In MCI local response capabilities are not overwhelmed, but

there are still a large number of patients requiring medical
care.

• Having at least three or more patients

• Stress on resources; requires mutual aid response

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 Types of disaster and Mass Casualty Incidents (MCI)
• Mass casualty incidents and disaster can take on a number of forms, both natural and man-made
(Technological):
• Natural:
• They are caused by nature, and men have no control over them. Earthquakes, tsunamis, floods,
landslides, hurricanes, wildfires, droughts, and volcanic eruptions are some examples of natural
disasters.
• Endanger not only populations, but also entire environments can result in immense damage to
structures as well as human life.
• Acute events such as earthquakes, landslides and cyclones, and rising tide events such as heatwaves,
floods or severe cold weather can result in significant numbers of casualties.
• Man-made (Technological):
• Are events that are caused by humans and occur in or close to human settlements.
• Man-made disasters are less complicated and occupy smaller areas making them easier to control.
• For instance, transportation systems (aircraft, road traffic, railroads, shipping) make up a fair share of
incidents. The same holds true for industrial incidents involving factory fires and buildings collapse.
• Similarly, outbreaks of diseases can test the healthcare facilities’ ability to control the spread of the
diseases.
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• The MCI and disasters increased recently for many reasons
are multifactorial: overpopulation, urbanisation, expanding
industrialisation, increased traffic, climate change, ongoing
threat of terrorism, and armed conflicts

• Disasters throughout history have had a significant impact on

the numbers, health status and lifestyle of populations.

• It induces deaths, severe injuries, requiring extensive

treatments, Increased risk of communicable diseases,
damage to the health facilities, damage to the water systems,
food shortage, Population movements.

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When we consider an incident as a disaster?
• The same incidents occurring in one area are considered disaster, but if it
occurred in another area, it is a MCI.
• The outcome of the event by its effects on human and environment decides
whether this is a disaster or MCI.
• The factors affecting the event outcome are:
(1) Scope of the impact (2) Speed of the impact
(3) Duration of the impact (4) Preparedness level

• Regardless of whether a situation is classified as a disaster or MCI, it requires

rapid and effective response methods.

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 The response for MCIs or disasters

• Lives could be saved if the affected communities were better prepared, with an organized scalable
response system already in place.
• Although disasters and MCIs are of diverse types and effects, their medical responses have common
features.

• EMS teams need to be prepared for all kinds of emergency incidents and disaster.

• Preparedness is the most effective approach for the management of disaster risks, and it is essential
for the EMS providers, such as paramedics, emergency medical technicians (EMT), and other EMS
personnel.

• The response for MCIs or disasters should use the developed and efficient systems such as Incident
Command System (ICS)?
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 FIRST AMBULANCE CREW ON SCENE
Approach the incident with safety.
• Park the ambulance in a safe and upwind location.
• Wear all protective equipment (PPE) e.g. safety glasses, gloves, safety vest and helmet.
• A rapid assessment of the scene is essential.
• The information gathered is used to determine the initial Health Service response to the scene.
• Assess the situation and send a Situation Report (SITREP) to the Ambulance Commander or the
Communications Centre (if the Ambulance Commander is not on scene).
• The quality of the first information that is passed from the scene will be important in determining
the speed and adequacy of the subsequent response.
• The acronym METHANE is recommended as a reminder of the key information to be passed

M Major incident Confirm call - sign. Advise major incident ‘ standby ’ or ‘ declared ’
E Exact location (Grid reference, road names, landmarks, etc).
T Type of incident( Rail, chemical, road traffic collision, etc).
H Hazards Actual and potential
A Access/egress (Safe direction to approach and depart).
N Number of casualties (An estimate in the first instance and then upgraded with their
severity/type).
E Emergency services Present and/or required.

• If greater than six (6) casualties, assume the roles of Triage Officer and Transport Control Officer. 15
 TRIAGE OFFICER
The Triage Officer role is undertaken by the most clinically experienced Paramedic on
scene. They assume responsibility for casualty triage, collection and clinical management
(patient care) at the incident site.
Initiate Triage by quickly assessing, prioritising and labelling casualties.
• Direct and control supporting Paramedics to casualties.
• Maintain communications with the Ambulance Commander, Transport Control Officer
and Paramedics.
• Co-ordinate support provided from allied emergency services and supporting agencies,
in moving casualties from the incident site, to the Casualty Collecting and Treatment
Area.
• At the Casualty Collecting Area, separate casualties into distinct priority classification
groups, to facilitate evacuation, treatment and transport.
• Patients with life-threatening injuries / illness should not be left unattended, if at all
possible.
• Undertake continuing Triage of all casualties, re-assessing the priority of treatment and
transport.
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 TRANSPORT CONTROL OFFICER (TCO)
The TCO assumes responsibility of the Casualty Collecting Area (CCA), casualty
evacuation and transport at the incident site.
• Determine the most appropriate access and exist routes, and vehicle staging
area for ambulance vehicles. Advise the ACTAS Communications Centre of
these, for communication to other responding resources.
• In consultation with the Triage Officer and Ambulance
Commander (if present), select a CCA in a safe, upwind
environment.
• Select an Ambulance Marshalling Area, in a safe,
upwind environment, in close proximity to the CCA.

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• Ensure all arriving ambulances are correctly positioned, that keys
are left in the vehicle ignition and that the vehicle is configured for
two stretcher patients.

• Prevent congestion at the Ambulance Loading Point by

ensuring that ONLY ONE VEHICLE is being loaded with
casualties, at any one time.

• Record on the Casualty Movement Log, the number of

casualties transported, their priority and destination and
the ambulance vehicle identification number.

• Maintain communications with the Ambulance

Commander and the Triage Officer.
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 SUBSEQUENT AMBULANCE CREWS
• Approach the incident with safety.
• If the transport control area is set up, position the ambulance or support vehicle
correctly in the marshalling area, leaving the keys in the ignition.
• Once at the incident, all warning devices should be switched off unless otherwise
directed.
• Wear all protective equipment provided (i.e. safety glasses, gloves, safety vest and
helmet).
• Report to the Ambulance Commander on arrival for a SITREP and tasking.
If the Ambulance Commander is not on scene, report to the Triage Officer for tasking.
• If Paramedics are tasked to transport casualties to hospital they will:
• transport casualties to the hospital or medical centre nominated by the Transport
Control Officer
• advise the receiving emergency department, by radio, the number of casualties
being transported and the priority classification
• ensure that the receiving hospital or medical centre facilitates the QUICK TURN
AROUND of ambulance and support vehicles.

Report availability to the Ambulance Connection Officer at hospital ED (if present), or the
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Communications Centre, for further tasking.
 Incident Command System (ICS)
• Many incidents, whether major
accidents, minor incidents, or disasters
require a response from a number of
different agencies.

• Regardless of the size of the incident

or the number of agencies involved in
the response, all incidents require a
coordinated effort to ensure an
effective response and the efficient,
safe use of resources.

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What is Incident Command System (ICS)?

• ICS is the model tool for command, control,

and coordination of a response.

• Is a standardised, on-scene all-hazard incident

management concept.

• Allows its users to adopt an integrated

organizational.

• Structure matching the complexities and

demands of single or multiple incidents

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 History of ICS
• ICS was developed in the 1970s by an interagency group in Southern
California called FIRESCOPE.
• FIRESCOPE stood for Firefighting Resources of Southern California
Organized for potential emergencies, and they set out to develop two
interrelated, yet independent, systems for managing wildland fire.
• Weaknesses in incident management before ICS:
• Lack of accountability
• Poor communication
• Lack of a planning process
• Overloaded Incident Commanders
• No method to integrate interagency requirements

ICS provides an organized system to manage incidents and addresses

these weaknesses

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 Purpose of ICS

• Using best practices, ICS ensures:

• Safety of responders and others.

• Achievement of tactical objectives.

• Efficient use of resources.

• Stabilizing the incident and protecting life,

property, and the environment.

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 Basic Features of ICS
• Common terminology • Predesignated incident locations
• Modular organization and facilities
• Management by objectives • Resource management
• Reliance on an Incident Action • Information and intelligence
Plan (IAP) management
• Chain and unity of command • Integrated communications
• Unified Command • Transfer of command
• Controllable span of control • Accountability
• Mobilization

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 Key Benefits of ICS

• Manages events of any size or type.

- Establishes a clear chain of command
• Personnel from different agencies or departments can be integrated
- Provides a common structure:
- Effectively address issues.
- Delegate responsibilities.
• Provides logistical and administrative support to operational personnel
• Ensures key functions are covered
• Eliminates duplication

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 11ICS Management Organization
• ICS is a management system
• ICS principal tenets
- Every incident or event requires that certain management functions be
performed
• Problems are evaluated
• A plan developed to address the problem
• Implement corrective actions
• Assign necessary resources
- The ICS organization does NOT correlate to the administrative structure of
the agency
• Normal roles may not be assumed in ICS

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 ICS Management Functions

• The Management functions Command:

• Logistics
• Planning
• Finance/Administration
• Operations

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 ICS Management: Command
• Command:
• Sets the objectives
• Establishes strategies and priorities
• Maintains overall responsibility for managing the incident
• The Incident Commander:
• Is the only position always filled in on an incident regardless of its nature
• May be able to undertake all management functions alone on small incidents
• On larger incidents effective management may require that each function be
established as a separate section
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 ICS Management: Operations
• Conducts the tactical operations.
• Carries out the plan using defined objectives.
• Directs all needed resources.

ICS Management: Planning

• Collects and evaluates information for decision support.

• Maintains resource status.
• Prepares documents such as the Incident Action Plan.
• Maintains documentation for incident reports.
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 ICS Management: Logistics and
Finance/Administration
• Logistics:
• Provides support, resources, and other essential services to
meet the operational objectives.

• Finance/Administration:
• Monitors costs related to the incident.
• Provides accounting, procurement, time recording, and cost
analyses.

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 ICS Command Staff

• The Command Staff include:

• Public Information Officer
• Safety Officer
• Liaison Officer (Connection)

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 ICS Command Staff (2)
• Public Information:
• Advises the Incident Commander on information broadcasting and media relations
• Obtains information from and provides information to the Planning Section
• Obtains information from and provides information to the community and media

• Officer Safety Officer

• Advises the Incident Commander on issues regarding incident
safety
• Works with the Operations Section to ensure the safety of field
personnel
• Ensures safety of all incident personnel
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 ICS Command
Staff (3)

Liaison Officer:
• Serves as a point of contact for agency representatives
• Supporting the operations provides briefings and
answers questions from supporting agencies.

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 ICS Terminology
• Unified command
• Sections
• Divisions
• Groups
• Branches
• Task Forces
• Strike Teams
• Single Resources
• Transfer of command

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 Unified Command
• Enables all responsible agencies to
manage an incident.
- Establish a common set of incident
objectives and strategies.
• Allows Incident Commanders to make
joint decisions by establishing a single
command structure.
• Maintains unity of command.
- Each employee only reports to one
supervisor.
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 Sections
• Organizational levels with responsibility for a major
functional area of the incident.
• Operations
• Planning
• Logistics
• Finance/Administration
• The person in charge is the Chief.

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 Transfer of Command
• Moves the responsibility for incident command from one
Incident Commander to another
• Must include a transfer of command briefing
• Oral
• Written
• Both oral and written

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 The Incident Planning Process
• Six Steps in Incident Planning:
1. Understanding policy and direction.
2. Assessing the situation.
3. Determining objectives.
4. Determining appropriate strategies to achieve the objectives.
5. Providing tactical direction and ensuring that it is followed:
- Example: The correct resources assigned to complete a task and
their performance monitored.
6. Providing necessary back-up.
- Assigning more or fewer resources.
- Changing tactics

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 Review Key Points
• Benefits of ICS are:
• Manages routine or planned events.
• Establishes a clear chain of command.
• Provides a common structure.
• Provides logistical and administrative support to operational
personnel.
• Ensures key functions are covered and eliminates duplication.

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 Review Key Points
• ICS is modular and scalable to the scope and magnitude of the incident
• Incident Commander always activated
• Other positions activated as needed
• There are five management functions:
• Command
• Operations
• Planning
• Logistics
• Administration
• ICS provides a common terminology and position titles to enhance
standardization among agencies and responders.

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