EMS teams need to be prepared for all kinds of situations that might cause other people to freeze or panic. EMS teams take on the responsibility of keeping a level head in tense situations, even when everything is descending into chaos.
A big part of the successful split-second decision making required for EMS teams is based on continuous training so that working efficiently is second nature. By putting in the training ahead of time, performance could improve noticeably during a real incident.
We’ve created this resource to help foster a greater understanding of MCIs and MCI response.
What Is an MCI?
MCI is an acronym that typically stands for Mass Casualty Incident. In some cases, it is used to stand for Multi-Casualty Incident or Multiple-Casualty Incident. No matter which variation of the name, an MCI refers to an incident where emergency medical services respond to a single event with multiple casualties.
No number of casualties qualifies one incident as an MCI over another. An active shooter event with 3 casualties could be considered an MCI, while a natural disaster with 50 or more casualties will also be considered an MCI, on a much higher level. In a large-scale MCI, the number of casualties has the potential to exceed the resources available to provide support.
Several types of resources are likely to be depleted in an MCI. There will be a limited number of EMS professionals, meaning only so many people can receive treatment at a time. There may also be a shortage of medical professionals to go around to treat everyone quickly.
Medical personnel isn’t the only resource that is likely to be exhausted during an MCI, however. Supplies like bandages, medication, medical equipment and other resources will also be in high demand and may not be available in adequate quantities for all patients.
What Are Some Examples of Mass Casualty Incidents?
Many disasters can lead to an MCI. A few of the most common ones include:
- Active Shooter Situations: Unfortunately, shootings have become increasingly common in recent years. An active shooter incident is likely to result in a high number of casualties.
- Terrorist Acts: This is something of an umbrella term, as a terrorist act can take many forms such as a vehicle incident, an active shooter or something else altogether. In any case, these incidents will likely result in a higher rate of casualties.
- Explosions: Whether it is intentional, or the result of some unintended reaction or malfunction, explosions can lead to a large number of casualties relatively quickly.
- Natural Disasters: Sometimes, an MCI is the result of nature taking its course and people getting caught in the crossfire. This might be a hurricane, tornado, tsunami, volcano or any number of other natural phenomena.
- Multi-Vehicle Accidents: This category refers to things like multi-car pileups on the highway. While an accident between only two cars can be devastating, it isn’t likely to be referred to as an MCI. As more and more cars get involved in an accident, however, the number of casualties increases and it is more likely to be considered an MCI.
- Mass Transit Mishaps: If a plane crashes, a train derails, a bus topples off a bridge or any incident like this occurs, this is what’s called a mass transit mishap. Because so many people are generally crowded onto mass transit, this is usually classified as an MCI.
What Are the Most Important Aspects of MCI Response for EMS?
It is imperative that EMS teams know how to respond quickly and accurately in the event of an MCI. That means more than just knowing how to help the injured. It also means knowing how to work efficiently with other personnel and how to contribute without getting in the way of other responders.
With this in mind, here are five essential points for a responder to be aware of during an MCI.
1. Early Command Decisions and Communication Between EMS Responders
In most situations, an MCI response consists of a team of EMS workers. As part of a team, it’s crucial that all members of the team work together with each other, as well as with other medical professionals that may be present. If each party heads off and begins acting independently without any communication between the groups, it will be impossible to coordinate efforts, resulting in duplication of efforts or interference with the work of another group.
Instead, it’s vital to make decisions early on. If someone is in charge of the team, let them assign roles or areas to work. Once they give these orders, follow through with them. It’s equally important to communicate with fellow EMS workers. Keep them informed of what is happening, what changes to make and what developments are underway. This keeps incident management efforts efficient, allowing the team to help the greatest number of people.
2. Requesting Additional Resources Early
When first called to a scene, it might not initially be clear how many casualties there are after an incident, or how severe their injuries are. It may not be clear whether 5 or 15 additional personnel are needed. Quickly surveying the situation and requesting the additional resources necessary can help the team work faster and save more lives.
3. Knowing the Distance to Exit and Access Points
Entryways and access points are of critical importance during an MCI. Whether coordinating medical supplies, evacuating people, or directing additional personnel, it’s of the utmost importance to understand and communicate where the access points are, including any potential obstructions.
4. Initial Search and Assessment
This is an essential phase of any MCI. After arriving on site and taking stock of the situation at hand, it is critical to determine whether the incident is ongoing or has concluded, fan out and search the wreckage, locate as many injured people as possible and assess their injuries. It is also necessary to determine if people can safely be moved or if their injuries are too severe. If the immediate surroundings are too dangerous for an injured person to remain, it may be the best action to move them despite their injuries.
While communication with the rest of the team is always important, it is especially important during this phase to figure out what has happened and how to best organize efforts.
5. Triage and Treatment
Triage is one of the biggest differences that sets MCIs apart from any other medical emergency. In addition to a shortage of supplies, MCIs are also typically categorized by the need for triage.
Triage refers to the process by which injuries are cataloged and ranked in order of severity and urgency. For example, triage might consist of deciding a large abdominal wound is much more severe and should receive treatment before a broken finger. However, during an MCI, triage must be completed on a much larger scale.
While completing the search and assessment of the disaster site, EMS personnel need to take stock of the injuries observed, decide which should be treated right away and which can wait while the supplies go to the more extreme injuries.
What Are the Biggest Challenges With MCIs?
MCIs are highly stressful situations that bring with them a whole host of challenges. To prepare for an MCI, consider the following problems that are unique to these situations:
- Location of the Incident: MCIs don’t always happen in convenient locations. Sometimes, they’re complicated to get to and are not in a place that’s convenient for efficiently delivering additional supplies and personnel. Other times, they happen far from any hospital or medical care facility.
- Staffing Levels: Because these incidents usually happen unexpectedly, there aren’t normally enough medical professionals to go around. Because of this, everyone has to work twice as hard to try to make up the difference.
- Limited Equipment: Just as there aren’t enough doctors or EMS workers to go around, there usually isn’t enough equipment. Any equipment available is generally insufficient, meaning you may have to wait until more equipment can arrive from the nearest hospital or supplier.
- Ambulances From Another System: Ambulances, workers and equipment from surrounding areas may need to be called in. It may be difficult to work with these other services, as they’re likely to be unfamiliar with local policies and procedures.
- Ongoing Gunfire or Explosions: Sometimes, an MCI is ongoing even as the call for help is received. Treatment of the injured may need to begin even as there is still gunfire, explosions or other violent disturbances happening. This can present an enormous challenge keeping EMS teams safe while also helping the injured.
- Not Having Proper Training: An incident like this may happen before proper training has been taken. Or, you may find yourself in a position that no amount of training could ever prepare you for. Perhaps you’re trained, but your only team-members are inexperienced and untrained. No matter what the specific case, this can make the situation much more difficult.
How Do EMS Agencies Train for MCI Response?
If it’s so difficult to form a correct EMS response to mass casualty incidents, how do most EMS agencies deal with this? How do they go about crafting their large-scale casualty response? How do they train their EMS workers, when by definition, an MCI is chaotic, confusing and difficult to handle correctly?
Here are five steps most agencies take during an MCI.
1. Create a Response Plan
Having a mass casualty incident plan is very important for any EMS agency. This means that when word of an incident reaches them, they have a go-to method for how they’ll deploy EMS workers, as well as how they will respond when the workers report they need more help. It’s imperative to create this plan before an incident happens. This way, everyone will be equipped to handle an MCI and understand their responsibilities.
2. Triage Skill Practicing
As discussed above, triage is the process of deciding which injuries are more urgent and require care immediately and which ones can wait until additional assistance or supplies arrive. While different agencies and organizations may have their own systems when it comes to triage, a fairly standard system is one that involves color-coded tags, where each color symbolizes a different priority level.
The color coding system is as follows:
- Red Tag (Immediate): This individual requires immediate medical care or they are not likely to survive. Examples include severe bleeding and internal hemorrhaging.
- Yellow Tag (Delayed): Injuries are still severe, but can wait two to four hours without treatment. An example would be an open fracture of the femur.
- Green Tag (Minimal): These injuries are minimal. While they still need care, they can wait and are not likely to be life-threatening. An example might be a broken wrist or several broken fingers.
- Black Tag (Expectant): This tag is reserved for individuals who are either already deceased or not expected to live, even with medical care.
3. Plan the Scenario
When training EMS workers, agencies should work to carefully plan out possible scenarios as well as their planned responses to these potentials incidents. While it’s impossible to predict every aspect of a disaster scenario, it is possible to be prepared for possibilities and ensure everyone knows their role when an MCI does occur.
4. Coordinate With Receiving Hospitals
In any type of MCI, EMS agencies and hospitals will be natural partners. It is only fitting, then, that both parties should coordinate with one another to establish routines, training measures and response plans. That way, if an incident happens, both parties will be better equipped and prepared to handle it smoothly.
5. Review Your Training
An EMS agency, a hospital or any other organization can provide all the training in the world. It’s up to you to review the training and make sure you know what to do. Make a point of reexamining what you’ve learned on a regular basis until it becomes second nature. If an MCI occurs, you don’t want to panic and forget what you know — you want it to be so ingrained in your mind that you couldn’t forget it even if you tried.
The Best Ways to Increase the Efficiency of an MCI Response
You can do plenty of things to increase efficiency and readiness when it comes to mass casualty incident management. Start by running drills, training workers about mass casualty triage and establishing necessary procedures. All of these are excellent ideas, but one of the best things you can do is use an MCI management software.
If you’re interested in implementing an MCI management software into your crisis response program, browse our site to learn more about DataTech911 and all the benefits our program has to offer you.