I. Introduction

A. El Dorado County, as part of OES Region 4, has developed a plan to manage multi-casualty incidents utilizing the Incident Command System that is consistent with the Region 4 MCI plan and FIRESCOPE ICS.

B. This SOP is identical to the county-wide MCI plan, and shall be used on all Multi-Casualty incidents.

C. A Multi-Casualty Incident is defined as an incident involving five or more patients.

II. Definitions

A. Company - A fire service suppression unit and crew, including engines, squads, and trucks. For the purposes of this Plan, the first arriving emergency unit (Fire, Medic, or Law Enforcement) shall be considered the first arriving company if that unit arrives more than two minutes prior to the next unit.

B. Ambulance - A medical unit with transport capabilities.

C. Chief Officer - A Fire Department Officer at or above the rank of Battalion Chief.

D. MCI - Any single incident resulting in 5 or more patients at one location.

III. El Dorado County EMS Multi-Casualty Procedure

A. Priority of Assignments for Suppression Companies

1. 1st Company (may be a Medic Unit).

Initial IC, Medical Group Supervisor & Initial Triage. Establish Treatment Areas and Initiate Triage.

a. Position near scene for equipment needs.

b. Officer assumes command.

c. IC designates the incident a "Multi-Casualty Incident" in situations involving five or more patients.

d. IC gives an accurate report on conditions to Central Dispatch.

e. IC requests appropriate resources. Initially consider one ambulance for every two patients.

f. IC establishes areas for IMMEDIATE, DELAYED and MINOR treatment.

g. IC develops separate traffic plans for fire apparatus and ambulances.

h. Engineer begins triage, using the START system and triage tags.

2. 2nd Company

Treatment Unit Leader and Treatment Area

a. Responds to treatment areas.

b. Officer becomes TREATMENT UNIT LEADER.

c. Treatment Unit Leader develops designated areas into usable treatment areas by using salvage covers or other appropriate materials..

d. Treatment Unit Leader identifies areas as IMMEDIATE, DELAYED, and MINOR.

e. Treatment Unit Leader identifies and designates an area for MEDICAL SUPPLY.

f. Treatment Unit Leader assigns engineer to MINOR treatment area.

3. 3rd Company

Triage Unit Leader

a. Officer receives report from 1st Company engineer, assumes the role of TRIAGE UNIT LEADER, and advises IC or Medical Group Supervisor (if activated) of the change.

b. Company personnel become additional Triage Unit members, moving patients from the impact area to the appropriate treatment areas.

4. 4th Company

Medical Supply Coordinator

a. Positions near treatment areas.

b. Officer assumes the role of MEDICAL SUPPLY COORDINATOR.

c. Company personnel become additional Triage Unit members, moving patients from the impact area to the appropriate treatment areas.

5. Additional Companies Arriving at Scene

a. Initially strip companies of medical supplies and place them at the Medical Supply Area.

b. In the absence of an assignment on arrival, report to:

1). Incident Staging. If not activated, report to:

2). Operations Section Chief. If not activated, report to:

3). Incident Commander.

c. A number of options exist for assignment of additional companies:

1). Assignment to Medical Group to assist already assigned personnel.

2). Assignment to Operations for fire suppression or rescue.

3). Assignment to Morgue Unit until relieved by law enforcement.

4). Assignment to Staging.

B. Priority of Assignments for Ground Ambulances

1. 1st Ambulance

Treatment Managers (if 1st Medic Unit will be first arriving unit by more than 2 minutes, assume 1st company responsibilities)

a. Crew splits and assumes functions of IMMEDIATE and DELAYED TREATMENT AREA MANAGERS.

b. Establish and build up Treatment teams.

c. Utilize ambulance for initial medical supply.

2. 2nd Ambulance

Patient Transportation Group Supervisor

Communications Coordinator

a. Crew splits and assumes functions of PATIENT TRANSPORTATION GROUP SUPERVISOR and COMMUNICATIONS COORDINATOR.

b. One member establishes Transportation Group and coordinates with the Treatment Unit Leader to identify the first patients to be transported.

c. One member becomes Communications Coordinator, and is responsible for contacting the Disaster Control Facility (DCF).

3. 3rd Ambulance

First patient transportation unit. Unit members report to the Transportation Group Supervisor or the Operations Section Chief for assignment.

4. Additional Ambulances Arriving at Scene

a. In absence of an assignment on arrival, report to:

1). Ambulance Staging. If not established, report to:

2). Transportation Group Supervisor. Of not established, report to:

3). Operations Section Chief. If not established, report to:

4). Incident Commander.

C. Priority of Assignments for Chief Officers

1. 1st Chief Officer

Incident Commander

a. Receives briefing from initial IC.

b. Establishes Incident Command Post

c. 1st Company Officer becomes MEDICAL GROUP SUPERVISOR

2. 2nd Chief Officer

Operations Section Chief

a. Receives briefing from IC.

b. Assumes position of OPERATIONS SECTION CHIEF

3. 3rd Chief Officer

Logistics Section Chief

a. Receives briefing from IC.

b. Assumes position of LOGISTICS SECTION CHIEF.

4. Fire Chief

Incident Commander

a. Receives briefing from IC.

b. Assumes position of INCIDENT COMMANDER.

c. 1st Chief Officer becomes PLANNING SECTION CHIEF, and remains at the Incident Command Post (this person possesses the most broad based knowledge of the incident, and is invaluable to the new IC).

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