How prepared is your system?

Achilles

Achilles

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With all the talk about MCI's, whether it be human cause or natural disaster. How prepared is your system or agency for an MCI?
Does your agency have a system in place for a MCI?
Do your neighboring agencies?
How about your area hospitals?
If your trauma hospitals are overloaded where will you go?
Do you keep MCI supplies in a marked cabinet (IC gear, tags, etc)
How often does your agency train for an MCI?
While your agency may be top notch in MCI's, what about your neighboring agencies?
I under stand its going to be different for each level, but for this, lets say level 3 to a level 5 MCI.
 
My county is in the process of making it mandatory for EMTs/medics to take a 6-8 hour MCI class in order to recert. All of the employees at my agency (ambulance) have a very basic understanding (some more than others) of how to run a MCI. The fire department has much more training in MCIs.

Yes we have a system in place. Everyone is included in the system (Hospitals, Ambulance, BLS companies, Police, Fire Departments, School buses, Public transport systems).

The neighboring agencies are all the same companies so yes they have the same training as us.

Area hospitals signed a contract with the county EMS office agreeing to certain things, so yes they know, and yes they are trained in it also.

HEMS and ground units can transport to all hospitals. (In reality we have 5 trauma centers that we can transport to). We can also put 2 EMTs on a bus and fill it with minor or delayed patients and have that transport to hospitals.

On the ambulance (all BLS and ALS ambulances county wide) we have to carry 20 or 30 MCI tags, and certain ICS forms. The fire departments carry a lot more of the ICS forms and IC gear (designated vests for IC, Med Comm, Traige unit leader, etc)

Each of our 911 ambulance companies in the county (same company just different divisions) have a MCI trailer with an assortment of supplies from medical supplies to water to portable toilets and showers.

As of right now the only training that all employees have are ICS 100, 200. NIMS 700, 800. Various employees have more training than that. Supervisors all have more ICS classes and more training. Im not 100% sure on the training that the fire department gets. As I mentioned before the fire department is trying to make MCI training mandatory for recert.

Neighboring agencies are all the same agencies (one nice thing about have a state wide fire department is they all have the same training standards). Once the framework for the incident is set up there is not much for the ambulance to do. They line up behind the other ambulances and pull forward when called or directed to do so. They load the patient/s and take off to the hospital that has bed availability. So once all the IC positions are filled it is extremely easy to work with ambulance companies who have 0 MCI training.

My division runs about 15 ambulances during the mid day. We can get 50+ ambulances in under 2 hours. In under 4 hours we can easily have well over 100 ambulances respond and be on scene (take in ambulances from LA and San Diego).
 
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I don't have the energy to come up with a response like Desert but to answer your question yes, we have a county-wide MCI plan. We do a MCI drill once a year if not twice a year. The county plan covers EMS, FD, PD and Hospitals. We actually just did a drill last week.

The airport authority FD has a massive MCI truck based at the international airport that can respond to anywhere in the greater urban area and outlying valleys in <30 minutes.

Our county MCI plan specifies how many reds, yellows and greens can go to each area hospital. Transport destination is determined by dispatch in the presence of an MCI. They track how many patients of what level have gone where.

Each ambulance has an MCI kit that hangs behind the passenger seat in the cab. It has triage tags for ~15 people (can't remember the exact number), red, green and yellow tape as well as armbands to signify the different ICS positions as well until the supervisor shows up with the big MCI kit with vests, flags, a gazillion START Triage tags and some other random stuff in it.

We are the most trained on MCIs in the region and are pretty damn efficient at them. I'm not just saying that either, we've been recognized nationally for a few different events we've had.

We generally handle all our MCIs within our agency. An all call page goes out to backfill the 911 system.
 
In terms of equipment and resources I'd say we're pretty well prepared and getting more so, I think training of front line staff is where we fall flat.

We are a third service municipal agency serving a population of 1.1 million people over, 1700 Km sq mixed urban, suburban and rural. We staff ~45 transport Ambulances at peak times, 7 rapid response units, 3 Special Response Units (tactical, bariatric, rescue support, MCI) and 3 District Superintendents. The seven fire departments in our catchment are mixed professional, composite and paid on call none higher than First Responder medical training.

For MCI resources we have:
- Every vehicle carries an MCI kit containing 50 tags, vests and tracking sheets.
- District Sups exercise command on scene.
- SRU trucks also contain six extra oxygen bags, six extra trauma bags and extra backboards as well as micro command post cabinet with MCI kit and work area. SRU trucks also have small light masts on them for better scene lighting than the Ambulance, though Fire still generally provides the best lighting.
- Centrally located we have an Incident Command Trailer, and Treatment/Rehab trailer and inflatable shelters to be used as a field treatment area. These can be picked up and towed by any of the SUV's but are primarily brought to the scene by SRU. All of the trailers carry patient care equipment as well as food, water, coffee and the like for crews on scene.
- Logistics Support Unit: a cube van with emerg lights and packed with gear.
- Coming into service in the next few months is our Multi-Patient Transport Unit (bus) being made by Crestline and the Emergency Support Unit that goes with it which has a small command area inside and roll up cabinets around the outside full of patient care equipment. These units are similar to the ones used by Toronto that we currently rely on for MCI's and will still have available for back-up.

We have preplanned MCI assignments that deploy a certain number of resources based on real or potential patient numbers. Our Sup's and SRU medics to regular tabletop training and review. Our biggest issue is the dearth of full scale simulation. I last did an MCI drill when I was hired 4 years ago and that didn't include allied agencies or the Hospital. Hopefully this is something we address in the future.
 
We're oddly well prepared for School Bus MVAs in particular. We have a fairly well developed overall MCI plan as well, but school bus accidents in particular have standing agreements with local school districts and schools, response priorities with supervisors and admin, and a specific folder of paperwork on every unit.

Last months ConEd day was solely dedicated to MCI Training. I've been involved with one MCI drill since I've been here as well that involved HEMS, dispatch, fire, and us. The main difficulty in MCI preparedness here seems to be coordination with the fire companies. Overall Incident Command would come from any one of 21 Volunteer Fire Departments in the region with varying degrees of competency and call volume. We train expecting that we (as ALS for the county) will be placed in charge of Medical Branch and the positions that go with it, but conversations with some of the EMTs and Fire EMS supervisors in the area have indicated that may not be the vision they have for MCI management.

Resource wise, we're fairly well stocked IMO. Each Paramedic unit has an MCI folder with various paperwork, a Triage Kit with tags, officer roles, and OPAs, and vests. Each Supervisor unit has additional Tarp supplies and further MCI gear. We also have a HazMat unit, Med Surge unit, several support trailers, and a Communication Bus that can be activated and respond to the scene on large scale incidents.
 
we have enough equipment to handle almost any MCI. between what our ambulances carry, and all of our special operations vehicles, we are equipped to handle a 50-100 person MCI, and our staff is trained in how to handle them.

Where we fail is in our available manpower and staffing levels. We don't have enough ambulances to handles the routine volume (city won't pay for enough units), so when an MCI happens, we end up relying healivy on mutual aid (if we can get them, as our inner city EMS neighbors are usually tied up on calls as well), and can't alway staff our special operations vehicles, because our manpower is tied up on other 911 calls.

Don't get me wrong, we do handle the small MCIs (less than 10 patients) very well, and make things work as good as the next agency, but more than that, and if we are extremely busy, the 2nd and 3rd due ems unit might end up responding out of the ER on a delayed response
 
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