MCI Training-Do You Have Enough?

[Trailrider]

Do you think as EMS providers we receive adequate training to handle MCIs? It seems like major incidents are becoming a pretty thing around the world unfortunatly.. Where do we lack and what can we do to improve services? I would like to see some kind of training where EMS providers both metro/rural do training exercises with the military/hospital on a regular basis. Nothing is will stop an MCI but I think we can certainly be prepared. What do do you think?

 

[DesertMedic66]

Areas are all different. So far this year I have attended 3 MCI drills/Training events that included multiple police departments, multiple fire departments, my 911 ambulance company, 2 BLS companies in the area (non 911), 3 Hospitals (all the hospitals in my response area), school bus companies, and city buses.

My area is working on making it mandatory for EMTs/Medics to go through a MCI class (6 hours) every 2 years in order to recert.

We (by we I mean the Fire Department's MCI training staff) are also in the process of getting our state to use one and only one type of triage tags.

 

[NPO]

I have never received MCI training.

My company (non 911) has responded to MCIs in the past at the request of 911 agencies.

Good 'ol Los Angeles County.

 

[mcdonl]

It is all relative to the likely hood of having an MCI...

In my town... we have done it once in about 6 years, but have not had an MCI in about 15, and none document before that school bus accident.

30 Minutes east, in Portland they have a large drill at the air port/Maine Medical Center every year.

 

[Bullets]

Initially? probably not, though all NJ EMTs get ICS 100 in the basic course so they have some idea that ICS exists and there is a system. And they teach the NJ Triage Tag so students are familiar with them. Ultimately it falls upon the individual agency and town. My town runs a township wide drill every year that can be anything from bombings to HAZMATs.

The NJ EMS Task Force does a great job getting courses and offering them to their members. Topics such as Staging Area Managers, EMS response to Large Scale Incidents, Active Shooters and advanced courses through TEEX and COBRA

 

[Trailrider]

It is all relative to the likely hood of having an MCI...

In my town... we have done it once in about 6 years, but have not had an MCI in about 15, and none document before that school bus accident.

30 Minutes east, in Portland they have a large drill at the air port/Maine Medical Center every year.

Do they ever call for assistance?

 

[mcdonl]

Do they ever call for assistance?

If you mean, during an MCI... No. There are 3 Full time staffed departments in the greater portland area, and to get to my town you go through 5 towns with daytime per-diem crews. We would likley be station coverage/mutual aid for the towns they would call.

 

[DesertMedic66]

What is the definition of a MCI for your areas? (As in how many patients).

For ours it's 5 or more patients, provider discretion, and/or more patients than personnel on scene.

Also all medics and EMTs for my area have ICS 100, 200, 700, 800

 

[Trailrider]

What is the definition of a MCI for your areas? (As in how many patients).

For ours it's 5 or more patients, provider discretion, and/or more patients than personnel on scene.

Also all medics and EMTs for my area have ICS 100, 200, 700, 800

Now I have to look it up for my local area, on the grand scale of things something significant such as an earth quake, storm,9/11.

 

[Aprz]

In Santa Clara County, they require ICS 100, NIMS 700, NIMS 704, AWR 160, IS 3, Hazmat FRO, and SEMS. EMTs/Paramedics have to attend an orientation for Santa Clara County EMS. (Santa Clara County EMS - Policy 214 - Prehospital Training Standards)

Paramedics and Paramedics interns are required to take a test to get accreditted with the county. From what I've been told, there are some questions about our MP^2 plan and where are muster stations.

We have a volunteer group that's intended to be used for large scale MCIs called Medical Volunteers for Disaster Rescue (MVDR).

In our ambulances, we are required to have an emergency response guidebook (ERG), multiple patient management plan (MPMP, in real life, we refer to it as "MP^2" or "MP squared"), ICS 219 T cards, field operating guide (FOG), EMS Quick Guide, and a Fire Quick Guide.

Santa Clara County EMS has an MCI drill once a year (over 2-3 days). They'll do a powerpoint presentation on our MP^2 plan and START triage which counts towards CE credit. (Photo slide of last year MCI drill)

I'd like to see our county try to implement this more regularly on smaller scale events like concerts at the Shorline Amphitheater in Mt. View. I am unsure if they had any QA/QI for our previous drills eg how long did it take for everyone to be triaged and transported, were people correctly triaged initially, and correctly reevaluated/retriaged? For when we reevaluate/retriage, I think we should use Revised Trauma Score (RTS) instead of START again. The only practice they get right now is that yearly MCI drill.

There are radio channels dedicated for events and MCIs "Command" 92-94 (92 used as a last resort), and a radio channel for mutual aid for multijurisdictional events "BAYMACS".

The county wants to be NIMS compliant over the radio so personnel aren't suppose to say things like "CODE 4". I think we use the most English over the radio compared to any other nearby county, lol. (Santa Clara County EMS - Policy 818 - EMS Comm. System Guide)

Overall, I still feel under prepared for MCIs in general, but I'm an employee at an IFT-only company with minimal training and experience. I am not sure if the exclusive operating agency (EOA) that responds to 911 receives more training and are better prepared. At the MCI drill, I was a volunteer (did not represent my company there), and it seems EMS has a preassigned role of transport only. EMS did not participate in triage at all. It looked pretty easy for them to drive around the parking lot only. :[ So if MCIs are like that for EMS, I think I am over prepared. Fire looked somewhat overwhelmed and things were kinda hectic, but things eventually got taken care of, which I guess counts. Although I think using RTS would be nice when retriaging/reevulating a patient, I was surprised by how many firefighters couldn't even follow START triage. <_< I honestly wouldn't expect EMS to do better though.

 

[Tigger]

The private company I worked for in Boston did not really do anything specific for MCI training beyond appropriately programming radios.

In Boston for the most part city EMS is going to do most of the triage and treatment, and then the private companies will transport those patients to city EMS determined facilities. The city will also contact private companies dispatch via the BAMA (Boston Ambulance Mutual Aid) radio and request ambulances to a staging point set up by Boston EMS. If needed, private company field supervisors may take some roll in the setup of these points, I know my old company did so during the marathon bombings.

So while I never got any MCI training, the system is setup assuming that all of the private ambulance crews have none.

At my new place here in rural Colorado I have not had anything specific yet but then again a large scale MCI is unlikely in our 550 square miles with 30k people. Our worst case is a tour bus accident. We have three ambulances in district and another two mutual aid in about 35-40 minutes. But after that we have to wait for Colorado Springs units and that could take more than an hour.