MCI on the High Seas

Just when you start to get comfortable responding to single-patient emergencies and begin to understand your department's day-to-day operational processes, the inevitable happens: a multiple-casualty incident.

You are dispatched to Cruise Terminal No. 5, where a passenger cruise ship is returning to port because its captain reported a "listing" situation (a sudden tilt to one side). Reports are coming in that numerous passengers sustained injuries when the ship leaned, and some are critical.

Where do you begin? Fortunately, the agencies that managed this real event had an MCI plan and a clear understanding of the Incident Command System. When the ship arrived at the terminal, 102 patients were triaged, treated and transported, five of whom suffered serious injuries. How did all these patients get evaluated and transported while the EMS system maintained control of the situation?

Know Your MCI Plan
As a BLS provider, you might be asked to assist during large-scale events. Are you familiar with your jurisdiction's multiple-casualty incident (MCI) plan?

Upon receiving notification of this incident, the agency having jurisdictional authority activated its county MCI plan. This plan, essentially a template, is designed to help the Incident Commander, first responders and local hospital administrators ensure that all resources necessary to manage large patient events are used when one occurs. It had been reviewed and rehearsed by local agencies, including surrounding hospitals, prior to this event, and was subject to regular ongoing review to ensure its information was accurate and up to date.

The plan required that the Incident Command System (ICS) be used, an Incident Commander be assigned to the incident, and a designated Incident Command Post (ICP) be established. This was all done before the ship returned to port. Command Post personnel then received information from paramedics on board that there were at least five critically injured patients and around 100 with moderate to minor injuries.

What is ICS?
The Incident Command System is an organized, systematic approach to managing large-scale incidents. It is designed to have one primary incident commander and four functional sections--Operations, Planning, Logistics and Finance--below him. Not all of these sections are activated with every incident; some can depend on an incident's size, and each can be further divided if an event dictates as well. Due to the limited space of this article, I recommend visiting www.fema.gov for a more detailed explanation.

For this incident, an Operations Section Chief was assigned to oversee all operational functions. Reporting directly to this person was a Medical Group Supervisor responsible for the triage, treatment and transport teams. Due to the event's magnitude, a Logistics Section Chief was also assigned. This person was responsible for overseeing coordination of all the necessary medical supplies and support for first responders. The extra supplies, food and personnel were all assigned to a staging area. When the ship reached port, triage teams were ready to be deployed inside, treatment teams were ready on the loading dock, and there were 15 ambulances, two city buses and two trauma-center helicopters standing by and available for transport. Being that there was a medical team on board the ship, some of the patients had already been triaged prior to arrival at the terminal. In an attempt to further facilitate patient triage and transport coordination after the ship docked, an EMS medical liaison was assigned to work with the prehospital providers and the ship's medical staff. This proved beneficial.