Mass Casualty Incident Management: Part 5

While it may seem daunting to be the first due crew to an MCI, if you know your equipment and responsibilities, you’ll be able to manage those critical first minutes of the incident.


You and your partner are finally grabbing lunch when the radio crackles to life. There’s a three-car MVA on the highway, and you’re going to be the first due crew. It doesn’t sound like the end of the world, but it might involve more patients than your city has ambulances immediately available for.

You arrive on scene to see a few people obviously hurt, some in their cars, some walking around, and a bunch of people who could either be bystanders or additional patients. You decide to “call” the MCI so that other incoming units know to be in scene-management mode rather than direct hands-on care mode. But until they arrive there’s just you, your partner and a big rolling box with a bunch of medical supplies. What next?

You’ll recall from our last article that there are five key jobs to do at any MCI and that each job has the same five easy-to-remember steps to success. Now we get to see it in action, beginning with the EMS Officer (also known as the EMS Branch Director).1 While being the first due crew and the EMS Officer may seem daunting, you will usually find yourself doing less hands-on work than anyone else. This is because the bigger the incident, the more work you delegate. Remember, you’re getting hired as the boss here, so delegate, delegate, delegate.

Step 1: Take the Job

The first thing that you do follows ICS/NIMS. In the absence of an Incident Commander (IC), you need to take command of the incident, at least until ranking officers arrive. If there is already an IC in place, you’ll need to coordinate with the individual, taking the position of EMS Officer, or, depending on the scope of the incident, EMS Branch Director. You will then either need to perform a size-up yourself or, if the IC is in place, get a briefing directly from the IC. Either way, you’ll want to know and report the following five key pieces of information in your size-up report:2,3,4

  • The name and location of command
  • The rough number of patients (include the “possible bystanders” to begin with)
  • The extent/boundaries/scope of the MCI area
  • The access points into and out of the MCI area
  • The immediate additional resources you’ll need to deal with any obvious or suspected hazards. This may include police, fire, additional EMS, public works and others.

Step 2: Dress for Success

Put on the vest identifying you as the EMS Officer and locate your MCI management resources. These will vary depending on the MCI management system your agency uses. They will typically include writing instruments, a clipboard or command board that contains a checklist of your job tasks and enables you to keep track of the MCI officers with whom you will be coordinating, an Incident Action Plan (IAP) sheet and NIMS/FEMA worksheets.

Step 3: Set Up Your Work Space

The workspace you’ll be using as the EMS Officer is the entirety of the MCI area. That may seem overwhelming at first, but think of it as all your sandbox to play in. You will want to identify the boundaries of the incident, the command post, ingress and egress points and areas for triage, treatment, transport and staging. If the MCI is low-impact, you may not have to officially designate these areas.5

Step 4: Go to Work

This is the easy part. Your job is to tell other people what to do. You’ll be assigning the jobs of triage, treatment, transport and staging. Of course, as in any work environment, if the business (incident) is small, you may have to do one or more of these jobs yourself. You’ll also want to make sure that you supply the resources for your “employees” to do their jobs. You’ll want to contact the IC or call directly for structures, staff and stuff as needed by your incident.

Step 5: Communicate

You’ll need to communicate with those upstream and downstream from you in order to move patients along. As the EMS Officer, your upstream partner will be the Incident Commander. If you are the IC, then upstream will be your dispatch or communications center. Downstream communications will be with your Triage, Treatment, Transport and Staging Officers as you’ve assigned them according to the needs of the incident.1

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