Mass Casualty Incident Management: Part 7

There’s a three-car MVA on the highway, and you and your partner are responding. It doesn’t sound like the end of the world, but it might involve more patients than your city can immediately accommodate with ambulances. You arrive close behind the first-in units and see a few people obviously hurt, some in their cars, some walking around, and a bunch of people who could be bystanders or more patients. The first-due crew has designated this a mass or multi-casualty incident (MCI) and assigned you to be the treatment officer. What next?

Step 1—Take the job: The first thing you do is coordinate with the EMS officer to get briefed. He or she should be able to give you an idea of the approximate number and severity of patients involved. This will be key in setting up your treatment area and deploying your resources. The EMS officer may have already secured a location for your treatment area, along with resources to get you started. So let’s get started.

Step 2—Dress for success: You will need to obtain and don the treatment officer vest to identify yourself. You will also need to obtain any checklists and materials specific to the treatment officer for the MCI management system you use.

Step 3—Set up your work space: When setting up your work space (the treatment area), you’ll want to think big. You’ll need it to not only be big enough for all your patients as they get sorted into subsections according to priority, you’ll also need room for your resources (responders and supplies) as well as room to maneuver into, out of and around in your treatment area.

You’ll also want to think protected. The treatment area should be protected from the patient generator (the thing that’s hurting people and causing the MCI) as well as from the weather, bystanders and any other hazards that may be present. Although this is the treatment area, it isn’t definitive treatment. You’ll need to consider ingress and egress to facilitate the movement of patients through your area as efficiently as possible. For larger incidents you may need to control points of ingress and egress with EMS, fire or law enforcement personnel. Depending on the scope of the incident, you may also want to use tarps, flags or other designators to make it intuitive for responders to know where patients of different priorities, as well as the resources to care for them, go.

Step 4—Go to work: Of course your job as treatment officer is to coordinate the treatment and care of patients, beginning with those of the highest priority. Thankfully the EMS officer (through the staging officer) will be directing incoming personnel and physical resources to the treatment area for you to put to work. In the early moments of the incident, you’ll likely need to move resources around quite a bit. Still, as soon as it is feasible to do so, you should ensure that once a provider begins patient care, they stay with that patient during treatment and, if possible, during transport to definitive care.

Many providers don’t realize that it’s often the responsibility of the treatment officer to coordinate movement of patients from the triage area to the treatment area. Depending upon the circumstances, the treatment officer may elect to utilize bystanders or even ambulatory patients to assist in moving other patients to the appropriate section (immediate priority, delayed priority, minimal priority). Finally, as resources become available to do so (typically as the triage area empties), the treatment officer should ensure triage is ongoing in the treatment area.

Step 5—Communicate: The treatment officer should communicate upstream with the triage officer to facilitate ingress of patients to the treatment area and monitor the number of patients still to be brought in. In order to move patients from the “inbox” that is the treatment area, the treatment officer will also communicate downstream with the transport officer.

What makes the position of treatment officer great is that you’re the one who gets all the resources. Incoming EMS personnel come to you carrying the stuff you’ll need to care for patients just long enough to get them the heck out of your area. He with the most stuff wins!

In next installment: Transport.

An emergency responder for more than 20 years with career and volunteer fire departments, public and private emergency medical services and hospital-based healthcare, Rom Duckworth is an internationally recognized subject matter expert, fire officer, paramedic and educator. He is currently a career fire lieutenant, EMS coordinator and an American Heart Association national faculty member.