Summary of "Chp 40 Incident Management"

Summary of Chapter 40: Incident Management (YouTube Video)

This chapter provides a comprehensive overview of incident management with a focus on emergency medical services (EMS) operations during mass casualty incidents (MCIs) and hazardous materials (hazmat) situations. It emphasizes structured frameworks, roles, communication, resource management, triage, and safety protocols critical for effective disaster response.

Key Frameworks, Processes, and Playbooks

Incident Command System (ICS) / Incident Management System (IMS)

Standardized national framework (NIMS 100, 200, 700, 800 courses).
Goals:
- Ensure responder and public safety.
- Efficient resource use.
- Effective incident management.
Structure:
- Sections: Operations, Planning, Logistics, Finance.
- Branches, Divisions/Groups.
Span of control: 1 supervisor per 3–7 workers.
Roles:
- Incident Commander.
- Command Staff: Public Information Officer, Liaison Officer.
- Finance, Logistics, Operations, Planning.
Command turnover allowed when more experienced personnel arrive.
Emphasis on early establishment of command and face-to-face communication to reduce radio traffic.
Record-keeping is critical for reimbursement and accountability.

Triage Frameworks

START (Simple Triage and Rapid Treatment): Primary triage in the field to categorize patients quickly.
JUMPSTART: Pediatric-specific triage system for patients under 8 years or weighing less than 100 lbs.
Triage categories:
- Red (Immediate): Severe injuries requiring urgent care (shock, airway problems, severe bleeding).
- Yellow (Delayed): Serious but not immediate threat (major fractures, burns without airway compromise).
- Green (Minor): Walking wounded.
- Black (Deceased/Expectant): No chance of survival or dead.
Supervisory roles:
- Triage supervisors oversee initial assessment and prioritization.
- Treatment supervisors manage secondary triage and patient care.
- Transport supervisors coordinate patient distribution to hospitals, tracking ambulance use and hospital capacity.

Hazmat Awareness and Response

First responders must recognize hazmat situations and understand associated risks.
Use visual indicators such as placards, containers, leaks, and odors.
Reference resources like the Emergency Response Guidebook and Material Safety Data Sheets (MSDS).
Establish control zones:
- Hot zone: Contaminated area.
- Warm zone: Decontamination area.
- Cold zone: Safe area where EMS operates.
Protective equipment levels (NFPA 704):
- Level A: Fully encapsulated suit with SCBA (most hazardous).
- Level B: SCBA plus eye protection, not fully encapsulated.
- Level C: Air-purifying respirators.
- Level D: Basic coveralls and gloves.
EMS role:
- Provide minimal care in hazmat zones.
- Prioritize rapid removal and decontamination.
Utilize external resources such as hazmat teams and Chemtrec for chemical identification and guidance.

Key Metrics, KPIs, and Targets

Span of control: Maintain 3–7 personnel per supervisor to avoid overload.
Mass casualty incident threshold: Defined as 3 or more patients or resource exhaustion.
Triage prioritization: Focus on maximizing survival by treating red-tagged patients first.
Resource tracking: Record time, personnel, and equipment use for reimbursement (local and federal).
Decontamination zones: Proper setup between hot and cold zones to prevent contamination spread.

Concrete Examples and Case Studies

Early 1980s tornado in a small town:
- Lack of triage and communication led to hospital overload.
- Highlighted the importance of coordinated transport and command.
9/11 response:
- Lack of interoperable communication and command structure caused chaos.
- NIMS developed post-2004 to address these issues.
Industrial paramedic experience at General Motors:
- Example of hazardous chemical storage and emergency evacuation protocols involving chemical totes.
9/11 mortuary management:
- Decision-making on handling body parts during mass fatalities.

Actionable Recommendations

Training & Preparedness

Continuous planning and training on likely disasters.
All responders should complete NIMS courses.

Communication

Avoid 10-codes except universally recognized ones (e.g., 10-4).
Use face-to-face communication when possible.
Integrate communication systems across agencies.

Command & Control

Establish command early by the most trained senior official.
Maintain clear accountability and thorough record-keeping.

Triage & Patient Management

Prioritize triage even for EMTs; triage is not only for paramedics.
Use visible triage tags and color-coded tape.
Coordinate transport to avoid overloading hospitals.

Hazmat Safety

Recognize hazmat indicators before entering scenes.
Stay in cold zone unless properly equipped.
Use Emergency Response Guidebook and Chemtrec for chemical information.
Avoid prolonged or complex care in hazmat zones.

Responder Rehabilitation

Establish rehab zones for rest, hydration, and stress monitoring.

Presenters / Sources

Content delivered by an experienced EMS professional with paramedic and industrial experience.
References include NIMS courses, NFPA standards, and federal/state emergency management frameworks.
Anecdotal experiences from mass casualty incidents and hazmat responses.

This summary captures the business and operational tactics of incident management, focusing on frameworks, resource optimization, communication, triage, and safety protocols essential for EMS and emergency response leadership.