July 2009 CE Site code #107200E-1209 Region X Multiple ......• Flail chest • Limb paralysis and...
Transcript of July 2009 CE Site code #107200E-1209 Region X Multiple ......• Flail chest • Limb paralysis and...
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July 2009 CE
Site code #107200E-1209
Region X Multiple Patient Management Plan
Prepared by: Steve Holtz FF/PM
Libertyville Fire Department Review/revision by: Sharon Hopkins, RN, BSN, EMT-P
To view on the website visit: www.condell.org/emsce/
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Date: July 2009 Topic: Region X Multiple Patient Management Plan Time Frame: 3 Hours Level of Instruction: All department members at all levels Behavioral Objectives
Upon successful completion of this module, the EMS provider will be able to:
1. Explain the purpose of the Region X Multiple Patient Management Plan. 2. Define Class 1, Class 2, and Class 3 incidents. 3. Identify responsibilities of the fire department for each class. 4. Define criteria for Category I, Category II, and Category III trauma patients. 5. Define primary, secondary, and reverse triage. 6. Identify the components of the Ems Division of the Incident Management System. 7. Identify the communication process for Class 1, Class 2, and Class 3 incidents. 8. Describe documentation requirements for Class 1, Class 2, and Class 3 incidents. 9. Describe the purpose of the After Action Report. 10. Define triage 11. Identify the principles of START and JumpStart triage. 12. Identify when primary and secondary triage techniques should be implemented. 13. Identify components of the SMART Triage Packs. 14. Identify the role of critical incident stress management (CISM) in MCI. 15. Given a simulation, correctly triage patients using START triage. 16. Given a simulation, correctly perform secondary triage. References: Bledsoe, B. Porter, R., Cherry, R. Paramedic Care Principles and Practices. Region X Multiple Patient Management Plan, 2009. Region X SOP’s. March 2007, Amended January 1, 2008 Smartmci.com (TSG Associates Ltd 2004 -2008.)
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REGION X
MULTIPLE PATIENT MANAGEMENT PLAN
FIELD PROVIDER LOG FORM
Date: ________________________ Time: _______________________ Fire Department: _______________
Hospital you are contacting: ___________________________________ ED Phone #:___________________
CLASS 1: “Business as usual”
Field personnel call the closest appropriate hospital
“Hello. This is the __________________________
Fire Department. We are on the scene of a Class 1
multiple patient incident. The incident is a
__________________________________________ (describe the event to the ECRN).
Our total number of patients is ________________.
We have: (fill in the specific numbers of patients) _____ Category I Trauma _____ Category I Medical
_____ Category II Trauma _____ Category II Medical
_____ Category III Trauma _____ Category III Medical
How many patients can you take?” ____________
If patients will be transported to other hospitals report those destinations to the
ECRN and record below. NO MORE THAN TWO PATIENTS MAY BE
SENT TO HOSPITALS WITHOUT PRIOR APPROVAL FROM THE
RECEIVING HOSPITAL.
Complete table
with specific
hospital name(s),
#’s and patient
acuities.
Ho
spital:
Ho
spital:
Ho
spital:
Ho
spital:
Cat I Trauma
Cat II Trauma
Cat III Trauma
Cat I Medical
Cat II Medical
Cat III Medical
TOTALS
NOTE:
1) Complete an After-Action Report (critique form) 2) Fax both this form and the After-Action Report to the EMS Office
of the Resource Hospital IMMEDIATELY following the incident.
CLASS 2 or CLASS 3 Field personnel call their Resource Hospital for Transportation Management
“Hello. This is the __________________________
Fire Department. We are on the scene of a Class __
multiple patient incident. The incident is a
__________________________________________ (describe the event to the ECRN).
Our estimated number of patients is ___________.
We estimate that we have the following types of
patients:
RED: _____ YELLOW: _____ GREEN: ______ DECEASED: _____
Our closest hospitals are:” (IMPORTANT: List in order of proximity to the incident)
1. ________________________________________
2. ________________________________________
3. ________________________________________
4. ________________________________________
5. ________________________________________
“MY CALL BACK TELEPHONE
NUMBER IS”: _________________
*Use SMART® Command Board to record hospital
availability and patient destinations.
NOTE:
1) Complete an After-Action Report (critique form) 2) Fax both this form and the After-Action Report the EMS Office of
the Resource Hospital IMMEDIATELY following the incident.
Your Name:
Contact Phone #:
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REGION X MULTIPLE PATIENT MANAGEMENT PLAN 2/13/08 CLASS 1 CLASS 2 CLASS 3
Def
init
ion
Able to meet normal level of care
Unable to meet normal level of care
Note: Box Alarms may be activated
Overwhelmingly unable to meet normal
level of care
Note: May require EMS Divisions or
on-scene treatment areas
EMERGENT EVACUATION
OF A
HEALTHCARE FACILITY (PATIENTS REQUIRING MEDICAL CARE)
Init
ial
Co
mm
un
icat
ion
Contact closest hospital
State: “WE ARE ON THE SCENE OF A
CLASS 1
MULTIPLE PATIENT INCIDENT”
Contact Resource Hospital
State: “WE ARE ON THE SCENE OF A
CLASS 2
MULTIPLE PATIENT INCIDENT”
Contact Resource Hospital
State: “WE ARE ON THE SCENE OF A
CLASS 3
MULTIPLE PATIENT INCIDENT”
Contact Resource Hospital
State: “WE ARE ON THE SCENE OF AN
EMERGENT EVACUATION OF A
HEALTHCARE FACILITY”
Init
ial
Info
rmat
ion
• Event description
• Specific # patients
• Specific patient categories
• Closest appropriate hospitals
• Event description
• Estimate # pts.
• Estimate patient acuities
(Use RED, YELLOW, GREEN)
• Closest Hospitals
• Event description
• Estimate # pts.
• Estimate patient acuities
(Use RED, YELLOW, GREEN)
• Closest Hospitals
• Event description
• Estimate # pts.
• Closest hospitals
• Possible alternative receiving
facilities
Pat
ien
t
Dis
bu
rsem
ent
• After conferring with closest hospital, transport
agreed upon # patients to that hospital
• Disburse no more than two patients to each
remaining hospital
• If it is determined that more than two patients
should be transported to a hospital, the closest
hospital will confirm with desired hospital(s)
prior to transport.
• Communicate remaining patients’ destinations
to closest hospital
Resource Hospital coordinates
transportation destination of patients
• Resource Hospital coordinates
transportation destination of patients
• POD Hospital may be activated for
assistance with communication and
additional resources
• Resource Hospital works in conjunction
with field command and administration of
affected facility to determine where
patients will be transported
• POD Hospital may be activated for
assistance with communication and
additional resources
Tri
age
Tag
s
Triage tags not used
Triage tags MUST be used
Triage tags MUST be used
Triage tags MUST be used
Tri
age
Met
hod
Use rapid assessment to
identify patient category
START Triage
START Triage
• Within facility use REVERSE TRIAGE
• Prior to transport use START TRIAGE
Am
bu
lan
ce t
o
Ho
spit
al
Co
mm
un
icat
ion
Every transporting ambulance contacts their
receiving hospital with abbreviated report
State:
“WE ARE TRANSPORTING FROM A
MULTIPLE PATIENT INCIDENT”
NO CONTACT BETWEEN TRANSPORTING AMBULANCE
AND RECEIVING HOSPITAL
NO CONTACT BETWEEN TRANSPORTING AMBULANCE
AND RECEIVING HOSPITAL
NO CONTACT BETWEEN TRANSPORTING AMBULANCE /
PATIENT TRANSPORTATION
VEHICLE AND
RECEIVING FACILITIES
Pt
Car
e
Rep
ort
s
Complete patient care reports as usual
Complete patient care reports as usual
No patient care reports
(Triage Tags serve as written report)
No patient care reports
(Triage Tags serve as written report)
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REGION X: CLASS 1 ACTIVATION
CLASS 1 D
efin
itio
n
Able to meet normal
level of care
Init
ial
Co
mm
un
icat
ion
Contact closest hospital
State: “WE ARE ON THE
SCENE OF A
CLASS 1 MULTIPLE PATIENT
INCIDENT”
Init
ial
Info
rmat
ion
• Event description
• Specific # patients
• Specific patient categories
• Closest appropriate hospitals (*Closest hospital must take
at least two patients.)
Pat
ien
t D
isbu
rsem
ent
-After conferring with closest
hospital, transport agreed upon
# of patients to that hospital
(not less than two)
-Disburse no more than two
patients to each remaining
hospital.
-Communicate remaining
patients’ destinations to closest
hospital
Am
bu
lan
ce t
o H
osp
ital
Co
mm
unic
atio
n
Transporting ambulance
quickly contacts receiving
hospital with an abbreviated
report
State:
“WE ARE TRANSPORTING
FROM A MULTIPLE
PATIENT INCIDENT”
OT
HE
R
• Triage Tags not utilized
• Use rapid assessment to
identify patient category
• Complete patient care reports
TRAUMA • Traumatic Arrest, Isolated Burns >20%: Transport to closest Trauma Center
• NO AIRWAY: Transport to CLOSEST Emergency Department
MEDICAL
↓ ↓
CATEGORY I TYPE OF HOSPITAL CATEGORY I Unstable Vital Signs:
• Systolic BP ≤ 90 x 2 (Peds ≤ 80 x 2)
• Glasgow Coma Scale ≤ 10 or deteriorating mental status
• Respiratory Rate ‹ 10 or › 29
• Revised Trauma Score ‹ 11
Anatomy of Injury:
• Penetrating injuries to head, neck, torso or groin
• Combination trauma with burns ≥ 20%
• Two or more proximal long bone fractures
• Unstable pelvic
• Flail chest
• Limb paralysis and / or sensory deficits above the wrist or ankle
• Open and depressed skull fractures
• Amputation proximal to wrist or ankle
Transport to
highest
level
Trauma
Center(s)
within
25 minutes
Transport to
closest
Emergency
Department(s)
UNSTABLE
• Altered mental status
• Systolic BP < 100
mmHg
CATEGORY II TYPE OF HOSPITAL CATEGORY II Mechanism of Injury:
• Ejection from automobile
• Death in the same passenger compartment
• Motorcycle crash › 20 mph or with separation of rider from bike
• Rollover (unrestrained)
• Falls ≥ 20 feet (Peds falls ≥ 3X body length)
• Pedestrian thrown or run over
• Auto vs. pedestrian / bicyclist with › 5 mph impact
• Extrication › 20 minutes
• High speed MVC: Speed › 40 mph, intrusion ≥ 12”,
major deformity ≥ 20”
Co-Morbid Factors:
• Age ≤ 5 without car / booster seat
• Bleeding disorders or on anticoagulants
• Pregnancy ≥ 24 weeks
Transport to
closest Trauma
Center(s)
Transport
To
closest
Emergency
Department(s)
STABLE
• Patient alert
• Skin warm and dry
• Systolic BP >100
mmHg
CATEGORY III TYPE OF HOSPITAL CATEGORY IIIOther simple trauma Transport to closest hospital(s)
Other simple medical
1/23/08
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Primary & JumpSTART Triage
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Secondary Triage
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REGION X
MULTIPLE PATIENT MANAGEMENT PLAN
AFTER-ACTION REPORT
Date of Incident: ________ Time of Incident: ________ Primary Fire/Rescue Agency: ___________________
Description of Incident: ______________________________________________________________________
Check One:
CLASS 1 �: Total # patients: ____ (Specific # Trauma: Cat I___ Cat II___ Cat III___ Medical: Cat I___ Cat II ___ Cat III ___) CLASS 2 � / CLASS 3 �: Total # patients: _____ (Specific #: Red _____ Yellow _____ Green _____ Deceased _____)
Please answer the following questions. Use the reverse side for additional comments (take note when faxing form).
Which hospital was first contacted by field personnel?______________________________________________
Mode of communication between field and hospital: Cell phone � Telemetry � MERCI � Other:_______
Any difficulties with initial communication? No � Yes:__________________________________________
Was it difficult to determine the ‘Class’ of the incident? No � Yes:________________________________
Any difficulties with triage? No � Yes:_______________________________________________________
Receiving Hospitals / # pts to each hospital: ______________________________________________________
Any difficulties with patient disbursement? No � Yes:___________________________________________
Any difficulties with ambulance to hospital communication (Class 1 only): No � Yes:_________________
Was the two-sided Multiple Patient Management Plan REFERENCE CARD used? Yes � No �
If yes, was it helpful? Yes � No � Comments: _________________________________________
Was a Region X Multiple Patient Management Plan LOG FORM used? Yes � No �
If yes, was it helpful? Yes � No � Comments: _________________________________________
Overall, how effective was Region X Multiple Patient Management Plan in successfully disbursing patients from the
scene to area-wide hospitals?
Very Effective � Effective � Ineffective � Very Ineffective �
The success of the plan depends on your detailed comments. Please provide us with any additional information that
may be helpful:
_________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________ Hospital Personnel – Submit this form and Emergency Department Log form to your hospital EMS Coordinator.
Field Personnel – Fax this form and Field Provider Log Form to the Resource Hospital EMS Office.
Name:
FD or Hosp:
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Two autos have been involved in a head-on crash. Each auto
was traveling in excess of 60 mph. Three people have
been thrown from the wreckage and are unconscious.
Four others are trapped inside with various types of severe injuries.
What Class?
What Category trauma?
Which hospital do you contact?
What do you say?
How does this affect the transporting
ambulances?
The administrator at a private school calls 911 to report
that a strange odor in the building has caused several
students to collapse. Someone has pulled the fire
alarm to evacuate the building.
As you arrive, students are running towards you.
What Class?
What Category medical?
Which hospital do you contact?
What do you say?
How does this affect the transporting
ambulances?
What Class?
What Category trauma?
Which hospital do you contact?
What do you say?
How does this affect the transporting
ambulances?
Two patients were in this car.
One patient is in traumatic
arrest.
One patient is unresponsive
but
breathing.
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What Class?
What Category trauma?
Which hospital do you contact?
What do you say?
How does this affect the transporting
ambulances?
Four teenagers have stolen
this vehicle and hit the building
at a moderate rate of speed.
Upon your arrival,
all victims are sitting
on the curb with minor
injuries and in police custody.
What Class?
What Category medical?
Which hospital do you contact?What do you say?
How does this affect the transporting ambulances?
Five members of a family
were rescued from this home.
All five are exhibiting signs of
severe smoke inhalation.
What Class?
Which hospital do you contact?
What do you say?
How does this affect the transporting
ambulances?
This accident involves
a total of five patients:
2 Category I Trauma Patients
3 Category II Trauma Patients
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What Class?
Which hospital do you contact?What do you say?
How does this affect the transporting
ambulances?
This crash involves four vehicles.
Category I = 3 patients
Category II = 1Category III = 2
What Class?
Which hospital do you contact?What do you say?
How does this affect the transporting
ambulances?
A car traveling at 60 mph
has hit a group of sevenbicycle riders. The bikes were
traveling at a high rate of speed.
The victims include:
6 Category One Trauma Patients
1 Category Two Trauma Patient
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Pre-Quiz
Review of Region X Multiple Patient Management Plan
From July 2009 CE Material Name_________________________________Date___________ 1. What is the definition of a Class 1 multiple patient incident? 2. List 1 vital sign criteria and at least 3 anatomical criteria for classifying the patient as a Category I trauma patient. Vital signs: Anatomical criteria: 3. What is the purpose of primary triage and when is it performed? Purpose: Performed: 4. During a Class 1 incident, which hospital does EMS contact? 5. During Class 2 or 3 incidents, which hospital does EMS contact? 6. For which class in the Multiple Patient Management Plan are triage tags used? Class 1: YES NO Class 2: YES NO Class 3: YES NO
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7. When is the After Action Report used and why? 8. What is the first question asked of patients when starting to use primary triage? 9. When would JumpSTART triage be used? 10. Your patient goes from a yellow to a red in the treatment area. How do you fix the triage tag to show the change?
File: CE, EMS; CE Packets; Quizzes; 2009; July 2009 Pre-quiz