The MCI and You
So you have just arrived on the scene of your first mass casualty incident (MCI), what now? Well if you really are in the middle of experiencing your first MCI, now would be a terrible time to learn. Since I am nearly certain that you are not in the midst of an MCI, pay attention so you don’t get in the situation where you are clueless. MCI’s come in different levels or scales. These levels vary by agency but as a general rule level one is 5-10 victims, level two is 11-20, and level three is 21+ victims. The amount of people involved in an MCI can reach into the thousands, causing a serious problem for medical care providers. The burning question is: Who do we treat first? Well there is actually a system, and it isn’t find your friends and treat them first. In an MCI responders have to triage patients. They to a quick assessment and then based on a few basic, easily attainable things, make a decision on if they are deceased or expected to be deceased very soon, need immediate care, delayed care, or if their injuries are minor enough that they can wait a while. Hospital emergency departments triage people every day. If I walked in to an ER with a stick through my leg and you walked in with a little abrasion, they will sit you in a chair and care for me first because I would die first. When triaging, responders have to be fast, spending less than 30 seconds per patient. Each responder has 30 seconds to make contact with a victim and assign him or her a category, tag the individual and move on. Triage tags (see below) or tape are used to mark patients. Black means deceased, red means immediate, yellow means delayed, green means ambulatory, white means uninjured. Often times to weed out the greens and whites the triage officer (the individual in charge of triage) will say “anyone who can walk, walk over to me.” Those people immediately get a green tag. The START triage system is the most widely used triage system in the US. Start focuses on RPM’s, respiratory effort, pulse/perfusion, and mental status. First check respirations. If the victim is not breathing, try to position the airway once, if that works they are tagged immediate, if not they are tagged black which means they are either deceased or are about to be. If they have respirations over 30 breaths per minute they are tagged immediate, if the respirations are normal check perfusion. If capillary refill takes more than 2 seconds, stop any bleeding and tag red. If capillary refill takes less than 2 minutes, check mental status. Altered mental status is red, normal mental status is yellow. Once tagged reds should be immediately evacuated to definitive care, then yellows, the greens, then blacks. Triage for children is different. For children, responders should use the JUMP START system. Most things remain the same. However if a child is not breathing after the positioning of the airway and there is a pulse present, give 5 rescue breaths, if that fails to work tag the child black, if it does work, tag red. Also if the breathing rate if under 15 over 45 for a child, they should be tagged red. All infants under 1 year of age get secondary triage, meaning no greens. All babies under one year are at least yellows. So now you have a basic understanding of triage. Those are the rules, you have to follow them no matter what and it is important that patients follow those rules too. START triage provides the best care possible to save the most lives using the resources available to the incident commander. Watch this video by Venture Crew 2000 to see a simulated MCI.