Major Incidents, Mass Casualty Incidents, Operations, Patient Care

Manhattan MCI: Report from the pile of a crane collapse

Issue 5 and Volume 33.

Although there’s truly no way to prepare for such a horrific event, we have come away from the incident having learned many lessons that will help us prepare our communityƒand, we hope, othersƒfor handling these incidents.„

Establish earlier consolidation of responding agencies into a unified command system, including:

> More effective use of a transportation officer and the staging of units;

> Improved coordination of multiple air medical services and„EMS„command, and communications between them;

> Earlier consultation with medical command assets; and

> An effective public information officer.

Consider the use of a remote transport officer, such as a physician at the central point (receiving facility). Potential benefits include:

> Increased scene safety without the distraction of the actual event;„

> Adequate communication resources without reliance on cell phones or two-way radios;

> Adequate resource identification, such as all air medical command„telephone numbers, surrounding trauma center and pediatric trauma center telephone numbers;

> Authority to discuss resources physician to physician; and„

> Ability to integrate multiple information resources with several„designated personnel as the event unfolds. This includes having„television, Internet and standard methods as well as 9-1-1 dispatch and multiple phone lines available.

Use first-arriving air medical service providers as treatment personnel until sufficient ground resources arrive, because:

> Initial providers may be emotionally exhausted and need relief;

> New providers have a fresh perspective and aren’t from the local response area;

> Air medical personnel are typically experienced practitioners;

> Helicopter pilots can contact the closest airport and the FAA and get air space restricted to avoid multiple helicopters operating in the same air space simultaneously;

> Air crews can bring large caches of medical supplies, including„paralytic agents;

> Pilots can use helicopter communication resources to circumvent clogged„EMS, fire and police channels, as well as problematic cell-phone reception; and

> Pilots have the experience landing in the area and could help others plan their landing zone.

Ensure appropriate protocols and procedures are in place. Take„steps to:

> Modify local„EMS protocols or additional protocols specifically„for patient management during an MCI to address patient„identification when religious or cultural beliefs delay standard„identification methods;

> Consider the need for paralytics on ground ALS units;

> Maintain frequent communication and pre-planning with all schools within your response area;

> Establish pre-planned staffing contingencies to maintain„EMS system levels for regular response during an MCI;

> Consider short and long-term financial impact on agencies involved with an MCI, including the cost of back-filling an EMS system and the loss of productive work hours due to ongoing psychological care of providers involved;

> Utilize high-level emergency management resources early in an event, such as county/state EMA or county/state incident support team;„

> Conduct specific training for law enforcement personnel in disaster triage; and

> Consider the use of alternative means of medical command during an MCI to ensure one physician is not required to command the care of all patients.

Recognize worker’s compensation (as a whole) for PTSD as a work-related injury/illness. Further:

> Have„EMS service medical directors or affiliated physicians help„facilitate psychiatric services for providers;

> Know what psychiatric resources are available to assist„EMS personnel;

> Consider use of resources outside of the immediate area to enhance the comfort level of providers and ensure the confidentiality of the information derived;

> Ensure medical referrals are to specialists with knowledge of„specific issues that will arise after an event of this type;

> Have a specific service-level guideline or plan for immediate„psychological/emotional care for providers involved beyond the„realm of standard Critical Incident Stress Debriefing (CISD); and

> Have specific service guidelines/policies in place to backfill clinical shifts as needed.