FDIC 2018 Quick Take: Engine company first strike MCI
Assign MCI member roles, report often and maximize the first five minutes on scene to deploy triage quickly and keep incoming units informed
By Kerri Hatt
INDIANAPOLIS — The engine company is the workhorse of the modern fire company, according to Justin Schorr, rescue captain, San Francisco Fire Department.
“We are a rolling toolbox and the fire service knows it,” Schorr told attendees at his session, “Engine Company First Strike MCI,” in the Indianapolis Convention Center at FDIC 2018.
Schorr noted the engine company has the resources to:
- Recognize available resources before an incident.
- Use member assignments to maximize readiness.
- Perform an initial MCI size-up.
- Rapidly and effectively deploy a triage team.
- Identify and establish an immediate red treatment area.
- Utilize the walking wounded.
- Formulate an LCAN report.
“I’m taking what you know as an engine company and applying it to an event that may occur in your jurisdiction,” Schorr said. “You already have the solution.”
Memorable quotes on engine company MCI response
Here are some memorable quotes from Schorr on engine company response to an MCI:
“Gone are the days of ‘everyone who can hear my voice, come to me,’ now is the day of ‘everyone who can hear my voice, stand up, find someone sicker than you and bring them to me.’”
“Give your community the tools to help you before things go wrong.”
“Consider ingress and egress, most patients will try to come out the way they came in.”
“Drill until you can’t get it wrong.”
Top takeaways on engine company MCI response
The answer to almost any incident, emergency or situation? “Send an engine.” As such, the engine company is going to be first in at almost anything the fire department encounters, Schorr noted. But preparing an engine company to coordinate triage and response to an MCI isn’t difficult, Schorr explained, if you use the tools and processes already at your disposal.
Here are the three top takeaways on preparing an engine company to manage the scene at an MCI.
1. Assign an MCI role based on fire assignment for each shift
“We don’t wait until we get to the fire to assign roles, why do we wait for an MCI,” Schorr asked. Using the beloved crew of “Emergency!” and a typical assignment sheet, Schorr broke down for attendees how traditional engine roles, like officer, layout and nozzle can be concurrently assigned MCI roles.
- Incident command: In his model, in the event of an MCI, the company officer will establish command, give the initial report, determine the immediate treatment area, request resources and get an update from the team.
- Casualty collection point: Schorr noted the “big red truck” is the easiest landmark for directing helpers and victims to stage triaged casualties. It’s easy to find, and the tailboard can provide a bird’s eye view of the scene. Let the engine chauffer manage the casualty collection point, Schorr advises. “It’s his engine, let him keep it.” The engineer will place the engine in an appropriate place, close to patients, considering ambulance ingress and egress; establish the warm zone and use tools to delineate the collection point, moving medical gear to the treatment area.
- Triage: the nozzle man or woman is the triage leader in Schorr’s model, carrying a flagging set, identifying reds and maintaining the injury count for the team, communicating with IC. The member of the crew assigned to layout can assist in triaging victims, reporting counts to the triage leader.
Each member can also be given a medical assignment; such as BVM, CPR and AED treatment.
Schorr recommends the LCAN acronym for reporting on the status at an MCI:
- Location: Provide updates on company location and advise incoming units on safe approach routes.
- Conditions: Advise on the status at the scene, the number of victims, any safety concerns, and possible causes of the event (police will be particularly interested in this item).
- Actions: What’s the status of triage? Is the casualty count complete?
- Needs: What areas need help? Where are additional resources not already assigned and incoming units needed most?
Report often and include as much detail as possible, he advised. “
3. Enlist the help of able-bodied victims
At a mass-casualty event, your focus needs to be on the most critically injured patients. Focus on the red patients, Schorr stressed. “Yellows are just greens that can’t walk.”
While his team drills with live “victims” annually for MCI response at the airport where he works, he also conducts smaller, quicker MCI response drills frequently using small traffic cones.
Each cone has a condition written on the bottom, and his firefighters quickly assess and triage, flagging each simulated patient with a yellow, green, red or black strip from their triage flagging set. Then, red cones are conducted to the casualty collection point. Each red cone, despite its tiny stature, requires two firefighters to move it, for authenticity. With the exception being; a firefighter who collects two green cones can leave a red in their care.
Use the uninjured bystanders, Schorr implores. You don’t need litter bearers. Ask the bystanders to bring the injured to the collection point.
Additional resources on mass casualty incident response
Check out these additional resources from FireRescue1 to learn more about MCI response:
- Training for a firefighter mission shift: Mass casualty incidents
- Prepare for the worst: Four Fire/EMS takeaways from the Las Vegas shooting
- Rapid response: MCIs are not contained to any one environment
- When the MCI hits close to home
- Rapid response: How can fire chiefs prepare citizens to be MCI responders
- Resilient communities train citizens to be first responders
- Why recent acts of mass violence should change the way fire, EMS and police train
- Officials: Las Vegas responders trained extensively for mass casualty event