I’m FEMA certified in ICS – the Incident Command System, which is the US National emergency system. I serve in times of crisis in my local community as well as anywhere I’m needed or sent. MCI (Mass or Multiple Casualty Incident) falls under that command system. By definition, a MCI is any event that places excessive demands on personnel and equipment, and involves three or more patients. Like in a Haz-Mat situation, a small town can rapidly become overwhelmed by a MCI. Then again, even in a large metropolitan city, chaos can and does occur if there’s enough conflict – extreme weather, rush-hour traffic, an earthquake that affected most of the city, etc.

Some examples of a MCI: Structure fire and/or explosion, MVC (motor vehicle collision), gang-related violence, bus rollover, tornado, flood, public shooting, etc.

ICS is also used in preparatory and scene control for large crowd events like: Sporting events, concerts, a visit from the US President, etc. ICS is in place during as well as pre and post these events to handle normal activity and to deal with any emergency crisis if one or more occurs.

Numerous emergency agencies are involved in handling a MCI. Together, the ICS allows us all to efficiently and effectively work together. The first EMS personnel to arrive on scene of a MCI becomes the EMS incident commander. That person sets up the following sectors:

A)     Mobile Command

B)     Extrication

C)     Staging

D)     Supply

E)      Treatment

F)      Transportation

G)     Triage

For this post, I’ll discuss triage only. Typically, there are two phases of triage – primary and secondary. For this general explanation, assume I wasn’t the first to arrive on the scene, and when I did arrive, the EMS incident commander assigned me in triage.

1) Primary Triage: In the staging area, I suit-up in my necessary protective gear and grabequipment. I enter the hot zone of the MCI. I quickly assess each patient, one-by-one. Based on my assessment findings, I then categorize each patient by placing them in their appropriate priority status.

Priority 1 – Referred to as Red, these patients need immediate care and transport to a hospital.

Priority 2 – Referred to as Yellow, these patients’ conditions will tolerate a delay in emergency care and transport.

Priority 3 – Referred to as Green or the walking wounded, these patients only have minor injuries and are ambulatory (able to walk under their own power).

Priority 4 – Referred to as Black, these victims are either dead or they’ve suffered fatal injuries and there’s nothing anyone can do for them. Yes, it sounds cruel to leave them and move on to the next person, but these patients are unconsciousness, dead, or will soon die, and in a mass causality incident most likely we cannot save everyone, so we must save those who can be saved.

After I assess a patient, I place a colored (example – Red) and named (example – Priority 1) tag on that patient, and move on to the next. I may give some medical care before I move on, but it’s quick.

2) Secondary Triage: Once the patient is extricated to the triage sector, a reassessment is performed. If there are any changes in the patient’s condition that alters their priority status, they’ll either be upgraded to a higher priority or downgraded to a lower one.

Jordyn here: Let’s practice our triage skills. You arrive at a five-car pileup and are assigned by the incident commander to triage. These are your three patients.

1.      Patient #1: A 32 y/o woman with an obvious deformity to her left forearm. She was able to get out of her car and is standing by the road side.

2.      Patient #2: A 10y/o male ejected from his vehicle. He is found on the road side. He is awake but having severe difficulty breathing. There are no breath sounds heard on his left chest.

3.      Patient #3: A 65y/o male with open head injury. His pupils are fixed and dilated and he is taking agonal respirations.

What triage level would you give each of these patients?