Chapter 39: Incident Management

National Incident Management System (NIMS)

A Department of Homeland Security system designed to enable federal, state, and local governments and private-sector and nongovernmental organizations to effectively and efficiently prepare for, prevent, respond to, and recover from domestic incidents, regardless of cause, size, or complexity, including acts of catastrophic terrorism.

single command system

A command system in which one person is in charge, generally used with small incidents that involve only one responding agency or one jurisdiction.

unified command system

A command system used in larger incidents in which there is a multiagency response or multiple jurisdictions are involved.

Material Safety Data Sheet (MSDS)

A form, provided by manufacturers and compounders (blenders) of chemicals, containing information about chemical composition, physical and chemical properties, health and safety hazards, emergency response, and waste disposal of a specific material; also known as a safety data sheet (SDS).

START triage

A patient sorting process that stands for Simple Triage And Rapid Treatment and uses a limited assessment of the patient's ability to walk, respiratory status, hemodynamic status, and neurologic status.

Emergency Response Guidebook (ERG)

A preliminary action guide for first responders operating at a hazardous materials incident in coordination with the US Department of Transportation's labels and placards marking system. Jointly developed by the DOT, the Secretariat of Communications and Transportation of Mexico, and Transport Canada.

cold zone

A safe area at a hazardous materials incident for the agencies involved in the operations. The incident commander, the command post, EMS providers, and other support functions necessary to control the incident should be located in the cold zone. Also referred to as the clean zone or the support zone.

JumpSTART triage

A sorting system for pediatric patients younger than 8 years or weighing less than 100 lb. There is a minor adaptation for infants since they cannot ambulate on their own.

incident command system (ICS)

A system implemented to manage disasters and mass-casualty incidents in which section chiefs, including finance, logistics, operations, and planning, report to the incident commander.

secondary triage

A type of patient sorting used in the treatment area that involves retriage of patients.

primary triage

A type of patient sorting used to rapidly categorize patients; the focus is on speed in locating all patients and determining an initial priority as their conditions warrant.

disaster

A widespread event that disrupts community resources and functions, in turn threatening public safety, citizens' lives, and property.

Which of the following patients would have the HIGHEST treatment priority at the scene of a mass-casualty incident? A. 24-year-old man who is unconscious, has snoring respirations, and severe burns B. 32-year-old woman who is pulseless and apneic with an abdominal evisceration C. 29-year-old woman who is in full cardiac arrest with massive open chest trauma D. 32-year-old man with an open head injury, exposed brain matter, and no carotid pulse

A. 24-year-old man who is unconscious, has snoring respirations, and severe burns

Which of the following is NOT a responsibility of the treatment supervisor? A. Primary assessment B. Secondary Triage C. Patient packaging D. Communication with the medical branch director

A. Primary assessment

Chemical Transportation Emergency Center (CHEMTREC)

An agency that assists emergency responders in identifying and handling hazardous materials transport incidents.

mutual aid response

An agreement between neighboring EMS systems to respond to mass-casualty incidents or disasters in each other's region when local resources are insufficient to handle the response.

joint information center (JIC)

An area designated by the incident commander, or a designee, in which public information officers from multiple agencies distribute information about the incident.

casualty collection area

An area set up by physicians, nurses, and other hospital staff near a major disaster scene where patients can receive further triage and medical care.

Mass Casualty Incident (MCI)

An emergency situation involving three or more patients or that can place great demand on the equipment or personnel of the EMS system or has the potential to produce multiple casualties.

secondary containment

An engineered method to control spilled or released product if the main containment vessel fails.

hazardous materials (HazMat) Incident

An incident in which a hazardous material is no longer properly contained and isolated.

closed incident

An incident that is contained; all casualties are accounted for.

open incident

An incident that is not yet contained; there may be patients to be located and the situation may be ongoing, producing more patients.

incident action plan

An oral or written plan stating general objectives reflecting the overall strategy for managing an incident.

nonbulk storage vessels

Any container other than bulk storage containers such as drums, bags, compressed gas cylinders, and cryogenic containers. Nonbulk storage vessels hold commonly used commercial and industrial chemicals such as solvents, industrial cleaners, and compounds.

bulk storage containers

Any container other than nonbulky storage containers such as fixed tanks, highway cargo tanks, rail tank cars, totes, and intermodal tanks. These are typically found in manufacturing facilities and are often surrounded by a secondary containment system to help control an accidental release.

hazardous material

Any substance that is toxic, poisonous, radioactive, flammable, or explosive and causes injury or death with exposure.

container

Any vessel or receptacle that holds material, including storage vessels, pipelines, and packaging.

control zones

Areas at a hazardous materials incident that are designated as hot, warm, or cold, based on safety issues and the degree of hazard found there.

Which of the following is NOT a common role of the EMT at the scene of a HazMat incident? A. Rehabilitation B. Decontamination C. Transportation D. Triage and treatment

B. Decontamination

Which of the following statements regarding transport of patients from a multiple-casualty incident or disaster site is correct? A. Delayed-priority patients should be transported five at a time. B. Immediate-priority patients should be transported two at a time. C. Walking wounded patients should be taken to the closest hospitals. D. Patients who are in cardiac arrest should clearly be transported first.

B. Immediate-priority patients should be transported two at a time.

Which of the following situations MOST likely involves a hazardous material? A. Milk truck that overturned and is leaking fluid B. Tractor trailer rig that is emitting a visible cloud C. Moving van that collided head-on with a small car D. Pickup truck from the gas company that struck a tree

B. Tractor trailer rig that is emitting a visible cloud

Injuries or conditions that would be classified as first priority (red tag; immediate) include all of the following, EXCEPT: A. severe medical problems. B. fractures of multiple long bones. C. any airway or breathing difficulty. D. uncontrolled or severe hemorrhage

B. fractures of multiple long bones.

drums

Barrel-like containers used to store a wide variety of substances, including food-grade materials, corrosives, flammable liquids, and grease. Drums may be constructed of low-carbon steel, polyethylene, cardboard, stainless steel, nickel, or other materials.

When dealing with a hazardous materials incident, where should you set up your decontamination area?

Between the hazard zone and treatment area

How does a disaster differ from a mass-casualty incident? A. Disasters may not involve personal injuries. B. In a disaster, EMS may be on the scene for days or weeks. C. Only an elected official can declare a disaster. D. All of the above.

D. All of the above.

What is the purpose of the incident command system (ICS)? A. Ensuring responder and public safety B. Achieving incident management goals C. Ensuring the efficient use of resources D. All of the above.

D. All of the above.

Which of the following statements BEST describes a mass-casualty incident? A. At least half of the patients are dead. B. Either a bus or an airplane has crashed. C. You have more than two critical patients. D. The patient count exhausts your resources.

D. The patient count exhausts your resources.

When EMS responds to a disaster, as part of their response within the ICS, EMS would start with a scene size-up. What is the next step for the first-responding units?

Establishing command

carboys

Glass, plastic, or steel containers, ranging in volume from 5 to 15 gallons.

rescue supervisor

In incident command, the person appointed to determine the type of equipment and resources needed for a situation involving extrication or special rescue; also called the extrication officer.

extrication supervisor

In incident command, the person appointed to determine the type of equipment and resources needed for a situation involving extrication or special rescue; also called the rescue officer.

transportation supervisor

In incident command, the person in charge of the transportation sector in a mass-casualty incident who assigns patients from the treatment area to awaiting ambulances in the transportation area.

rehabilitation supervisor

In incident command, the person who establishes an area that provides protection for responders from the elements and the situation.

public information officer (PIO)

In incident command, the person who keeps the public informed and relates any information to the press.

staging supervisor

In incident command, the person who locates an area to stage equipment and personnel and tracks unit arrival and deployment from the staging area.

safety officer

In incident command, the person who monitors the scene for conditions or operations that may present a hazard to responders and patients; he or she may stop an operation when responder safety is an issue.

liasion officer

In incident command, the person who relays information, concerns, and requests among responding agencies

morgue supervisor

In incident command, the person who works with area medical examiners, coroners, and law enforcement agencies to coordinate the disposition of dead victims.

treatment supervisor

In incident command, the person, usually a physician, who is in charge of and directs EMS providers at the treatment area in a mass-casualty incident.

finance

In incident command, the position in an incident responsible for accounting of all expenditures.

operations

In incident command, the position that carries out the orders of the commander to help resolve the incident.

logistics

In incident command, the position that helps procure and stockpile equipment and supplies during an incident.

command

In incident command, the position that oversees the incident, establishes the objectives and priorities, and from there develops a response plan.

planning

In incident command, the position that ultimately produces a plan to resolve any incident.

span of control

In incident command, the subordinate positions under the commander's direction to which the workload is distributed; the supervisor/worker ratio.

personal protective equipment (PPE) levels

Indicates the amount and type of protective equipment that an individual needs to avoid injury during contact with a hazardous material.

toxicity levels

Indicates the risk that a hazardous material poses to the health of an individual who comes into contact with it.

Which toxicity level would you assign a hazardous material spill that could cause a person temporary damage or residual injury unless prompt medical treatment is given?

Level 2

According to the START triage system, what should you do if you encounter an unresponsive patient who is not breathing?

Open the airway and reassess breathing status.

cylinders

Portable, compressed gas containers used to hold liquids and gases. Uninsulated compressed gas cylinders are used to store substances such as nitrogen, argon, helium, and oxygen. They have a range of sizes and internal pressures.

intermodal tanks

Shipping and storage vessels that can be either pressurized or nonpressurized.

placards

Signage required to be placed on all four sides of highway transport vehicles, railroad tank cars, and other forms of hazardous materials transportation; the sign identifies the hazardous contents of the vehicle, using a standardization system with 10¾-inch diamond-shaped indicators.

hot zone

The area immediately surrounding a hazardous materials spill/incident site that is directly dangerous to life and health. All personnel working in the hot zone must wear complete, appropriate protective clothing and equipment. Entry requires approval by the incident commander or other designated officer.

transportation area

The area in a mass-casualty incident where ambulances and crews are organized to transport patients from the treatment area to receiving hospitals.

warm zone

The area located between the hot zone and the cold zone at a hazardous materials incident. The decontamination corridor is located in the warm zone.

rehabilitation area

The area that provides protection and treatment to fire fighters and other personnel working at an emergency. Here, workers are medically monitored and receive any needed care as they enter and leave the scene.

decontamination area

The designated area in a hazardous materials incident where all patients and rescuers must be decontaminated before going to another area.

command post

The designated field command center for the incident commander and support staff are located

termination of command

The end of the incident command structure when an incident draws to a close.

treatment area

The location in a mass-casualty incident where patients are brought after being triaged and assigned a priority, where they are reassessed, treated, and monitored until transport to the hospital.

incident commander (IC)

The overall leader of the incident command system to whom commanders or leaders of incident command system divisions report.

demobilization

The process of directing responders to return to their facilities when work at a disaster or mass-casualty incident has finished, at least for those particular responders.

Decontamination

The process of removing or neutralizing and properly disposing of hazardous materials from equipment, patients, and rescue personnel.

triage

The process of sorting patients based on the severity of injury and medical need to establish treatment and transportation priorities.

triage supervisor

The process of sorting patients based on the severity of injury and medical need to establish treatment and transportation priorities.

freight bills

The shipping papers used for transport of chemicals along roads and highways. Also referred to as bills of lading.

bills of lading

The shipping papers used for transport of chemicals over roads and highways. Also referred to as freight bills.

freelancing

When individual units or different organizations make independent and often inefficient decisions about the next appropriate action.

Interoperability, an important feature of the NIMS, refers to the ability of:

agencies of different types or from different jurisdictions to communicate with each other.

Upon arriving at a scene in which the incident command system has been activated, you should expect to:

be passed from sector to sector, as needed, in between assignments.

A carboy is a container that would MOST likely be used to store and transport:

corrosives.

A 49-year-old man has been removed from his overturned tanker, which was carrying a hazardous material. The tank ruptured and he was exposed to the material. When rescue personnel bring him to the decontamination area, they note that he is unconscious and has slow, shallow breathing. They should:

cut away all of the patient's clothing and do a rapid rinse to remove as much of the contaminating matter as they can.

You and your partner are the first to arrive at the scene of a motor vehicle accident. As you approach the scene, you can see multiple patients, some walking and others who are still in their vehicles. You should:

declare a multiple-casualty incident and request additional resources.

The process of removing or neutralizing and properly disposing of a hazardous material is called:

decontamination.

During a motor vehicle collision involving multiple patients, the incident commander would MOST likely:

designate a safety officer, but retain other command functions.

The purpose of the incident command system (ICS) is to:

ensure responder and public safety, achieve incident management goals, and ensure the effective use of resources.

As the first-arriving senior EMT at the scene of an incident, you should perform a scene size-up and then:

establish command.

A large tanker truck has overturned on a highway. When you arrive, you see a clear liquid leaking from the rear of the tanker. The driver, who appears to be unconscious, is still in the vehicle and is bleeding heavily from the face. You should:

fully assess the situation and request the appropriate assistance.

General principles for approaching a potential HazMat incident include:

maintaining a safe distance and viewing the scene with binoculars.

You and your partner arrive at the scene where a truck has crashed into a small building, injuring eight people. You immediately request additional ambulances and begin the triage process. The first patient that you triage is a young female who is unconscious and apneic. She has an open head injury and her pulse is weak and thready. You should:

place a red tag on her and continue triaging.

You have a critically injured patient in the back of your ambulance, ready to be transported. There are other injured patients at the scene and it will be approximately 10 minutes before other ambulances will arrive. Law enforcement personnel are at the scene. You should:

remain at the scene until at least one other ambulance arrives.

A Level 4 hazardous material:

requires specialized gear designed for protection against that particular hazard.

According to the JumpSTART triage system, infants or children not developed enough to walk or follow commands, including children with special needs:

should be taken to the treatment area for immediate secondary triage.

The reference used as a base for your initial actions at a HazMat incident is:

the Emergency Response Guidebook.

The MOST appropriate location to park your ambulance at a HazMat incident is:

upwind at least 100 feet from the incident.