ASTM F1288-90(2003)
(Guide)Standard Guide for Planning for and Response to a Multiple Casualty Incident
Standard Guide for Planning for and Response to a Multiple Casualty Incident
SIGNIFICANCE AND USE
This guide is intended to assist the management of the local EMS agencies or organizations in the design, planning, and response of their jurisdiction’resources to multiple casualty incidents (MCIs).
This guide does not address all of the necessary planning and response of pre-hospital care agencies to an incident that involves the total destruction of community services and systems.
This guide does not address the necessary design, planning, and response to be undertaken by a medical care facility to an internal or external event that necessitates the activation of the facility’disaster plan.
This guide provides procedures to coordinate and provide a systematic and standardized response by responsible parties, including the local elected officials, emergency management officials, public safety officials, medical care officials (pre-hospital and hospital), local EMS agencies/organizations and others with objectives and tasks for the pre-hospital management of a significant incident.
This guide provides for the establishment of an incident command system with position descriptions that identify mission, functions, and responsibilities of the command structure to be used at a MCI. The incident command functions include but are not limited to staging, logistics, rescue/extrication, triage, treatment, transportation (air, land, and water), communications, and fatality management.
This guide provides examples and other management tools that can assist in providing training objectives and decision making models for dispatch, response, triage, treatment, and transportation for local jurisdictions experiencing multiple casualty incidents. PLANNING Top
SCOPE
1.1 This guide covers the planning, needs assessment, training, integration, coordination, mutual aid, implementation, provision of resources, and evaluation of the response of a local emergency medical service (EMS) organization or agency to a multiple patient producing situation that may or may not involve property loss. This guide is limited to the pre-hospital response and mitigation of an incident up to and including the disposition of patients from the incident scene.
1.2 This guide addresses the background on planning, scope, structure, application, federal, state, local, voluntary, and nongovernmental resources and planning efforts involved in developing, implementing, and evaluating an EMS annex, or component, to the local jurisdiction's emergency operations plan (EOP) as defined in the Federal Emergency Management Agency (FEMA) publication, Civil Preparedness Guide (CPG) 1-8.
1.3 This standard does not purport to address the safety concerns associated with its use. It is the responsibility of the user of this standard to establish appropriate safety and health practices and determine the applicability of regulatory limitations prior to use.
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Designation:F1288–90 (Reapproved 2003)
Standard Guide for
Planning for and Response to a Multiple Casualty Incident
This standard is issued under the fixed designation F 1288; the number immediately following the designation indicates the year of
original adoption or, in the case of revision, the year of last revision. A number in parentheses indicates the year of last reapproval. A
superscript epsilon (e) indicates an editorial change since the last revision or reapproval.
1. Scope 3.1.2 disaster—a sudden calamity, with or without casual-
ties, so defined by local, county, or state guidelines.
1.1 This guide covers the planning, needs assessment,
3.1.2.1 medical disaster—a type of significant medical in-
training, integration, coordination, mutual aid, implementation,
cidentwhichexceeds,oroverwhelms,orboth,thecapabilityof
provision of resources, and evaluation of the response of a
local resources and of routinely available regional or multi-
local emergency medical service (EMS) organization or
jurisdictional medical mutual aid, and for which extraordinary
agency to a multiple patient producing situation that may or
medical aid from state or federal resources is very likely
may not involve property loss. This guide is limited to the
required for further diagnosis and treatment.
pre-hospital response and mitigation of an incident up to and
3.1.3 EMS control/medical group supervision— the first
including the disposition of patients from the incident scene.
emergency medical services response at the incident scene, or
1.2 This guide addresses the background on planning,
designated by the local response plan or incident command to
scope, structure, application, federal, state, local, voluntary,
be responsible for the overall management of the incident’s
and nongovernmental resources and planning efforts involved
EMS operation.
indeveloping,implementing,andevaluatinganEMSannex,or
3.1.4 extrication management—the function of supervising
component, to the local jurisdiction’s emergency operations
personnel who remove entrapped victims.
plan (EOP) as defined in the Federal Emergency Management
3.1.5 fatality management—the function designated by ex-
Agency (FEMA) publication, Civil Preparedness Guide (CPG)
isting plans, or the EMS control/medical group supervisor, to
1–8.
organize, coordinate, manage, and direct morgue services.
1.3 This standard does not purport to address the safety
3.1.6 incident commander—the individual responsible for
concerns associated with its use. It is the responsibility of the
the overall on-site management and coordination of personnel
user of this standard to establish appropriate safety and health
and resources involved in the incident.
practices and determine the applicability of regulatory limita-
3.1.7 logistics resources management—the function respon-
tions prior to use.
sible for acquiring personnel, equipment (including vehicles),
2. Referenced Documents
facilities, supplies, and services as requested by the incident
commander.
2.1 ASTM Standards:
3.1.8 medical communications management—the function
F 1149 Practice for Qualifications, Responsibilities, and
designated by the incident commander or EMS control/ medi-
Authority of Individuals and Institutions Providing Medi-
cal group supervisor to establish, maintain, and coordinate
cal Direction of Emergency Medical Services
effective communication between on-site and off-site medical
3. Terminology
personnel and facilities.
3.1.9 medical supplies management—the function desig-
3.1 Definitions of Terms Specific to This Standard:
nated by the incident commander to manage equipment and
3.1.1 command post—the physical location from which
report to EMS control/medical group supervisor.
incident command exercises direction over the entire incident.
3.1.10 mental health coordinator—a qualified mental health
professional responsible for coordinating the psychosocial
This guide is under the jurisdiction of ASTM Committee F30 on Emergency
assessments and interventions for responders, affected indi-
Medical Services and is the direct responsibility of Subcommittee F30.03 on
viduals, and groups.
Organization/Management.
Current edition approved Sept. 10, 2003. Published October 2003. Originally
3.1.11 multiple casualty incident (MCI)—a type of signifi-
approved in 1990. Last previous edition approved in 1998 as F 1288 – 90 (1998).
cant medical incident that may fall into the following catego-
Available from FEMA, 500 C St., SW, Washington, DC 20472.
ries:
Annual Book of ASTM Standards, Vol 13.02.
Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.
F1288–90 (2003)
3.1.11.1 extended—an incident for which local medical 4. Summary of Guide
resources are available and adequate to provide for field
4.1 This guide is based upon a body of knowledge on the
medical triage and stabilization, and for which appropriate
planning, implementation, and evaluation of the emergency
local facilities are available and adequate for further diagnosis
medical components of the local pre-hospital response to
and treatment.
multiple casualty incidents.
3.1.11.2 major—an incident producing large numbers of
4.2 Thebodyofknowledgeonwhichtheguideisbasedwas
casualties, for which routinely available regional or multi-
drawn from a wide variety of sources, including individual
jurisdictional medical mutual aid is necessary and adequate for
authors, academic institutions, and federal, state, regional, and
further diagnosis and treatment.
local organizations.
3.1.12 mutual aid—the coordination of resources, including
4.3 This guide is organized in such a way as to provide
butnotlimitedtofacilities,personnel,vehicles,equipment,and
those responsible for planning, implementing, and evaluating
services, pursuant to an agreement between jurisdictions pro-
the emergency medical components of the local pre-hospital
viding for such interchange on a reciprocal basis in responding
response to multiple casualty incidents with information they
to a disaster or emergency.
can readily use to ensure that their response is as expedient and
3.1.13 needs assessment—a preliminary survey of real or
appropriate as is reasonably possible.
potential hazards in a specific geographic area.
4.4 The guide was created to organize, collate, and distrib-
3.1.14 operations offıcer—individual who assists the inci-
uterelatedinformationinsuchawayastobereadilyaccessible
dent commander on issues relating to the operations of the
to people in the fields of emergency medical services and
incident.
emergency management.
3.1.15 public information—a function designated by the
4.5 This guide should not be perceived as an inflexible rule
incidentcommanderforthedisseminationoffactualandtimely
or standard but as a guide that should be adapted to the needs
reports to the news media.
of the individual community, and should be refined and
3.1.16 safety management—the function that identifies real
improved as the body of knowledge on which it is based
or potential hazards, unsafe environment or procedures at the
increases.
incident scene, and recommends the appropriate corrective or
preventive actions under the authority of the incident com-
5. Significance and Use
mander, to ensure the safety of all personnel at the incident
5.1 This guide is intended to assist the management of the
scene.
local EMS agencies or organizations in the design, planning,
3.1.17 sector offıcers (group supervisors/leaders/
and response of their jurisdiction’s resources to multiple
managers)—qualified personnel who control a specific area or
casualty incidents (MCIs).
task assignment.
5.2 This guide does not address all of the necessary plan-
3.1.18 staging area—the location where responding emer-
gency services equipment and personnel assemble for assign- ning and response of pre-hospital care agencies to an incident
that involves the total destruction of community services and
ment.
systems.
3.1.19 staging management—thefunctiondesignatedbythe
5.3 This guide does not address the necessary design,
incident commander that is responsible for the orderly assem-
bly and utilization of resources in a designated area. planning, and response to be undertaken by a medical care
facility to an internal or external event that necessitates the
3.1.20 transportation management—the function desig-
activation of the facility’s disaster plan.
nated by the EMS control/medical group supervisor that is
responsible for the transportation of the patients from the
5.4 This guide provides procedures to coordinate and pro-
incident scene and for coordination with EMS control/ medical vide a systematic and standardized response by responsible
group supervisor, communications, and the incident com-
parties, including the local elected officials, emergency man-
mander. agement officials, public safety officials, medical care officials
3.1.21 treatment area—the site at or near the incident for (pre-hospital and hospital), local EMS agencies/organizations
emergency medical treatment prior to transport. and others with objectives and tasks for the pre-hospital
3.1.22 treatment management—the function that is respon- management of a significant incident.
sible for the definitive on-scene medical treatment of patients. 5.5 This guide provides for the establishment of an incident
3.1.23 triage—the process of sorting and prioritizing emer- command system with position descriptions that identify mis-
gency medical care of the sick and injured on the basis of sion, functions, and responsibilities of the command structure
urgency and type of condition present, and the number of to be used at a MCI. The incident command functions include
patients and resources available in order to properly treat and but are not limited to staging, logistics, rescue/extrication,
transport them to medical facilities appropriately situated and triage, treatment, transportation (air, land, and water), commu-
equipped for their care. nications, and fatality management.
3.1.24 triage area—a location near the incident site to 5.6 This guide provides examples and other management
which injured persons should be brought, triaged, and taken
tools that can assist in providing training objectives and
directly to the treatment area.
decision making models for dispatch, response, triage, treat-
3.1.25 triage management—the function that is responsible ment, and transportation for local jurisdictions experiencing
for triage and preliminary treatment of casualties. multiple casualty incidents.
F1288–90 (2003)
PLANNING 6.4.2.4 The type and quantity of mutual aid and support
services that might be required outside the normal jurisdic-
6. Planning
tional services.
6.1 Purpose—Planning should be a cooperative effort be-
6.4.3 Components—There are three basic parts to a needs
tween local EMS providers and the jurisdiction in which they
assessment:
deliver services. The plan should be written to establish the
6.4.3.1 Consideration of the potential for specific incidents,
emergency organization, basic policies, responsibilities, and
6.4.3.2 Evaluation of the potential harm resulting from the
actions required for support of local operations of emergency
incident, and
medical/health plans. Plans should ensure rapid medical assis-
6.4.3.3 Evaluation of the resources required to respond to
tance to persons requiring aid due to an incident. Plans should
the incident.
describe a system for coordination of alerting, dispatching, and
6.4.4 Approach—The following are suggested approaches
uses of medical personnel and resources whenever a local
to completing a needs assessment:
emergency medical health agency requires assistance from
6.4.4.1 Form a team to identify the potential hazards, risks,
another EMS agency/jurisdiction. The plan should be designed
and impact relating to potential MCIs.
to be an extension of day to day service, facilities, and
6.4.4.2 Consult the local or state civil defense/emergency
resources.
preparedness offices for assessment information.
6.2 Goal—The plan ensures adequate and coordinated ef-
6.4.4.3 After identifying potential MCIs, evaluate them for
forts that will minimize loss of life, disabling injuries, and
their potential hazards, risks, and impact.
human suffering by providing effective medical assistance
6.4.4.4 Evaluate the area’s resources.
through efficient use of medical and other resources in the
6.4.5 Resources Assessment—Consider the personnel re-
event of emergencies resulting in multiple casualty incidents.
quired for performing such tasks as emergency medical ser-
6.3 Objectives—The primary objectives of a plan should
vices, firefighting, and rescue. Inventory equipment for the job
include a process whereby:
and evaluate its ability to perform the task. Prepare a written
6.3.1 Each EMS agency/jurisdiction should have a plan to
description of what potential incidents exist, and the ability to
meet its own needs within its capabilities.
respond to these incidents.
6.3.2 Each EMS agency/jurisdiction should enter into mu-
6.4.6 Once complete, the needs assessment becomes part of
tual aid agreements with other local or regional jurisdictions
the plan.
which can be invoked when local capability to manage a
6.5 Plan Components—The plan should include provision
situation has been exceeded. Each jurisdictional plan should
for the following:
facilitate the access and utilization of local and state resources.
6.5.1 Organizational Structure for Response:
6.3.3 The EMS agency/jurisdiction’s plan should conform
6.5.1.1 The plan should define an overall incident organiza-
to appropriate regional and state plans.
tion based on a strategy of efficient and effective utilization of
6.3.4 Each EMS agency/jurisdiction should define training
resources.
requirements, and develop and utilize a training program based
6.5.1.2 The plan should address chain of command, includ-
on the needs assessment of the community.
ing transfer of authority of any officer or position.
6.3.5 The plan should be a coordinated interagency effort.
6.5.2 Organization of Manpower and Resources for Re-
Responsible agencies should have regular interaction in order
sponse:
to facilitate working relations during an incident.
6.5.2.1 The plan should provide for delineation of respon-
6.3.6 Plans and procedures should be reviewed and revised
sibilities and authority for all involved response personnel and
regularly on the basis of tabletop exercises, simulated inci-
agencies.
dents, or actual events.
6.5.2.2 The plan should address necessary resources for
6.4 Needs Assessment and Hazards Analysis:
each level of event and prepare for availability and updating of
6.4.1 A needs assessment is a preliminary survey of
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