INCIDENT MANAGEMENT
INCIDENT MANAGEMENT
This section is designed to provide university Emergency Response Teams (ERT) with a structured approach to effectively manage and respond to incidents on campus. It focuses on maintaining safety, minimizing disruption, and ensuring compliance with emergency management standards.
In this section you will learn the necessary steps to effectively prepare and respond to incidents, assess an emergency scene, and assess patients to deliver the appropriate treatment.
For an Emergency First Response Team, the Incident/Emergency Management System typically follows a structured series of steps to ensure a coordinated and effective response to emergencies. Here’s a general outline of the steps:
Preparation & Planning
Risk Assessment: Identify potential hazards, vulnerabilities, and risks that the team may encounter.
Training & Drills: Conduct regular training sessions, drills, and simulations to prepare team members for various emergency scenarios.
Resource Allocation: Ensure necessary resources (equipment, medical supplies, communication tools) are readily available and accessible.
Establish Protocols: Develop standard operating procedures (SOPs) and protocols for different emergency types, including clear communication plans.
Role Assignment: Define and assign roles and responsibilities for team members, such as first aid, triage, communication, and logistics.
Detection & Activation
Monitor for Emergencies: Use alert systems or on-site observation to detect signs of an emergency.
Incident Assessment: Quickly assess the severity and type of emergency to determine the appropriate response level.
Activate Emergency Response: Notify and activate the Emergency First Response Team based on the initial assessment. Initiate communication with other relevant stakeholders as needed.
Incident Response
Initial Scene Assessment: Upon arrival, the team conducts a quick, thorough assessment of the scene to identify potential hazards, number of casualties, and resource needs.
Safety & Perimeter Control: Establish a safe perimeter around the scene and manage bystander control to prevent additional risks.
Triage & Medical Care: Triage individuals based on the severity of their injuries and provide immediate medical care to stabilize patients.
Coordination & Communication: Maintain clear communication with team members, emergency services, and any other on-site responders to ensure coordination.
Incident Stabilization
Contain Hazards: If possible, take action to mitigate or contain any hazards present, such as fires, chemical spills, or unstable structures.
Resource Management: Allocate resources (medical supplies, equipment, personnel) to support ongoing response efforts effectively.
Continue Medical Support: Provide continued care to those in need and prepare critical patients for potential evacuation.
Communication with External Agencies
Notify Emergency Services: Alert local emergency services, such as EMS, fire, or police, and provide a detailed report of the situation.
Information Sharing: Share relevant information (injury severity, patient numbers, scene hazards) with incoming emergency services to facilitate seamless handover.
Coordination with Command Structure: If the response escalates, the team will operate within the broader incident command structure, following the directives of the Incident Commander.
Evacuation & Handover
Assist with Patient Evacuation: Work with EMS and other responders to safely evacuate patients from the scene, prioritizing those with severe injuries.
Handover of Information: Provide a detailed handover report to emergency services on each patient’s condition, treatment administered, and any other pertinent information.
Demobilization
Resource Reallocation: After the emergency has been stabilized, begin demobilizing response resources and return equipment to readiness.
Account for Personnel: Ensure all team members are accounted for and that no personnel remain in hazardous areas.
Stand Down the Team: Officially close the incident response phase and prepare the team for return to normal operations.
Post-Incident Review & Documentation
Debriefing: Conduct a post-incident debrief with team members to discuss the response, identify strengths and weaknesses, and address any psychological impacts.
Documentation & Reporting: Complete all necessary incident reports, including timelines, actions taken, injuries, and resource use.
Evaluation & Improvement: Assess the response to identify lessons learned and areas for improvement, updating protocols and training based on these insights.
Recovery & Follow-Up
Equipment & Resource Replenishment: Ensure all equipment is cleaned, restocked, and repaired as needed.
Follow-Up Care for Affected Individuals: Coordinate follow-up with any individuals who received care and may need additional medical support.
Update Preparedness Plans: Revise and improve emergency plans based on the incident review, incorporating feedback to enhance future response capabilities.
This structured approach ensures that the Emergency First Response Team can respond efficiently and effectively to emergencies while minimizing risks and improving resilience for future incidents.
Scene assessment is a critical first step to ensure responder safety, determine the nature of the incident, and prioritize actions.
Scene Safety
Personal Safety: Ensure that you, as the responder, are safe before entering the scene. Check for hazards such as fire, electrical risks, dangerous chemicals, unstable structures, or violent individuals.
Bystander Safety: Assess potential risks to bystanders and control access to the area if needed, redirecting people to a safe distance.
Environmental Hazards: Identify any hazards specific to the environment, such as traffic, hazardous materials, weather conditions, or unsafe terrain.
Assess the Mechanism of Injury or Nature of Illness
Identify the Type of Incident: Determine if the situation is due to trauma (e.g., car accident, fall) or a medical emergency (e.g., cardiac arrest, seizure).
Clues from the Scene: Look for objects or environmental clues that could indicate the cause of injury or illness, such as broken glass, weaponry, or signs of substance use.
Potential for Additional Hazards: Consider if the incident could lead to secondary issues (e.g., a fire risk after a car accident or chemical exposure after a spill).
Initial Triage of Casualties
Count the Casualties: Quickly assess the number of victims to determine if additional help is required.
Level of Responsiveness: Check for signs of consciousness and responsiveness among individuals (e.g., moving, calling for help).
Severity of Injuries: Conduct a visual assessment to identify visible life-threatening injuries (e.g., heavy bleeding, severe burns) that may need immediate attention.
Establish Control & Request Additional Resources
Take Command of the Scene: If you’re the first responder on the scene, establish control and take charge of the response until additional help arrives.
Request Additional Help: Call for backup or specialized emergency services if the situation requires more personnel or specialized equipment (e.g., EMS, firefighters, hazmat team).
Assign Tasks: If others are available to help, assign roles and delegate tasks based on priority needs and responder skills.
Establish a Safe Zone & Triage Area
Define the Safe Zone: Identify a safe area near the incident where casualties can be treated without exposure to further hazards.
Set Up Triage Area: Begin organizing a triage area if there are multiple victims, where initial assessments can be performed and casualties prioritized by severity.
Perform Primary Survey (ABCs)
Airway: Check if the airway is open and clear any obstructions.
Breathing: Confirm if the patient is breathing and assess the quality of breathing.
Circulation: Check for a pulse and any significant bleeding, controlling major bleeds immediately.
Secondary Scene Assessment
Detailed Observation: Once immediate life-threatening issues are managed, conduct a more detailed assessment of the scene and casualties.
Look for Other Victims or Hazards: Re-evaluate for additional casualties or hazards that may have been initially overlooked.
Environmental Context: Assess environmental factors (e.g., temperature, darkness) that could affect treatment or transport.
Communication with Dispatch/Additional Responders
Update Dispatch: Relay any updated information to dispatch or incoming responders, such as the number of casualties, severity of injuries, and types of hazards present.
Clear Instructions to Arriving Teams: Provide guidance to incoming emergency services on safe entry points, hazards to avoid, and where to access the triage area.
Document Scene Information
Record Observations: Note key details about the scene, injuries, and actions taken. This documentation is vital for future responders and any medical personnel who take over care.
Take Photos if Safe and Permitted: Capture images of the scene to document hazards or mechanisms of injury, but only if it is safe, ethical, and permitted by protocol.
This outline serves as a structured approach for an Emergency First Responder to ensure a comprehensive scene assessment, prioritize immediate actions, and establish a safe environment for response activities.
Emergency responders often use the acronym SCENE to assess a scene. It serves as a quick checklist to ensure safety, control, and efficient response. Here’s what SCENE stands for:
S – Safety
Ensure your own safety and that of other responders, patients, and bystanders.
Look for hazards like fire, hazardous materials, unstable structures, or aggressive individuals.
C – Cause of Injury / Nature of Illness
Identify the mechanism of injury (trauma) or nature of illness (medical) based on clues from the environment.
Determine whether the situation is likely due to an accident, assault, or medical issue.
E – Environment
Consider environmental factors that may affect the response, such as weather, lighting, or location (e.g., confined space, traffic).
Adjust your approach and request any necessary resources for specific environmental challenges.
N – Number of Patients
Quickly count the number of casualties and assess if additional resources are needed.
Triage patients to prioritize based on the severity of injuries.
E – Extra Resources
Call for additional resources if necessary (e.g., EMS, fire department, hazmat team).
Ensure adequate personnel and equipment are available to manage the incident effectively.
SCENE helps first responders remember the essential steps to secure the area, identify hazards, and prepare for a safe and effective response.
The acronym GLASS is often used by emergency responders to quickly assess scene safety. Each letter reminds responders of key hazards or checks to consider when arriving at an emergency scene:
For GLASS, the letters cover similar safety checks:
G - Gloves: Put on gloves to protect yourself from bodily fluids or contaminants.
L - Look for Hazards: Survey the scene for potential dangers (traffic, electricity, weapons).
A - Assess for Additional Victims: Look to see if there are more victims that need attention or assistance.
S - Stop, Think, and Act: Take a moment to plan the next steps before acting.
S - Scene Safety: Ensure the scene remains safe for responders and bystanders.
Some responders may also add Fire, Wire, Gas, Glass as a more detailed scene safety checklist:
Fire: Check for fire or heat hazards.
Wire: Be aware of electrical wires or power lines.
Gas: Look out for gas leaks, chemicals, or other hazardous substances.
Glass: Be mindful of broken glass, sharp objects, or other risks that could cause injury.
These acronyms help responders prioritize their own safety and maintain situational awareness in emergencies.
PATIENT ASSESSMENT PROCEDURES
The patient assessment process for Emergency First Responders involves a structured approach to quickly evaluate a patient’s condition, address life-threatening issues, and gather essential information for ongoing care. Here’s an outline of the patient assessment process and checklist:
Scene Safety & Initial Approach
Scene Safety Check: Confirm that the scene is safe to enter.
Personal Protective Equipment (PPE): Ensure gloves, masks, or other PPE are on.
Introduce Yourself & Obtain Consent: Introduce yourself to the patient, if conscious, and ask for consent to assist.
Initial Impressions: Quickly note the patient’s position, visible injuries, responsiveness, and any signs of distress.
Primary Survey (Initial Assessment)
The primary survey focuses on identifying and managing life-threatening conditions. Use the ABCs approach:
A - Airway:
Check if the airway is clear.
Open the airway using the head-tilt/chin-lift or jaw-thrust maneuver if necessary.
Clear any obstructions or secretions if present.
B - Breathing:
Look, listen, and feel for breathing.
Check the quality, rate, and depth of breaths.
Provide rescue breaths if the patient is not breathing adequately.
C - Circulation:
Check for a pulse, typically at the carotid artery in adults.
Control any severe bleeding with direct pressure, elevation, or a tourniquet if necessary.
Assess skin color, temperature, and capillary refill as indicators of circulation.
D - Disability (Neurological Status):
Assess responsiveness using the AVPU scale (Alert, Voice-responsive, Pain-responsive, Unresponsive).
Check for signs of head injury or altered mental status.
E - Exposure/Environment:
Expose any areas with potential injuries to assess for further trauma.
Keep the patient warm and protected from environmental hazards.
Secondary Survey (Focused or Detailed Assessment)
If no immediate life threats are present, conduct a thorough assessment to identify less obvious injuries or issues.
Vital Signs:
Measure and record the patient’s blood pressure, pulse rate, respiratory rate, and oxygen saturation (if available).
Head-to-Toe Examination:
Head & Neck: Check for lacerations, bruises, deformities, or bleeding. Check pupils for reactivity to light.
Chest: Inspect and palpate for pain, deformity, or irregularities in breathing.
Abdomen: Check for tenderness, distension, or rigidity.
Pelvis: Gently press the pelvis to check for stability or pain.
Extremities: Examine each arm and leg for fractures, deformities, and pulse quality.
Back & Spine: If spinal injury is suspected, maintain spinal precautions and examine the back if it can be done safely.
SAMPLE History
Gather a medical history using the SAMPLE acronym to understand the patient’s background and current health status.
S - Signs & Symptoms: Note the symptoms the patient is experiencing and any signs observed.
A - Allergies: Ask about any known allergies (e.g., medications, food, environmental).
M - Medications: Determine if the patient is taking any prescribed, over-the-counter, or recreational drugs.
P - Past Medical History: Inquire about any pre-existing medical conditions or recent hospitalizations.
L - Last Oral Intake: Ask when and what the patient last ate or drank, including any medications.
E - Events Leading Up to the Incident: Understand what the patient was doing before the incident to help identify the cause.
Ongoing Assessment (Reassessment)
Continuous Monitoring: Reassess the patient’s vital signs, ABCs, and level of consciousness at regular intervals, especially if conditions are changing.
Document Changes: Record any changes in the patient’s condition, new symptoms, or responses to interventions.
Prepare for Handover: Organize patient information, interventions performed, and observations for transfer to advanced medical personnel.
Documentation and Communication
Record Findings: Document all assessment findings, interventions, and patient responses in detail.
Communicate with Incoming Responders: Clearly relay the patient’s condition, treatment administered, and pertinent history to EMS or advanced care providers during handover.
This assessment process ensures that Emergency First Responders can quickly and efficiently assess patients, prioritize treatments, and provide clear information to additional medical teams. It combines immediate life-saving steps with thorough patient examination and documentation.
The Patient Triage Process and Checklist for Emergency First Responders, helps to ensure patients are quickly and effectively assessed, prioritized, and treated based on the severity of their condition. Triage helps allocate limited resources efficiently, especially in mass-casualty incidents.
Scene Size-Up and Initial Assessment
Ensure Scene Safety: Confirm that the scene is safe for responders and patients. Secure the area if necessary.
Determine Number of Patients: Conduct a quick scan to assess the number of casualties and types of injuries.
Call for Additional Resources: If there are multiple patients, notify dispatch or command for backup if needed.
Use a Triage System
Apply START Triage (Simple Triage and Rapid Treatment): START is commonly used by first responders in the field to categorize patients quickly.
Use Color-Coded Triage Tags: Mark patients with color-coded tags based on the severity of their condition. Typical categories are:
Red (Immediate): Life-threatening injuries requiring immediate care.
Yellow (Delayed): Serious but not life-threatening injuries, treatment can be delayed.
Green (Minor): Minor injuries, “walking wounded.”
Black (Deceased/Expectant): No signs of life or injuries incompatible with survival.
Perform Primary Survey (ABC Assessment)
Airway: Check if the patient’s airway is open and clear obstructions.
Breathing: Ensure the patient is breathing; assess rate and quality of breathing.
Circulation: Check for a pulse and control any major bleeding.
Mental Status: Use AVPU scale to assess alertness:
A - Alert
V - Responds to Voice
P - Responds to Pain
U - Unresponsive
Assess and Prioritize Based on Condition
Red (Immediate): Patients with compromised airway, severe breathing difficulty, or major bleeding that can be controlled.
Yellow (Delayed): Patients who are stable but have injuries requiring attention, such as fractures or moderate bleeding.
Green (Minor): Patients who are stable with minor injuries and can move on their own.
Black (Deceased/Expectant): No breathing after airway repositioning or injuries beyond treatment capabilities.
Secondary Survey (Detailed Assessment) for Non-Critical Patients
After the initial triage, conduct a secondary assessment on Yellow and Green patients if time permits:
Head-to-Toe Examination: Check for hidden injuries.
Vital Signs Monitoring: Record heart rate, respiratory rate, and other vital signs.
Pain Assessment: Check for pain levels and identify areas of injury.
Triage Checklist for Emergency First Responders
Scene Safety & Initial Overview
Ensure the scene is secure and safe.
Determine the total number of patients.
Identify any immediate hazards.
Call for additional resources if necessary.
Primary Survey (ABC)
Airway: Check and clear airway.
Breathing: Check for breathing and assess quality.
Circulation: Control major bleeding, check pulse.
Mental Status: Assess alertness (AVPU scale).
START Triage Assessment
Check for patients able to walk (identify Green / Minor).
Assess non-ambulatory patients in place:
Red (Immediate): Life-threatening conditions.
Yellow (Delayed): Serious but stable.
Black (Deceased/Expectant): No signs of life or injuries incompatible with survival.
Secondary Survey for Stable Patients (if time allows)
Conduct head-to-toe assessment.
Monitor vital signs.
Assess pain levels.
Documentation & Handover
Document patient conditions, triage tags, and any treatments provided.
Prepare for handover to advanced medical personnel with clear and concise information.
This structured approach allows Emergency First Responders to quickly assess and categorize patients, prioritizing those who require urgent care. It helps manage resources efficiently, ensuring the best possible outcome for each patient.
Triage, Christian, Michael D. Critical Care Clinics, Volume 35, Issue 4, 575 - 589
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