1、Designation: F 1288 90 (Reapproved 2003)Standard Guide forPlanning for and Response to a Multiple Casualty Incident1This standard is issued under the fixed designation F 1288; the number immediately following the designation indicates the year oforiginal adoption or, in the case of revision, the yea
2、r of last revision. A number in parentheses indicates the year of last reapproval. Asuperscript epsilon (e) indicates an editorial change since the last revision or reapproval.1. Scope1.1 This guide covers the planning, needs assessment,training, integration, coordination, mutual aid, implementation
3、,provision of resources, and evaluation of the response of alocal emergency medical service (EMS) organization oragency to a multiple patient producing situation that may ormay not involve property loss. This guide is limited to thepre-hospital response and mitigation of an incident up to andincludi
4、ng 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 involvedin developing, implementing, and evaluating an EMS annex, orcomponent,
5、 to the local jurisdictions emergency operationsplan (EOP) as defined in the Federal Emergency ManagementAgency (FEMA) publication, Civil Preparedness Guide (CPG)18.21.3 This standard does not purport to address the safetyconcerns associated with its use. It is the responsibility of theuser of this
6、standard to establish appropriate safety and healthpractices and determine the applicability of regulatory limita-tions prior to use.2. Referenced Documents2.1 ASTM Standards:F 1149 Practice for Qualifications, Responsibilities, andAuthority of Individuals and Institutions Providing Medi-cal Directi
7、on of Emergency Medical Services33. Terminology3.1 Definitions of Terms Specific to This Standard:3.1.1 command postthe physical location from whichincident command exercises direction over the entire incident.3.1.2 disastera sudden calamity, with or without casual-ties, so defined by local, county,
8、 or state guidelines.3.1.2.1 medical disastera type of significant medical in-cident which exceeds, or overwhelms, or both, the capability oflocal resources and of routinely available regional or multi-jurisdictional medical mutual aid, and for which extraordinarymedical aid from state or federal re
9、sources is very likelyrequired for further diagnosis and treatment.3.1.3 EMS control/medical group supervision the firstemergency medical services response at the incident scene, ordesignated by the local response plan or incident command tobe responsible for the overall management of the incidentsE
10、MS operation.3.1.4 extrication managementthe function of supervisingpersonnel who remove entrapped victims.3.1.5 fatality managementthe function designated by ex-isting plans, or the EMS control/medical group supervisor, toorganize, coordinate, manage, and direct morgue services.3.1.6 incident comma
11、nderthe individual responsible forthe overall on-site management and coordination of personneland resources involved in the incident.3.1.7 logistics resources managementthe function respon-sible for acquiring personnel, equipment (including vehicles),facilities, supplies, and services as requested b
12、y the incidentcommander.3.1.8 medical communications managementthe functiondesignated by the incident commander or EMS control/ medi-cal group supervisor to establish, maintain, and coordinateeffective communication between on-site and off-site medicalpersonnel and facilities.3.1.9 medical supplies
13、managementthe function desig-nated by the incident commander to manage equipment andreport to EMS control/medical group supervisor.3.1.10 mental health coordinatora qualified mental healthprofessional responsible for coordinating the psychosocialassessments and interventions for responders, affected
14、 indi-viduals, and groups.3.1.11 multiple casualty incident (MCI)a type of signifi-cant medical incident that may fall into the following catego-ries:1This guide is under the jurisdiction of ASTM Committee F30 on EmergencyMedical Services and is the direct responsibility of Subcommittee F30.03 onOrg
15、anization/Management.Current edition approved Sept. 10, 2003. Published October 2003. Originallyapproved in 1990. Last previous edition approved in 1998 as F 1288 90 (1998).2Available from FEMA, 500 C St., SW, Washington, DC 20472.3Annual Book of ASTM Standards, Vol 13.02.1Copyright ASTM Internation
16、al, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.3.1.11.1 extendedan incident for which local medicalresources are available and adequate to provide for fieldmedical triage and stabilization, and for which appropriatelocal facilities are available and adequate
17、for further diagnosisand treatment.3.1.11.2 majoran incident producing large numbers ofcasualties, for which routinely available regional or multi-jurisdictional medical mutual aid is necessary and adequate forfurther diagnosis and treatment.3.1.12 mutual aidthe coordination of resources, includingb
18、ut not limited to facilities, personnel, vehicles, equipment, andservices, pursuant to an agreement between jurisdictions pro-viding for such interchange on a reciprocal basis in respondingto a disaster or emergency.3.1.13 needs assessmenta preliminary survey of real orpotential hazards in a specifi
19、c geographic area.3.1.14 operations offcerindividual who assists the inci-dent commander on issues relating to the operations of theincident.3.1.15 public informationa function designated by theincident commander for the dissemination of factual and timelyreports to the news media.3.1.16 safety mana
20、gementthe function that identifies realor potential hazards, unsafe environment or procedures at theincident scene, and recommends the appropriate corrective orpreventive actions under the authority of the incident com-mander, to ensure the safety of all personnel at the incidentscene.3.1.17 sector
21、offcers (group supervisors/leaders/managers)qualified personnel who control a specific area ortask assignment.3.1.18 staging areathe location where responding emer-gency services equipment and personnel assemble for assign-ment.3.1.19 staging managementthe function designated by theincident commande
22、r that is responsible for the orderly assem-bly and utilization of resources in a designated area.3.1.20 transportation managementthe function desig-nated by the EMS control/medical group supervisor that isresponsible for the transportation of the patients from theincident scene and for coordination
23、 with EMS control/ medicalgroup supervisor, communications, and the incident com-mander.3.1.21 treatment areathe site at or near the incident foremergency medical treatment prior to transport.3.1.22 treatment managementthe function that is respon-sible for the definitive on-scene medical treatment o
24、f patients.3.1.23 triagethe process of sorting and prioritizing emer-gency medical care of the sick and injured on the basis ofurgency and type of condition present, and the number ofpatients and resources available in order to properly treat andtransport them to medical facilities appropriately sit
25、uated andequipped for their care.3.1.24 triage areaa location near the incident site towhich injured persons should be brought, triaged, and takendirectly to the treatment area.3.1.25 triage managementthe function that is responsiblefor triage and preliminary treatment of casualties.4. Summary of Gu
26、ide4.1 This guide is based upon a body of knowledge on theplanning, implementation, and evaluation of the emergencymedical components of the local pre-hospital response tomultiple casualty incidents.4.2 The body of knowledge on which the guide is based wasdrawn from a wide variety of sources, includ
27、ing individualauthors, academic institutions, and federal, state, regional, andlocal organizations.4.3 This guide is organized in such a way as to providethose responsible for planning, implementing, and evaluatingthe emergency medical components of the local pre-hospitalresponse to multiple casualt
28、y incidents with information theycan readily use to ensure that their response is as expedient andappropriate as is reasonably possible.4.4 The guide was created to organize, collate, and distrib-ute related information in such a way as to be readily accessibleto people in the fields of emergency me
29、dical services andemergency management.4.5 This guide should not be perceived as an inflexible ruleor standard but as a guide that should be adapted to the needsof the individual community, and should be refined andimproved as the body of knowledge on which it is basedincreases.5. Significance and U
30、se5.1 This guide is intended to assist the management of thelocal EMS agencies or organizations in the design, planning,and response of their jurisdictions resources to multiplecasualty incidents (MCIs).5.2 This guide does not address all of the necessary plan-ning and response of pre-hospital care
31、agencies to an incidentthat involves the total destruction of community services andsystems.5.3 This guide does not address the necessary design,planning, and response to be undertaken by a medical carefacility to an internal or external event that necessitates theactivation of the facilitys disaste
32、r plan.5.4 This guide provides procedures to coordinate and pro-vide a systematic and standardized response by responsibleparties, including the local elected officials, emergency man-agement officials, public safety officials, medical care officials(pre-hospital and hospital), local EMS agencies/or
33、ganizationsand others with objectives and tasks for the pre-hospitalmanagement of a significant incident.5.5 This guide provides for the establishment of an incidentcommand system with position descriptions that identify mis-sion, functions, and responsibilities of the command structureto be used at
34、 a MCI. The incident command functions includebut are not limited to staging, logistics, rescue/extrication,triage, treatment, transportation (air, land, and water), commu-nications, and fatality management.5.6 This guide provides examples and other managementtools that can assist in providing train
35、ing objectives anddecision making models for dispatch, response, triage, treat-ment, and transportation for local jurisdictions experiencingmultiple casualty incidents.F 1288 90 (2003)2PLANNING6. Planning6.1 PurposePlanning should be a cooperative effort be-tween local EMS providers and the jurisdic
36、tion in which theydeliver services. The plan should be written to establish theemergency organization, basic policies, responsibilities, andactions required for support of local operations of emergencymedical/health plans. Plans should ensure rapid medical assis-tance to persons requiring aid due to
37、 an incident. Plans shoulddescribe a system for coordination of alerting, dispatching, anduses of medical personnel and resources whenever a localemergency medical health agency requires assistance fromanother EMS agency/jurisdiction. The plan should be designedto be an extension of day to day servi
38、ce, facilities, andresources.6.2 GoalThe plan ensures adequate and coordinated ef-forts that will minimize loss of life, disabling injuries, andhuman suffering by providing effective medical assistancethrough efficient use of medical and other resources in theevent of emergencies resulting in multip
39、le casualty incidents.6.3 ObjectivesThe primary objectives of a plan shouldinclude a process whereby:6.3.1 Each EMS agency/jurisdiction should have a plan tomeet its own needs within its capabilities.6.3.2 Each EMS agency/jurisdiction should enter into mu-tual aid agreements with other local or regi
40、onal jurisdictionswhich can be invoked when local capability to manage asituation has been exceeded. Each jurisdictional plan shouldfacilitate the access and utilization of local and state resources.6.3.3 The EMS agency/jurisdictions plan should conformto appropriate regional and state plans.6.3.4 E
41、ach EMS agency/jurisdiction should define trainingrequirements, and develop and utilize a training program basedon the needs assessment of the community.6.3.5 The plan should be a coordinated interagency effort.Responsible agencies should have regular interaction in orderto facilitate working relati
42、ons during an incident.6.3.6 Plans and procedures should be reviewed and revisedregularly on the basis of tabletop exercises, simulated inci-dents, or actual events.6.4 Needs Assessment and Hazards Analysis:6.4.1 A needs assessment is a preliminary survey of real orpotential hazards in a specific ge
43、ographic area. Basic to theplanning process is an understanding of the problems thatshould be anticipated in the specific area.6.4.1.1 A needs assessment lets the EMS agency/jurisdiction know what to expect.6.4.1.2 It prevents planning for unnecessary events.6.4.1.3 It provides an incentive for the
44、EMS agency/jurisdictions plan.6.4.1.4 It might indicate preventive measures.6.4.1.5 It creates an awareness of new hazards.6.4.2 When the needs assessment is complete, the jurisdic-tion should be able to make the following decisions:6.4.2.1 The type of planning desired,6.4.2.2 What types of response
45、 to emphasize,6.4.2.3 What resources will be needed to fulfill that re-sponse, and6.4.2.4 The type and quantity of mutual aid and supportservices that might be required outside the normal jurisdic-tional services.6.4.3 ComponentsThere are three basic parts to a needsassessment:6.4.3.1 Consideration
46、of the potential for specific incidents,6.4.3.2 Evaluation of the potential harm resulting from theincident, and6.4.3.3 Evaluation of the resources required to respond tothe incident.6.4.4 ApproachThe following are suggested approachesto completing a needs assessment:6.4.4.1 Form a team to identify
47、the potential hazards, risks,and impact relating to potential MCIs.6.4.4.2 Consult the local or state civil defense/emergencypreparedness offices for assessment information.6.4.4.3 After identifying potential MCIs, evaluate them fortheir potential hazards, risks, and impact.6.4.4.4 Evaluate the area
48、s resources.6.4.5 Resources AssessmentConsider the personnel re-quired for performing such tasks as emergency medical ser-vices, firefighting, and rescue. Inventory equipment for the joband evaluate its ability to perform the task. Prepare a writtendescription of what potential incidents exist, and
49、the ability torespond to these incidents.6.4.6 Once complete, the needs assessment becomes part ofthe plan.6.5 Plan ComponentsThe plan should include provisionfor the following:6.5.1 Organizational Structure for Response:6.5.1.1 The plan should define an overall incident organiza-tion based on a strategy of efficient and effective utilization ofresources.6.5.1.2 The plan should address chain of command, includ-ing transfer of authority of any officer or position.6.5.2 Organization of Manpower and Resources for Re-sponse:6.5.2.1 The plan shou
