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A mass causality event or terrorism incident- time to use ISC! 

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A mass causality event or terrorism incident- time to use ISC! 

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Incident Command Management or NIMS is so important to use on any large scale incident. If you are the first on scene of a large vehicle incident, building collapse, or heaven forbid a domestic terrorism incident, keep NIMS in mind. You are going to need help, but before you can get specifics, let Central Dispatch know what you have 'in general' and begin your department triage procedure, whether it be START or SALT, make sure you get a snapshot of who is Red, Yellow, Green or Black. As you assess from patient to patient, be prepared at any point to hand off important information to higher trained personal and a scene size up to Central Dispatch when you complete your START triage. In general, when the scene is assessed, understand that overall as a EMR you need to work within the IC system. Many different units of emergency rescue will be on scene, Fire, Police, EMT, and Hazmat will be involved, NIMS allows for a centralized command with important parts, IC, resource management, communications & information management, logistics all working together with a common goal. If you yourself started as IC, be prepared to pass all the important information on and know your role within that overall system. Be safe and treat all patients. There will be a lot going on, stay calm and communicate well.

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Incident command is a structured chain of command. It was put in place to help keep things unified on an emergency scene. It ensures common terminology, safety of responders, response objectives and the efficient use of resources. Incident command is used in conjunction with the National Incident Management System to handle immediate response from small to large natural and human made incidents. When NIMS is deployed correctly it helps local, state, regional and federal agencies during all phases of a large incident. The way we use incident command is to help simplify a scene. The incident commander delegates specific tasks to those working the scene, they also make decisions to not create a chaotic environment. A command post is established to help with direct scene control and is often located in the vicinity of the site to ensure anyone working a scene can communicate quickly and efficiently.

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When shhhh- it hits the fan, what are you going to do? Incident Command Management is going to keep the chaos contained during incidents that could involve a large number of patients. Incidents that include hazardous materials, mass-casualties, and terrorism. Incident Command Management uses the National Incident Management System (NIMS) to provide a comprehensive, consistent, and unified approach to handling emergency incidents. NIMS allows different agencies to essentially speak the same language. NIMS does so by using the Incident Command System (ICS) which is to provide an effective an efficient approach to managing and coordinating incidents using a chain of command, common terminology, safety of responders, achievement of response objectives, and efficient use of resources. By doing so, multiple agencies, such as regional, state, and federal agencies, can work cohesively with minimal miscommunication allowing the greater good for the most patients.

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Incident management is the most effective way to handle an incident. It helps set up for other agencies to work together for as long as the incident goes on. We use incident management to provide effective coordination of an incident, It makes an approach that uses a standard flexible structure you can follow. It makes the most efficient use of resources and keeps responders safe and gets objectives accomplished. When you NIMS and ICS for WMD or Terrorism incidents it will make the situation go a lot easier because there is unified command and you can disperse the work load.

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without Incident Management things run amuck

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Originally I had a picture of a scene with firefighters and EMS helping two different patients...but the word amuck always makes me think of this scene...and well...they are chaotic.

Incident Management is something that needs done to keep sudden chaos organized.

When we get dispatched we need to mentally prepare for what we are headed toward. What information were we given by dispatch, what past events have we been a part of similar to the call we are headed toward, what sort of extra help might be needed once we are there. Thinking about these things can help keep a calm head. When arriving, get a visual of any hazards, how many patients potentially, can you see severity of injuries upon arrival?

If you are first on scene, you set up Incident Command. Let dispatch know updates on what you have seen, if there is a need for additional services, are there hazards other units need to be aware of, what sort of injuries are there and how many involved. Being calm is important, being concise and clear is a must.

If you are not first on scene, report in with the incident command before just heading out to the scene. That way the command knows how many workers there are, and can send you where you are needed the most.

As command you are the one setting up a route for emergency vehicles to drive through. It helps elimate confusion when entering and exiting the scene. Keeping unnecessary vehicles out of the way completely.

Triage is sorting of patients. This is not a fun task but necessary. It is the actual act of choosing who gets treatment fastest, and who might be able to wait if needed and who is to be considered non-viable. Checking airways first, if the airway is not able to be corrected easily you have to move on. If the airway needs corrected and bleeding needs controlled. Age of the patient doesn't matter during this, it is really about who will benefit. During the START triage we literally tag patients. Red, Yellow, Green and Black. That way EMS arriving on scene can go to the Red tags. It is the responsibility of the personal doing the triage to report to the command how many of each type of patient that there is. Command would then be able to relay the information to dispatch or any additional services on scene for specific things.

Having the Incident Command on a scene that has a lot of patients involved helps keep things running as smoothly as possible. It assures more patients can be helped in the best possible way and as quickly as possible. Without an incident command, there would be confusion, not just on scene but also with dispatch and other responding agencies, services.

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Incident command management is a command that is organized for a specific incident. The command can change based on every new large incident. One example would be a hazardous material incident that requires multiple agencies. Fire Department and other emergency first responders and teams may respond to the incident. Incident management is to have all the agencies involved under one command and operating with the same protocols. There is a commander and usually 4 other sections for responsibility. Though depending on the incident and number of personnel, the same person could be responsible for multiple things. Controlling a chaotic situation with multiple agencies is what Incident management is all about.

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The goal of incident management is to effectively and efficiently "run" or manage an emergency scene. Essentially it is a structured system that allows the scene command to organize & make decisions that will alleviate the chaos of an intense emergency situation. This could be a working fire, a hazmat issue, acts of terrorism, or any type of mass-casualty incident. The person in charge of incident command could be managing one or multiple departments. It is beneficial to have an incident command in situations like this so that there is clearly a single person in charge of communicating with dispatch and other necessary agencies, the safety of those on scene, utilizing resources, and all around communication.

Incident management allows for a simple emergency scene with clear objectives, plans, and execution.

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Incident management is a universal system designed to assist during a mass-casualty incident. Many first responders communicated through different methods that resulted confusion and frustration. In order to simplify this communication process, there was a universal system that can be utilized during a mass-casualty incident. Having the skills to utilize this system can be extremely beneficial, making sure everyone has the information they need is crucial. In addition to NIMS, you also want to make sure Central Dispatch is aware of the incident and any additional information such as: number of patients, incident location, additional resources needed and the specific resources you need, etc. Prior to arriving on scene, you want to formulate a plan or a course of action upon arrival and most importantly, stay calm.

During a mass-casualty incident, you want to be quick and efficient. We utilize processes like triage to make sure patients are getting the emergency medical care they need. There are specific color coded systems to designated each patient to the kind of medical care they require at that time. Red: Priority one immediate care needed, Yellow: Priority Two urgent care needed, Green: Priority Three delayed care, and Black: Priority Four deceased no care needed. These quick assessments should only take up to 60 seconds.

These processes were designed to be quick and efficient to help as many people as we can. In addition, preventing them from having any further injury. This process also helps to ensure that everyone is able to communicate and that we are safe while the job is being completed.

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Together as new EMR's I believe incident management is something that we're hoping that we're not alone when it comes to an all out, full on, serious situation. No matter the situation it all comes down to safety! Then setting up a command post with a clear chain of command (this is who's in charge and who does what and when and how), constant communication (what when and how things are happening, what and who is needed, when and where it's needed), resource management goes right along with communication and includes follow up to make sure everything is being done in the most effective way possible. Even in full chaos there is always opportunities to improve and or adjust what is going on. Do your best to stay calm and stay focused on what and where the most effective changes can be made.

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An incident command system is a way for a caustic scene to stay under control and for accountability to know where and what everyone is doing on scene. Many incidents where the ICS could be used is on a regular car accident or an MCI (mass casualty incident) or a HAZMAT operation. When on an MCI it is important to start a triage system and knowing who is able to walk and who can't. Green is those who can walk, yellow is serious but not life threatening, and red life threatening priority 1 ASAP care. A Triage system is important to use in an MCI especially when you don't have enough personnel to get assigned to each patient. When using NIMS on a serious accident or emergency event we are able to have better communication and are able to be more organized with the different agencies responding to the scene. its important that we keep our professional look along with being productive in what we are trained to do in these certain types of events. Along with being safe and keeping respect for any patient we are helping.

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Incident management brings order and calm to a chaotic situation. It can be established by protocols or my formal officer and commander hierarchies. Incident management protocols can be as simple as which EMR was on scenes first to which duty officers arrive on scene and can expand to county and state wide managers that operate remotely (usually from a county or regional dispatch center) to manage all of the different agencies and teams in operation. It is the duty of the EMRs that arrive first on scene to size things up and request additional resources as needed. They must keep their heads about them and unlike my GIF above not lose their cool.

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much like a blacksmith, the methods of incident management allow us to forge order and direction out of pure chaos. it allows those who are responding to the scene a structured approach to deal with the situation. it uses a standard method so it is easy to integrate more and more resources as they arrive/depart, and allows (in theory) near seamless integration of resources that may be rarly used, such as state level responses for larger disasters/incidents. all with the goal of saving as many lives and reducing property damage as much as possible

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incident managment is just making sure that we are keeping our cool and not panicking and just making sure that each step is calculated so the situation can gradually become controlled and maintaned. The use is to prevent the situation from escalating and becoming more dangerous or causing more damage to by standers or property around the effected area.

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ICS is the structure that prevents "freelancing" in MCI's. It prevents breakdown in communication, and keeps good order in stressful and chaotic situations such as mass shootings, natural disasters or even something as simple as a working fire.

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Incident command is put place to keep a scene organized and keep everything moving as it should, and keeping it safe as well it is the first responder on scene to set up incident command, and then it can be transferred to a another responder once someone else has arrived in, but their job is to ensure safety of the patients and the other responders to communicate with dispatch so they know what is going on as well and to also let the other responders know what their task is on the scene and there are incident commanders on every call, but they are most important on MCI’s to keep the balance in the heck situation.

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Incident management is the process in which we figure out how to help as many people as we can while being organized in the chaose. It starts with a scene size up, assessment of the situation gathering all the important information such as how much help is on deck calling for hazmat if need be and how many patients there are or if a hot warm and cold area has been started. Going to sorting and triage determining who goes where and what tags go on each patient based on breathing, circulation & mental status. All while following the NIMs & ICS

protocol. Proper PPE in order and insuring we clearing areas before entering to keep fellow responders safe and secured.

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Incident command is to help the flow of pure chaos not be as bad, they are creating areas of pickup for ALS, tell people what they are going to be doing, creating comms between the scene and dispatch, hospitals, ambulances and maybe helicopters.

In Triage we are going to use START, asking walking patients to move to a nearby area, then we are going to begin assessments in order using Breathing (open/clear airway), Circulation (checking the pulse), Mental status (verbal stimuli), depening on the findings they maybe a Priority 1 (red), Priority 2 (yellow), Priority 3 (green) or Priority 4 (Black).