Orchestrating the Fast Moving MCI

Literature Review on Medical Incident Command

“…, 47 - 48 , 66 , 79 , 87 Some favor the use of daily routines in incident command and recommend the use of ICS principles on the smallest of incidents to make this the daily routine 51 55 , 69 - 70 , 74 , 81 , 98 A contrasting view is that incident command is a distinct discipline with its own set of specific competencies, and that the speed of transition from routine to crisis operations in an organization “is a major determinant of whether an incident will be managed effectively.” 57…”

“…The incident ground can be divided into “working regions” or “sectors,” both an organizational and a spatial term 50 82 Some functions will be tied typically to a designated area: vehicle staging, 3 , 74 , 94 , 103 treatment area or casualty clearing station, 3 , 69 , 71 , 74 , 93 morgue, 93 access and egress routes, 3 and ambulance loading zone 69 . Commanders must also position themselves, often at a command post or command position 3…”

“…With a growing number of personnel at the scene, the organization should be expanded with functional (and if needed, spatial segment) units with subordinate commanders or unit leaders §§ . Such units may include triage, 63 , 74 treatment, 63 , 74 transport, 63 , 69 , 74 staging, 63 , 74 and communications 74 . Where separate unit leaders for each of these function are not needed, Christen and Maniscalco suggest delegating responsibilities for all functions to a specific subcommander, along with other functions.…”

“…Communication is another core task of commanders, 3 , 36 , 38 , 45 , 50 , 56 - 57 , 91 including “information management” and “gathering and analyzing information.” 101 , 105 Information that needs to be communicated includes: the incident address or position, 74 type of event, 82 situation reports, ††† resource requirements, 82 , 88 plan or strategy, 19 , 78 - 79 distribution of patients to hospitals, 88 casualty figures, 55 logistical and clinical information on individual patients, 55 , 88 , 91 task assignments and instructions, 68 , 101 and vulnerability and risks 79 . Liaison with collaborating agencies (police, fire and rescue, and others) through their commanders, is highlighted ‡‡‡ .…”

“…Timeliness of transport and definitive treatment is emphasized, and different time stamps and intervals are suggested as a quality measurement: first patient transport to transport of last immediate patient, 74 and incident to last survivable patient in treatment facility 63 . The benchmark time requirement is mostly expressed as “as soon as possible,” 63 , 71 , 105 but Gryth et al refer to “the golden hour.” 60 …”