Incident Command and Multiple-Patient Situations
Help Questions
NREMT: EMT Level › Incident Command and Multiple-Patient Situations
During triage at a mass casualty incident, you encounter a patient who is breathing 8 times per minute and has no radial pulse but does have a carotid pulse. According to START triage, this patient should be tagged:
BLACK - expectant care due to unsurvivable injuries or conditions
YELLOW - urgent but stable injuries that can wait for treatment
RED - immediate priority requiring urgent intervention and transport
GREEN - walking wounded with minor injuries requiring delayed treatment
Explanation
This patient meets RED tag criteria: breathing rate under 30/min (though barely adequate at 8/min), altered mental status implied by shock, and signs of shock (no radial pulse but carotid present). While the prognosis is poor, this represents a salvageable condition requiring immediate intervention. BLACK tags are reserved for patients with no pulse, no breathing after airway repositioning, or obviously fatal injuries.
At a hazardous materials incident with multiple patients, what is the PRIMARY consideration before beginning triage and patient care?
Setting up a treatment area downwind from the hazardous material source
Ensuring all patients and responders have been properly decontaminated first
Establishing rapid access routes for incoming ambulances and emergency vehicles
Determining the number of patients and severity of injuries present
Explanation
In HazMat incidents, decontamination must occur before any patient contact to prevent secondary contamination of responders and equipment. Patient care cannot begin until decontamination is complete. While access routes, patient assessment, and treatment areas are important, they are secondary to preventing responder exposure and further contamination spread.
During a train derailment with 30 injured passengers, what is the MOST important factor in determining when to request additional resources?
Weather conditions are deteriorating and may affect patient care quality
The number of RED-tagged patients exceeds your available transport capability
The incident involves hazardous materials that require specialized response teams
Media attention is increasing and crowd control is becoming problematic
Explanation
The critical factor for requesting additional resources is when patient needs exceed available capabilities, particularly for critical patients requiring immediate transport. While weather, HazMat, and crowd control are legitimate concerns, the primary driver for additional EMS resources is the patient-to-resource ratio, especially for high-priority patients who need immediate care and transport.
At a multiple-patient vehicle accident, you complete initial triage and find 3 RED, 5 YELLOW, 2 GREEN, and 1 BLACK tagged patients. What information should you include in your initial report to dispatch?
Detailed injury descriptions for each patient and estimated transport times
Total patient count, triage categories, resources needed, and scene safety status
Request 3 ALS units for RED patients and 5 BLS units for remaining patients
Hospital destinations for each patient category and required specialty care needs
Explanation
Initial reports should include total patient count by triage category, resource needs, and safety status to help coordinate the response. Specific unit requests, detailed injuries, and hospital destinations are typically handled in subsequent communications or by other units. The initial report focuses on overall incident scope and immediate resource needs.
During JumpSTART pediatric triage, you encounter a 4-year-old child who is breathing 45 times per minute, has a weak pulse, and does not follow simple commands. This child should be tagged:
YELLOW because the child is conscious but has abnormal vital signs
RED because of respiratory distress and altered mental status signs
BLACK because multiple system failure indicates poor survivability prospects
GREEN because pediatric patients are more resilient than adults
Explanation
This child meets RED criteria in JumpSTART: respiratory rate over 15/min (45 is significantly elevated), perfusion issues (weak pulse), and altered mental status (not following commands). Children with these findings require immediate intervention. The combination of respiratory distress and neurologic changes in pediatric patients indicates critical status requiring immediate care, not delayed treatment or expectant care.
During a multi-vehicle accident, a family member demands to know about their relative's condition and treatment. As the Incident Commander, how should you handle this situation?
Provide basic information about injuries to maintain family cooperation with operations
Explain that patient privacy laws prevent sharing any medical information
Direct the family member to the Information Officer or designated liaison
Allow the family member to accompany their relative to observe care
Explanation
Information management should be handled by designated personnel (Information Officer or liaison) to maintain operational focus and ensure consistent, appropriate communication. The IC should not get involved in individual information requests. Simply citing privacy laws without offering appropriate channels is unhelpful, and allowing family into operational areas creates safety and operational interference issues.
You are managing a treatment area at a mass casualty incident when you run out of critical supplies needed for RED-tagged patients. What is the appropriate action?
Contact the Logistics Unit to request immediate resupply of critical materials
Continue providing care with available supplies and improvise alternatives when possible
Reassign RED patients to YELLOW status until adequate supplies are available
Transport all remaining RED patients immediately to preserve existing supply levels
Explanation
The Logistics Unit is responsible for resource management and resupply during incidents. This is the proper chain of command for resource requests. Improvising care, changing triage categories based on supply issues, or making transport decisions solely based on supply levels rather than patient needs are all inappropriate responses that could compromise patient care.
At a school bus rollover, you must establish helicopter landing zones for critical patient transport. What is the MINIMUM safe distance from the incident scene for the landing zone?
75 feet from the scene on level ground with overhead obstruction clearance
100 feet from the scene with clear approach paths and dust control measures
150 feet from the scene with dedicated safety officer and emergency equipment
50 feet from the scene with adequate lighting and ground personnel present
Explanation
Standard helicopter landing zone requirements include 100 feet minimum distance from the scene, level ground, clear approach and departure paths, and consideration for rotor wash effects including dust and debris. While 50 and 75 feet might seem adequate, they don't provide sufficient safety margin for rotor wash and emergency maneuvering. 150 feet exceeds minimum requirements and may create unnecessary delays in patient transport.
At a multiple-patient incident, the Incident Commander assigns you to establish a staging area. What is the PRIMARY purpose of this staging area?
Establish a treatment location for patients requiring extended care periods
Organize and coordinate incoming resources before assignment to operational tasks
Create a holding area for uninjured bystanders and family members
Provide a location for media representatives to observe operations safely
Explanation
Staging areas are designed to organize and coordinate incoming resources (personnel, equipment, vehicles) before they are assigned specific operational roles. This prevents freelancing and ensures resources are deployed where needed most. Media management, bystander control, and extended patient treatment occur in different designated areas with specific purposes.
During a hazardous materials incident with multiple patients, what determines the order of patient decontamination?
Ambulatory patients should be processed first to clear them quickly
Highest medical priority patients should receive decontamination priority
Patients with the most severe chemical exposure should be decontaminated first
Patients who can assist with their own decontamination to maximize efficiency
Explanation
Medical priority determines decontamination order - the most critically ill patients need decontamination first to enable immediate medical care. While processing ambulatory patients is faster and exposure severity matters, medical priority ensures that patients who need immediate life-saving interventions receive them soonest. Efficiency considerations are secondary to medical needs.