# Mass-casualty incidents (MCI)

Orange County MCI guide: scene command, START and JumpSTART, OCEMS 900.00, ambulance strike teams, incident layouts, ICS forms and FEMA training.

Status: published. Updated 2026-10-02

## 10-second priorities

- Establish command; estimate patients, hazards and MCI level. Request resources early.
- One Med Com coordinates destinations with OCC/base. Start triage and safe ambulance access.
- Tag, reassess and track every departure. Match patient, transport capability and assigned destination.

## First arriving crew: establish control and start patient movement

An MCI begins when the patient demand and incident complexity exceed the routine response. Do not wait for an exact count before establishing command, announcing the problem and ordering help. Estimate a range, identify hazards, and update the estimate after the first triage sweep. A small number of critically injured patients can create more pressure than a larger group with minor complaints.
Choose a safe approach.
Identify traffic, fire, unstable structures, violence, electrical hazards and possible contamination. Report access limitations and the safe staging approach. Do not place ambulances where later arrivals will block rescue or evacuation.
Name command and the incident.
Give dispatch the location, incident type, approximate patient count, provisional MCI level, hazards and requested resources. State who is handling triage and who is establishing Med Com.
Separate the functions.
Assign people to find and categorize patients, coordinate destinations, and organize ambulances. The first officer can initially retain unfilled functions, but must deliberately transfer them as supervision expands.
Start Med Com early.
OCC and the assigned base need time to assess receiving capacity. Begin that process while triage and rescue continue.
Make the first transport possible.
Identify an accessible loading point and an exit route. Move ready patients when transport and a destination are available; a complete set of tarps and every overhead position are not prerequisites.
Initial size-up — practice wording
“Dispatch, establish [incident name] Command. We have [incident type], approximately [range] patients, with [hazards/access problem]. Declare a provisional Level [number] MCI. Send [specific resources] to [safe staging location and approach]. [Unit] is triage; [unit/person] is establishing Med Com. Patient categories will follow.”
This is a teaching script, not a replacement for agency radio procedures. Avoid guessing an exact count or promising a hospital destination.

Sources: Orange County Fire Chiefs Association - MCI Plan 2019 — https://www.ochealthinfo.com/sites/healthcare/files/2023-04/OC%20Fire%20Chiefs%20Assoc.MCI%20Plan.2019%20%28attachment%20to%20900.00%29.pdf (pp. 3–7, 10–12); Multi-Casualty Incident (MCI) Response Plan — https://www.ochealthinfo.com/sites/healthcare/files/2026-01/900.00%20MCI%20%2812-30-2025%29.pdf (§IV A–D)

## How the field annex and OCEMS Policy 900.00 work together

Use the
2019 Fire Services Operational Area Annex
to organize the scene. Use
OCEMS Policy 900.00
for the medical-system interface: OCC, base assignment, patient distribution, hospital responsibilities, backup communications and documentation. The current linked policy prints an effective date of January 1, 2026; the OCEMS update page also lists it in the April 2026 implementation cycle. Both dates are past as of this guide’s source check.
Which source answers the operational question?
Question
Primary reference
What crews should do
Who runs triage, treatment, staging and loading?
Annex, including Attachment A
Build the field organization around workload and geography; assign clear supervisors and handoffs.
Who coordinates hospitals?
900.00 §IV; annex communications
Use one incident Med Com and the OCC-assigned coordinating base, with OCC assistance when the system expands.
How much patient information is sent?
900.00 Appendix A
Use the report appropriate to incident conditions and level; explain when information is unavailable.
Which patients need specialty care?
Applicable specialty policy, including 310.30; 900.00 §IV E
Communicate the specialty need. Base distribution considers both that need and available specialty capacity.
Does MCI activation change clinical scope?
Applicable standing orders, procedures and 310.00
Continue authorized care. An organizational assignment does not grant new medications, procedures or credentials.
What if the radio fails?
900.00 §VII; 330.15 for required medical-control failures
Distinguish destination coordination from permission for an ALS intervention; follow each applicable fallback.
What is recorded?
900.00 §VIII; 300.10; local worksheets
Maintain patient records and tracking as well as incident activity logs. One does not replace the other.
Who closes the incident?
900.00 §V; annex conclusion
Med Com reports scene clearance to base; base closes the hospital MCI notification and records are reconciled.
Two differences deserve special attention. The older annex lists approximately
3–9 / 10–29 / 30+
patients; current 900.00 Appendix A prints approximately
3–10 / 10–30 / 30+
. These overlap and are estimates, not a rigid counting formula. Communicate the declared level and the actual patient burden. Also, the annex’s older base-report wording must be read with current 900.00, which requires worksheet data to be entered into the base hospital’s electronic report/database at the conclusion.
Key terms used in this guide
OCC
Orange County Communications: the coordination point for base assignment and incident medical communications.
PCCI
Patient Care Capacity Inventory: the receiving-capacity framework, including the default distribution tables in 900.00.
Med Com / PTUL / GAC
Medical Communications Coordinator, Patient Transportation Unit Leader and Ground Ambulance Coordinator: linked but distinct communication, distribution and ambulance-control functions.
Operational Area / MHOAC
The county-level coordination area and Medical and Health Operational Area Coordinator program used in medical-health mutual aid.
AST / MTF / DMSU
Ambulance Strike Team, Medical Task Force and Disaster Medical Support Unit: a like-capability team, a mission-specific mix and a support resource, respectively.
The annex’s historical hospital examples are not a live capacity list. Use assigned destinations and current coordination. In this guide,
local requirement
means a source-backed OC instruction;
teaching example
means an illustrative arrangement to adapt through command.

Sources: Orange County Fire Chiefs Association - MCI Plan 2019 — https://www.ochealthinfo.com/sites/healthcare/files/2023-04/OC%20Fire%20Chiefs%20Assoc.MCI%20Plan.2019%20%28attachment%20to%20900.00%29.pdf (pp. 4, 9–13); Multi-Casualty Incident (MCI) Response Plan — https://www.ochealthinfo.com/sites/healthcare/files/2026-01/900.00%20MCI%20%2812-30-2025%29.pdf (§IV–VIII and Appendix A); 9-1-1 Advanced Life Support Base Contact, Standing Order, and Transport Criteria — https://www.ochealthinfo.com/sites/healthcare/files/2025-03/310.00%20ALS%20Base%20Contact%204-2025.pdf (complete policy); Trauma Triage — https://www.ochealthinfo.com/sites/healthcare/files/2024-05/310.30%20Trauma%20Triage%20%285-24%29.pdf (complete policy); OC-MEDS - Clinical Document Standards — https://www.ochealthinfo.com/sites/healthcare/files/2024-10/300.10%20OC-MEDS%20clin%20Doc%20Stand%2010-2024.pdf (complete policy)

## MCI levels and the patient report

Level describes a system problem as well as a patient count. Acuity, entrapment, distance, pediatric concentration, contamination, hospital capacity and threats can justify escalation. Do not delay a needed request while deciding whether the tenth or thirtieth patient changes a label.
Current OCEMS 900.00 Appendix A reporting reference
Level
Approximate count
Report when available
1
3–10
Tag number’s last three digits; category; specialty need; age; sex/gender field; major injuries; vital signs including BP or pulse quality; destination/specialty request; ambulance identifier.
2
10–30
Tag number’s last three digits; category; destination/specialty request; ambulance identifier; additional information as available.
3
30 or more
Level 2 report when possible; destination or specialty-center request. Hazard and urgency may sharply limit the report.
Preserve the complete tag number in patient records and tracking. The last-three-digit convention is for the specified MCI communications and hospital tracking workflow; it is not a reason to discard the full identifier. Clarify a duplicate or ambiguous abbreviated identifier immediately.
Abbreviated report — fictional example
“[Incident] Med Com: tag ending 417, Immediate, adult, specialty trauma destination requested, transporting unit Ambulance 12. Additional findings available on request.” Record the assigned destination and read it back. Add age, injuries and vital signs when the level and conditions permit.
OCC notifies the EMS Duty Officer for
20 or more victims
under §IV D. That notification threshold is separate from the Level 3 patient-count description. Dispatch notifications and department EOC/FOC activation also follow the annex and agency procedures.

Sources: Multi-Casualty Incident (MCI) Response Plan — https://www.ochealthinfo.com/sites/healthcare/files/2026-01/900.00%20MCI%20%2812-30-2025%29.pdf (§IV D and Appendix A); Orange County Fire Chiefs Association - MCI Plan 2019 — https://www.ochealthinfo.com/sites/healthcare/files/2023-04/OC%20Fire%20Chiefs%20Assoc.MCI%20Plan.2019%20%28attachment%20to%20900.00%29.pdf (pp. 4, 9–12)

## Command, supervision and role assignments

Build only the organization needed to control the work. In the initial response, the IC manages unassigned responsibilities and gives named personnel the critical functions. A reinforced response can add treatment and transportation leaders, safety, air coordination and staffed treatment areas. A distributed incident can require multiple medical groups and a Medical Branch, while patient distribution remains coordinated through one transportation system and one Med Com.
Diagram: Illustrative medical group: Triage, Treatment, Patient Transportation and Medical Supply. Patient Loading reports through Treatment. Med Com coordinates with transportation. Other ICS functions are omitted for clarity. — https://www.ocmedic.com/assets/mci/organization.svg
OCMedic teaching illustration
A medical group under incident command
. Illustrative medical group: Triage, Treatment, Patient Transportation and Medical Supply. Patient Loading reports through Treatment. Med Com coordinates with transportation. Other ICS functions are omitted for clarity.
Role responsibilities and essential handoffs
Role
Owns
Key handoff
Incident Commander / Unified Command
Objectives, priorities, safety direction and overall resource allocation.
Give incoming command the hazards, counts, assignments, unmet needs and current transport picture.
Medical Branch Director
Medical branch execution of the IAP; coordination across medical groups and transportation.
Report progress and constraints to Operations; prevent competing patient-distribution systems.
Medical Group Supervisor
Medical work within the group; locations, leaders, personnel and supply needs.
Connect triage, treatment and transportation; escalate bottlenecks and safety needs.
Triage Unit Leader
Triage teams, litter movement from the triage area, counts and triage-area control.
Send category counts and resource needs to the supervisor; coordinate movement with treatment.
Treatment Unit Leader
Treatment areas, reassessment, preparation for movement and Patient Loading Coordinator.
Tell transportation which patients are ready and which need a special transport capability.
Immediate / Delayed / Minor Area Managers
Care and repeated triage within their assigned area.
Maintain a reliable census and announce deterioration rather than waiting for the next routine report.
Patient Transportation Unit Leader (PTUL)
Patient movement off incident, transportation coordination and destination records.
Join patient readiness, assigned destination and an appropriate transport resource.
Med Com
Incident-to-base/OCC destination communications and current receiving-capacity picture.
Relay assigned destinations to transportation and crews; maintain one coherent distribution picture.
Ground Ambulance Coordinator (GAC)
Ambulance staging, availability, routes and dispatch to loading.
Provide the requested ambulance capability and track when resources become available again.
Patient Loading Coordinator
Transfer from treatment to loading; readiness, priority and patient/ambulance matching.
Reports to Treatment; coordinates with PTUL/Med Com and treatment managers.
Medical Supply Coordinator
Medical supplies supporting the group.
Translate shortages into specific resource requests; coordinate caches, trailers or DMSU support.
Morgue Manager / law enforcement / coroner interface
Designated temporary area and controlled handling under assigned supervision.
Keep identification, scene integrity and access controlled; do not merge this space with minor-patient holding.
Air Ambulance Coordinator / Helispot Manager
Patient air-transport coordination / safe helispot management, respectively.
Coordinate with transportation and Air Operations; a landing zone does not independently assign destinations.
At expansion, say both the
position
and the
person/unit
taking it. Hand over the worksheet and radio plan, not just the vest. Identify which responsibilities remain combined. A person tasked with taking care of a patient cannot reliably maintain a large incident’s destination board at the same time.
The ICS
Medical Unit
supporting responders and their medical plan is distinct from the Medical Group or Branch treating incident victims. Responder rehabilitation, water, relief and an emergency plan for injured personnel must have an owner as the incident grows.
From FEMA: the broader ICS organization
The incident commander oversees Command Staff (public information, safety and liaison) and four General Staff sections: Operations, Planning, Logistics, and Finance/Administration. The medical organization above fits within this larger incident structure.
Diagram: FEMA ICS chart: Incident Commander, three Command Staff positions and four General Staff section chiefs. The text above describes the hierarchy. — https://www.ocmedic.com/assets/mci/fema-ics-original.png
Original FEMA IS-700.B course graphic, displayed without content changes. Swipe the chart on a phone or open the full image. Source inclusion does not imply agency endorsement.
[Open full-size graphic](/assets/mci/fema-ics-original.png)
[FEMA source & explanation](https://emilms.fema.gov/_is0700b/groups/68.html)

Sources: Orange County Fire Chiefs Association - MCI Plan 2019 — https://www.ochealthinfo.com/sites/healthcare/files/2023-04/OC%20Fire%20Chiefs%20Assoc.MCI%20Plan.2019%20%28attachment%20to%20900.00%29.pdf (pp. 3, 5–8 and Attachment A, pp. 15–19); FEMA ICS Forms Resource Center — https://training.fema.gov/emiweb/is/icsresource/icsforms/ (ICS 203, 206 and 207)

## Lay out the scene around patient and vehicle movement

Choose the loading and traffic arrangement early. A beautiful treatment layout fails if ambulances cannot enter, turn, load and depart. Consider hazard direction, rescue access, terrain, lighting, security, weather, public access and the distance patients must be carried. The diagrams below are conceptual; they do not establish hazard boundaries, isolation distances or approved landing zones.
Diagram: Patients move from triage to treatment, loading and the receiving facility. Reassessment continues throughout; ready patients need not wait for all areas to be built. — https://www.ocmedic.com/assets/mci/patient-flow.svg
OCMedic teaching illustration
Keep patients moving through a controlled system
. Patients move from triage to treatment, loading and the receiving facility. Reassessment continues throughout; ready patients need not wait for all areas to be built.
Triage and rescue interface:
keep a consistent point at which patients enter the medical system. Use litter teams when movement consumes treatment personnel. Attachment B describes three or four personnel per litter team; match safe movement to the patient, equipment and terrain.
Treatment:
make Immediate, Delayed and Minor locations unmistakable with words and signs as well as colors. Keep an accessible route for wheelchairs and people who cannot walk for reasons unrelated to the incident.
Staging:
hold unassigned ambulances clear of the loading area. Record unit, crew, care level, special equipment, availability and contact method.
Loading:
bring forward only the resources requested. Keep patient-ready and ambulance-ready information visible to the people matching them.
Separate spaces:
provide controlled locations for minors/family support, responder rehab, supplies and a temporary morgue if needed. Protect privacy and scene integrity.
Multiple sectors:
local treatment and loading points can feed one distribution function. Label sector and loading point in every request to avoid sending an ambulance to the wrong side of the incident.
Review the layout whenever hazards move, congestion develops, patient numbers change or a new rescue area opens. Moving a tarp requires communicating the change to triage, transport, dispatch and incoming resources; otherwise the old location remains the one everyone drives toward.

Sources: Orange County Fire Chiefs Association - MCI Plan 2019 — https://www.ochealthinfo.com/sites/healthcare/files/2023-04/OC%20Fire%20Chiefs%20Assoc.MCI%20Plan.2019%20%28attachment%20to%20900.00%29.pdf (pp. 6–8 and Attachment A)

## START, JumpSTART and repeated triage

START: adult checkpoints
Walking patients: Minor, then reassess; see the annex’s small-incident spinal-precaution exception.
Apneic: open airway. Breathing resumes → Immediate. Still apneic → Deceased/Expectant triage category.
Breathing >30/min → Immediate.
Absent radial pulse or capillary refill >2 seconds → Immediate.
Cannot follow commands → Immediate. Otherwise → Delayed.
JumpSTART: child checkpoints
Walking children: Minor, then secondary triage. Carried/nonambulatory children need full primary evaluation.
Apneic: open airway. Breathing resumes → Immediate. Still apneic: check pulse. No pulse → Deceased/Expectant. Pulse present → five rescue breaths. Resumes breathing → Immediate; remains apneic → Deceased/Expectant.
Rate <15, >45 or irregular → Immediate.
No pulse in an apparently uninjured limb → Immediate.
Alert, responds to voice or appropriate pain response → Delayed. Inappropriate pain response or unresponsive → Immediate.
Read with the full triage explanation below.
These are OCMedic text-based teaching graphics based on annex Attachment B and the linked HHS CHEMM airway branch, not an independent triage protocol. Categories require reassessment; a triage label is not a death pronouncement.
Triage is a rapid sorting process followed by reassessment. It is not a diagnosis or a guarantee that a patient will remain in the same category. The annex uses ribbons for initial categorization and numbered tags when a treatment team takes responsibility or before the patient leaves the scene. Complete assessment follows team assignment.
Adult START decision reference from Annex Attachment B
Check
Finding
Category / next action
Walking
Able to walk under the applicable scene instructions
Minor area for further evaluation. The annex modifies this in smaller trauma incidents when spinal precautions and resources are available; do not automatically tell every injured person to stand.
Breathing
Not breathing
Open the airway. Breathing resumes: Immediate. Still not breathing: annex black/white category.
Respiratory rate
Greater than 30/min
Immediate. Otherwise assess perfusion.
Perfusion
Radial pulse absent or capillary refill greater than 2 seconds
Immediate. Otherwise assess ability to follow simple commands.
Mental status
Cannot follow simple commands
Immediate. If the preceding checks are adequate and commands are followed: Delayed.
Children: the important JumpSTART differences
The annex directs use of JumpSTART when the victim appears to be a child and START when the victim appears to be a young adult. A carried infant or a child who is normally unable to walk needs the nonambulatory assessment; arriving in the green area does not establish a green category.
Assess spontaneous breathing. If absent, open the airway. If breathing resumes after airway positioning, categorize Immediate (also shown explicitly in the linked HHS CHEMM algorithm). If breathing remains absent, check a pulse.
No pulse with no breathing: use the annex expectant/deceased category. If a pulse is present, give
five rescue breaths
. Resumption of spontaneous breathing means Immediate; continued apnea follows the annex expectant/deceased pathway.
For spontaneous breathing, a rate
below 15, above 45, or irregular
means Immediate. A rate within 15–45/min proceeds to perfusion.
No palpable pulse on a seemingly uninjured limb means Immediate. If a pulse is present, assess mental status.
Alert, response to voice, or an appropriate localized response to pain follows the Delayed branch after adequate breathing and perfusion. Inappropriate response to pain or unresponsiveness means Immediate.
The source uses “expectant/deceased” together. That triage label is not an independent pronouncement, DNR decision or substitute for applicable clinical policy. Attachment B calls for reassessment of these patients after critical interventions for Immediate and Delayed patients, except where injuries are clearly incompatible with life. Use the official algorithm and current medical direction for actual decisions.
Keep category, identity and movement connected
Report counts by category and location. Reassess at treatment entry, while waiting, before loading and when condition changes. Record the change so the old category does not remain on the transport request. Place ribbons visibly; use the actual tag’s instructions for category tabs and detachable tracking portions. The patient’s tag must continue with the patient. A location ribbon on a vehicle is not an individual patient record.
Plan for language, hearing, cognitive or developmental barriers. Failure to follow a spoken instruction needs context; inability to walk may predate the incident. Use clinical assessment and the applicable algorithm rather than treating a disability as a new injury.

Sources: Orange County Fire Chiefs Association - MCI Plan 2019 — https://www.ochealthinfo.com/sites/healthcare/files/2023-04/OC%20Fire%20Chiefs%20Assoc.MCI%20Plan.2019%20%28attachment%20to%20900.00%29.pdf (Attachment B, pp. 21–25); Multi-Casualty Incident (MCI) Response Plan — https://www.ochealthinfo.com/sites/healthcare/files/2026-01/900.00%20MCI%20%2812-30-2025%29.pdf (definitions and §VIII); HHS CHEMM — JumpSTART pediatric triage algorithm — https://chemm.hhs.gov/incident-primer/triage/jumpstart-triage (airway-positioning branch)

## Treatment, loading and destination assignment

Treatment should remove the immediate barrier to survival and make transport possible. The annex favors prompt movement when transport is available, with necessary care continuing en route. Contamination, rescue constraints or unavailable transport may require a treatment area and longer holding period. Keep requesting what will shorten that delay.
The annex’s resource planning model assigns a paramedic, an EMT and an ambulance to each Immediate or Delayed patient as resources allow, and at least an EMT for a small group of Minor patients. That model describes demand; it is not a reason to stop movement while waiting for an ideal assignment. Report shortages and use the authorized contingency organization. Consider how separating an ALS ambulance’s clinicians affects both patient care and the remaining vehicle’s capability.
Before a patient leaves the loading point
Identify:
confirm the patient’s tag and current category with the treatment team.
Match:
verify transport capability, needed equipment, crew and any mobility, pediatric or special-care needs.
Assign:
receive the destination through Med Com/PTUL; communicate the specialty request and available clinical information.
Read back:
crew confirms patient/tag, destination and unit identifier. Resolve similar hospital names or changed assignments before departure.
Record:
capture departure time, ambulance and escort, destination and ETA when available; update the scene census.
Maintain contact:
monitor the assigned communications for changes. A receiving-center update must identify the patient as already assigned from the MCI, with the relevant identifying details.
Specialty designation and immediate receiving capacity are different. Policy 900.00 prioritizes specialty placement through field findings, Med Com/base communication and bed availability. Under a large burden, base may need to prioritize which patients benefit most from scarce specialty beds. Do not send every red-tagged patient to the nearest trauma center on the assumption that category alone establishes destination.
Under 900.00, a receiving facility may not divert an assigned declared-MCI patient unless it is closed because of the internal-disruption exception defined in Policy 310.96. Route a change through the coordinating system so the tracking record and receiving notification remain consistent. Do not treat a routine diversion message as permission to improvise a new destination.
Air transport, buses, vans and other alternatives need the assigned command/transport coordination and applicable local policy. Do not infer that multiple seats are usable patient positions, that an ambulance has unlimited stretcher capacity, or that a green category removes the need for reassessment and accountability.

Sources: Orange County Fire Chiefs Association - MCI Plan 2019 — https://www.ochealthinfo.com/sites/healthcare/files/2023-04/OC%20Fire%20Chiefs%20Assoc.MCI%20Plan.2019%20%28attachment%20to%20900.00%29.pdf (pp. 5–8, 11; Attachment A); Multi-Casualty Incident (MCI) Response Plan — https://www.ochealthinfo.com/sites/healthcare/files/2026-01/900.00%20MCI%20%2812-30-2025%29.pdf (§IV E–G); Trauma Triage — https://www.ochealthinfo.com/sites/healthcare/files/2024-05/310.30%20Trauma%20Triage%20%285-24%29.pdf (specialty destination criteria)

## Med Com, base hospitals, OCC and communications failure

Med Com should be identifiable, stationary enough to maintain records, and near the loading operation without obstructing it. The current Med Com checklist directs initial contact with OCC on
6 Alpha
, using “[incident name] Med Com.” OCC assigns the coordinating talk group and base; Policy 900.00 identifies
6-Bravo through 6-Kilo
as coordination talk groups. Confirm the actual assignment rather than selecting one from this guide.
Diagram: The scene reports through one Med Com. OCC assigns the coordinating base and talkgroup. The base coordinates hospital capacity; assigned destinations return to transportation and crews. — https://www.ocmedic.com/assets/mci/communications.svg
OCMedic teaching illustration
One Med Com, one destination picture
. The scene reports through one Med Com. OCC assigns the coordinating base and talkgroup. The base coordinates hospital capacity; assigned destinations return to transportation and crews.
Med Com supplies the incident description, location, estimated count, level and evolving needs. Base initiates the ReddiNet MCI module, polls potential receivers, and at minimum polls all base hospitals. OCC can assist or coordinate destinations directly when the annex’s expanded response requires it. The field still needs a single, reconciled destination record.
For a geographically spread incident, use assigned medical tactical communications between remote transportation/loading personnel and Med Com. Do not create independent hospital-allocation desks at each sector. Transporting ALS crews needing medical direction request an assignment through OCC, normally to the base managing the MCI; OCC can assign an alternative if that base cannot handle the call.
Dispatch and agency notification responsibilities
The annex assigns dispatch a staged notification workflow.
Level 1
includes affected-department overhead notifications.
Level 2
adds regional dispatch, Operational Area overhead and regional ambulance notifications.
Level 3
adds North/South Medical Task Force activation, Operational Area MCI trailers/resources and department FOC/EOC activation under department policy. Dispatch should prompt for the level if it was omitted and anticipate additional channels on a complex incident.
OCC notifies the normally assigned base, monitors the incident communications and assists distribution. Base/MICN assesses receiving capacity, maintains the base worksheet, communicates specialty-bed availability and assignments, notifies receivers, and asks for OCC assistance when its workload exceeds capacity. Ambulances monitor the assigned tactical frequency or Med-9 after departure for authorized destination changes. Each function must explicitly hand over its records if responsibility changes.
Use the right fallback for the actual failure
900.00 backup sequence
Failure
Source-directed route
Keep track of
ReddiNet unavailable
Base uses telephone or another available system; the attached default PCCI supports initial assignments.
Assignments already made, updated capacity and receiver notification.
OCC in FAILSAFE
Med Com uses established FAILSAFE procedures to contact the base normally assigned to the area.
Who is coordinating and the working communications channel.
800 MHz system unavailable
Try OCC by Med-9, landline or cellular phone.
Successful contact path and any message backlog.
No OCC or base contact by any alternate means
Med Com uses the default PCCI attached to current 900.00 for destinations.
Every allocation so the same fallback capacity is not reused independently by different sectors.
The PCCI is a distribution contingency, not a live bed dashboard or a patient-care algorithm. Keep a current copy of
[900.00’s PCCI pages 7–8](https://www.ochealthinfo.com/sites/healthcare/files/2026-01/900.00%20MCI%20%2812-30-2025%29.pdf#page=7)
available through agency procedures. This guide links those tables rather than recreating phone numbers and capacity values that can become stale.
A clinical intervention requiring online medical control is a separate question. Follow 330.15 when its communication-failure conditions apply, including the required ePCR questions and subsequent review. Record failed attempts and the actual care provided; an MCI declaration alone does not suspend medical-control requirements.

Sources: MCI Worksheet Attachment 2 - Mass Casualty Incident Response Plan - Med Com — https://www.ochealthinfo.com/sites/healthcare/files/2025-11/900.00%20MCI%20Worksheet%20Attachment%202%2010-2025.pdf (checklist, PDF p. 3); Multi-Casualty Incident (MCI) Response Plan — https://www.ochealthinfo.com/sites/healthcare/files/2026-01/900.00%20MCI%20%2812-30-2025%29.pdf (§IV D–G and §VII); Treatment Without Base Contact Communication Failure — https://www.ochealthinfo.com/sites/hca/files/2021-05/330.15%20ALS%20Treatment%20without%20Base%20Hospital%20Contact%20%2804-01-2021%29.pdf (complete policy)

## Patient tracking, records and reconciliation

Diagram: Patient care documentation, patient movement tracking and incident activity logs are separate records that must agree. — https://www.ocmedic.com/assets/mci/tracking.svg
OCMedic teaching illustration
Every transfer needs a connected record
. Patient care documentation, patient movement tracking and incident activity logs are separate records that must agree.
Maintain one patient identity across the treatment area, transportation worksheet, ambulance record and receiving facility. The most consequential administrative error is often a patient who has physically left but still appears on the scene count, or a departure with no recorded destination.
Clinical record:
assessment, care, response and handoff in the ePCR/PCR. Under current 900.00, field records are completed en route or at receiving centers until agency personnel are no longer available; then triage tags and ambulance run sheets support documentation. Check the MCI box for MCI victims.
Movement record:
tag, category, location, ambulance/escort, destination, departure and ETA as available. The OCEMS Med Com worksheet is designed for this coordination.
Incident record:
decisions, assignments, resource requests, changes and significant events in ICS 214 and the incident documentation system.
Use an explicit status such as “awaiting transport,” “assigned,” “departed,” “arrival confirmed” or “unresolved” in a teaching or agency-approved tracking method. Do not equate a destination assignment with actual departure. Reconcile treatment-area totals with transportation departures at regular briefings and before closure.
Include people who decline care, leave before completion, self-transport or are handed to another authorized resource in the appropriate agency workflow. Do not silently erase them from the count. Apply the relevant assessment, refusal and documentation policies; a green tag is not a discharge order.
Retain tags with patients for the hospital medical record. Protect patient details in approved systems; general incident activity logs do not need full patient narratives, personal identifiers or medical histories. Record operational events and refer to the authorized clinical/tracking record where necessary.
The base worksheet and Med Com worksheet are complementary. Base transfers its worksheet data into the required electronic record. Hospitals update received-casualty information and retain tags. Scene clearance therefore starts a reconciliation process; it does not eliminate the receiving system’s remaining work.

Sources: Multi-Casualty Incident (MCI) Response Plan — https://www.ochealthinfo.com/sites/healthcare/files/2026-01/900.00%20MCI%20%2812-30-2025%29.pdf (§IV E–G, §V and §VIII); OC-MEDS - Clinical Document Standards — https://www.ochealthinfo.com/sites/healthcare/files/2024-10/300.10%20OC-MEDS%20clin%20Doc%20Stand%2010-2024.pdf (complete policy); MCI Worksheet Attachment 2 - Mass Casualty Incident Response Plan - Med Com — https://www.ochealthinfo.com/sites/healthcare/files/2025-11/900.00%20MCI%20Worksheet%20Attachment%202%2010-2025.pdf (worksheet); MCI Worksheet Attachment 1 - Mass Casualty Incident Response Plan - BH — https://www.ochealthinfo.com/sites/healthcare/files/2023-05/900.00%20Attachment%201%20%285-2023%29.pdf (worksheet)

## HazMat awareness and the clean patient-care boundary

At a suspected release, protect the medical system from becoming part of the exposure. Recognize warning signs from a safe location, withdraw or stay out as appropriate, notify command and request trained HazMat resources. Do not approach a placard, container or patient simply to improve identification when doing so exposes the crew.
Awareness-level training does not qualify a crew to enter a hazard area, perform decontamination or manage contaminated patients.
OSHA’s EMS interpretation distinguishes care after removal from danger and thorough decontamination from duties involving contaminated or only superficially decontaminated victims. Required training, PPE and employer authorization depend on the assigned duty.
In an MCI layout, make the transition from hazardous/contaminated operations to clean medical operations explicit. HazMat/command determines zones and the decontamination process. Ambulance loading, supplies and ordinary treatment should not become a bypass around that control point. Tell Med Com about the agent or exposure concern, decontamination status and special receiving needs when known. Do not label a patient “clean” merely because clothing was removed or a quick rinse occurred.
Plan a separate way to identify and redirect self-presenting contaminated people without drawing them through treatment or loading. Recheck wind, runoff, vehicle movement and changing conditions through command. No fixed distance in a teaching diagram establishes a safe location.
For training, use
[FEMA CDP AWR-358 dL](https://cdp.dhs.gov/training/course/AWR-358%20dL)
and the
[Cal OES/CSTI First Responder Awareness pathway](https://www.caloes.ca.gov/office-of-the-director/operations/planning-preparedness-prevention/california-specialized-training-institute/hazardous-materials-program/hazmat-outreach-program/)
, with employer confirmation of acceptance.
[The training section](#training)
also links FEMA IS-5.A, clearly labeled as an introduction that does not meet the cited HAZWOPER response-training requirement.

Sources: OSHA: HazMat training requirements for EMS personnel — https://www.osha.gov/laws-regs/standardinterpretations/2017-03-31 (EMS training interpretation); FEMA CDP Hazardous Materials Awareness Distance Learning — AWR-358 dL — https://cdp.dhs.gov/training/course/AWR-358%20dL (course overview); Cal OES / CSTI Hazardous Materials Outreach Program — https://www.caloes.ca.gov/office-of-the-director/operations/planning-preparedness-prevention/california-specialized-training-institute/hazardous-materials-program/hazmat-outreach-program/ (training pathway); Orange County Fire Chiefs Association - MCI Plan 2019 — https://www.ochealthinfo.com/sites/healthcare/files/2023-04/OC%20Fire%20Chiefs%20Assoc.MCI%20Plan.2019%20%28attachment%20to%20900.00%29.pdf (decontamination responsibilities)

## Ambulance strike teams: what to request and how they fit

An ambulance strike team packages transport resources under a leader so command can supervise a coherent capability. It is not simply every ambulance parked together. The California public manual describes five similarly capable transport vehicles, a leader with a vehicle and compatible communications. FEMA’s April 2024 ALS and BLS definitions use
five or more ambulances of the same type
, common communications and a leader in a separate command vehicle; their minimum configuration lists five ambulances and one command vehicle.
Diagram: A minimum illustrated ambulance strike team has five same-type ambulances and a leader in a separate command vehicle. Confirm the resource order and current typing. — https://www.ocmedic.com/assets/mci/strike-team.svg
OCMedic teaching illustration
Five ambulances plus a strike team leader
. A minimum illustrated ambulance strike team has five same-type ambulances and a leader in a separate command vehicle. Confirm the resource order and current typing.
Specify
ALS or BLS capability, quantity, staffing and mission
in the request. Do not rely on “Type 1” or “Type 2” alone: the older California manual’s numbering shorthand and current national single-type ALS/BLS definitions are different frameworks. Confirm the resource package actually ordered, including pediatric, bariatric, wheelchair, critical-care or other needs.
A medical/ambulance task force is a mission-designed mix rather than a homogeneous ambulance team. It may solve a different problem, such as moving patients with mixed clinical and mobility requirements. A Disaster Medical Support Unit or cache supports operations but is not an extra transport ambulance. A request for the wrong label can deliver resources that cannot do the intended work.
Request capability through the approved system
Describe the incident, task, quantity and level of care, required arrival time, reporting location, safe route, contact, communications, expected duration and logistics. Route requests through command, dispatch and the applicable medical-health mutual-aid process. Out-of-area assistance involves the Operational Area/MHOAC and regional coordination as applicable. Do not self-dispatch or promise another jurisdiction’s resources.
At the incident, the team leader receives a specific assignment and supervisor. The leader retains personnel accountability and communicates readiness or limitations. GAC controls the ambulance staging/dispatch function; PTUL and Med Com control the patient-distribution interface. The AST leader does not establish a competing hospital allocation system merely because the team arrived as one package.
Capability request — fictional planning example
“Request one ALS ambulance strike team for transport from the east loading point. Confirm five staffed ALS ambulances, an AST leader/command vehicle and interoperable communications. Report through incident staging by the requested time. Anticipated assignment is six hours; confirm fuel, relief, meals, oxygen resupply and destination coordination. Pediatric patients are present; advise any limitations.” This is request wording, not confirmation of availability or a binding resource order.
The linked California manual is dated April 2010 even though its public file was uploaded in 2021. Use it for system background, and verify current California deployment, credentialing, reimbursement and mission-specific requirements with the responsible program. Do not treat its historical contact addresses, fees or training rules as current instructions.
From California EMSA: the mutual-aid program structure
This historical diagram connects state, regional and operational-area medical-health coordination with the AST lead entity, team leader and ambulance resources. It explains the program’s organizational layers; use current local procedures for an actual resource request.
Diagram: Historical EMSA Figure 1: state, region, operational area and resource-level coordination, ending in an AST leader with five ambulance resources. — https://www.ocmedic.com/assets/mci/emsa-program-original.png
California EMSA AST/MTF System Manual, April 2010, Figure 1 (PDF page 15). The figure itself is marked draft, October 2009 v1.6. The page is rotated upright only; its content is unchanged. Older agency labels and role titles are retained in this source reproduction and are not represented as current credentialing or ordering instructions.
[Open full-size graphic](/assets/mci/emsa-program-original.png)
[Open EMSA source PDF](https://emsa.ca.gov/wp-content/uploads/sites/71/2021/11/Ambulance-Strike-Team-Medical-Task-Force-System-Manual-2021-11-02.pdf#page=15)

Sources: California EMSA AST/MTF System Manual — April 2010, public PDF uploaded 2021 — https://emsa.ca.gov/wp-content/uploads/sites/71/2021/11/Ambulance-Strike-Team-Medical-Task-Force-System-Manual-2021-11-02.pdf (§§200–400 and glossary); FEMA ALS Ambulance Strike Team — April 2024 — https://rtlt.preptoolkit.fema.gov/Public/Resource/ViewFile/3-508-1294?type=Pdf (2024 resource definition); FEMA BLS Ambulance Strike Team — April 2024 — https://rtlt.preptoolkit.fema.gov/Public/Resource/ViewFile/3-508-1295?type=Pdf (2024 resource definition); FEMA Ambulance Strike Team Leader — September 2025 — https://rtlt.preptoolkit.fema.gov/Public/Position/ViewFile/3-509-1224?type=Pdf (2025 position definition)

## AST leader and crew deployment checklists

Diagram: Mobilize only through an authorized request. Check in, obtain an assignment, track work and demobilize through the incident process. — https://www.ocmedic.com/assets/mci/ast-lifecycle.svg
OCMedic teaching illustration
Strike team assignment lifecycle
. Mobilize only through an authorized request. Check in, obtain an assignment, track work and demobilize through the incident process.
Before accepting and mobilizing
Confirm official activation, mission/resource-order identifier, deploying authority, requested capability and expected duration.
Account for every unit and crew member; record credentials and mission limitations through the approved process. Verify the designated leader and relief/trainee arrangements.
Check vehicle readiness, fuel, oxygen, medications and controlled-medication accountability, batteries, communications, PPE, patient-movement equipment and supply replacement.
Clarify work/rest, lodging, meals, sanitation, security, occupational exposure support and resupply. Plan for an extended assignment without assuming local facilities can support incoming crews.
Set the rendezvous, route, travel communications, lost-contact procedure and breakdown plan. A convoy assignment does not justify unsafe following distances or unauthorized emergency driving.
At check-in and briefing
Check in where directed with the resource-order number and full resource inventory; use ICS 211 or the incident’s approved system.
Obtain the reporting chain, assignment, current hazards, communications plan, responder medical plan, destination process and reporting schedule.
Brief crews on safe travel routes, staging and loading points, return/reporting procedure, decontamination requirements if relevant, and what to do with a conflicting assignment.
Start or continue leader and unit ICS 214 logs. Confirm where completed records and time documentation go.
Resolve cross-jurisdiction clinical scope, medical control and optional-scope questions before assignment. Do not infer authority from the vehicle’s ALS label or from an old manual.
During the operational period
Track actual unit states: staged, assigned, loading, transporting, at hospital, returning, resting or out of service. Record the reason for a lost capability and notify the supervisor before another patient is committed to that unit. Ask about offload delay, resupply and crew fatigue; “at hospital” does not mean available.
Keep unit crews connected to the team leader. If command changes the team’s assignment or separates resources, clarify who supervises each resource, whether the resource order changes, and how accountability and logs will continue. Escalate immediate safety concerns promptly rather than waiting for a scheduled briefing.
Transport throughput — a planning estimate
Five available ambulances carrying one suitable patient each with a 60-minute total cycle produce a theoretical five patients per hour. If travel, handoff, cleaning and return increase the cycle to 90 minutes, the theoretical rate falls to about 3.3 per hour. This arithmetic is an OCMedic teaching estimate, not a capacity guarantee. Patient needs, crew relief, vehicle availability and receiving delays can reduce it further; do not use it to justify overloading a vehicle.
Before release and return
Obtain formal release and the demobilization instructions. Complete required checkout, reconcile logs and patient movements, document equipment or exposure issues, replenish for safe travel and brief the return route. Notify the designated coordination point and home agency of release and arrival. No unit leaves merely because its latest transport is complete.

Sources: California EMSA AST/MTF System Manual — April 2010, public PDF uploaded 2021 — https://emsa.ca.gov/wp-content/uploads/sites/71/2021/11/Ambulance-Strike-Team-Medical-Task-Force-System-Manual-2021-11-02.pdf (§§307–313 and Appendix 701); FEMA Ambulance Strike Team Leader — September 2025 — https://rtlt.preptoolkit.fema.gov/Public/Position/ViewFile/3-509-1224?type=Pdf (duties and logistics); FEMA ICS Forms Resource Center — https://training.fema.gov/emiweb/is/icsresource/icsforms/ (ICS 211, 214 and 221)

## ICS forms and OCEMS worksheets: use the right record

Start with the records needed to run the incident. As complexity grows, Planning and the assigned supervisors organize an Incident Action Plan and supporting forms. A crew should know which forms it supplies and which it receives; it should not invent a second planning process.
Official ICS forms: choose the record for the job
Form / PDF
Use on an MCI or strike team
[ICS 201 — Incident Briefing](https://training.fema.gov/EMIWeb/IS/ICSResource/assets/ICS%20Forms//ICS%20Form%20201%2C%20Incident%20Briefing%20%28v3%29.pdf)
Snapshot for initial briefing and transfer of command.
[ICS 202 — Incident Objectives](https://training.fema.gov/EMIWeb/IS/ICSResource/assets/ICS%20Forms//ICS%20Form%20202%2C%20Incident%20Objectives%20%28v3.1%29.pdf)
Objectives for the operational period.
[ICS 203 — Organization Assignment List](https://training.fema.gov/EMIWeb/IS/ICSResource/assets/ICS%20Forms//ICS%20Form%20203%2C%20Organization%20Assignment%20List%20%28v3%29.pdf)
Who is assigned to the incident organization.
[ICS 204 — Assignment List](https://training.fema.gov/EMIWeb/IS/ICSResource/assets/ICS%20Forms//ICS%20Form%20204%2C%20Assignment%20List%20%28v3.1%29.pdf)
Resource assignments and instructions for the period.
[ICS 205 — Incident Radio Communications Plan](https://training.fema.gov/EMIWeb/IS/ICSResource/assets/ICS%20Forms//ICS%20Form%20205%2C%20Incident%20Radio%20Communications%20Plan%20%28v3.1%29.pdf)
Assigned radio functions and channels.
[ICS 205A — Communications List](https://training.fema.gov/EMIWeb/IS/ICSResource/assets/ICS%20Forms//ICS%20Form%20205A%2C%20Communications%20List%20%28v3%29.pdf)
Contact methods for assigned personnel/functions.
[ICS 206 — Medical Plan](https://training.fema.gov/EMIWeb/IS/ICSResource/assets/ICS%20Forms//ICS%20Form%20206%2C%20Medical%20Plan%20%28v3%29.pdf)
Medical support and emergency procedures for incident personnel.
[ICS 207 — Incident Organization Chart](https://training.fema.gov/EMIWeb/IS/ICSResource/assets/ICS%20Forms//ICS%20Form%20207%2C%20Incident%20Organization%20Chart%20%28v3%29.pdf)
Wall chart showing the incident organization and assigned personnel.
[ICS 208 — Safety Message-Plan](https://training.fema.gov/EMIWeb/IS/ICSResource/assets/ICS%20Forms//ICS%20Form%20208%2C%20Safety%20Message-Plan%20%28v3.1%29.pdf)
Incident safety message and precautions.
[ICS 211 — Incident Check-In List](https://training.fema.gov/EMIWeb/IS/ICSResource/assets/ICS%20Forms//ICS%20Form%20211%2C%20Incident%20Check-In%20List%20%28v3.1%29.pdf)
Accountability at arrival and check-in.
[ICS 213 — General Message](https://training.fema.gov/EMIWeb/IS/ICSResource/assets/ICS%20Forms//ICS%20Form%20213%2C%20General%20Message%20%28v3%29.pdf)
Documented message and reply.
[ICS 213RR — Resource Request Message](https://training.fema.gov/EMIWeb/IS/ICSResource/assets/ICS%20Forms//ICS%20Form%20213RR%2C%20Resource%20Request%20Message%20%28v3%29.pdf)
Resource need and request tracking; use the approved local medical-health request process.
[ICS 214 — Activity Log](https://training.fema.gov/EMIWeb/IS/ICSResource/assets/ICS%20Forms//ICS%20Form%20214%2C%20Activity%20Log%20%28v3.1%29.pdf)
Notable activities for a unit, leader or other assigned resource.
[ICS 221 — demobilization check-out](https://training.fema.gov/EMIWeb/IS/ICSResource/assets/ICS%20Forms//ics%20form%20221%2C%20demobilization%20check-out%20%28v3.1%29.pdf)
Authorized checkout before departure.
ICS 206 is the incident personnel medical plan.
It is not a patient-by-patient destination sheet. Similarly, ICS 214 records operational activity; it does not replace an ePCR, a triage tag, the Med Com worksheet or required time/cost records. Use the current incident-approved versions and submission process.
For OC-specific patient distribution, open the
[Med Com MCI worksheet and checklist](https://www.ochealthinfo.com/sites/healthcare/files/2025-11/900.00%20MCI%20Worksheet%20Attachment%202%2010-2025.pdf)
and the
[Base Hospital MCI worksheet](https://www.ochealthinfo.com/sites/healthcare/files/2023-05/900.00%20Attachment%201%20%285-2023%29.pdf)
. The county index labels the Med Com attachment October 2025, while the downloaded form footer says revised April 9, 2025; these are publication/index and form revision labels, not two interchangeable versions.
Direct FEMA PDF links are provided alongside the
[official forms directory](https://training.fema.gov/emiweb/is/icsresource/icsforms/)
. If a direct file is blocked by a browser or agency network, use the directory to obtain the current official copy. Do not substitute an unofficial answer-key or form-download site.

Sources: FEMA ICS Forms Resource Center — https://training.fema.gov/emiweb/is/icsresource/icsforms/ (official forms and instructions); MCI Worksheet Attachment 2 - Mass Casualty Incident Response Plan - Med Com — https://www.ochealthinfo.com/sites/healthcare/files/2025-11/900.00%20MCI%20Worksheet%20Attachment%202%2010-2025.pdf (all three pages); MCI Worksheet Attachment 1 - Mass Casualty Incident Response Plan - BH — https://www.ochealthinfo.com/sites/healthcare/files/2023-05/900.00%20Attachment%201%20%285-2023%29.pdf (worksheet)

## How to complete ICS 214: activity log with a worked example

Diagram: A mobile reading map for the official ICS 214. Use the linked FEMA form for the actual activity log. — https://www.ocmedic.com/assets/mci/ics-214-map.svg
OCMedic teaching illustration
ICS 214: identify, log, sign
. A mobile reading map for the official ICS 214. Use the linked FEMA form for the actual activity log.
Use the incident-assigned name and operational period, not a personal shift nickname. A unit log should let the next supervisor understand what was assigned, what happened, what remains unresolved and who was told.
ICS 214 blocks 1–8
Block
Enter
1 — Incident Name
The official incident name.
2 — Operational Period
Start and end dates/times for the period covered; use the 24-hour clock and clarify the incident’s time-zone convention.
3 — Name
Organizational unit or resource designator, such as the assigned strike-team identifier.
4 — ICS Position
Name and ICS position of the person in charge of that unit/resource.
5 — Home Agency (and Unit)
The preparer’s agency and applicable unit.
6 — Resources Assigned
Assigned people/resources, their ICS positions and home agencies/units.
7 — Activity Log
Date/time and concise notable activities: assignment, action, change, problem, notification and result.
8 — Prepared by
Preparer’s name, position/title, signature and preparation date/time; identify continuation pages.
Fictional training log: Harbor Exercise
Resource: Training AST Alpha. Operational period: October 2, 2026, 0800–2000, local time; the example continues across the leader relief documented at 1125. All identifiers and events below are invented for instruction.
Sample Block 7 entries — operational activity, not patient charting
Time
Notable activity
0805
Received exercise assignment to east staging from Transportation Supervisor; confirmed five ambulances and leader vehicle.
0820
Completed check-in; briefed crews on the assigned radio plan, safe approach, loading location and responder emergency procedure.
0842
Unit A3 reported low oxygen reserve after transport; marked unavailable for new assignments and requested replacement through Logistics.
0855
Transportation Supervisor notified of reduced team availability; remaining units held to current assignment.
0918
Unit A3 confirmed replenishment and crew readiness; updated Transportation Supervisor and resource status.
1125
Relief briefing completed; passed unit status, unresolved requests and log copies to incoming leader.
1320
Received authorized release, completed required checkout and notified home coordination of return ETA.
A useful entry is specific enough to explain the decision: “A3 unavailable, supervisor notified, oxygen requested.” “Busy with patients” cannot support a handoff or later reconstruction. Use dates when an operational period crosses midnight; distinguish an event time from a later documentation time.
FEMA routes completed logs through supervisors to the Documentation Unit and recommends retaining a copy. Follow the incident’s record-handling process. Keep patient identifiers and clinical narratives in the approved patient records rather than this general activity log.

Sources: FEMA ICS Forms Resource Center — https://training.fema.gov/emiweb/is/icsresource/icsforms/ (ICS 214 v3.1 and instructions); California EMSA AST/MTF System Manual — April 2010, public PDF uploaded 2021 — https://emsa.ca.gov/wp-content/uploads/sites/71/2021/11/Ambulance-Strike-Team-Medical-Task-Force-System-Manual-2021-11-02.pdf (§603 and Appendix 701)

## Six incident setups for tabletop discussion

The following are
OCMedic teaching examples
, not predetermined dispatch packages, staffing standards, hazard distances or hospital allocations. The IC adapts them to actual hazards, access, patient burden and available personnel. Arrows show patient or information movement, not an instruction to enter an unsafe area.
1. Six-patient road collision: compact organization
Diagram: Traffic-controlled scene. Rescue / triage. Compact treatment. Single loading point. Resource support: Ambulance staging. Patients depart toward: Protected exit. Keep access lanes open; scale roles to workload. This is a teaching layout, not a prescribed footprint. — https://www.ocmedic.com/assets/mci/road.svg
OCMedic teaching illustration
Road collision — illustrative setup
. Traffic-controlled scene. Rescue / triage. Compact treatment. Single loading point. Resource support: Ambulance staging. Patients depart toward: Protected exit. Keep access lanes open; scale roles to workload. This is a teaching layout, not a prescribed footprint.
Problem:
several patients, live traffic, limited shoulder space and one possible entrapment. Begin with command, triage, Med Com and an ambulance coordination function. Establish traffic protection and rescue access through the appropriate agencies before positioning the medical operation.
Setup:
use a protected treatment/loading location with clear ambulance ingress and egress. Patients ready for movement can go directly to an assigned ambulance when appropriate; do not create a distant tarp area merely to make the incident resemble a diagram. Keep walking patients supervised and accounted for.
Expand when:
extrication delays, additional patients, multiple critical injuries or traffic geometry exceed the combined assignments.
Exercise question:
who still owns triage when the first officer transfers command, and how is the last transported patient reconciled?
2. Bus collision with children: sustained treatment and transport
Diagram: Bus / extrication area. Triage + child assessment. Three treatment areas. Loading + patient IDs. Resource support: Ambulance staging. Patients depart toward: Assigned hospitals. Keep children identified and track reunification separately. This is a teaching layout, not a prescribed footprint. — https://www.ocmedic.com/assets/mci/bus.svg
OCMedic teaching illustration
Bus collision with children — illustrative setup
. Bus / extrication area. Triage + child assessment. Three treatment areas. Loading + patient IDs. Resource support: Ambulance staging. Patients depart toward: Assigned hospitals. Keep children identified and track reunification separately. This is a teaching layout, not a prescribed footprint.
Problem:
mixed adult/pediatric patients, some separated from caregivers, and a transport queue. Establish a Medical Group with dedicated triage, treatment and transportation supervision as resources arrive. Request pediatric equipment and sufficient personnel for movement and repeated assessment.
Setup:
maintain identified treatment areas, a supervised minor-patient area and a separate family/reunification interface through command. Preserve each child’s identifier during movement and handoff; do not assume an adult accompanying a child is the responsible caregiver. The transport record must reflect who accompanied the patient.
Expand when:
specialty/pediatric capacity or transport turnaround limits movement. An AST can add a supervised transport package, but it does not solve an unidentified-patient or receiving-capacity problem.
Exercise question:
how will a carried, nonambulatory child arriving in the minor area get an appropriate primary assessment?
3. Multi-location violence: several collection points, one distribution system
Diagram: Site A        Site B. Separate collection points. Medical groups A / B. Coordinated loading. Resource support: One Med Com. Patients depart toward: Assigned hospitals. Threat assessment controls access. One destination picture. This is a teaching layout, not a prescribed footprint. — https://www.ocmedic.com/assets/mci/distributed.svg
OCMedic teaching illustration
Multiple incident locations — illustrative setup
. Site A        Site B. Separate collection points. Medical groups A / B. Coordinated loading. Resource support: One Med Com. Patients depart toward: Assigned hospitals. Threat assessment controls access. One destination picture. This is a teaching layout, not a prescribed footprint.
Problem:
multiple casualty locations and changing access/security. Law-enforcement and fire/EMS command coordinate the safety framework and authorized medical access. This guide does not provide tactical entry procedures. Ordinary ambulance staging remains in the location assigned as safe for its role.
Setup:
separate authorized casualty-transfer points feed identified medical sectors. Give each loading point a clear name. Use one Med Com and a transportation function capable of reconciling requests from all sectors. Route resources using current command instructions, not the shortest route on a map.
Expand when:
concentrated critical injuries saturate specialty care even below 30 patients. Request logistical and hospital-system support early.
Exercise question:
how will two sectors avoid using the same reported hospital capacity twice?
4. Hazardous-material release: protect the clean system
Diagram: HOT • controlled hazard area. WARM • specialist decon. COLD • cleared patients. Clean treatment / loading. Resource support: Clean ambulance staging. Patients depart toward: Assigned hospitals. Boundaries set by HazMat. No distances or wind direction implied. This is a teaching layout, not a prescribed footprint. — https://www.ocmedic.com/assets/mci/hazmat.svg
OCMedic teaching illustration
Hazardous-material release — illustrative setup
. HOT • controlled hazard area. WARM • specialist decon. COLD • cleared patients. Clean treatment / loading. Resource support: Clean ambulance staging. Patients depart toward: Assigned hospitals. Boundaries set by HazMat. No distances or wind direction implied. This is a teaching layout, not a prescribed footprint.
Problem:
exposed people may contaminate rescuers, treatment areas, ambulances and hospitals. Establish awareness-level recognition/notification and wait for the assigned hazard-control organization; only qualified, equipped personnel perform their authorized hazard-zone tasks.
Setup:
HazMat/command manages the contaminated side and the decontamination boundary. An identified handoff feeds clean triage/treatment, then loading. Keep ambulances, replacement supplies and uninvolved people from crossing into the contaminated stream. Record the exposure concern and decontamination information needed for receiving coordination.
Expand when:
ambulatory arrivals bypass control, symptoms evolve, or contaminated vehicles need removal from service.
Exercise question:
who can confirm the handoff conditions, and where is a self-presenting person redirected without contaminating clean operations?
5. Earthquake or collapse: distributed rescue and long transport cycles
Diagram: Rescue sites A / B. Rescue-controlled handoff. Treatment + reassessment. Accessible loading point. Resource support: Staging / fuel / relief. Patients depart toward: Assigned hospitals. Plan for repeated patient waves and long ambulance cycles. This is a teaching layout, not a prescribed footprint. — https://www.ocmedic.com/assets/mci/collapse.svg
OCMedic teaching illustration
Collapse or earthquake — illustrative setup
. Rescue sites A / B. Rescue-controlled handoff. Treatment + reassessment. Accessible loading point. Resource support: Staging / fuel / relief. Patients depart toward: Assigned hospitals. Plan for repeated patient waves and long ambulance cycles. This is a teaching layout, not a prescribed footprint.
Problem:
blocked routes, prolonged rescue, infrastructure loss and several medical sites. Expand through Operations into rescue and medical functions with safety and logistics support. The Medical Branch may supervise several Medical Groups while transportation coordination remains unified.
Setup:
name the sector treatment/loading points and identify usable transport corridors. Plan repeated communications checks, backup recordkeeping, medical supplies, responder relief and alternate receiving coordination. Request capabilities for the actual mission, including air resources only through the assigned air/transport system.
Expand when:
local coverage is depleted or turnaround makes the ambulance queue unsustainable. Use the medical-health mutual-aid request process, documenting what is requested, accepted and still outstanding.
Exercise question:
how does the transport picture change if the principal route closes or communications fail for one sector?
6. Facility evacuation: match the mission to patient needs
Diagram: Originating care facility. Manifest + clinical needs. Match patient to capability. Supervised departure. Resource support: Transport + support. Patients depart toward: Confirmed receiving site. Verify acceptance, oxygen, equipment and handoff records. This is a teaching layout, not a prescribed footprint. — https://www.ocmedic.com/assets/mci/evacuation.svg
OCMedic teaching illustration
Facility evacuation — illustrative setup
. Originating care facility. Manifest + clinical needs. Match patient to capability. Supervised departure. Resource support: Transport + support. Patients depart toward: Confirmed receiving site. Verify acceptance, oxygen, equipment and handoff records. This is a teaching layout, not a prescribed footprint.
Problem:
patients with different mobility, monitoring and ongoing-care needs must leave a facility. Coordinate facility command, receiving arrangements and the appropriate medical-health system. An evacuation does not automatically make every resident a START trauma patient or every requested vehicle an ALS ambulance.
Setup:
facility staff identify patients, destination arrangements, care needs, equipment, medications and accompanying records. A controlled loading point matches the verified transport capability to the patient. Separate ambulatory transport planning from stretcher or specialized transport, and preserve belongings and identification through handoff.
Expand when:
receiving placement, equipment, oxygen, staff or route capacity blocks evacuation. A mission-tailored task force may be more appropriate than a homogeneous AST.
Exercise question:
what prevents a patient with a higher care need from being assigned to a vehicle based only on the order in which it arrives?

Sources: Orange County Fire Chiefs Association - MCI Plan 2019 — https://www.ochealthinfo.com/sites/healthcare/files/2023-04/OC%20Fire%20Chiefs%20Assoc.MCI%20Plan.2019%20%28attachment%20to%20900.00%29.pdf (modular organization, movement and communications); Multi-Casualty Incident (MCI) Response Plan — https://www.ochealthinfo.com/sites/healthcare/files/2026-01/900.00%20MCI%20%2812-30-2025%29.pdf (destination coordination and documentation); Tactical Casualty Care — https://www.ochealthinfo.com/sites/hca/files/import/data/files/85126.pdf (training and role boundaries); FEMA ALS Ambulance Strike Team — April 2024 — https://rtlt.preptoolkit.fema.gov/Public/Resource/ViewFile/3-508-1294?type=Pdf (mission/logistics specifications); OSHA: HazMat training requirements for EMS personnel — https://www.osha.gov/laws-regs/standardinterpretations/2017-03-31 (HazMat EMS role limitations)

## Close the scene, support the hospitals and improve the next response

Before releasing the medical organization, reconcile the patient count with documented transports and other dispositions. Resolve unknown destinations and missing identifiers through the assigned channels. Med Com notifies base when the scene is clear; base communicates closure to the involved hospitals. Clinical care, hospital tracking and documentation continue after the last ambulance leaves.
The annex specifically recognizes that Level 2 and 3 incidents can leave receiving hospitals under pressure. Command should assess that continued need through the authorized hospital/dispatch interface and consider requested support. Anticipate people who self-present outside the coordinated ambulance stream; those arrivals can change the receiving system’s burden.
Use formal resource release and the incident’s checkout process; maintain accountability through return travel.
Replenish or remove depleted/damaged resources from service, address contamination/exposure issues and communicate coverage gaps.
Collect Med Com/base records, clinical records, resource logs and time/cost documentation through the appropriate custodians.
Record unresolved issues, corrective-action owner and follow-up date. Preserve privacy when developing training lessons.
For a drill, measure observable actions: time to command and Med Com, first useful resource request, reliable category count, assigned destination readback, first departure, patient-record reconciliation, and a successful backup-communications test. These are proposed exercise measures, not official OCEMS time standards.
Policy 900.00 calls for annual MCI-readiness disaster drills by system participants and base-coordinator review of MCI reports. Use the after-action process to test whether the next revision fixes the observed problem, such as a duplicate destination assignment or an untracked ambulance departure.

Sources: Orange County Fire Chiefs Association - MCI Plan 2019 — https://www.ochealthinfo.com/sites/healthcare/files/2023-04/OC%20Fire%20Chiefs%20Assoc.MCI%20Plan.2019%20%28attachment%20to%20900.00%29.pdf (conclusion, pp. 12–13); Multi-Casualty Incident (MCI) Response Plan — https://www.ochealthinfo.com/sites/healthcare/files/2026-01/900.00%20MCI%20%2812-30-2025%29.pdf (§V–VI); California EMSA AST/MTF System Manual — April 2010, public PDF uploaded 2021 — https://emsa.ca.gov/wp-content/uploads/sites/71/2021/11/Ambulance-Strike-Team-Medical-Task-Force-System-Manual-2021-11-02.pdf (§313)

## FEMA ICS courses and HazMat awareness training

Use these official course pages for enrollment details and current versions. The five requested ICS/NIMS courses are also listed in FEMA’s September 2025 Ambulance Strike Team Leader qualification document. Course completion alone does not establish position qualification, agency authorization or California AST leader credentialing.
FEMA ICS and NIMS course links
Course
Delivery
Why it matters
[IS-100.C — Introduction to the Incident Command System, ICS 100](https://training.fema.gov/programs/independent-study/courseoverview.aspx?code=IS-100.c&lang=en)
Online independent study
Common terms, roles and the basic organization.
[IS-200.C — Basic Incident Command System for Initial Response, ICS-200](https://training.fema.gov/programs/independent-study/courseoverview.aspx?code=IS-200.c&lang=en)
Online independent study
Initial-response supervision and transfer of command.
[ICS-300 / E/L/G0300 — Intermediate ICS for Expanding Incidents](https://training.fema.gov/programs/nims-ics-position-specific/icstraining.aspx)
Instructor-led; locate a state/local offering
Expanding organization, planning and resource management.
[IS-700.B — An Introduction to the National Incident Management System](https://training.fema.gov/programs/independent-study/courseoverview.aspx?code=IS-700.b&lang=en)
Online independent study
How NIMS supports coordinated incident management.
[IS-800.D — National Response Framework, An Introduction](https://training.fema.gov/programs/independent-study/courseoverview.aspx?code=IS-800.d&lang=en)
Online independent study
How the broader national response framework fits together.
ICS-300 is instructor-led.
Use FEMA’s course information and your state/local training provider for an offering; it is not an independent-study “IS-300” course with the same online exam workflow as IS-100. Confirm prerequisites and the accepted delivery format with the host.
HazMat awareness: choose an appropriate pathway
[FEMA CDP AWR-358 dL — Hazardous Materials Awareness Distance Learning](https://cdp.dhs.gov/training/course/AWR-358%20dL)
: official awareness-level distance learning; the listing shows eight contact hours. Confirm enrollment and employer acceptance.
[Cal OES/CSTI Hazardous Materials Outreach Program](https://www.caloes.ca.gov/office-of-the-director/operations/planning-preparedness-prevention/california-specialized-training-institute/hazardous-materials-program/hazmat-outreach-program/)
: California First Responder Awareness and higher-level training pathway. Use its training portal or agency training officer to find accepted offerings.
[FEMA IS-5.A — An Introduction to Hazardous Materials](https://training.fema.gov/programs/independent-study/courseoverview.aspx?code=IS-5.a&lang=en)
: useful foundational study, but FEMA explicitly states it does
not
meet the HAZWOPER response requirements cited in the course description.
The agency must match training, competency, PPE and authorization to actual duties. A completion certificate does not authorize hot-zone entry, decontamination, contaminated-patient handling or technical rescue. Use the
[OSHA EMS training interpretation](https://www.osha.gov/laws-regs/standardinterpretations/2017-03-31)
with the employer’s applicable requirements to distinguish awareness from operations-level duties.

Sources: FEMA ICS training progression and ICS-300 information — https://training.fema.gov/programs/nims-ics-position-specific/icstraining.aspx (course progression); FEMA Ambulance Strike Team Leader — September 2025 — https://rtlt.preptoolkit.fema.gov/Public/Position/ViewFile/3-509-1224?type=Pdf (training requirements); FEMA CDP Hazardous Materials Awareness Distance Learning — AWR-358 dL — https://cdp.dhs.gov/training/course/AWR-358%20dL (course listing); Cal OES / CSTI Hazardous Materials Outreach Program — https://www.caloes.ca.gov/office-of-the-director/operations/planning-preparedness-prevention/california-specialized-training-institute/hazardous-materials-program/hazmat-outreach-program/ (official program); OSHA: HazMat training requirements for EMS personnel — https://www.osha.gov/laws-regs/standardinterpretations/2017-03-31 (EMS training interpretation)

## Annex coverage and source-version notes

This crosswalk makes the scope inspectable. The guide addresses every main annex topic and both attachments; examples and worksheets supplement that explanation. It does not reproduce the complete official plan or authorize deviations from it.
2019 MCI annex coverage map
Annex element
Source pages
Guide section
Intent and definitions
pp. 2–3
[How the field annex and OCEMS Policy 900.00 work together](#policy-integration)
Basic considerations and four response organizations
p. 3
[Command, supervision and role assignments](#command-roles)
MCI levels
p. 4
[MCI levels and the patient report](#levels-reports)
Command and resource needs
pp. 5–6
[First arriving crew: establish control and start patient movement](#first-actions)
Triage
p. 6
[START, JumpSTART and repeated triage](#triage)
Treatment and transportation
p. 7
[Treatment, loading and destination assignment](#treatment-transport)
Med Com and report examples
pp. 8–10
[Med Com, base hospitals, OCC and communications failure](#communications)
Fire, OCC, base, ambulance and dispatch procedures
pp. 10–12
[Med Com, base hospitals, OCC and communications failure](#communications)
Documentation
p. 12
[Patient tracking, records and reconciliation](#tracking)
Conclusion and hospital support
pp. 12–13
[Close the scene, support the hospitals and improve the next response](#demobilization)
Attachment A: ICS positions
pp. 14–19
[Command, supervision and role assignments](#command-roles)
Attachment B: ribbons, tags, litter teams, START and JumpSTART
pp. 20–25
[START, JumpSTART and repeated triage](#triage)
Source check:
October 2, 2026. The county policy directory still links the January 2019 annex and the January 2026 900.00 PDF. Current policy controls the hospital interface where older annex wording differs. Training pages and FEMA form versions were checked against their official listings. The California AST manual is an older background source; current mission orders and responsible program guidance govern deployment details.
Review status:
published educational guide. The explanations, scenario diagrams and fictional logs are original teaching material. No independent clinical or incident-command review is claimed. Review the complete sources before operational use.

Sources: OCEMS current policy directory — https://www.ochealthinfo.com/providers-partners/emergency-medical-services/ems-policies-procedures-standing-orders/ems-policies (current links); Orange County Fire Chiefs Association - MCI Plan 2019 — https://www.ochealthinfo.com/sites/healthcare/files/2023-04/OC%20Fire%20Chiefs%20Assoc.MCI%20Plan.2019%20%28attachment%20to%20900.00%29.pdf (complete plan); Multi-Casualty Incident (MCI) Response Plan — https://www.ochealthinfo.com/sites/healthcare/files/2026-01/900.00%20MCI%20%2812-30-2025%29.pdf (complete policy); California EMSA AST/MTF System Manual — April 2010, public PDF uploaded 2021 — https://emsa.ca.gov/wp-content/uploads/sites/71/2021/11/Ambulance-Strike-Team-Medical-Task-Force-System-Manual-2021-11-02.pdf (version on title page)