Orange County MCI field operations annex

Four-function field model

• The Annex organizes an MCI around four basic functions: Command, Triage, Treatment, and Transport. The structure is modular; fill only the positions needed for the incident, then expand as patient count, geography, hazards, or system impact increase.
• The operational priority is early organization and prompt movement to appropriate receiving centers. When transportation is available, definitive care generally takes priority over prolonged scene treatment, except when hazards such as required decontamination prevent safe movement.

Declare the MCI level

• Estimate early rather than waiting for an exact count. Initial ranges such as 3-5, 10-15, 30-50, or 100-plus are adequate until triage produces a better count.
• The Annex level is driven by both patient count and complexity. A lower-count active-shooter event may be designated Level 3 when trauma capacity, scene resources, and multi-agency coordination will be overwhelmed.

First-arriving command actions

1. Establish command and identify the incident as an MCI.
2. Assign triage as soon as possible. Use START for patients who appear adult and JumpSTART for patients who appear to be children.
3. Estimate the patient count, declare the MCI level, and report the incident type, location, estimated count, and resource needs to dispatch.
4. Order adequate ALS, EMT, ambulance, and special resources early. When resources permit, the Annex plans for one paramedic, one EMT, and one ambulance for each Immediate and Delayed patient, with at least one EMT for each small group of Minor patients.
5. Establish the essential positions appropriate to the event: Incident Commander, Triage Unit Leader, Medical Communications Coordinator, Patient Transportation Unit Leader, and Ground Ambulance Coordinator.
6. Identify safe triage, treatment, ambulance staging, loading, ingress, and egress locations. Address hazards, security, rescue, fire suppression, and decontamination before committing personnel or moving contaminated patients.

Scalable ICS organization

• On a small incident, the Incident Commander may directly manage the medical functions. A reinforced response may add Safety, Treatment, Patient Transportation, air-ambulance coordination, and a Helispot Manager.
• A larger incident can add a Medical Group, then a Medical Branch with multiple Medical Groups. Even with multiple medical locations, patient transportation is coordinated through one function to reduce duplicate assignments and hospital overload.

Role quick reference

• Each leader builds only enough organization to control the assigned function, reports resource needs early, and provides periodic status reports through the chain of command.

START adult triage

• Use the Annex's 30-2-CAN DO sequence: respirations, circulation, and ability to follow commands. Direct ambulatory patients to a predetermined Minor area for secondary evaluation unless trauma precautions make walking inappropriate.
• Primary triage is deliberately rapid. Apply the ribbon, perform only immediate lifesaving actions within the triage method, report the count and categories, and move to the next patient.

JumpSTART pediatric triage

• If a patient appears to be a child, use JumpSTART; if the patient appears to be a young adult, use START. Infants carried to the Minor area and other non-ambulatory children still require a complete primary evaluation rather than automatic green categorization.
• JumpSTART uses the same four categories but changes the respiratory and mental-status criteria for children.

Ribbons, tags, and patient movement

• Use colored ribbons for primary triage: black or white for Deceased / Expectant, red for Immediate, yellow for Delayed, and green for Minor. Place the ribbon on a visible limb; ribbons may also identify vehicles or patient locations.
• Assign a triage tag when a treatment team is committed or before the patient leaves the scene. The tag supports secondary triage, treatment documentation, patient identity, and movement tracking.
• When using the source triage tag, remove tabs below the desired category and leave both category tabs in place. If the patient moves to a treatment area, one tab may be given to the Treatment Area Manager for tracking.
• Use litter teams when triage, treatment, staging, and loading are separated. The Annex describes a litter team as three or four people.
• Reassess category during secondary triage and throughout treatment. Attachment B directs reassessment of Deceased / Expectant patients after critical interventions for Immediate and Delayed patients are complete, unless injuries are clearly incompatible with life.

Treatment areas and priorities

1. Establish clearly defined Immediate, Delayed, and Minor treatment areas when scene size requires them. Isolate the morgue and Minor area from Immediate and Delayed areas.
2. Perform secondary triage, place a tracking tag on each patient, and continue reassessment. Move patients between areas if their condition or priority changes.
3. Stabilize immediate life threats and prepare for transport. Avoid delaying available transport for nonessential scene care; paramedics should use standing orders when possible to expedite care and movement.
4. Assign treatment resources based on availability. The Annex seeks one paramedic and one EMT for each Immediate and Delayed patient; depleted resources may require EMT evaluation, BLS transport, or multiple-patient transport.
5. Use a Patient Loading Coordinator when treatment areas are large or dispersed. The coordinator confirms priority and readiness, communicates with transportation and Med Com, records tracking data, and manages movement to loading.

Transport and Med Com workflow

1. Establish one Medical Communications Coordinator early, in a fixed position near and forward of ambulance loading. Use the current OCC-assigned channel and identify the position as the incident-name Med Com.
2. Med Com reports the incident description, estimated patient count, MCI level, and available patient information to the assigned base or coordinating facility. Current OCEMS Policy 900.00 controls the destination-assignment process.
3. The Patient Transportation Unit Leader maintains the master record of patient identity, condition, transport unit, and destination, and coordinates Med Com, ambulance staging, and patient loading.
4. The Ground Ambulance Coordinator establishes ambulance staging and travel routes, maintains contact with providers, and sends ground ambulances only as requested through the transportation function.
5. Maintain a clear one-way path for ambulance ingress, loading, and egress. Coordinate air transport with the Air Ambulance Coordinator and Helispot Manager when those positions are activated.
6. After departure, transporting units continue monitoring the assigned tactical frequency or Med-9 because Med Com, OCC, or the base hospital may need to change the destination.

Radio report by Annex level

• Limit the report to information that is pertinent and actually available. Do not hold scene movement while trying to complete unavailable fields.

Dispatch and hospital coordination

• OCC notifies the base hospital normally assigned to the incident area with the incident type, location, and estimated patient count; monitors communications; and assists as needed. During a Level 3 or complex Level 2 event, OCC may coordinate destinations directly with Med Com and poll receiving centers through ReddiNet.
• The base-hospital MICN assesses current trauma and receiving-center capacity, uses the MCI worksheet, prioritizes trauma capacity, assigns destinations without unnecessary delay, and determines whether the base can manage the incident complexity.
• Dispatch notifications expand with level: Level 1 uses affected-department overhead notifications; Level 2 adds regional dispatch, Operational Area overhead, and regional ambulance notifications; Level 3 adds medical task-force activation, Operational Area MCI resources, and possible department FOC or EOC activation.
• Large or dispersed events may use additional medical tactical frequencies for remote transportation positions, but all destination needs remain coordinated through the single Med Com.

Documentation and incident closeout

• Complete ALS ePCRs en route or at the receiving center while agency personnel remain available; use a downtime form if ePCR is unavailable. Complete BLS reports before departure when possible without delaying transport.
• When a modified report is necessary, preserve the CAD information, triage-tag number, and destination. On highly complex incidents, use triage tags with ambulance run sheets when agency personnel cannot complete normal reports.
• At the end of a Level 2 or Level 3 event, the Incident Commander should have affected hospitals polled to confirm that adequate resources remain. Fire resources may be needed at receiving centers to assist with treatment and stabilization.
• Anticipate self-transported patients arriving at nearby hospitals. Dispatch centers should notify the Incident Commander if hospitals request field resources for triage or treatment.
• Close the scene-to-hospital loop under current OCEMS Policy 900.00: Med Com reports scene clear to the assigned base hospital, patient tracking is reconciled, and hospitals finish casualty-received reporting.