Extrication crash at Lake Cook Road and McHenry Road, Buffalo Grove with 10 transported by paramedics to various hospitals.
Wednesday night a popular Facebook page (not affiliated with Cardinal News), that uses the social media site to report emergency incidents, posted a crash as a “mass casualty crash.” The classification may have misled some readers in the community. The use of the term “Mass Casualty” may have caused readers to believe that a crash at Lake Cook Road and McHenry Road was at a crisis level higher than the actual situation, and higher than reported by Buffalo Grove Fire Department command.
A Mass Casualty Incident (often abbreviated MCI) is any incident in which emergency medical services resources, such as personnel and equipment, are overwhelmed by the number and severity of casualties. Regarding general public understanding, the term Mass Casualty Incident is associated with mass shootings, plane crashes, passenger train derailments, bus accidents, and other disasters that involve a large number of patients that overwhelm fire departments and paramedics. It is unlikely that a three-vehicle crash involving passenger vehicles — even with multiple patients — would overwhelm EMS personnel and resources to the extent that a Mass Casualty Incident would be declared. EMS resources connected to Buffalo Grove Fire Department were not overwhelmed Wednesday night.
The Buffalo Grove Fire Department activated an EMS Box Alarm for a multiple patient incident. No Mass Casualty Incident was declared, according to Buffalo Grove Fire Department. Ten patients were transported, and it is believed that one of the patients was initially classified as Code Red (Priority 1). The other patients are believed to have been transported Code Yellow (Priority 2) and Code Green (Priority 3).
“This is Northwest Central Dispatch MABAS Division I to all locals, the Buffalo Grove Fire Department is requesting Box #99-25 to the Box Level for the accident with entrapment, westbound Lake Cook and McHenry.”
— NWCDS Radio Alert Wednesday Night alert transcribed
Since 2016 (effective January 2017) and revised on February 1, 2017, the STANDARD OPERATING PROCEDURES/STANDING MEDICAL ORDERS for paramedics use the term Multiple Patient Incident, not Mass Casualty Incident. Paramedics, Battalion Chiefs and Fire Chiefs in the northwest suburbs do not declare incidents as Mass Casualty Incidents (MCI).
According to the Northwest Community Emergency Medical Services System (NWCEMSS), The Standard Operating Procedures/Standing Medical Orders are used in medium-to-large scale multiple patient incidents, given that the usual and customary forms of communication (for example, radio or telephone communications with the hospital/nurses/physicians) are contraindicated as specified in the Region IX disaster plan (intro/cover letter).
Region IX includes the McHenry Western Lake County EMS System, Northwest Community Hospital System, Greater Elgin Area EMS System, Advocate Sherman Hospital, Southern Fox EMS System, Delnor Community Hospital, Presence St. Joseph Hospital-Elgin Elgin, and Advocate Lutheran General.
Advocate Condell Medical Center in Libertyville is in Region X, where the term Multiple Patient Management Plan and System Wide Crisis is used in the Region X Policy Manual.
Ordinarily, Buffalo Grove Fire Department paramedics transport patients to Northwest Community Hospital or Advocate Condell Medical Center. Buffalo Grove Fire Department operates in the Northwest Community Emergency Medical Services System, and in fact was the first fire department to transport a patient into the Northwest EMS system on Friday, December 1, 1972 — 13 minutes after the two-way radio for paramedics and hospital communications was activated. The emergency call and transport was also the first paramedic call in Illinois.
In the Northwest Community Emergency Medical Services System (NWCEMSS), there are two categories of triggers of a multiple patient scaled incident based on available resources: A Small Scale Incident, and a Medium-to-Large Scale Incident.
Small Scale Incident Defined
• # of pts, nature of injuries, and resources
that can arrive at scene w/in 15 minutes
(secondary response time) make normal
level of EMS care achievable for most
• All time-sensitive patients can be
transported within a 10 min scene time.
“Business as usual”- within scope of
Medium-to-Large Scale Incident
• # of pts and/or nature of injuries make normal level of
EMS stabilization and care unachievable; and/or
• # responders/ambulances that can be brought to site
within secondary response times is INSUFFICIENT to
manage scene and provide normal levels of care and
transport under normal operating procedures and/or
• Stabilization capabilities of hospitals that can be reached
within ground transport time of 30 min are INSUFFICIENT
to handle all pts. May need to activate disaster plans.
The crash in Buffalo Grove at Lake Cook Road and McHenry Road would likely be defined as a Small Scale Incident, and would not have been defined as a Mass Casualty Incident under previous use of the phrase.
Why is the understanding of terms important?
The use of term Mass Casualty Incident compared to the term Multiple Patient Incident has a different effect on the concerned reaction of the general public, and how paramedics define the scalability of their duties, responsibilities, and performance.
The general public is much more alarmed by the use of the term Mass Casualty.
Mass Casualty indicates performance demands beyond capability. When EMS personnel and resources are overwhelmed, Standard Operating Procedures allow paramedics to change how they operate compared to performance for routine medical emergency situations. For example, paramedics can use an abbreviated report form, and in the extreme, paramedics can even stop CPR, or withhold or cease resuscitative efforts when they would otherwise probably not withhold or cease resuscitative efforts.
Indications: Multiple patient incidents; BLS transports with normal assessment findings; CRITICAL patients where priorities rest with patient care and # of EMS responders is limited to give a radio report.
1. ID information: Hospital contacted, EMS agency, receiving hospital and ETA
2. Identify the nature of the situation and how it meets the criteria for an abbreviated report
3. Patient age, gender, level of consciousness and orientation
4. Chief complaint and brief history of present illness: Initial impression including perceived acuity/severity; apparent life threats; degree of distress
5. Vital signs and major interventions/resuscitation provided
(NWCEMSS, Page 6)
EMS personnel may withhold or cease resuscitative efforts in the following circumstances:
• There is a risk to the health and safety of EMS personnel
• Resources are inadequate to treat all patients (i.e., medium to large scale multiple patient incident)
• Death has been declared by a physician, Medical Examiner or coroner
• A child (< 18 years), where a Court Order is provided to EMS personnel indicating that CPR is not to be commenced • Patient w/ blunt trauma who is found apneic, pulseless, and asystolic upon arrival of EMS at the scene (NWCEMSS, Page 7)
Understanding the evolution of terms from Mass Casualty Incident to Multiple Patient Incident also demonstrates the dedication and precision that has built excellence into the EMS system
Mistovich, Joseph J.; Karren, Keith J.; Hafen, Brent (2013). Prehospital Emergency Care. Prentice Hall. ISBN 978-0133369137.
Region IX STANDARD OPERATING PROCEDURES/STANDING MEDICAL ORDERS NORTHWEST COMMUNITY EMS SYSTEM EDITION Effective: December 1, 2016
Chicago Tribune ’72 saw 1st use of EMS in state
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