2/300 FA
Battalion Aid Station
MASS-CASUALTY SOP

INTRODUCTION

This incident plan for 2/300 FA Battalion Aid Station (BAS), has been developed in order to respond to massive incidents involving multiple casualties. Mass casualties occur when the numbers of patients overwhelm the local medical resources in place. Examples of these incidents may result from vehicular accidents, fire related hazards, hazardous resources, and is deemed necessary by the 2/300 FA Physician Assistant (PA). This plan assigns responsibilities and makes the best use of available medical resources at the BAS. It is the purpose of this SOP to familiarize personnel with this plan and enable them to follow the proper procedures to provide effective response and Level I and II medical care.

PURPOSE: To ensure proper triage, medical treatment, and necessary evacuation of casualties.

1. INTRODUCTION: This plan shall be placed into action in the event of any incident that results in mass casualties or deemed necessary by the 2/300 FA PA or his representative.

a. MANPOWER/EQUIPMENT: BAS personnel shall supply all medical resources for any incident which involves casualties that occur within our AO. In the event that an incident arises and exceeds the ability to provide adequate medical care, the PA shall coordinate with all assets within close proximity to receive additional resources.

b. COMMAND and CONTROL: 2/300 FA BAS shall provide Level II medical care to any and all casualties during any incident and shall coordinate any additional medical/non-medical resources needed directly with higher levels of care.

2. NOTIFICATION;

a. Once an incident is identified, the Commander or his representative will notify the BAS with the type of incident, location, approximately number of casualties, types of injuries, and scene security level.

b. Upon notification of an incident, all BAS personnel will muster on station and begin preparation for the receiving of patients.

c. In the event of notification after normal working hours, the duty crew will notify the Officer in Charge, Senior Medical Officer, and NCOIC by cell phone. Duty crew will recall remaining TMC personnel and the NCOIC will conduct muster and report the accountability of all personnel and direct personnel accordingly. All personnel will muster at the designated rally point: 2/300 FA BAS. Unaccounted for personnel will be documented.

3. STAGING/MANNING MEDICAL TEAMS:

a. The BAS waiting area will be cleared out and set up for MASCAL operations as soon as incident notification has been received. Treatment personnel will setup litters and pre-staged medical supplies (CLS-type bags) in the BAS hallways/waiting area and prepare for casualties. All MASCAL supplies and logistics are contained in the locker box in the BAS area.

b. BAS Radio/Communication personnel will ensure there is an open line of communication with the Commander via telephone or cell phone and request additional resource personnel (medics, combat life savers, messengers, litter bearers, security, etc.). Communication personnel will be responsible for contacting MEDEVAC support. The 9-line (war time) MEDEVAC request will be utilized for all helicopter MEDEVAC procedures.

c. The Ambulance Crew will ensure any additional supplies they deem necessary are loaded onto the FLA (Field Litter Ambulance) and stage in the back area of the BAS until dispatched. The dispatching of additional assets will be determined by the BAS Officer in Charge (MASCAL Officer). Adjacent camps might be contacted for additional FLA support.

d. Secondary Triage team (if available) will muster near the back door to the BAS. Treatment personnel will stand by near the back door and assist the secondary triage team as directed and provide litter bearer support when necessary.

e. Supply personnel will ready the BAS by providing any additional stock anticipated to be used in response to the incident (consumables, IV therapy fluids, splinting material, trauma dressings, etc.).

f. Bases on initial information or at any time during the incident, the OIC (MASCAL Officer) may deem it necessary to contact adjacent camps for medical support.

4. BAS GENERAL RESPONSE TO INCIDENT:

a. Ambulance crew shall be dispatched upon notification from the MASCAL Officer. Off-base incident response will need Commander approval and security escort if required.

b. Upon arrival of Ambulance crew to the incident scene, ambulance NCOIC or triage Officer will receive debrief from Incident Commander on the situation to include scene security, number of casualties, types of injuries, and medical action taken prior to arrival.

5. INITIAL TRIAGE:

a. Ambulance crews will continue with the mass triage of casualties with the support of the Combat Life Savers (CLS) on scene prior to arrival, under the direction of the triage Officer.

b. Ambulatory patients will be asked to move to a designated collection area.

c. Non-ambulatory patients will be instructed to move an arm or leg.

d. Patients unable to move will be assessed and be classified First Priority.

e. Patients displaying extremity involvement will be assessed and be classified Secondary Priority.

f. Casualties that are ambulatory will be classified Last Priority.

g. All patients that are unable to ambulate to the collection area will be moved via litter.

6. ASSIGNMENT OF TRIAGE CATEGORY/IDENTIFICATION:

a. Immediate/Red - severe, life threatening wounds that require procedures in short duration. Examples include:

1. Mechanical airway obstruction 2. Sucking chest wound 3. Tension pneumothorax 4. Facial wounds that compromise the airway 5. Unstable chest and abdominal wounds 6. Incomplete amputations 7. Profuse hemorrhaging 8. Second and third degree burns over 15 to 40% of the body.

b. Delayed/Yellow - can tolerate delay without compromising outcome. Examples include: 1. Stable abdominal wounds without significant hemorrhaging or gastrointestinal perforated bowel injury 2. Soft tissue wounds requiring debridement 3. Facial trauma without compromise of the airway 4. Immobilized cervical spine injuries 5. Smoke inhalation (no respiratory distress) 6. Vascular injuries with positive circulation 7. Major orthopedic injuries 8. Most eye and central nervous system injuries

c. Minimum/Green – require little more than first aid. Examples include: 1. Superficial wounds 2. Closed fractures 3. Psychiatric disorders 4. Minor burns < 15% TBSA 5. Auditory blast injuries

d. Expectant/Black – casualties requiring unjustifiable use of limited resources, triaged away, but not abandoned.

e. All casualties will be identified numerically and tagged with the appropriate triage card before transport.

f. Incident scene is considered medically cleared when all casualties have been identified and moved from the area.

7. TRANSPORT/TERTIARY TRIAGE:

a. Once patients are triaged, they will be transported based on priority level.

b. Patients are transported to the BAS where they will be met by BAS secondary triage Officer. Changes to the condition of any patient in route will be reported.

c. Secondary triage personnel will complete a secondary triage upon arrival to the BAS to determine a change in priority of any patient.

d. BAS Triage area is considered medically cleared when all casualties have been identified and moved into the BAS for treatment or evacuation.

8. BAS RESPONSE:

a. Patients will be directed to the appropriate treatment area based on the secondary triage. Patients displaying Red/Immediate triage tags will be litter carried to the trauma area in the back of the BAS. Patients displaying Yellow/Delayed triage tags will be placed in the exterior waiting area in the front of the BAS. Patients displaying Green/Minimal triage tags will be directed to the patient exterior waiting area outside the BAS front entrance. Patients displaying Black/Expectant triage tags or patients that are treated at the BAS and are determined to be Black/Expectant or deceased will be moved to a designated area for holding and comfort care.

b. Administrative personnel will write a number on each patient’s left hand as they are off loaded from the FLA. The number will be entered into the MASCAL log book with the patient’s injury. After all patients have arrived at the BAS, an admin staff member will record the name, SSN, DOB, and unit with each corresponding number. In addition, they will maintain last recorded disposition of any patient transported to alternate sites.

c. Providers/Treatment personnel will ensure all patients receive immediate and professional Level II medical care. All patients will continue to receive treatment based on an ongoing triage.

d. Ancillary Services personnel will initially work with the providers and other corpsmen to stabilize patients until their specific services are needed.

e. Supply NCOs will ensure that the BAS remains adequately stocked throughout the evolution and be responsible for communication with pad managers to coordinate efforts in directing the use of resource personnel. All medical equipment and supplies required for an incident will be properly stored and maintained at the TMC. Prepackaged triage and first aid supplies will be utilized and should the incident overwhelm the available medical supplies, the auxiliary camps will be contacted for assistance and possible re-supply. All MASCAL supplies will be located in the lockers located in the designated areas.

f. Resource personnel designated by the QRF (Quick Reaction Force) will ensure that the flow of patient traffic is not obstructed. They will detain any person who appears to be a threat to themselves or others.

g. The S-1 NCOIC and medic will supervise the Morgue (in the designated area). They should ensure the comfort of all expectant patients and maintain records of all personal items of the deceased.

9. EVACUATION TO A LEVEL III TREATMENT FACILITY

a. Ambulance crew will transport casualties to the designated Landing Zone (LZ) should they need to be air evacuated to a Level III Treatment Facility

b. BAS Communications will be in constant communication with higher medical assets as well as the BDE Surgeon.

c. Receiving facility and transport will require the 9-Line MEDEVAC Request to be accurate for each casualty to be evacuated. Combining patients on the 9-line message is encouraged.

d. Proper triage level identification of each patient will continue until casualty arrives at the Level III Treatment Facility.

e. If a casualty needs to be ground evacuated to a Level III Treatment Facility, BAS communications/ambulance crew will coordinate efforts with Command Staff to identify means of transportation.

f. Appropriate medical care and proper triage level identification will continue until the casualty reaches the Level III Treatment Facility.

g. Ambulance crew NCOIC will supervise all ground and aerial medical evacuations.

h. When established by the OIC that all casualties have been positively identified, receiving treatment, considered stable, or have been evacuated to a Level III Treatment Facility, the BAS will be medically cleared and incident debrief will be held by MASCAL Officer at the BAS.