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MCI Response Concepts for EMS (#31daysofEMS)

Mass casualty incident response for EMS is one of my favorite topics as a trainer and as a student. I have had the good fortune to work on several MCI for EMS consulting projects throughout Wisconsin that have involved writing/rewriting EMS plans, developing training materials, and delivering training exercises. The purpose of these projects has generally been to improve responder knowledge of MCI response tools, minimize risks to emergency responders, increase the efficiency of patient triage, and ensure that patients, especially critical patients, are transported early to the facilities best capable for caring for them.

Tomorrow, December 16, I will be presenting MCI Concepts for EMS as an session. The session is a compilation of sessions I have presented at numerous EMS training sessions. It represents a “best of the best.” Make sure you check out the live presentation. Register now at

When responding to an MCI remember these Everyday EMS Tips:
MCI Response photos from EPS411
1. An MCI is defined by responder capabilities, not patient numbers. Thus what is or is not an MCI varies from day-to-day and region to region. Talk through potential scenarios to understand what an MCI might mean for your service.

2. Plan and prepare for MCIs using an all hazards approach versus a prescriptive plan for dozens, hundreds, or even thousands of different scenarios. Generally training, equipment, and protocols should prepare for any type of incident.

3. MCI response is not all or nothing. Use the components of a plan, response equipment, and ICS positions appropriate for the incident.

4. Communicate with receiving facilities early and often about the number and type of patients to expect. Make sure they are aware when patient triage and transport has concluded.

5. The first ambulance on scene needs to identify and confirm the MCI, initiate the plan, and assume command if it has not already been initiated. Next assess the hazards, general numbers, and MOI/NOI. Don’t begin patient triage or treatment until these steps are complete.

6. Assume any MCI is a crime scene until told otherwise by law enforcement. Nonetheless, patient care is critical. Do not delay or under deliver patient care because of evidence protection concerns. Forensic examiners are sophisticated enough to differentiate holes in shirt from shrapnel from the rips from trauma shears.

7. Remember the importance of establishing functional areas (staging, command post, treatment areas, decon, etc) early.

8. Finally, if you are the Incident Commander stay put. This is one time management by walking around is counter productive. Receive and deliver information from the incident command post.

For more training, tips, and resources on multiple casuality incidents check out these resources: continuing education lesson on MCI incident response. Approved for 1.0 CECBEMS credits.

5 Tips to Survive an MCI is a guest post from contributor Steven Kanarian.

MCI Response in Israel is a series of podcasts and articles I made during a week-long mass casualty response workshop in Israel.

Complete the NFA online course EMS Response at Multi-Casualty Incidents

Share your MCI response tips and training resources in the comments area.

By Greg Friese

Greg Friese, Stevens Point, Wisconsin, is an author, educator, paramedic, and marathon runner.

Greg was the co-host of the award winning EMSEduCast podcast, the only podcast by and for EMS educators. Greg has written for,, Wilderness Medical Associates, JEMS Magazine, and EMS World Magazine, and the NAEMSE Educator Newsletter.