EMS Education Tips EMS Tips Operations

Tips for Mass Casualty Incident Training

MCI Response photos from EPS411Mass casualty incidents are infrequent for most EMS professionals. We have few opportunities to practice and improve our MCI response skills. Lectures can help us become familiar with concepts, but regular hands on practice through table top exercises, drills, and full-scale simulations is needed to achieve competency. Here are some Everyday EMS Tips for MCI training:

  1. Scenario planning. A scenario is a story that needs to have a beginning, middle, and end. The beginning is usually what happened before EMS arrives. The middle is the actual EMS response including triage, patient assessment, treatment, and transport. The end is the resolution of the MCI and the demobilization of EMS.
  2. Identify clear training objectives. What do you want personnel to accomplish during the training program? Remember create objectives that are specific, attainable, and measurable.
  3. Focus the training. Other than an occasional full-scale simulation you cannot do every MCI role and task in a training session. Focus training on areas most needed for practice based on analysis of past incidents and current capabilities.
  4. Involve the right people. Based on the objectives and focus for the training invite the right groups of emergency responders. For example, fire suppression readiness is certainly a needed function at most motor vehicle collision MCIs, but if the focus of the training is extrication and airway management you might not need or want an engine company simply standing and watching.
  5. Document the training for analysis and debrief. Use a digital camera and/or handheld camcorder to record the training program. I usually record short bursts of action, such as quick moments of triage, extrication, and treatment. Try to limit the total amount of video recorded to ten to fifteen minutes. Sometimes I provide audio commentary as I record. During the debrief play back the video. Video and photos allow personnel to see other parts of the scene that they could not see during the actual training.
  6. Debrief what went well. Most debrief sessions quickly devolve into discussion about the short comings of the training plan and the negative performance actions. Focus the debrief on positive lessons learned and how to apply those lessons to future trainings and actual incidents.

Finally, make incident management roles and responsibilities part of the routine. Some services conduct Triage Tuesday and use triage tags on every patient one Tuesday a month. Implement EMS command at all motor vehicle collisions, even when there is only one patient. Regular practice will prepare you for an incident with multiple patients.

Updated December 19, 2012. Read Steve Whitehead’s great post about Mass Casualty Incident Reality

Updated October 3, 2012. EMS Educator Rommie Duckworth has written an excellent series on Mass Casualty Incident Management for EMS World.


To learn more visit for a training session – MCI Concepts for EMS – I deliver to EMS agencies. The session includes materials for a twenty patient tabletop triage exercise you can facilitate for your service. You are also welcome to contact me for information on bringing me to your agency or conference to conduct an MCI Concepts of EMS training session.

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.