🚨 MCI Reference

Mass Casualty Incident

START triage algorithm, sector setup, radio formats, and resource request guide for ERLC MCI scenarios.

Declaring an MCI
MCI Declaration: An MCI exists when the number of patients exceeds the capacity of responding units to provide individual patient care. In ERLC, declare MCI when you have 3+ patients and only 1–2 units on scene.

When you declare an MCI, your role changes. You are no longer treating — you are triaging and commanding. Get a global picture first. Do not get drawn into treating any individual patient until the scene is organized.

Common mistake: Starting treatment on the first patient you reach. Walk the entire scene first. Count patients. Declare. Assign sectors. Then treat.
START Triage Categories

🔴 RED — Immediate

Life-threatening but survivable with immediate intervention. Airway compromise, severe hemorrhage, tension PTX. These patients die without treatment now.

🟡 YELLOW — Delayed

Serious but stable. Can wait 15–60 min. Fractures with good pulses, significant lacerations, moderate pain. Monitor closely — can deteriorate.

🟢 GREEN — Minor

Walking wounded. Minor injuries, ambulatory. Can self-evacuate to treatment area. Do not commit resources here until Reds and Yellows are managed.

⬛ BLACK — Expectant

Unsurvivable or requires resources that would divert too many resources from salvageable patients. Apneic after airway repositioning, massive burns, decapitation.

START Algorithm — Walk Through This on Every Patient
Step 1 — Can the patient walk?
Yes → GREEN (walking wounded) No → Continue assessment
Step 2 — Is the patient breathing?
No — Reposition airway. Still no → BLACK Yes → Continue
If breathing only after repositioning → RED. Note: In MCI, you do NOT do CPR — resources aren't available. Apneic after repositioning = BLACK.
Step 3 — Breathing rate?
>30/min or <8/min → RED 8–30/min → Continue
Step 4 — Radial pulse present? (Perfusion)
No radial pulse → RED Radial pulse present → Continue
Control major bleeding if found. Takes seconds — tourniquet only, no dressing changes.
Step 5 — Mental status? (Can follow simple commands?)
Cannot follow commands → RED Can follow commands → YELLOW
Sector Setup

Once patients are triaged, establish sectors. Announce sector assignments over radio. Move patients from triage to the appropriate treatment sector.

🔴 Red Treatment Sector
  • Location: Closest to ambulances for fastest load
  • Staffing: Most experienced providers (Paramedics if available)
  • Goal: Stabilize for transport — airway, hemorrhage, decompression
  • Each patient gets one provider until transport ready
🟡 Yellow Treatment Sector
  • Location: Adjacent to Red sector, secondary loading point
  • Staffing: BLS providers acceptable
  • Goal: Monitor for deterioration, basic care
  • Reassess every 5 min — Yellows can turn Red
🟢 Green / Ambulatory Sector
  • Location: Away from scene, upwind/uphill
  • Staffing: Minimum — 1 provider monitoring
  • Goal: Hold until transport available
  • Can have walking wounded assist with minor care
🚑 Transport Sector
  • Location: Ambulance staging area — clear egress route
  • Staffing: Transport officer tracks unit assignments
  • Goal: Coordinate load order — Reds first
  • Track which hospital each patient goes to
⌨️ Command Post
  • Location: Visible, accessible, away from hot zone
  • Staffing: IC + communications
  • Goal: Maintain situational awareness, resource requests
  • IC does NOT treat patients
⬛ Expectant / Morgue Sector
  • Location: Separated from treatment sectors
  • Staffing: Periodic reassessment only
  • Maintain dignity — cover patients when possible
  • Reassess if resources free up — Black can become Red if situation changes
Radio Communications
Initial MCI Declaration
[Unit] to Dispatch — MCI declared at [location]. Approximately [#] patients. Requesting [# additional units], [ALS if needed], [police if scene not secure]. Establishing command.
Triage Report to IC
Triage to Command — triage complete. [#] Red, [#] Yellow, [#] Green, [#] Black. Total [#] patients. [Any immediate life threats to report].
Unit Transport Report
[Unit] transporting [#] patients — [Red/Yellow/Green] — to [hospital]. ETA [#] minutes. Requesting [trauma/STEMI/stroke] activation if applicable.
Resource Request
Command to Dispatch — requesting [resource type] at [location]. Reason: [brief justification]. Priority: [routine/urgent/emergency].
Scene Termination
Command to all units — MCI terminated. All patients transported. [# Red] to [hospitals]. Returning to service. Command post dissolved.
MCI Quick Reference Numbers
Breathing — RED threshold
>30/min or <8/min
No Radial Pulse
→ RED (regardless of other findings)
Cannot Follow Commands
→ RED
Walking Wounded
→ GREEN (skip full START)
Apneic After Repositioning
→ BLACK (no CPR in MCI)
Yellow Reassessment
Every 5 minutes
IC Does Not Treat
Command = awareness only
Transport Priority
Red → Yellow → Green → Black