MCI Week

for additional information contact your EMS Duty Officer



As soon as you recognize that there are more patients than responding units can transport, initiate the Incident Command System, establish an Incident Commander, and begin initial START triage.

If the victims are in multiple vehicles or dispersed over a relatively large area, attach the appropriate ribbon to the patient's wrist (or the ankle if the wrist is unavailable due to entrapment or injury) using START triage criteria.

If the victims are confined to a relatively small area, such as a bus or rail car, consider using ribbons AND tags during initial triage. Do not fill out the tag at this time, simply attach it to the ribbon, remove one of the 6 barcode labels, and stick the barcode label to the seat where the patient is sitting or the floor/ground area where the patient lay. This is of invaluable importance in crash reconstruction and is especially important in incidents involving public transportation and/or fatalities.

Green ribbon (walking wounded or those denying injury) should be removed to a designated place away from the areas where patient extrication or on-scene care are performed. Once all victims have been START triaged, the incident commander can call for appropriate additional units and establish treatment areas for red and yellow ribbon patients awaiting transport.

The fewer people who are involved in the START triage, the better and more accurate the triage process will be. A person who is triaging 10 patients at a given incident has a far clearer view of the 'big picture' than the rescuer triaging only 2 patients. Once START triage has been completed, designated triage personnel should reassess all patients to confirm the findings of the START triage or upgrade/downgrade the victims's priority. 

It is imperitive that personnel on additionally requested units report to the staging area and personnel remain with their unit unless given specific orders report to a given place.  Never leave your unit empty-handed!   EMS  units being utilized for transport will probably be stripped of all but the essential supplies and equipment needed for transport in order to supply the treatment areas.


Presented as option for station officers to engage shift personnel in a
discussion. Review the MCI Significant Incidents as a shift. Identify the
themes for things done well and areas for improvement
Presented as option for station officers to engage shift personnel in a
discussion. Review the MCI Significant Incidents as a shift. Identify the
themes for things done well and areas for improvement

MCFRS MCI Significant Incidents (these reports are password protected)

START Triage Powerpoint 


Triage Reference Cards  (pdf file)


Option for Battalion Chiefs to engage station officers, face-to-face or via e-mail with dialog that pertains to each publication

San Bernardino Active Shooter Incident  link to document

J EMS: MCI Efficiency It Takes More than Triage Tags to Run an MCI  link to document

Here are five (5) steps you can take to help prevent a negligence claim against you or your agency based on your conduct at an MCI:  link to document

Are you prepared to handle a variety of "MCI magnifiers"? Lessons learned from Los Angeles County Fire Dept.'s MCI. link to document


Pre Training Survey

Pre-Training Survey


MCI Drill for Unit & Battalion Chief Officers

Active Assailant    PDF Download

MCI Week Battalion Based Remote Training Scenarios

These training scenarios have been developed to assist the Battalion Chiefs conduct MCI readiness training with their unit officers. 

There are two scenarios that have been developed – one active assailant (scenario 1) and one carbon monoxide poisoning (scenario 2).  The scenarios are tailored so that the patients can be moved from the scene with the five (5) transport units that respond on an EMS task force.

During these training sessions, the Battalion Chief will be the scenario moderator.  These training scenarios were developed with intent that the scenario moderator and unit officers will be at their home station, at a computer terminal, with a radio available.  If you wish to have the unit officers assembled at one location, the documents will need to be printed out prior to beginning the training. 

Included in the scenarios are interaction guidelines titled as such.  It is the moderator’s choice how they wish deliver the included information i.e. by radio, email, etc.  No script was developed.  Also included in the scenarios are links to documents and forms that may be presented to a unit officer by the EMS Duty Officer if they were to be one of the group leaders.  The intent of using these real documents and forms is to present the opportunity for the unit officers to be exposed to the documents and forms in training before they are expected to use them at an actual event.

This is a remote training session with three to four of your officers.  The scenario also requires an officer to be in command.  It is your choice if
you will be in command of the event or if you wish one of your officers to be ‘command'.  The remaining officers will be a supervisor for one of the following groups:


          The officers will need to be at a computer terminal and have a radio available.  Please contact B/C Baltrosky to secure a talkgroup for the training.  Included are links to documents for you to email to your officers as the training unfolds.

          Utilize the task list to evaluate the participants in the events.  In addition to the benchmarks, each event has individual milestones that should be reached.

Task list link:
            This document will provide you with the framework to facilitate the training.  There are specific interactions that you should have with your unit officers – these interactions are included in the document.  Feel free to add or remove information at your will.

Shooting – ALS2


Pick an office park in your first due to add authenticity

Dispatched units:

3 or 4 of your primary units – two must be Paramedic Engines, as they are dispatched on the EMS task force.  Add 5 transport units to the call – these units are available for transport and they will ghost units unless you wish to verbalize them checking on the scene on the radio.

Note: there is a similar event in another battalion, and there are no other units available for dispatch.


Police are on the scene.  The scene is safe – the threat has been neutralized.  There are multiple shooting victims.


  • Maintain communication between supervisors and command
  • Proper distribution of patients between trauma centers

  • Establish command
  • Designate supervisors for
    • Triage
    • Transport
    • Treatment

Patient information:
  • Patients have been assembled in a casualty collection point
  • Total Patients: 7
    • Acuity
      • 2 Deceased
      • 3 Immediate
      • 1 Delayed
      • 1 Minor

Transport units:

Transport units in a MCI should be moving patients.  There are no additional transport units available in the county.  If command or one of the group supervisors dedicates a transport unit to a task other than that of transporting a patient, do not allow the unit to be used for transport without adding a significant delay to its availability.

Triage Group Supervisor


The  Triage Group Supervisor should utilize their crew to perform the triage.   The supervisor should receive this return from their crew:

  • 7 Patients total – all traumas
    • Acuity
      • 2 Deceased
      • 3 Immediate
        • 2 Pediatric
        • 1 Adult
      • 1 Delayed
        • Adult
      • 1 Minor
        • Pediatric
The  Triage Group Supervisor should relay this information to command via the radio.

Transport Group Supervisor


The  Transport Group Supervisor will need to obtain hospital bed availability and track the patients as they are moved to the hospitals.

This is the bed availability:
  • Baltimore Shock Trauma
    • 4 Immediate
    • 2 Delayed
    • 0 Minor
  • Children’s DC
    • 3 Immediate
    • 4 Delayed
    • 0 Minor
  • Suburban Trauma
    • 1 Immediate
    • 1 Delayed
    • 1 Minor
  • MedStar Trauma
    • 2 Immediate
    • 2 Delayed
    • 0 Minor

The  Transport Group Supervisor is responsible for managing the ambulance staging area.  These are the 5 ambulances dispatched in the EMS task force.  There are no additional transport units available.

The  Transport Group Supervisor should coordinate with the treatment group supervisor and move the patients out to the appropriate hospitals as soon as the patients are ready.  They should also document the amount of patients transported to each hospital and the destination for each patient. 

The  Transport Group Supervisor and the  Treatment Group Supervisor should be communicating to each other via the radio.

The  Transport Group Supervisor, or their designee, is the only person that shall communicate with the hospitals.

Treatment Group Supervisor


The  Treatment Group Supervisor will utilize the crew of their unit to treat the patients as they arrive in treatment area.

The crew from the triage group should be reassigned to work under the  Treatment Group Supervisor after triage is complete.  This manpower unit will be the victim carriers needed to assemble the patients in the treatment area.  The treatment area should be in the cold zone - away from the casualty collection point.

The facilitator should tell the treatment group supervisor when they have patients in the treatment area and when the victims are ready for transport.  The immediates should be moved out first, followed by delayed, and then minor.  Randomize the severity of the victims that are arriving and ready for transport so that the supervisor may execute the proper decisions.


MCI Drill for Unit & Battalion Chief Officers

Carbon Monoxide Incident        





MCFRS Forms/Documents