North Central C-MED, Region 3 Mass Casualty Incident, Protocol, Pre-Hospital, by North Central Connecticut EMS Council Management of Hartford, Connecticut

Mass Casualty Incident Communications



The establishment of MCI levels is to automatically trigger operational movement of resources without the CMED communicator needing special authority/direction. In theory, the EMS officer would declare an MCI (level 1-4) and CMED following established protocol on page 4 of the aforementioned manual. Sandy Hook was a level 2 MCI:

Level 2 MCI (21-50 victims)

15 ambulances

 3 EMS Supervisors

1 Regional MCI trailer

Consider 1 bus

RED Plan Notification


On page 6 of the North Central Connecticut EMS Council Management manual we read:

SETUP the scene for management of the casualties:

Establish staging.

Identify access and egress routes.

Identify adequate work areas for Triage, Treatment, and Transportation.

SMART triage:

Begin where you are.

Ask anyone who can walk to move to a designated area.

Use SMART Triage tags to mark patients.

Move quickly from patient to patient.

Maintain patient count.

Provide only minimal treatment.

Keep moving!


Staging Areas

All responding EMS units should go directly to the assigned STAGING AREA and await further instructions. Do not leave the staging area until you are instructed to do so by the Medical Branch Director/Medical Group Supervisor or the direction of North Central CMED.

Patient Dispersal from the Scene

Patients will be sorted according to SMART Tag criteria of RED/YELLOW/GREEN/BLACK. Upon receiving direction from the Medical Branch Director/Medical Group Supervisor, CMED will contact all area hospitals to determine RED/YELLOW/GREEN capabilities.

Red: Priority 1

Life-threatening but treatable injuries requiring immediate medical attention

Yellow: Priority 2

Potentially serious injuries, but are stable enough to wait a short while for urgent medical treatment

Green: Priority 3

Injuries that can wait for longer periods of time for delayed treatment

Black/Blue: Dead/Expectant

Dead or (expectant still with life signs but injuries are incompatible with survival in austere conditions


To assure hospital capabilities have not reached capacity, transporting units will be assigned hospital destination by North Central CMED.

Patient Dispersal to Receiving Hospitals



The purpose of this protocol is to assure that the treatment of patients at the scene of a mass casualty incident and transportation to receiving hospitals is done in accordance with accepted medical and communication standards. Radio traffic should be kept at a minimum. In accordance with the statewide program of Mass Casualty Care in Connecticut, patients requiring advanced life support will have effective medical control communications providing guidance for, advanced life support care without the need for individual orders, alternative transportation for patients receiving advance life support when insufficient MICU unit are available, and assurance that trauma patients are taken to appropriate trauma centers. Communications to hospitals and requests for medical control will be processed through the individual that has assumed responsibility for the EMS function at the scene of an incident.


Scene Management

Upon arrival at the scene of a mass casualty incident, the EMS provider sets up EMS scene control and designates and the Medical Branch Director/Medical Group Supervisor per their Mass Casualty Incident Plan. Whenever possible, CMED should be advised of the incidentís scope. CMED will alert the hospitals closet to the incidentís scene. During the incident, CMED will provide periodic updates to the hospitals in the affected area. These hospitals should report any changes in their status during an incident that may affect scene management, directly to CMED.


Ambulance Coordinator

The Ambulance Coordinator reports to the Patient Transportation Unit Leader, manages the ambulance staging area(s), and dispatches ambulances as requested.