Dutch Creek Serious Accident Task Team (Task Team), assembled by the NWCG
Executive Board in February 2010, was tasked to provide recommendations
to resolve the findings from the Dutch Creek Serious Accident Investigation
Report and Accident Review Board. Based on the work and recommendations
of the Task Team, NWCG is providing direction in three main areas:
- Standardized Medical
Emergency Procedures for Incident Management Teams (IMT) to include
in their Incident Emergency Plans
- Standardized Communication
- An expanded ICS
206 Medical Plan to include emergency medical procedures that will be
reviewed each Operational Period at the Planning Meeting.
Incorporating these procedures and protocols into daily operations and
practicing the critical elements should result in faster and more effective
medical emergency medical response.
Specifically all IMTs
need to incorporate the following protocols into daily operations:
- Each IMT will include
the standard Medical Emergency Procedures (Attachment A) in their Incident
Emergency Plan. These procedures will help ensure safe and efficient
responses to any medical emergency that may occur on an incident.
- . Each IMT will
follow the Incident Communication Center Protocol – Standard Elements
(Attachment B). The Communication Unit Leader will ensure that everyone
in the Center is familiar with the protocol.
- Each IMT will
complete a 206 Block 8 Attachment (Attachment C) when completing their
ICS 206 Medical Plan to provide detailed information regarding communication
procedures, and roles and responsibilities during a medical emergency.
The 206 Block 8 Attachment will document mitigations to hazards (similar
to the ICS 215, Operational Planning Worksheet and 215A, Incident Action
Plan Safety Analysis) and be approved at the Planning Meeting for each
- Each IMT should
train to understand and practice the medical emergency procedures outlined
in their Incident Emergency Plan. Incident simulations or sand table
exercises at IMT workshops will help achieve a clear understanding of
how the IMT will respond to a medical emergency.
To achieve successful medical response within incident management, it
is imperative that agency home units recognize their role and take the
necessary steps associated with Bullet Nos. 1 through 3 prior to incident
team arrival. Identification of medical evacuations options, clarification
of local/county/state/federal resource capabilities, ordering procedures,
role of dispatch centers, and key contacts or liaisons should be provided
the team during in-briefs.
The NWCG Executive
Board recognizes that all IMTs place safety as their No. 1 priority and
are committed to caring for everyone assigned to incidents. For background
information on the Dutch Creek Accident, please click on the Internet
This memorandum will
be distributed to the NWCG organization, Geographic Area Coordinating
Group Chairs (GACG), Geographic Area Coordination Center (GACC) Managers,
and National Multi-Agency Coordinating Group’s Area Command/Incident
Command Council (AC/IC) Chair. NWCG requests that Fire Directors ensure
distribution of this memorandum through their respective directorates
in order to reach unit Agency Administrators.
Medical Emergency Procedures
B – Incident Communication Center Protocol –
C – Expanded ICS 206 Medical Plan
cc: NWCG Executive Board
Fire Executive Council (FEC)
The direction provided in these procedures is intended to create a standard
set of protocols for Incident Management Teams (IMTs) and Communication
Centers to follow during a medical emergency. These procedures will be
incorporated into IMT Incident Emergency Plan upon arrival at an incident
and will allow for the integration of incident management operations with
local/county/state emergency service systems.
Options for Medical Evacuations
The lead Safety Officer
for the IMT will identify and prioritize transport options in terms of
efficiency, based on resource availability, proximity, and potential for
success—with a contingency plan in case the preferred mode of transportation
cannot be used.
One On-Scene Point of Contact
At the scene of a medical emergency, an on-scene point of contact will
be determined or designated by chain of command. This point of contact
and the person assessing/treating the patient may or may not be the same
person. The point of contact will:
- Take charge of
the scene and identify/determine who is in charge of assessing and treating
- Use the Incident
Communication Protocol to relay critical information regarding patient
assessment, transportation, and resource needs.
- Coordinate the
request for transportation and/or other resources based on patient assessment.
- Ensure that information
about patient assessment, transportation or other resource needs is
transmitted directly to the Incident Command Post Communications in
order to reduce the time it takes to communicate essential information
and to limit the potential for miscommunication.
Key Roles and Responsibilities
The IMT (Medical Unit
Leader and Safety Officer) will collaborate with local unit and local
Emergency Medical Services and Emergency Operations Center (EMS/EOC) to
ensure integration of local systems into IMT planning meetings, operational
briefings, and Incident Action Plan documents (ICS-206 and 206-Block 8
Expanded). Local systems can include specifics on ordering procedures,
resource limitations, availability and capability, policies, guidelines,
hours of operations, response times, billing, dispatch protocols, etc.
If necessary, the
IMT should assign a person to function as a liaison to coordinate with
the local jurisdiction with authority for Emergency Medical Services.
The position would report to the IMT Medical Unit Leader or Safety Officer.
The IMT should include
local EMS/EOC personnel in operational and planning meetings and briefings.
The host unit will provide the necessary information to the IMT on local/county/state
resource capabilities, capacities, ordering procedures, cooperative agreements,
role of dispatch centers, and key contacts or liaisons.
Incident Communication Protocol
1. Determine the
nature of the emergency.
2. If the emergency
is a medical injury/illness, determine if the injury/illness is life
3. If the injury
is life threatening, then clear designated frequency for emergency traffic.
4. Identify the
on-scene point of contact by position and last name (i.e. TFLD Smith).
5. Ensure that the
Medical Unit Leader is contacted immediately.
6. Identify number
injured, patient assessment(s) and location (geographic and/or GPS coordinates).
7. Identify on-scene
medical personnel by position and last name (i.e. EMT Jones).
8. Identify preferred
method of patient transport.
9. Determine any
additional resources or equipment needed.
10. Document all
information received and transmitted on the radio or phone.
11. Document any
changes in the on-scene point of contact or medical personnel as they
NWCG#025-2010 Memorandum, dated 5/25/10 -- Attachment A
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Incident Communication Center Protocol
will ensure the following information is obtained and recorded during
the nature of the emergency.
injury/illness? If injury/illness is it life threatening?
threatening, clear designated frequency for emergency traffic.
the on-scene Point of Contact (POC) by resource and last name
(i.e. POC is TFLD Smith).
Medical Unit Leader immediately.
POC to provide number injured, patient assessment, and location
(geographic and GPS coordinates).
on-scene medical personnel by position and name (i.e. on-scene
medical personnel is EMT Jones).
preferred method of patient transport.
if any additional resources and/or equipment are needed.
all information received and transmitted on the radio or phone.
any changes in the on-scene Point of Contact or medical personnel
as they occur.
by (Medical Unit Leader)
Reviewed by (Safety Officer)
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206 – Block 8, Emergency Medical Procedures (cont’d)
the event of a medical emergency provide the following information
to the Communications Unit
the nature of the emergency.
injury/illness? If injury/illness is it Life Threatening?
2. If Life Threatening, then request that the designated frequency
be cleared for emergency traffic.
3. Identify the on-scene Point of Contact (POC) by Resource and
Last name (i.e. POC is TFLD Smith),
4. Identify nature of incident, number injured, patient assessment(s)
and location (geographic and GPS coordinates),
5. Identify on-scene medical personnel by position and name(i.e.
6. Identify preferred method of patient transport,
7. Request any additional resources and/or equipment needed,
8. Document all information received and transmitted on the radio
9. Identify any changes in the on-scene Point of Contact or medical
personnel as they occur,
Medical Procedures (Provide detailed emergency medical
procedures by Division/Group, Spike Camps, etc. or any staffed incident
or event location)
|Prepared by (Medical
by (Safety Officer)
for Completion of ICS 206 Block 8, Emergency Medical Procedures
As appropriate the
following information should be included in the emergency medical procedures
for any staffed incident or event location. The plan must be reviewed
and/or updated and approved at each Planning Meeting.
- Include timeframes
(ETEs and ETAs) from and to specific locations
- Include GPS coordinates
for key locations such as spike camps, drop points, helispots, etc.
- List all potential
evacuation resources and/or equipment assigned to the incident/event
- Identify other
resources and/or equipment (types, capabilities, availability) not assigned
to the incident/event but possibly available if requested
- Identify contingencies
(alternate plan or procedure if the preferred option becomes unavailable
or identified resources cannot perform the mission)
- Identify specific
concerns by location (division, group, geographic area or location)
- Identify environmental
influences or factors and resource status changes that might keep the
preferred option from working
- Compare to 215-A
for mitigation of specific hazards associated with lengthy travel times
to access Advanced Life Support
- If the primary
evacuation plan is to use aviation, then a secondary plan should be
identified including time frames for patient extraction
The procedures must
be communicated to the entire incident/event and any external partners/cooperators
involved with the incident.
NWCG#025-2010 Memorandum, dated 5/25/10 – Attachment C
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