Definitions

MCI (Mass Casualty Incident)

Any incident where the number of patients exceeds the resources immediately on scene. The threshold is dynamic — a two-patient incident is an MCI for a single-unit response.

START Triage

Simple Triage and Rapid Treatment — the FEMA standard adult triage system. Categorizes patients by ability to walk, respiratory rate, perfusion (radial pulse / capillary refill), and mental status.

JumpSTART

The pediatric adaptation of START. Used for patients who appear under 8 years old or under approximately 100 pounds.

Triage Categories

GREEN (minor — ambulatory), YELLOW (delayed), RED (immediate), BLACK (deceased / expectant).

Purpose

To provide a standardized, scalable response when patient count exceeds resources — protecting the most patients possible by sorting based on urgency, not arrival order.

Scope

Applies to any incident where the first arriving member identifies more patients than can be effectively treated by available resources. Includes vehicle crashes, structure collapses, active assailant events, transportation incidents, and weather events.

MCI Declaration

• Any member may declare an MCI. There is no penalty for over-declaring.
• Declaration includes estimated patient count by triage category if known, or by overall total.
• Declaration triggers dispatch protocols — multi-agency notification, hospital alerting, EMS supervisor response.

MCI Levels (Adjust to Your Region)

First-Arriving Unit Actions

1. Size up — total scene, hazards, approximate patient count.
2. Declare MCI on the primary tactical channel; specify location, approximate patient count, hazards, requested resources.
3. Establish command. Identify yourself as MCI Command.
4. Begin START triage. Do not stop to treat individuals beyond immediate airway repositioning and major hemorrhage control.
5. Mark patients with triage tags or improvised markers (tape, ribbon).
6. Pass command to next arriving officer-level resource. Reassign to a sector role.

START Triage Algorithm — Adults

1. Direct walking wounded to a designated area — these are GREEN.
2. For non-ambulatory patients, assess Respirations: if no breathing, reposition airway. Still no breathing → BLACK. Breathing → continue.
3. Respiratory rate > 30 → RED.
4. Respiratory rate ≤ 30 → assess Perfusion: no radial pulse or capillary refill > 2 sec → RED.
5. Pulse / cap refill normal → assess Mental Status: cannot follow simple commands → RED.
6. Follows commands → YELLOW.

JumpSTART Triage Algorithm — Pediatric

1. Walking pediatric patients to GREEN area as with adults.
2. Non-walking, no breathing → open airway. Still apneic → check pulse. No pulse → BLACK. Pulse present → give 5 rescue breaths. Apnea persists → BLACK. Breathing resumes → RED.
3. Respiratory rate < 15 or > 45 → RED.
4. Respiratory rate normal range → check Perfusion (pulse).
5. No pulse → RED. Pulse present → assess Mental Status using AVPU.
6. Inappropriate posturing, unresponsive, or only responds to pain → RED.
7. Alert or appropriate verbal response → YELLOW.

Sectors

Hospital Notification

Medical Communications notifies all area hospitals of the MCI declaration and provides patient-count estimates by category. As patients are transported, Transport coordinates so no single facility is overwhelmed. Trauma centers receive RED patients when possible.

Documentation

• Each patient receives a triage tag with a unique number.
• Tag number, destination, and mode of transport recorded by Transport.
• Patient care reports for each transported patient completed after the incident — at minimum, a placeholder PCR is opened on scene.
• Family reunification information collected for unaccompanied patients.

Termination & After-Action

• MCI is terminated by Command when all patients transported and scene secured.
• A formal after-action review is conducted within 30 days for any Level 2 or higher incident.
• Lessons learned feed back into training and SOG revision.

Training Requirements

• All EMS members trained in START / JumpSTART at onboarding.
• Annual MCI tabletop exercise.
• Full-scale MCI drill every 2 years (joint with mutual aid).
• Officer-level training on sector command and Unified Command.

References

• START TriageNewport Beach Fire / Hoag Hospital protocol
• JumpSTART Pediatric TriageRomig, jumpstarttriage.com
• FEMA / USFA MCI Operational Guidanceusfa.fema.gov
• NIMS / ICS-100, ICS-200FEMA training.fema.gov
• State EMS MCI Plan[INSERT STATE] EMS bureau

Adapt this template

Before this template becomes your department's policy, review the following items and adjust accordingly. Anything else that does not match your operation should be updated as well.

• Adjust MCI levels to match your regional EMS / mutual-aid plan.
• List your dispatch's MCI alarm assignment by level.
• Identify approved triage tag system (SMART, METTAG, Mass Casualty Tag).
• Cross-reference Incident Command System SOG, EMS Response SOG, and Radio Communications SOP.