EMS Operations
Scene safety and command
No patient care happens in an unsafe scene. Identify hazards (traffic, fire, violence, hazmat), request additional resources early, and establish incident command at any multi-patient event. Only trained, equipped responders enter a hot zone; treatment areas are cold. Never enter a confined space or a weapon scene to 'quickly grab' a patient.
Triage and MCI
START triage sorts by respirations, perfusion, and mental status: walking wounded are green, and a patient who is not breathing after airway repositioning is expectant (black). Red patients need immediate intervention but not a prolonged scene time. The goal is to move the greatest number of patients to definitive care fastest, not to perfect one patient's care.
Transport operations
During transport the patient is secured, the stretcher locked, and the attendant restrained. Use lights and sirens judiciously - crash risk rises and time saved is small. Give a radio report with age, chief complaint, vital signs, treatment, and ETA.
Legal and documentation
Obtain consent (expressed, implied, or from a surrogate), honor valid DNR/POLST orders, and protect privacy. Document objectively and contemporaneously; if it was not written, it was not done.
Trap: questions offering 'triage the most critical patient first' - in a true MCI the walking wounded are cleared first and resources are matched to the number of patients, not to one dramatic case.
Rule of thumb: the first arriving unit's first job at an MCI is to establish command and call for help, not to begin treating the first patient it sees.