Mass Casualty

Mass Casualty Incident Triage Course


TARGET TRAINEE POPULATION: This course is intended for pre-hospital care providers who may be called on to respond to a mass casualty incident resulting when a large numbers of victims are injured or exposed to hazardous materials or WMD agents. The course will prepare trainees to use the Simple Triage and Rapid Treatment (START) system, along with the “All Hazards” or “All Risk” Triage Tag. The course will also cover use of the Incident Management System (IMS) to respond with maximum effectiveness to a mass casualty event.  Previous training of trainees may range from Medical First Responder or EMT-Basic to Paramedic.

Applicable Standards:

This course was designed to support both the National Incident Management System and the FIRESCOPE Field Operations Guide ICS420-1, multi-casualty START transport protocols.


After completing this course the trainee will be able to:

  1. Define Mass Casualty Incident (MCI).
  2. Recognize trauma and hazmat/WMD mass casualty events and identify the likely principle hazards to personnel.
  3. Identify local EMS resources needed to respond to a Mass Casualty incident.
  4. Calculate EMS transport requirements of mass casualty incidents.
  5. Establish control zones and patient movement for a mass decon site.
  6. Execute appropriate responsibilities in response to a mass casualty incident using the FIRESCOPE Field Operations Guide ICS 420-1.
  7. Describe and illustrate the major functions of mass casualty incident management.
  8. Be able to function in an assigned role in an IMS structure for a mass casualty incident response.
  9. Recognize the MCI situations that require implementing the Unified Command Structure.
  10. Identify and describe IMS organizational charts associated with mass casualty incident management.
  11. Identify key features of the All Risk Triage Tag.
  12. Describe functions of the “CONTAMINATED” strip on the triage tag.
  13. Identify and apply principles of patient triage utilizing the START system.
  14. Identify distribution and application of Triage Tag tear-off components.
  15. Describe patient transport and tracking component of the START system.
  16. Identify the proper equipment and procedures for performing triage for trauma, hazardous materials, and chemical agent incidents using the START system.



The First Responder’s Field Guide to Hazmat &Terrorism Emergency Response

Incident Command System -Field Operations Guide-(ICS 420-1)

Course folder with:

PowerPoint handouts

Time/Volume Relationship Formula

MCI Triage Course folder contents (continued):

START Flow Chart

MCI Resource List

All Hazards Triage Tag

Mass-Casualty Command: Action Guidelines checklist



I           Introduction

  1. Hazmat / WMD and Other Mass Casualty Events
  2. Characteristics and Challenges of MCIs
  3. Mass Casualty Preparedness
  4. Mass Casualty Management Resources


II.         MCI Lessons Learned and Allocation of EMS Resources

  1. Case histories of mass casualty events and lessons learned
  2. MCI Resource Allocation

d.    Exercise: Using the Time/Volume Relationship Worksheet to

calculate resource requirements

  1. Examples of Task Force and Strike Team resource allocations for mass casualty event


III.        Mass Decontamination for Hazmat and WMD Mass Casualty


  1. Types of patients and decontamination requirements
  2. Mass decontamination techniques and procedures
  3. Resources & equipment for mass decontamination


IV.        Establishing the IMS at MCIs

  1. The role of ICS/IMS/NIMS in MCI response
  2. Using the ICS 420-1 Field Operations Guide (FOG)
  3. Basics of ICS/IMS
  4. Incident management and safety issues
  5. ICS functional areas
  6. Managing patient flow during MCI response
  7. The IMS Medical Branch/Sector
  8. Using divisions and sectoring at the incident scene
  9. Singular versus unified command for MCI response
  10. Tabletop Exercise: Establishing MCI Medical Command
  11. Exercise: Perception is Reality


V.         Triage

  1. Triage Basics
    1. Using the Simple Triage and Rapid Treatment (START) System and the “All Hazards” triage tag
    2. Staging for MCI response
    3. Tabletop Exercise: Mass Casualty Trauma Triage
    4. Triage for Chemical Incident MCIs
    5. Tabletop Exercise: MCI triage following a nerve agent attack

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