MCI Mysteries

[chovesh 1]

On an MCI do we need to get an RMA for everyone involved? Do crews assisting at the scene have to write 004 PCRs (Treated by this unit, transported by another)?

For small MCIs (three car accidents) writing a PCR on everyone isn't a big deal; but when you have a situation like that 51 car pile-up in New Hampshire a few weeks ago you could be writing PCRs for days!

[x129K 1,393]

Call enough rescources and utilize them to their full potential. I would certainly demand a refusal from everyone not wishing transport.

[OoO 24]

In an MCI, I believe triage tags can be used instead of a PCR.

[NWFDMedic 58]

In an MCI, I believe triage tags can be used instead of a PCR.

Indeed. The transporting unit would do a PCR as usual. Patients treated in triage and not transported should have some kind of informed refusal documentation, whether it's on a PCR or some other form developed by your agency.

If you treated patients and turned them over to transporting agencies, I would think that you would have to do one PCR to account for your presence at the incident and include the appropriate documentation of your activities (triage tag portion not sent with transporting agency, some type of patient accountability listing).

[bil14ga 1]

Interesting enough, there are no written protocols for MCI both with NYS or the Hudson Valley Region. I have done some research on MCI for some training and can find very little by the way of protocols.

[ny10570 745]

I think the greater issue here is what the purpose or PCRs and RMAs. A PCR is just there to document the different aspects of treatment. In an MCI a triage tag is the standard and therefor acceptable documentation of any treatments made in the field. The PCR written by the transporting unit should reflect everything done in the field and during transport. RMAs are only for people involved that you believe need to be treated or evaluated at a hospital. Just because their car is involved it doesn't necessarily make them a patient.

[Guest alsfirefighter]

Call enough rescources and utilize them to their full potential. I would certainly demand a refusal from everyone not wishing transport.

Calling in enough resources initially and promptly is one pitfall that often happens, even with the 2 to 3 car accident. Get an idea of # of patients and call for the appropriate resources immediately and it helps the tide flow smoothly. All too often I see and here the piece mealing of units to scenes, calling one in every 5 to 7 minutes, instead of getting an initial size up done and calling all at once.

As far as "demanding" an RMA from everyone not wishing transport (or do you need to RMA everyone at the scene)...no way. First and foremost in a large MCI you might not be able to account for everyone in the first place and never get to all who may just stray from the scene. Secondly...RMA's (and for you clip board clingy providers) PCR info isn't a priority on any EMS call. Patient care is and I'm investing my resources to get rapid triage completed, the patients sorted by priority and get them off scene in an appropriate manner as needed. The treatment sector does not need to complete a PCR with a '004' disposition. The triage tag or some other form should have injuries and treatments noted on them.

Now in regards to the "green" or minor patients. Should you get documentation on each. Yes. But it doesn't mean you need to generate 50 or 100 PCR's. One simple form with their pedigree info, any minor injury they are complaining of and their signature will suffice. Read the or explain the disclaimer for RMA and remind them if anything changes while sitting around to let any person on scene know. Case closed.

Really..you get 2 tour buses with 50 people collide on it. You going to RMA 100 people? How much time is it even worth to them and who is going to witness 100 PCR forms?

If you get a 3rd party call to an address and you knock on the door. The person answers and asks you "Can I help you?" You explain that someone called about a person not feeling well here and the name dispatch gives you is the name of the person standing at the door. They state they are fine, don't know why anyone called and they are oriented, standing with a normal steady gate, etc. Do you RMA this person? No. They don't have a medical problem so they are not refusing treatment and they didn't even generate the call. Same thing...MVA...2 cars. None of them called for a bus. The officer arrived and all denied injury or illness. A passerby said someone was injured on their cell phone and never stopped. No RMA here either. They don't have an injury or illness they are not refusing treatment. Lift assist. You get there and the guy is on the floor and says..."I'm fine! I'm just old and can't get myself up I'm sorry for bothering you." You confirm he's oriented, he just tripped on the carpet because he thought he didn't need his walker for the short trip to the kitchen and he has no obvious injury and denies all pain. RMA? Hell no...he isn't refusing treatment he needs help getting up and guess what...who else is going to help him?

So let's see all the "CYA" "In this world you gotta protect yourself" people. Yes RMA's I believe still do lead the EMS industry in litigation rates. Why? Because of people who don't go out of their way to ensure they do all they need to do like explaining injury/illness risks and also not properly documenting the RMA. But you have to actually have an injury or illness to refuse treatment of such.

[helicopper 1,050]

I think the greater issue here is what the purpose or PCRs and RMAs. A PCR is just there to document the different aspects of treatment. In an MCI a triage tag is the standard and therefor acceptable documentation of any treatments made in the field. The PCR written by the transporting unit should reflect everything done in the field and during transport. RMAs are only for people involved that you believe need to be treated or evaluated at a hospital. Just because their car is involved it doesn't necessarily make them a patient.

Calling in enough resources initially and promptly is one pitfall that often happens, even with the 2 to 3 car accident. Get an idea of # of patients and call for the appropriate resources immediately and it helps the tide flow smoothly. All too often I see and here the piece mealing of units to scenes, calling one in every 5 to 7 minutes, instead of getting an initial size up done and calling all at once.

As far as "demanding" an RMA from everyone not wishing transport (or do you need to RMA everyone at the scene)...no way. First and foremost in a large MCI you might not be able to account for everyone in the first place and never get to all who may just stray from the scene. Secondly...RMA's (and for you clip board clingy providers) PCR info isn't a priority on any EMS call. Patient care is and I'm investing my resources to get rapid triage completed, the patients sorted by priority and get them off scene in an appropriate manner as needed. The treatment sector does not need to complete a PCR with a '004' disposition. The triage tag or some other form should have injuries and treatments noted on them.

Now in regards to the "green" or minor patients. Should you get documentation on each. Yes. But it doesn't mean you need to generate 50 or 100 PCR's. One simple form with their pedigree info, any minor injury they are complaining of and their signature will suffice. Read the or explain the disclaimer for RMA and remind them if anything changes while sitting around to let any person on scene know. Case closed.

Really..you get 2 tour buses with 50 people collide on it. You going to RMA 100 people? How much time is it even worth to them and who is going to witness 100 PCR forms?

If you get a 3rd party call to an address and you knock on the door. The person answers and asks you "Can I help you?" You explain that someone called about a person not feeling well here and the name dispatch gives you is the name of the person standing at the door. They state they are fine, don't know why anyone called and they are oriented, standing with a normal steady gate, etc. Do you RMA this person? No. They don't have a medical problem so they are not refusing treatment and they didn't even generate the call. Same thing...MVA...2 cars. None of them called for a bus. The officer arrived and all denied injury or illness. A passerby said someone was injured on their cell phone and never stopped. No RMA here either. They don't have an injury or illness they are not refusing treatment. Lift assist. You get there and the guy is on the floor and says..."I'm fine! I'm just old and can't get myself up I'm sorry for bothering you." You confirm he's oriented, he just tripped on the carpet because he thought he didn't need his walker for the short trip to the kitchen and he has no obvious injury and denies all pain. RMA? Hell no...he isn't refusing treatment he needs help getting up and guess what...who else is going to help him?

So let's see all the "CYA" "In this world you gotta protect yourself" people. Yes RMA's I believe still do lead the EMS industry in litigation rates. Why? Because of people who don't go out of their way to ensure they do all they need to do like explaining injury/illness risks and also not properly documenting the RMA. But you have to actually have an injury or illness to refuse treatment of such.

Thank you guys for stating what should be mandatory core training in EMS programs. No injury/illness/complaint = No patient. No patient = No RMA.

As for the MCI scenario, red/yellow tags, transported by ambulance - definitely a PCR candidate. Green tags complaining of some minor injury, transported by EMS or some other mechanism = PCR or other documentation in accordance with agency policy; Green tags because they were there but no complaint/no injury = no PCR. "If you can get up, get up and follow me off the bus/train/plane" does not a patient make!

alsff makes another excellent point about the need to properly size-up a job and request the right resources earlier rather than later. If you've got eight candidates for transport on a backboard, you better get at least four ambulances coming. The longer you wait, the longer the patient(s) wait and the longer the whole job takes. If two of the eight RMA later you can always release an ambulance or go to one patient/one ambulance transports.

Manage the scene or it will manage you!

[PEMO3 523]

Part of the answer lies in the actions of the personnel on scene. If you "identify" a patient that may require treatment and/or transport then you place yourself in a position to do a formal RMA. Personally once "patient" contact is made an RMA should be secured for everyone not transported. Just the fact that a person would allow you to evalute them as opposed to stating on initial contact "I am fine, I do not need help" places the question that not only you but the "patient" saw a potential need for treatment and/or transport. CYA with an RMA while time consuming is always the safest bet to protect not only your agency but you personnally.

[Guest Loud412]

I work for fdny ems in Manhattan. A couple of months ago my unit was assigned to an accident involving two motor coach type NJ transit busses in the Lincoln tunnel. Both busses were filled to capacity. A total of 3 bls line units, MERV 1, conditions supervisor (Lt.), Division Capt, and a deputy cheif. Intial triage was doen with triage tags, and out of a possible 100+ pts due to the busses capacity i think only 34 were claiming injury. Sothose 34 people were the only ones that recieved a triage tag, the vast majority of which were green tags, and there was only 1 or 2 people needing imobilization so they were yellow tags. Everyone else was given the NJ transits incedet iformation form to fill out and were put on a different bus and continued about their day. Of the 34 or so pt's only 8 of them didnt want to go to the hospital so RMA were written up on them and they were sent about their day. The rest were transported to area hospitals by the three line units and the MERV.

Its just like Chris192 said, if the person is allert and oriented and has no complaints, and there is no major mechanism of injury, then that person is not a patient. Which means that no paperwork gets done on that person.

[ny10570 745]

Loud, that reminds me of bus vs FDNY ladder MVA about 3 months back at 149 and concourse. Bus was stopped and the truck took a chunk out of the back of the bus trying to squeeze into position. 24 victims directed into a nearby restaurant by the FD captain. Once inside they asked everyone with an injury please stand up. Everyone stood up and the cop started walking them all to Lincoln. No one made it past the post office.