Kent County Chiefs Association

Standard Operating Guidelines &

Standard Operating Procedures

Subject: Mass Casualty

SOG # 1-1-3

Approved

June 1998

Approved by: President James L. Price, Jr

Revised

July 2026

I.             PURPOSE

  To establish guidelines that shall serve to provide a standard for Mass Casualty

  Incidents in Kent County in alignment with MIEMSS Region IV Council Multiple/Mass

  Casualty Incidents (MCI) Response Policy.  The policy herein is designed to provide

  a framework for responders to triage, treat, and transport victims of MCI incidents

  efficiently and effectively.  This policy is applicable for everyday use on all all-multi-

  victim situations and is intended to be utilized when the number of ill or injured

  exceeds the capabilities of the first-arriving units as well as for large-scale MCI’s

MCIs may include but not limited to:

• Five or more patients from one incident

• Multi-patient events that require specialized resources or rescue

• Three or more Priority 1 patients from one incident

• Multiple Pediatric patients requiring specialty resources

• Multiple burn patients requiring specialty resources

II. SCOPE

  This Policy/Procedure applies to all Fire and Rescue and EMS Companies or

   Department or Agencies that may respond to a Mass Casualty Incident in Kent

   County, Maryland and all employees of the Kent County Office of Emergency

   Services Communications Division and EMS Division.

III. Definitions

1. S.O.G. – Standard Operating Guideline

2. Mass Casualty Incident – An incident that requires an emergency response and has any number of casualties that exceeds the resources normally available from local resources.

3. MIEMSS – Maryland Institute for Emergency Medical Services System

4. Region IV Council – Governance body that advise MIEMSS on matters of policy, protocols, rules, and regulations.  The council serves as a forum for coordinating EMS activities among local EMS Operational Programs and is made up of Jurisdictional EMS Operational Programs, Local Governments, PSAP’s, Hospital Administrators, Medical Directors.

IV. General Guideline

1.         Initial Response

A.   The First arriving unit shall:

1.    Perform a scene size-up, estimating the number of victims and declare an MCI, to include requesting a level 1, 2, or 3 MCI response if not already performed by 9-1-1 communications personnel.

2.    An MCI declaration may be initiated while units are responding based on information provided by dispatch.

3.    If the MCI is an active threat or hostile event with unknown victims, the request shall be Level 1 response until a count can be determined to upgrade or downgrade as needed.

4.    Request additional units and/or specialized equipment through Incident Command (if established)

2.         When a Mass Casualty Incident is declared, the on duty 9-1-1 Specialist shall automatically implement the Mass Casualty Plan.  To utilize this plan, follow the instructions below.

A.        The first arriving officer shall establish command and:

1.    Identify a staging area.

2.    If an active threat incident or any tactical environment MCI, a Unified Command (UC) will be established with Law Enforcement (LE).  Law Enforcement will response per their SOP/SOG’s and relay relevant information to IC.  Rescue Task Force Operations (RFT) may be enacted.

3.    If area is deemed safe to enter, direct EMS responders and additional arriving personnel to initiate triage.

4.    When an incident commander declares an MCI, they will advise if they need a Phase I, II, or III response.

B.        Triage will be performed in accordance with START or JumpSTART.  Prioritize victims using color-coded ribbons:

1.    Red = Immediate Care

2.    Yellow = Delayed Care

3.    Green = Ambulatory (Minor)

4.    Black = Deceased (Non-Salvageable)

C.        Locate and direct the “walking wounded” to on causality collection point away from the incident scene, if possible.  These victims must be assessed as soon as reasonably possible, and a responder should be assigned to oversee and direct the walking wounded.

D.        As additional units arrive, Incident Command will designate the following assignments to unit/group supervisors:

1.    Triage (Initially the responsibility of first-arriving unit)

2.    Treatment

3.    Transport

4.    Medical Communication/Hospital Liaison

5.    Staging

E.        Additional Branches, groups, and/or units may be required depending on the complexity of the incident.  These directors, supervisors, or unit leaders may include, but are not limited to:

1.    Medial Branch

2.    Landing Zone

3.    Extrication

4.    Hazardous Materials

5.    Safety

6.    Rehabilitation

3.         MCI Considerations

A.   An MCI shall be declared by different levels based on the number of potential victims.  The number of victims will be based on the dispatch information, or initial scene size-up, prior to triage.

B.   Levels of response will augment the units already on the scene, units enroute will be included in the assignment.  The exception would be in the conjunction with a Fire Alarm assignment (i.e., a fire with multiple victims may be a second alarm with a MCI 3 response; this will be two separate assignments)

C.   Incident Command may upgrade MCI Level base upon anticipated resources demand, specialty care requirements, operational complexity, or scene hazards regardless of patient count.

D.   All assigned units shall respond emergency to the designated staging area unless otherwise directed by Incident Command.

E.   When announcing an MCI, specify the general category or injuries, i.e., trauma, Haz-Mat, smoke inhalation, etc.

F.    Request Law Enforcement to set up a safety perimeter and traffic control.

G.   Any victim meeting trauma transport criteria will be determined during secondary triage in the treatment phase.

H.   Consider early activation of Aviation for patients with critical injuries, and mass-transit resources for multiple walking wounded patients

I.     Consider using mobile command vehicles, medical supply trailers, and communication trailers as needed.

J.    Upon notification of an MCI, EMRC will be directed to control the Regional Administrator a gather any information about specific hospital’s capabilities and relay this information to the Medical Communications Coordinator.

1. On large-scale incidents, consider sending Hospital Liaison to each receiving facility to assist with communication.

K.   Transport units should be prepared for rapid off-load of patients at Hospital or Landing Zones.  Clearing units should return to staging until further directed.

V. LEVEL 1 MCI RESPONSE (5-9 PATIENTS)

  These response plan units shall be dispatched in addition to the initial alarm assignment:

1.         Dispatch the following

a.    Re-alert first alarm Fire and EMS apparatus that has not made a response.

b.    All County Medics

c.    Dispatch next 5 Ambulances (Staffed transport units BLS preferable)

1.    Ensure 1 Ambulance for each priority 1 patient.

d.    Dedicated EMS Supervisor; EMS Chief Pager,

e.    Dispatch next due Engine, Rescue, and Special Ops Trailer 8.

f.     All units are to operate on the assigned Talk-Group.

2.    Coordinate Talk Group with Incident Commander, as needed:

a.    Command Channel

b.    Operations Talk-Group

c.    Medical Talk-Group to include Triage, Treatment & Transport.

d.    Aviation Talk-Group

3.    Notify the closest hospital of the situation and possible number of patients.

4.    Dispatch additional Fire Police from the county area.

5.    Dispatch transfers to all depleted areas, for Fire, EMS, and Rescue

6.    This request should be from surrounding counties/states as appropriate.

7.    Notify the Chief of Communications, and Director of Emergency Services via phone call.

8.    Contact the closest off duty EMS and Dispatch staff and request any available to report for duty.

9.    Volunteer EMS ALL CALL

VI. LEVEL 2 MCI RESPONSE (10-19 PATIENTS)

1.         If a phase 2 MCI had been declared, and a phase 1 has not, you shall dispatch all equipment due on phase 1 and phase 2, you shall then follow instruction under phase 1 and 2.

2.         Dispatch additional resources

a.    10 Ambulances (Staffed transport BLS units preferable).

1.         Utilize any existing covers-ups.

b.    1 Suppression Unit

1.         Utilize any existing cover-ups.

c.    1 Rescue

1.         Utilize any existing cover-ups.

d.    Medial Ambulance Bus

e.    1 Dedicated Rehab Unit

  3. Automatically provide transfers for any depleted areas.

3.         Notify SYSCOM MIEMISS duty officer and closest appropriate hospitals of MCI.

4.         Notifications to Region IV Coordinators; Local & State EMS Medical Directors

  5. Consider mass casualty units from neighboring counties.

VII. LEVEL 3 MCI RESPONSE (20 or MORE PATIENTS)

1.         If as phase 3 has been declared and phase 1 and/or 2 has not, you shall dispatch all equipment due on phase 1 and 2, you shall then follow the instructions for phase 1, 2 and 3

2.         If a phase 3 MCI is declared ascertain approximate number of Priority 1, 2 and 3 patients.

a.    Ensure one Medic/Ambulance for each Priority 1 patient

b.    Ensure one Medic/Ambulance for each Priority 2 patient

c.    15 Staffed Transport Units

d.    3 Suppression Units

e.    2 EMS Supervisors

f.     2 Medical Ambulance Buses

g.    Dedicated Rehab Unit

  3.  Notify SYSCOM of total # of patients to be transported.

VIII. Additional Resources

1. The Incident Commander may request additional resources that may have to be

  completed by Emergency Management Director and the Emergency

   Operations Center Staff

a.    Check with Army National Guard for mass medical evacuation of priority patients.

b.    Check with School Board for buses for priority 3 patients

c.    Contact Maryland State Funeral Directors Association for mobile morgue if large loss of life is involved.

d.    Check with private Ambulance Companies

IX. SPECIAL INSTRUCTIONS

1.         Note any MCI Level Response Plan deployment requires notification to EMRC and Local Receiving Facilities and Specialty Centers.  Assistance accomplishing this can be done through EMRC or Region IV Coordinators

2.         EMRC, Receiving Facilities, and Specialty Centers shall be notified at the conclusion of the incident as well.

Betterton Volunteer Fire Company, Inc.

Chief Renny Grapes

YES      NO      NOT PRESENT

Chestertown Volunteer Fire Company, Inc.

Chief John Darling

YES      NO      NOT PRESENT

Community Volunteer Fire Company of Millington, Inc.

Chief Vince Baxter

YES      NO      NOT PRESENT

Galena Volunteer Fire Company, Inc.

Chief Jeffrey R. Haley

YES      NO      NOT PRESENT

Kennedyville Volunteer Fire Department, Inc.

Chief James L. Price, Jr.

YES      NO      NOT PRESENT

Kent & Queen Anne’s Rescue Squad, Inc.

Chief Jason Lobley

YES      NO      NOT PRESENT

Rock Hall Volunteer Fire Company, Inc.

Chief Mike Pinder

YES      NO      NOT PRESENT

Kent County Emergency Service Board

Chair Lynn Sutton

Submitted for Emergency Service Board Approval on ___September 14th, 2026__________

Compliance Date ________October 14th, 2026_________________________________

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