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Home > Topics > Mass Casualty Incidents
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EMS News in Focus
by Arthur Hsieh

5 ways to better handle an MCI

By Arthur Hsieh

Editor's note: Rescuers reflect on the horrors of the bus crash earlier this week that injured 23 and killed the driver of the bus. Editorial Advisor Art Hsieh offers these five tips if you're ever called to work in a similar situation.

You don't see reports about what happens after a major incident very often. Many of us will rarely be involved in a multi casualty event of this scope, and to be able to learn from others who have been there is essential to our development as public safety providers.

In this report, the incident commander does an excellent job breaking down the different operational aspects of MCI management. Keep in mind these basic tips if you're ever in a similar situation:

1) Keep calm. MCI scenes by definition are chaotic and filled with distraction. Take a deep breath and recognize one of your initial roles is to establish a sense of control for all involved.

2) Delegate roles early. Be confident in your ability to execute your system's MCI plan.

3) Communicate early and often. A lot of agencies will be involved during the event, and open lines of communications will be essential for moving patients out of the scene in a logical, organized manner.

4) Debrief, both formally and informally. While it's likely that there will be a structured operational debriefing, sometime after the event is over personnel involved in the rescue will begin the emotional debriefing much sooner.

Luckily, our profession recognizes that it's normal to feel stressed and anxious after being involved in such a rescue. Some will want to talk about it, others will want time to process internally. Having resources immediately available to help out the rescuers is important.

5) Learn. As the incident commander suggests, we can always do better then next time. Each incident should "end" with an after-action report that not only recognizes what went well, but also provides recommendations of what could be done better next time. Publish it widely, not only within the system but to others as well, so all can understand what happened and consider how to apply the lessons learned to their particular system or region.


About the author

EMS1 Editorial Advisor Art Hsieh, MA, NREMT-P currently teaches at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. Since 1982, Art has worked as a line medic and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook author, has presented at conferences nationwide, and continues to provide patient care at an EMS service in Northern California. Contact Art at
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