Major Incident Management: Command and Control

Deal with any scene in the following sequence

Command and Control

Tiers of Command

Responsibilities of medical personnel on scene

Deal with any scene in the following sequence:

1. Command & control
2. Safety
3. Communication
4. Assessment
5. Triage
6. Treatment
7. Transport

Command and Control   

• Command and control are the cornerstones of Major Incident Management.
• SCENE CONTROL is usually a POLICE responsibility.
• INCIDENT MEDICAL COMMANDER takes overall MEDICAL CONTROL at the scene

Tiers of Command:

BRONZE

• Operational area = “HOT Zone”
• Immediate hazard and casualty rescue area
• Boundary is the Inner Cordon
• Each Service designates a Bronze Commander (EMS = Forward Medical Commander)
• In large incidents there may be multiple forward commanders appointed – these are then designated SECTOR medical commanders
• Each service’s Bronze (Forward ) Commander reports to their Service’s Incident Commanders
• Forward Commanders from different services must also communicate with each other
• BRONZE CONTROL may be a FIRE responsibility if there is a specific hazard (eg. Fire or hazardous materials)

INNER CORDON:

• Not always physical barrier
• Controlled by police
• Access may be strictly limited if hazard on scene

SILVER 

• Tactical Command = Entire scene area
• Boundary is the Outer Cordon
• Each Service designates a Silver Commander (EMS = Incident Medical Commander)
• Incident commanders form “Silver Control”
• Incident Commanders may move physically into Bronze Areas
• The first Vehicle on scene from each service becomes the Initial Incident Command unit

OUTER CORDON

• Controlled by police
• Physical cordon
• Restricts general access

GOLD 

• Highest level of command
• (Strategic) Often remote from the scene
• Chief Officers of Emergency Services (& local Authorities & other representatives)

CASUALTY CLEARING STATION

• The site where patients are taken to from the incident for emergency treatment
• Must be SAFE from the “hot zone”; SHELTERED, FLAT ground, UPSLOPE and UPWIND.

Responsibilities of medical personnel on scene 

INCIDENT MEDICAL COMMANDER

• Overall Scene Medical Command
• Liaise with other agency Commanders
• Activate Incident Command System
• Appoint relevant Tasks
• Liaise with Media

SECTOR MEDICAL COMMANDER

• Overall Sector Medical command (bronze area)
• Coordinate Medical Rescue Operations
• Appoint Primary Triage Officer
• Liaise with Incident Medical Commander

CASUALTY CLEARING STATION OFFICER

• Accept patients
• Coordinate secondary triage and advanced life support treatments
• Liaise with transport officer for movement of patients
• Liaise with Incident Medical Commander

PRIMARY TRIAGE OFFICER

• Primary triage of patients in Bronze Area
• Feedback to Sector Commander

TRANSPORT OFFICER

• Organise and direct Transport
• Establish Holding Area, access and egress routes
• Load patients

SAFETY AND SECURITY OFFICER

• Assess situation for safety of staff, patients and bystanders.