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City of Toronto Emergency Plan
EMERGENCY SUPPORT FUNCTION
MASS CASUALTY
TORONTO PARAMEDIC SERVICES
Version 2.0
November 2014
Table of Contents
1.0 Introduction 2
1.1 Purpose 2
1.2 Scope 2
2.0 Concept of Operations 3
2.1 General 3
3.0 Roles and Responsibilities 5
3.1 Primary / Lead Agency / Division – Toronto Paramedic Services 5
3.1.1 Initial Actions 5
3.1.2 Toronto Paramedic Services Incident Site 5
3.1.3 Joint Area Command 8
3.1.4 Toronto Paramedic Services Division Operations Centre (DOC) 9
3.1.5 Toronto Paramedic Services Basic Response Organizational Chart 10
4.0 Supporting Agencies / Divisions 11
4.1 Toronto Police Service 11
4.2 Toronto Fire Services 11
4.3 Office of Emergency Management 12
Emergency Support Function
Mass Casualty
Primary / Lead Agency / Division: Toronto Paramedic Services
Supporting Agencies / Divisions: Toronto Police Service
(ABCD's) Toronto Fire Service
Office of Emergency Management
1.0 Introduction
1.1 Purpose
Toronto Paramedic Services, Toronto Police Service (TPS), and Toronto Fire Services (TFS) provide coordinated city assistance and resources to respond to mass casualty needs during an emergency.
A Mass Casualty Incident (MCI) is any event or emergency of varying duration where the number of victims and / or patients exceeds the immediately available resources, equipment or facilities.
Assistance provided under this Emergency Support Function is directed by Toronto Paramedic Services and is supported by several City divisions and external organizations.
1.2 Scope
This document provides a general overview of the coordinated medical response to an MCI that impedes routine health and medical services within the City of Toronto. Toronto Paramedic Services support includes:
People:
· Toronto Paramedic Services personnel including:
o Paramedics
o Emergency Medical Dispatchers
o Administrative and support staff including occupational health and safety and crisis intervention specialists
o Management staff
· Special Operations Team response participation, consultation, and technical assistance
o Joint CBRNE (Chemical, Biological, Radiological, Nuclear, Explosive) Team
o HUSAR (Heavy Urban Search and Rescue) Team
o ETF (Emergency Task Force)
o Toronto Paramedic Services ESU (Emergency Support Unit)
o Marine Unit
Processes:
· Incident Management System (IMS) model of response
o IMS is a comprehensive, flexible and adaptable approach to emergency management for unplanned and planned incidents encompassing personnel, facilities, equipment, procedures, and communications operating within a common organizational structure
o Is predicated on the understanding that in any and every incident there are certain management functions that must be carried out regardless of the number of persons who are available or involved in the emergency
o Management of any incident begins at the site level
· Incident response including all required command and general staff functions at multiple levels, if necessary:
o Toronto Paramedic Services Incident Site
§ Including Reception Centre Liaison
o Joint Area Command
o Toronto Paramedic Services Division Operations Centre (DOC)
o Toronto Emergency Operations Centre (EOC)
Places:
· Toronto Paramedic Services facilities including Toronto Paramedic Services Stations, Toronto Central Ambulance Communication Centre (CACC), DOC, etc.
Tools:
· Health/medical equipment and supplies
· Toronto Paramedic Services Fleet - Toronto Paramedic Services Ambulances, Support vehicles, MCI, CBRNE, and/or Special Event Pods, etc.
2.0 Roles and Responsibilities
2.1 Primary / Lead Agency / Division – Toronto Emergency Medical Services
2.1.1 Initial Actions
· Implementation of the Incident Management System (IMS)
· Notification of incident to allied agency partners, if not already completed
The following describes the basic organization of Toronto Paramedic Services response at the Incident Site, Joint Area Command, and DOC levels.
2.1.2 Toronto Paramedic Services Incident Site
Toronto Paramedic Services will establish Incident Site response in conjunction with allied emergency services and other partners.
General response priorities:
· Life safety
· Incident stabilization
· Maintain critical infrastructure
· Protect property and environment
Incident Site response takes into account:
· The severity of the incident
· The availability of resources
· The amount of site management required
An MCI may require, but is not limited to:
· Ambulance Units
· Emergency Support Units (includes Toronto Paramedic Services Bus)
· Toronto Paramedic Services Superintendents
· Toronto Paramedic Services Operations Commanders
· Tactical EMDs and dedicated radio channels
· DOC Activation
· Hospital notification
· Other resources as required
Pre- hospital response operates in two areas of the incident site:
1. Inner perimeter – Hot and Warm Zones
2. Outer perimeter – Cold Zone
Inner Perimeter-Hot and Warm Zones
The Hot Zone is the controlled danger or contaminated area that requires all medical responders working in this zone to be appropriately qualified. These qualifications are not limited to:
· CBRNE, HUSAR, etc. trained
· Part of a joint special team
· Have appropriate personal protective equipment (PPE)
o PPE is absolutely required in this zone.
The Warm Zone is the control area surrounding the controlled danger or contamination zone where life saving emergency care and decontamination are conducted. All medical responders working in this zone must be appropriately qualified. These qualifications are not limited to:
· CBRNE, HUSAR, etc. trained
· Part of a joint special team
· Have appropriate personal protective equipment (PPE)
o PPE is absolutely required in this zone.
Outer perimeter – Cold Zone
The Cold Zone is the area where normal medical triage and continuing medical treatment is provided. Normal medical triage prioritizes patients into minor, delayed, immediate, and deceased categories. Based on the acuity of the patient, they would be transferred to a staged Toronto Paramedic Services crew for continuing care and transport to the most appropriate hospital. In this area, rescuers do not require the same level of training or PPE as personnel in the Hot and Warm Zones unless it is specified.
Some or all of the following IMS functions may be activated, but are not limited to:
· Command and Command Staff
o Responsible for managing all responses to an incident
o May consist of a single person or team
o The title of “Command” is exclusive - only one per incident at each response level
o First and primary organizational component of IMS - all other functions report to Command
· Operations – including Joint Special Teams, Tactical Incident Site Communications support, etc.
o Directs and coordinates all incident tactical operations
o Is typically one of the first organizations to be assigned to the incident
o Expands from the bottom up
o Organizes, assigns, and supervises all resources assigned to an incident including the staging area
· Planning
o Maintains resource status
o Maintains and displays situation status
o Prepares the Incident Action Plan
o Develops alternate strategies
o Provides documentation services
o Prepares the demobilization plan
o Provides a primary location for Technical Specialists assigned to the incident
· Logistics
o Ordering, obtaining, maintaining, distributing and accounting for essential personnel, equipment and supplies, beyond those immediately accessible to operations
o Developing the telecommunications plan
o Providing telecommunications/IT services and resources
o Setting up food services
o Setting up and maintaining incident facilities
o Providing support transportation
o Providing medical services to incident personnel
· Finance and Administration
o Tracking timesheets for incident personnel and equipment
o Contract negotiation and monitoring, reimbursing expenses
o Making cost estimates for alternate response strategies
o Monitoring sources of funding
o Tracking and reporting of the financial usage rate
Within the cold zone, Toronto Paramedic Services may activate some or all of the following functions, but are not limited to:
· Triage
o Patients are assessed medically, classified appropriately by acuity of illness or injury and tagged for identification
· Treatment
o Patients receive appropriate medical and first aid treatment for their injuries, in priority of acuity, until transported from the Incident Site
· Staging
o Resources and personnel are assigned to the Staging area
o Provide resources as required to the Incident Site
· Transport
o Coordination of patient transport with the Communication Centre, based on Patient acuity and specialized treatment requirement
2.1.3 Joint Area Command
Toronto Paramedic Services may establish Joint Area Command in conjunction with allied emergency services and other partners
· Toronto Paramedic Services Area Command provides support and guidance to all Toronto Paramedic Services Incident Sites
Some or all of the following IMS functions may be activated, but are not limited to:
· Area Command and Command Staff
· Area Operations
· Area Planning
· Area Logistics
· Area Finance and Administration
2.1.4 Toronto Paramedic Services Division Operations Centre (DOC)
Toronto Paramedic Services may activate the Toronto Paramedic Services DOC
· Toronto Paramedic Services DOC provides support and guidance to Toronto Paramedic Services Area Command and Toronto Paramedic Services General Operations Command within the City of Toronto
Some or all of the following IMS functions may be activated, but are not limited to:
· DOC Command and Command Staff
o Command staff may be expanded to include support from:
· Allied GTA Emergency Medical Services
· Local Health Integration Network (LHIN)
· Community Care Access Centre (CCAC)
· Ministry of Health and Long-Term Care (MOHLTC)
o Emergency Health Services Branch (MOHLTC EHSB)
o Emergency Management Branch (MOHLTC EMB)
· Ontario Hospital Association (OHA)
· Coroner's Office
· Others as required
· DOC Operations
· DOC Planning
· DOC Logistics
· DOC Finance and Administration
· Toronto Paramedic Services may coordinate with support agencies to assist in providing health and medical services to citizens directly and indirectly impacted by the emergency
o This also includes response personnel and others involved in the incident
· Toronto Paramedic Services may coordinate the delivery of health and medical services with involved federal and provincial organizations including Health Canada and Ministry of Health and Long Term Care
· Toronto Paramedic Services may coordinate with the City's health and medical service providers, including the Ontario Hospital Association, hospitals and health care facilities (including medical and dental facilities)
2.1.5 Toronto Paramedic Services Basic Response Organizational Chart
3.0 Supporting Agencies / Divisions
3.1 Toronto Police Service
Police will be responsible for all site security and investigation including the following:
· Establishing a security and credentialing system
· Setting up a security perimeter and establishing a staffed entry/egress points.
· Briefing and debriefing personnel when entering or leaving the staging area.
· Removing unauthorized personnel from the scene.
· Acquire, assemble and coordinate all necessary TPS personnel, the materials required to support those personnel and the functions that will be required of them
· Provide advice and up to date information to the Incident Commander regarding TPS concerns, identifications or requirements of personnel.
· Apply special skills of officers within the identification processing group where required during the investigation.
· Assist Toronto Paramedic Services as required and/or requested.
3.2 Toronto Fire Services
Toronto Fire Services is dedicated to protect life, property and the environment from the
effects of fires, illness, accidents, natural disasters and other hazards. We are committed to enhancing fire safety and raising community awareness through education and involvement.
Toronto Fire Services will pursue the acquisition and use of the most effective technology, equipment and resources to ensure that we continue to perform in a competent and professional manner. We will always seek new opportunities to fulfill our mission.
Toronto Fire Services are dedicated to building a cohesive, equitable and unified workforce. We provide high quality and caring services to those who live in, work
in and visit our City – safely, efficiently and effectively.
3.3 Office of Emergency Management
The role of the Office of Emergency Management (OEM) is to strengthen the City's ability to prepare, respond and recover from major emergencies. The OEM is responsible for coordinating preparedness, mitigation, response and recovery activities for any major emergency or disaster (manmade or natural) affecting the City of Toronto.
This is achieved through:
· Maintaining the City's Emergency Plan
· Acting as curator of this Mass Fatality Operational Support Function
· Ensuring that this ESF complies with the City's Emergency Plan, and all other Operational Support Functions (ESFs), Risk Specific Plans and other relevant City of Toronto, Provincial and Federal emergency management legislation
· Ensuring Emergency Operations Centre Readiness
· Supporting implementation of the City Incident Management System at both site and Emergency Operations Centre levels
· Conducting Training
· Developing a multi-year comprehensive exercise program
· Conducting a Hazard Identification and Risk Assessment
· Delivering Public Education and Outreach
· Assisting Toronto Emergency Medical Services when updating this ESF based on current City of Toronto emergency plan, emergency management training, exercises and policies
Revision History – Mass Casualty
1.0 / I. Attard (Toronto Paramedic Services), M. Phair (TPS), J. Smysnuik (OEM), and M. Noormahamud (TFS) / · Complete update of the document with input from OEM, TPS, and TFS / April 2013
2.0 / J Smysnuik (OEM)
Adam Thurston (Toronto Paramedic Services) / · Incorporate change from EMS to Toronto Paramedic Services / November 2014
3.0
4.0 / ·
5.0
6.0 / ·
7.0 / ·
Mass Casualty ESF – November 2014 9