Appendix C

No Notice MCI Exercise Facilitator Checklist

Date: _______ Time:____________ Facilitator:___________________

ED Charge RN: ______________________________________________________
ED Supervisor/Lead: _________________________________________________
ED Physician: ______________________________________________________

The facilitator will enter the Emergency Department unannounced and identify the ED physician,
charge nurse, and ED HUC in the department at that time and walk through the initial steps of
an MCI response. This exercise shall not exceed 15 minutes.
Sample Scenario: The EMS radio announces a train collision….
Activating the MCI Protocol

 ED Charge RN or ED Supervisor/Manager will announce overhead: “ED physician, PA, ED triage

nurse, and ED HUC- report to the nurse’s station.”
 {Simulate} ED HUC or designee pages House Supervisor and ED leadership
 {Simulate} Assign a person to monitor EMS radio.
 Charge RN asks the huddle: Is AMCO very likely to receive patients? Will the event significantly
disrupt ED operations? Any security threats (call immediately)? Hazmat?
>> Decide if activating the MCI Protocol

Each role states top priorities within the ED:

 All role groups put on vest and maintain radio communication on channel one
1. ED HUC:
 {Simulate} WiTrac MCI notification, discuss what resources are available to the ED
 {Simulate} SWN to notify all ED staff and ED providers
 {Simulate} SWN to Surgeons and Hospitalists, report to ED
 {Simulate / Name} Assign a transporter to pick up 2 MCI blood coolers
2. ED Charge Nurse:
 {Simulate / Name} Assign RN to triage in EMS Garage and RN to ED entrance
 {Simulate / Name} Assign PSR to Ambulance Bay and ED Main entrance for registration
 Communicate needs to ED Manager or House Supervisor
3. ED Physician:
 {Simulate / Name} Appoint a provider to lead each below (in order):
o Triage / EMS Garage (oversee Disaster Registration Protocol) ED MD
o Acute Care Unit Leader (oversee Red pts) Surgeon
o Urgent Unit Leader (oversee Yellow pts) ED PA
o Minor Unit Leader (oversee Green pts) Hospitalist
 {Simulate /Name} Create/Manage Resuscitation teams
 {Simulate} Contact with Operating Room Control Desk
 {Simulate / Name} Designate a Blood Product Distribution Leader

Optional Educational Opportunities:

 Coordinated test call to switchboard operators (Clearly state “THIS IS A DRILL”)
 Coordinated Send Word Now message to leadership, OR, House Supervisors, etc.
 Coordinated test blood pick up (Clearly state “THIS IS A DRILL”)
 Test EHR Disaster Registration in the test environment

Notes:

9.2018
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