🚑 Mass Casualty Incident with Surge

Formally activate MCI protocol: START/SALT triage at scene, Casualty Collection Point (CCP) establishment, hospital pre-notification for incoming patient surge, medical branch director assignment, and patient tracking initiation.

“At what patient count does your MCI protocol trigger — and are you confident your local hospitals can absorb the patients before mutual aid can arrive?”

Open an Alternate Care Site (ACS) to decompress hospital emergency departments. Identify facility, activate healthcare staffing, establish patient intake screening, and coordinate medical supply logistics.

“Where is your pre-designated ACS, and does it have the medical staffing agreements and supply cache in place to activate within 12 hours?”

For communicable disease events: establish isolation protocols for patients, PPE requirements for responders and healthcare workers, contact tracing initiation, and coordination with infection control specialists.

“Which first responders and healthcare workers have already been exposed to this pathogen — and what is your protocol for their monitoring, isolation, and continued operational role?”

Coordinate with the Medical Examiner/Coroner on mass fatality operations: scene management, remains recovery priorities, victim identification process, family notification coordination, and temporary storage.

“At what point does the volume of fatalities exceed your Medical Examiner's capacity — and what is the mutual aid or federal support mechanism for mass fatality events?”

Submit a request through the state for Strategic National Stockpile (SNS) assets: pharmaceuticals, vaccines, medical countermeasures, ventilators, or personal protective equipment. Lead time is critical — request early.

“What medical countermeasures do you need in the next 48 hours that are not in your local cache — and have you submitted the state request for SNS already?”

Work with the Hospital Incident Command System (HICS) and regional Healthcare Coalition to implement surge protocols: patient diversion management, discharge acceleration, cancellation of elective procedures, and staffing surge.

“What is the actual surge capacity of your regional hospital system right now — and which hospital will hit maximum capacity first if this incident continues at current rates?”

Open and staff a Special Needs or Medical Needs Shelter for residents with medical conditions requiring support beyond a general population shelter. Coordinate with EMS, DOH, and home health agencies for patient intake.

“Do you have the nursing staff committed and the medical supply pre-positioned at your SpNS — and what happens when a shelter resident's medical needs exceed SpNS capability?”

Establish an expedited disease surveillance and case reporting system. Brief healthcare providers on the case definition, required reporting timeline, and the reporting mechanism. Assign an epidemiologist to data management.

“How long does it take for a clinician who sees a case to report it to your health department — and how does that delay affect your ability to understand the scale of this event?”

Stand up a dedicated public health hotline staffed by trained personnel who can answer questions about exposure, symptoms, treatment access, and protective measures. Provide consistent, accurate answers.

“What happens when your public health hotline receives more calls than it can handle — and how do you direct overflow callers to accurate information without them turning to social media?”

Deliver a structured clinical briefing to all hospitals, urgent care centers, and primary care providers in the jurisdiction: case definition, symptoms, diagnosis, treatment protocol, isolation requirements, and reporting.

“How do you reach private practice physicians and urgent care clinics that are not in your hospital system coordination network — and why does that gap matter for case identification?”

Issue a formal Public Health Advisory with specific, actionable guidance: symptoms to watch for, when to seek care, where to go, and what protective actions to take. Use plain language and multiple languages.

“What is the single most important action you want the public to take right now — and is your current public communication making that action clear and easy to execute?”

Open a Point of Dispensing (POD) or mass vaccination site. Coordinate with pharmacy partners, volunteer healthcare professionals, and security. Set up patient flow to minimize wait times and exposure.

“How many people can your POD vaccinate or treat per hour — and what is the realistic throughput over a 12-hour operational day given your current staffing?”

Monitor and rapidly correct dangerous misinformation about this public health event: false treatments, incorrect transmission routes, unverified case counts. Partner with trusted community voices.

“What is the most dangerous piece of public health misinformation currently spreading in your community — and who is the most credible messenger to correct it?”

Declare a Public Health Emergency at the appropriate level (local, state). Understand what legal authorities this activates: quarantine, isolation enforcement, expanded scope of practice, emergency procurement.

“Which public health emergency powers does your jurisdiction actually have — and which ones require a state or federal declaration before they become available to you?”

Establish direct coordination with the State Health Officer and state health department for resource support, regulatory guidance, media coordination, and escalation to federal partners (CDC, HHS).

“What do you need from the State Health Officer that you cannot get through normal channels — and have you made that specific ask directly to their office?”