IR Incident Checklist v1.0

• Conducted on

  Date

• Personnel

• Type of Call

  Select Brush CO Helicopter LZ Medical Disaster Missing Person Motor Vehicle Rescue Rope Rescue Structure & Miscellaneous Fire Trench Rescue

  • Brush
  • CO
  • Helicopter LZ
  • Medical Disaster
  • Missing Person
  • Motor Vehicle Rescue
  • Rope Rescue
  • Structure & Miscellaneous Fire
  • Trench Rescue

• 4018 to the Head of the Fire

• Select date

  Date

• 4017 Establishes an Advantageous Anchor Point of the Fire

• Select date

  Date

• Cover All Exposures

• Select date

  Date

• Assign Deputy Command or Operations Chief

• Select date

  Date

• Water Re-Supply of Brush Trucks

• Select date

  Date

• Establish Personnel Rehab Area

• Select date

  Date

• Establish Personnel Staging Area

• Select date

  Date

• Personnel Accountability

• Select date

  Date

• Initiate Cause & Origin Investigation

• Select date

  Date

Questions to ask occupants: Are any members of the household feeling ill?

• Headache

  Select Yes No

  • Yes
  • No

• Nausea

  Yes

  No

• Shortness of Breath

  Yes

  No

• Fatigue

  Yes

  No

• Dizziness

  Yes

  No

• Confusion

  Yes

  No

• If the response to any of the above was "yes" have the occupant evaluated by EMS

• Do you feel better when away from the house?

  Yes

  No

• What appliances were on at time of activation?

  Select Gas Dryer Furnace Fireplace Gas Space Heater Gas Hot Water Heater Stove/Oven Other

  • Gas Dryer
  • Furnace
  • Fireplace
  • Gas Space Heater
  • Gas Hot Water Heater
  • Stove/Oven
  • Other

• What appliances were in use for the last 24 hours?

  Select Gas Dryer Furnace Fireplace Gas Space Heater Gas Hot Water Heater Stove/Oven Other

  • Gas Dryer
  • Furnace
  • Fireplace
  • Gas Space Heater
  • Gas Hot Water Heater
  • Stove/Oven
  • Other

Gas Detection Meter Checklist

• Outside Reading

• Upon Entering

• Space Heater

• Hot Water Heater

• Gas Refrigerator

• Stove/Oven

• Gas Dryer

• Garage

• Furnace

• Chimney

• Fireplace

• CO Detector

CO Detector Information

• Make

• Model

• Serial #

• Firefighter handling CO monitor

• Officer completing checklist

• Assign Ground Contact- IREACH Frequency on the VHF System

• Select date

  Date

• Avoid Brush Taller Than Knee High

• Select date

  Date

• Firm and Flat Surface- No More Than 5 Degree Slope

• Select date

  Date

• 100’ x 100’ LZ

• Select date

  Date

• Clearance of Overhead Wires- Park Vehicles Under Lines If Possible

• Select date

  Date

• Shut Down Both Traffic Lanes on Roadways

• Select date

  Date

• Keep Vehicle Emergency Warning Lights On

• Select date

  Date

• Use Strobe Lights to Mark the LZ- Crossing the Headlights of Two Vehicles Can Mark the LZ Too

• Select date

  Date

• Attempt to Illuminate Wires, Trees, Poles, or Other Obstructions

• Select date

  Date

• Remove All Loose Items and Debris from the LZ

• Select date

  Date

• Patients Needing Decontamination Must Be Decontaminated Prior to Loading

• Select date

  Date

Information Provided to the Pilot- Use Compass Directions

• Landing Zone Description (Parking Lot, Roadway, Field)

• Establish GPS Coordinates

• Surroundings (Trees, Buildings, Fences)

• Obstacles or Hazards (Wires, Poles, Towers)

• Surface Winds (Calm, Light, Variable, Gusting)

• Clearest Path of Approach

• No Personnel Within 100’- Bystanders 200’+

• Only Approach from the Front and Only When Signaled by the Crew

• Hold Nothing Above the Shoulder

• Do Not Attempt to Open or Close Aircraft Doors

• Secure Hats and Helmets

Radio Announcement on Fireground Channel

• Secure All Loose Items Including Hats and Helmets

• Do Not Give Hand or Light Signals

• Only Approach the Aircraft From the Front and Only When Signaled by the Crew

• Consult the On-Scene Medical Personnel to Establish if a Medical Disaster Exists

• The Southwestern Illinois EMS Region defines a medical disaster as any incident that produces casualties in such numbers that the routine methods for patient care are not adequate. The region goes on to define a major medical disaster as an incident requiring resources beyond the capacities of one Resource Hospital and its system hospitals within the region.

• Strike a 4th Alarm on the Vehicle or Machinery Rescue Call Type- Special Request EMS First Responders

• Establish an EMS Branch - Separate Rescue and Fire Suppression Operations from Triage and EMS Transportation Operations and Appoint an EMS Branch Director, Triage Officer, and EMS Staging/Transportation Officer.

• Establish a Triage Group Under the EMS Branch- Assign a Separate Triage Officer

• Establish an EMS Staging Group Under the EMS Branch- Assign a Separate EMS Staging Officer

• EMS Communications Shall Be Established- If No Other Workable Talk Group/Frequency Is Established, Establish EMS Staging and Transportation on VHF Merci 340 (155.340).

• Notify the Memorial Hospital Emergency Room @ 257-5840

• Notify CENCOM via Radio Over the Dispatch Talkback Talk Group (Fire Common 1)

• Notify New Athens ESDA via CENCOM (Only if the Incident Lies Within the Village of New Athens Village Limits)

• Report the Number and Condition of Patients to Memorial Hospital and Give Updates.

• Inquire from Memorial Hospital if the RMERT Team is responding. The RMERT Team will assume triage responsibilities upon its arrival.

• Request Air Ambulance and Additional Ground Ambulances If Needed

• Notify Memorial Hospital When the Last Patient Is Transported

Age

• Select one if the person is very young or old. Select two or three if not.

Medical Condition

• Select one or two if the person is known to be injured or ill. Select three if they are healthy or a known fatality.

Number of Subjects

• Select one if the subject is alone. Select two or three if there is more that one.

Weather Profile

• Select one if you have existing hazardous weather or if there is predicted hazardous weather in less that eight hours. Select two if hazardous weather is predicted in more that eight hours and three if no hazardous weather is predicted.

Equipment Profile

• Select one if their equipment is inadequate for the environment two if it is questionable and three if it is adequate.

Subject Experience Profile

• Select one if the subject is not experience and does not know the area. Select one or two is the subject has no experience and knows the area. Select two if the subject is experienced and is not familiar with the area. Select three if they are experienced and know the area.

Terrain and Hazards Profile

• Select one if there is hazardous terrain and two or three if there is few or no hazards.

History

• Select one if there is a history of incidents in this area. Select two or three if not.

• Add up the sum of the questions and compair it with the chart below.
  
  Appropriate Response to Urgency Ratings
  Factor Sum Response
  8-12 Emergency Response
  13-18 Measured Response
  19-24 Evaluated Response
  25-27 Search Situation or Missing Person

• Apparatus Approach & Placement

• Assess Hazards- Utilities, Fuel, Airbag Deployment

• Lookup Hazards- Utilize the EX App to Identify Vehicle Hazards

• Establish Rescue Priorities & Numbers

• Air Ambulance Necessity

• Vehicle Stabilization

• Rescue Tool Deployment

• Deploy Fire Protection

• Scene Lighting

• Report EMS on the Scene

• Report Patients Extricated and In the Hands of EMS

• Report Law Enforcement on the Scene

• Report Tow Service on the Scene

• Establish Personnel Rehab Area

• Establish Personnel Staging Area

• Confirm KV Task Force Notification

• Determination of the Scope, Magnitude, and Nature of Incident

• The Exact Location of Incident

• Risk vs. Benefit Analysis- Rescue or Recovery

• Identification of Scene Access

• Identification of Environmental Factors

• Available and Needed Resources- Consider 2nd Alarm Response

• Determine the Ability to Contact Victim

• Identify and Remove Hazards

• Appoint Operations Chief & Safety Officer- Qualified to the Level of the Incident

• Engine & Aerial Placement

• Primary Search Initiated

• Primary Search/Rescue Completed

• Defensive or Offensive Attack

• Assign Deputy Command/Operations

• Water Supply

• Fire Department Connection

• Check & Cover Exposures

• Assign Safety Officer

• Assign RIT Team

• Secondary Search Initiated

• Secondary Search Completed

• Exterior Lighting

• Establish Personnel Rehab Area

• Establish Personnel Staging Area

• Personnel Accountability

• Ventilation

• Control of Utilities

• Utility Companies Notification

• Report Fire Under Control

• Assess CO Levels

• Interior Lighting

• Assign Salvage Operations

• Initiate Cause & Origin Investigation

• Confirm KV Task Force Notification

• Available and Needed Resources- Consider 2nd Alarm Response

• Limit Access to the Trench

• Do NOT Allow Personnel to Enter the Trench

• Approach the Trench from Ends to Recon

• Place a Ladder in the Trench for Victims to Self-Rescue

• Beware Of Secondary Collapses

• Stop All Sources of Vibration within 300’

• Set Up Ground Pads to Stand On Around the Trench Lip

• Move Spoils Pile At Least 2’ Back From the Trench Lip

• Locate the Victims’ Position

• Mark the Victims’ Location- Score Ground on Both Sides

• Estimate or Measure Depth of the Victims

• Interview Co-Workers to Determine the Victims’ Last Position

• Appoint Operations Chief & Safety Officer- Qualified to the Level of the Incident