The first ten minutes at a mass casualty incident
The first ten minutes set up the rest of the incident. The first crew on scene is not there to treat the first patient they see. They are there to take control.
This guide is general information for trained responders. Follow your own service's protocols and local rules, which may differ.
1. Safety first
Stop at a safe distance and look. Fuel, fire, traffic, power lines, unstable structures, an angry crowd. If it is not safe, do not go in.
2. Take command
One person says out loud "I am incident commander" and wears the vest. Until someone more senior takes over, that person runs the scene, not a patient.
3. Send the first METHANE report
Even a rough one. Control needs to start sending help now, not once you have counted everyone. See our guide on the METHANE report.
4. Start the triage sieve
Your partner starts the sieve: walking wounded to one place, then tag the rest. See triage sieve and sort explained.
5. Plan the scene
- Where incoming ambulances wait, and the way in and out.
- Where the casualty clearing station will be.
- Where the walking wounded wait.
6. Hand out roles as help arrives
Triage, treatment, transport, staging. Each person gets one job. Write down who has what.
7. Send updates
Send an updated METHANE when the numbers or hazards change.
Run this on a phone, not on paper
Incident Commander gives every responder the same picture: triage, patients, transport, METHANE reports, roles and a live scene map. It works without signal.