MCI Basics for EMTs: START, Command, and Your First 60 Seconds
The first-arriving unit's job at a mass casualty incident, START triage in plain language, and NIMS 100/700 rules to know.
November 3, 2026 · 8 min read
MCIs are chaos organized by protocol. If you're first on scene, you're incident commander until relieved — and the first 60 seconds set the tone for the entire response.
First-unit priorities
- Scene size-up over the radio: what, where, resources needed, hazards.
- Establish command by name and location.
- Do NOT commit to patient care — the temptation is huge, resist it.
- Request appropriate resources including additional ALS, buses, aeromedical.
START triage in one paragraph
Walking wounded = green. Then RPM: respirations > 30 = red, no radial = red, can't follow commands = red. Apneic after airway repositioning = black. Everyone else = yellow. Under 30 seconds per patient.
Sectors and staging
Once command is set, break the scene into triage, treatment, and transport sectors, plus a staging area for incoming units. Yellow and green tag treatment can wait; red patients move first.
The NREMT MCI question
When the scenario says 20 patients and one ambulance, the answer is almost never 'transport your critical patient.' It's 'establish command and request additional resources.' Care comes second to organization.
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