Mass casualty incidents require organized triage and incident management. Triage, often using the START algorithm, sorts patients by severity: walking wounded are first directed to a designated area and tagged Green; Red (immediate) is assigned to patients with respirations over 30 per minute, no radial pulse or capillary refill greater than 2 seconds, or inability to follow simple commands; Yellow (delayed) is given to those whose condition allows some delay; Black (deceased or expectant) is reserved for patients who are not expected to survive. The Incident Command System (ICS) provides a standardized organizational structure with a single Incident Commander responsible for overall management, while a Multiple-Casualty Incident (MCI) is any situation where the number of patients exceeds or challenges available resources.
Scene safety extends beyond initial size-up. At hazardous materials incidents, EMTs stage in the safe cold zone and provide care only after decontamination unless trained and equipped for hot zone entry; safety data sheets (SDS) provide essential information about hazardous substances. With downed power lines, all lines are treated as energized, and the EMT waits for the utility company or fire department to secure the scene before approaching. Standard precautions treat all body fluids as potentially infectious, with appropriate PPE including gloves, masks, and eye protection; for suspected active tuberculosis, an N95 or HEPA respirator is added. Emergency moves are used when a patient is in immediate danger and full spinal precautions cannot be maintained, while safe lifting technique keeps the back straight, bends at the knees and hips, holds the load close to the body, and uses the legs to lift. Emergency vehicle operation follows a legal standard of due regard for the safety of others, and lights and sirens are reserved for patients whose condition warrants expedited transport per local protocol.
Legal and ethical principles govern every patient contact. Consent may be expressed (verbally given by a competent adult), implied (assumed for an unresponsive or incapacitated patient who would reasonably want treatment), or, in true emergencies, applied to minors who lack parental availability; emancipated minors may provide their own consent under specific state laws. A competent adult patient may refuse treatment and transport if they have decision-making capacity, defined as being alert, oriented, and able to understand the risks and consequences of refusal; the EMT documents thoroughly and obtains a signed refusal form. Do Not Resuscitate (DNR) orders are honored when valid, with resuscitation withheld and documented per local protocol. Negligence requires proof of four elements: duty to act, breach of that duty, damages, and causation; scope of practice defines the duties and skills an EMT is legally permitted and trained to perform, and Good Samaritan laws protect those who provide emergency care in good faith within scope and without gross negligence. Abandonment is the termination of care without ensuring an equal or higher level continues.
Documentation is both a clinical and legal record. Every patient contact requires a complete, accurate patient care report (PCR) written in objective, factual language without opinions or judgmental statements. Errors are corrected by drawing a single line through the mistake, initialing it, and writing the correction rather than erasing or obliterating the original. The Health Insurance Portability and Accountability Act (HIPAA) protects patient confidentiality and limits disclosure of medical information to authorized parties.