A paramedic is first to respond to a nine-vehicle incident; after scene size-up, what is the next appropriate action?

• A. Begin ALS care to the most seriously injured
• B. Establish command and transmit a preliminary report to dispatch
• C. Report number of injuries to medical control
• D. Begin tagging all the patients and provide first aid care

Answer: (B)

The action being tested is establishing incident command and communicating with dispatch. When the first unit arrives at a complex, multi-vehicle incident, solid organization is essential to keep responders safe and to coordinate care for many patients. By assuming command, you create a clear point of responsibility and a structure for prioritizing tasks, managing resources, and maintaining scene safety. Transmitting a concise preliminary report to dispatch immediately informs the communications center of your location, scene conditions, hazards, the estimated number of patients and their general status, and what additional resources are needed. This early notification enables rapid deployment of additional ambulances, responders, and extrication tools, and sets the stage for orderly triage and treatment.

Begin ALS care to the most seriously injured and begin tagging all patients are important steps, but they come after establishing command and securing the flow of resources. Reporting the number of injuries to medical control is useful, but the first, most urgent action at an MCIs scene is to set up command and request support to prevent chaos and ensure coordinated care.