EM · Disaster & mass casualty
Disaster and mass casualty
The disaster and mass casualty management: the disaster cycle, the START triage, the incident command system, the surge capacity, the decontamination for the chemical/biological/radiological incident, and the ethical framework of the greatest good for the greatest number.
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Red flags
- The mass casualty incident changes the standard of care from the individual to the population — the greatest good for the greatest number
- The START triage categorises in under 60 seconds per patient: the immediate, the delayed, the minimal and the expectant
- The first patient to walk into the ED is often the least injured — the most injured arrive later by ambulance
- The incident commander does not treat patients — the commander coordinates
- The chemical, biological or radiological incident requires the decontamination before the entry to the ED
The disaster and the mass casualty incident (the MCI) is the event in which the number or the type of casualties exceeds the normal capacity of the emergency medical services, and it requires the shift from the individual standard of care to the population standard — the greatest good for the greatest number. The Fellowship candidate must know the disaster cycle, the START triage, the incident command system, the surge capacity, and the decontamination, because the MCI is the ultimate test of the emergency physician's ability to manage the system, not just the patient.[1]
The disaster cycle
The disaster management is a cycle of four phases. Prevention: the mitigation of the hazard (the building codes, fire safety, public health). Preparedness: the planning, training, stockpiling, drills, mutual aid agreements. Response: the activation, triage, treatment, transport, incident command. Recovery: the return to the normal, psychological support, debrief, review and the improvement. The emergency physician is involved primarily in the response, but the preparedness (the drills and the plans) determines the quality of the response.[1]
References8ShowHide
- [1]Sarin RR, et al. Core Disaster Medicine Education (CDME) for Emergency Medicine Residents in the United States Prehosp Disaster Med, 2019.PMID 31455462
- [2]Rossaint R, Bouillon B, Cerny V, et al. The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition Crit Care, 2023.PMID 36859355
- [3]Lerner EB, Schwartz RB, Coule PL, et al. Mass casualty triage: an evaluation of the data and development of a proposed national guideline Disaster Med Public Health Prep, 2008.PMID 18769263
- [4]Lerner EB, Schwartz RB, Coule PL, et al. Use of SALT triage in a simulated mass-casualty incident Prehosp Emerg Care, 2010.PMID 19947863
- [5]Jacobs L The Hartford Consensus: how to maximize survivability in active shooter and intentional mass casualty events World J Surg, 2014.PMID 24615600
- [6]Jacobs LM, McSwain NE Jr, Rotondo MF, et al. Improving survival from active shooter events: the Hartford Consensus J Trauma Acute Care Surg, 2013.PMID 23694864
- [7]Sasser SM, Sattin RW, Hunt RC, et al. Blast lung injury Prehosp Emerg Care, 2006.PMID 16531371
- [8]Wanner GK, Atti S, Jasper E. Chemical Disaster Preparedness for Hospitals and Emergency Departments Dela J Public Health, 2019.PMID 34467061