Mass casualty incident: Difference between revisions

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==Pre-hospital==
==Background==
===ICS===
*Mass Casualty Incident (MCI) defined as an incident where the number of patients (or the rate of their arrival to a medical facility) overwhelms local resources (and the ability to immediately supplement them).<ref name="Briggs">Briggs SM. Disaster management teams. Curr Opin Crit Care. 2005 Dec;11(6):585-9.</ref><ref name="Lee">Lee JS, Franc JM. Impact of a Two-step Emergency Department Triage Model with START, then CTAS, on Patient Flow During a Simulated Mass-casualty Incident. Prehosp Disaster Med. 2015 Jun 24:1-7.</ref>
 
==Potential Causes of MCI==
{{MCI types}}
 
==Management==
===Initial Triage===
*In an MCI, triage differs slightly from normal Emergency Department triage.
**Based not only on severity of injury/illness, but also on prognosis/survivability in the setting of limited resources<ref>Pesik N, Keim ME, Iserson KV. Terrorism and the ethics of emergency medical care. Ann Emerg Med. 2001 Jun;37(6):642-6.</ref>
*[[Mass casualty incident triage|START triage]] is the most common triage system utilized in the United States.
**Several other triage systems exist, but all (including START) lack validation or strong evidence (likely impossible given nature of MCIs)<ref name="Cross">Cross KP, Petry MJ, Cicero MX. A better START for low-acuity victims: data-driven refinement of mass casualty triage. Prehosp Emerg Care. 2015 Apr-Jun;19(2):272-8. doi: 10.3109/10903127.2014.942481.</ref><ref name="Kahn">Kahn CA, Schultz CH, Miller KT, Anderson CL. Does START triage work? An outcomes assessment after a disaster. Ann Emerg Med. 2009 Sep;54(3):424-30, 430.e1. doi: 10.1016/j.annemergmed.2008.12.035.</ref>
*Triage should be ongoing process, with patient statuses (and triage designations) updated as they change.
 
===Incident Command System (ICS)===
[[File:ICS org chart.bmp|thumbnail|ICS Organization Structure]]
[[File:ICS org chart.bmp|thumbnail|ICS Organization Structure]]
*Ensure the scene is safe
*Ensure the scene is safe
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*No more than 8 people per supervisor
*No more than 8 people per supervisor
**3-5 preferred
**3-5 preferred
===Medical operations===
*Establish triage area
**Utilize [[Mass casualty incident triage|START triage]]
**Ensure all patients receive physical tag
**Depending on size on incident, setup shelter for triage area
***In large incident, setup area for dead away from triage
*Call area hospitals and determine how many patients each can take
**Keep record of where each patient goes by tag number
==Hospital==
*Expect no more than 10 minutes notice for arrival of patients
*Discharge/move current ED patients to accommodate surge
*Ensure large quantity of resources are easily accessible in the (medications, stretchers, ect.)
*Triage all patients as they arrive, even if they were triage in prehospital setting
*Optimal to have 1:8 trauma teams per patient<ref>Hirshberg A., 2010 Nov, Triage and trauma workload in mass casualty: a computer model. J Trauma. 69(5):1074-81</ref>
==Differential Diagnosis==
{{MCI types}}
==Diagnosis==
*[[Mass casualty incident triage]]


==References==
==References==

Revision as of 08:36, 24 July 2015

Background

  • Mass Casualty Incident (MCI) defined as an incident where the number of patients (or the rate of their arrival to a medical facility) overwhelms local resources (and the ability to immediately supplement them).[1][2]

Potential Causes of MCI

Mass casualty incident

Management

Initial Triage

  • In an MCI, triage differs slightly from normal Emergency Department triage.
    • Based not only on severity of injury/illness, but also on prognosis/survivability in the setting of limited resources[3]
  • START triage is the most common triage system utilized in the United States.
    • Several other triage systems exist, but all (including START) lack validation or strong evidence (likely impossible given nature of MCIs)[4][5]
  • Triage should be ongoing process, with patient statuses (and triage designations) updated as they change.

Incident Command System (ICS)

ICS Organization Structure
  • Ensure the scene is safe
  • Establish Incident Commander (IC)
  • Request additional appropriate resources
    • Additional ALS/BLS
    • Fire resources (HAZMAT, heavy rescue, ect.)
    • Medevac
      • Establish landing zone
  • Establish staging areas for resources
  • No more than 8 people per supervisor
    • 3-5 preferred

References

  1. ↑ Briggs SM. Disaster management teams. Curr Opin Crit Care. 2005 Dec;11(6):585-9.
  2. ↑ Lee JS, Franc JM. Impact of a Two-step Emergency Department Triage Model with START, then CTAS, on Patient Flow During a Simulated Mass-casualty Incident. Prehosp Disaster Med. 2015 Jun 24:1-7.
  3. ↑ Pesik N, Keim ME, Iserson KV. Terrorism and the ethics of emergency medical care. Ann Emerg Med. 2001 Jun;37(6):642-6.
  4. ↑ Cross KP, Petry MJ, Cicero MX. A better START for low-acuity victims: data-driven refinement of mass casualty triage. Prehosp Emerg Care. 2015 Apr-Jun;19(2):272-8. doi: 10.3109/10903127.2014.942481.
  5. ↑ Kahn CA, Schultz CH, Miller KT, Anderson CL. Does START triage work? An outcomes assessment after a disaster. Ann Emerg Med. 2009 Sep;54(3):424-30, 430.e1. doi: 10.1016/j.annemergmed.2008.12.035.
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