Mass casualty incident

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  • 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


ICS Organization Structure

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)

  • An Incident Command System (ICS) is designed to allow for coordination of response to an MCI by providing for an integrated organizational/command structure[6]
    • ICS has been in use since the 1970's.
    • Designed to expand or contract in size in response to scope of incident.
  • After the September 11, 2001 terrorist attacks, the Department of Homeland Security proposed the National Incident Management System (NIMS) in response to perceived deficiencies in coordination between emergency responders.[7]
    • NIMS mandates the use of ICS in the United States for MCI response[6]

External Links

See Also


  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.
  6. 6.0 6.1 FEMA IS 0100.b - Introduction to the Incident Command System (ICS), Student Manual. Accessed 07/24/2015.
  7. Jensen J, Youngs G. Explaining implementation behaviour of the National Incident Management System (NIMS). Disasters. 2015 Apr;39(2):362-88. doi: 10.1111/disa.12103.