Mass casualty incident
- 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).
Potential Causes of MCI
- Radiation exposure (disaster)
- Dirty bomb
- Chemical weapons
- Mass shooting
- Natural Disaster (e.g. Hurricane, Earthquake, Tornado, Tsunami, etc)
- Unintentional large-scale incident (e.g. building collapse, train derailment, etc)
- Major pandemic
- 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
- START triage is the most common triage system utilized in the United States.
- 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
- 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.
- NIMS mandates the use of ICS in the United States for MCI response
- Briggs SM. Disaster management teams. Curr Opin Crit Care. 2005 Dec;11(6):585-9.
- 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.
- Pesik N, Keim ME, Iserson KV. Terrorism and the ethics of emergency medical care. Ann Emerg Med. 2001 Jun;37(6):642-6.
- 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.
- 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.
- FEMA IS 0100.b - Introduction to the Incident Command System (ICS), Student Manual. http://training.fema.gov/emiweb/is/is100b/student%20manual/02ics100b_sm_october2013.pdf. Accessed 07/24/2015.
- 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.