MASS CASUALTY MANAGEMENT

Definition
A mass casualty incident refers to any call

that involves more than one patient, as

well as any situation that places such a
great demand on available equipment or
personnel that the system is stretches to
its limit or beyond. E.g. airplane, bus
crashes or hurricanes

Introduction to Mass
Casualty Management
Points to Ponder:
1.

What are the capabilities of the

Emergency Medical Services?

2.

At What Point are these Facilities

Overloaded?

3.

What is the Role of the Police in a MCI

Fire
NGOs
Armed Forces

Mass Casualty Management

Aims of Disaster Management
Reduce (avoid, if possible) the

potential losses from hazards

Assure prompt and appropriate

assistance to victims when

necessary

Achieve rapid and durable recovery

Mass Casualty Event

Sequence of Events

Rescue
Triage
First aid
Transport to hospital
Medical care

Mass Casualty Management

Basic Rescue Chain
Search
Rescue

Triage

Triage

Definitive Care

First Aid

Disaster Area

Transportation

Hospitalization

Multi Sectoral Approach to

Mass Casualty Management
Organizations

Police
Defense Force
Fire Service
Emergency Ambulance Service
Hospital
N.G.O

Multi Sectoral Approach to

Mass Casualty Management
Police

Security -

At disaster site
At hospital
Traffic Control
Crowd Control
Incident Command
Crash Investigation

Multi Sectoral Approach to

Mass Casualty Management
Fire Service

Search and Rescue

Fire Control
Chemical spill Control

Emergency Room
Provide Personnel at the Disaster site
May assist staff at the Hospital Centers
Reception of the Victims at hospital

Multi Sectoral Approach to

Mass Casualty Management
Ambulance Service
First responder
Transportation of Victims to the Health
Care Facility

Hospitals
Reception and treatment of victims

Multi Sectoral Approach to

Mass Casualty Management
NGO
First Aid
Supplies Management
Assist with Transport
Communications (HAM Operators)
Psychological Support to:
Victims
Rescuers
Relatives of Victims

triage

History of Triage
Probably developed in the Napoleonic Wars, by
Army Surgeons trier to sort
To do the most good for the most people
Get the soldier back fighting
Refined during the Vietnam war
Process of prioritizing care to ensure the
sickest is seen the quickest.
Mid 70s adopted into civilian emergency
dept practice.

Triage Assessment
How does triage work
Practice
Knowledge
Training
Pattern recognition

Triage Assessment
Appearance
Airway
Breathing
Circulation
Disability
Pain
Presenting

complaint

MCI Alert vs. Activation

Alert-when

information is received which

indicates potential for large number of
casualties
Activation-when a confirmed single site
disaster with casualties overwhelms an
initial response unit capabilities.

Provide the following

information at time of activation:

Type of incident
Location of incident
Best access route
Number of injured (approximate)
Type of injuries (burns, respiratory, trauma)
Additional resources (special rescue equipment,
additional fire/police, communication equipment,
hazmat response, lights, coroner, helicopters)

Triage
Goals
Efficient use of personnel, equipment

and facilities
Not to relocate the disaster to the
hospital

Triage
Philosophy
Greatest

good to greatest number

Organized care within chaos
Preplanning/training are essential
Establishing ICS as soon as possible

Medical Triage Tag

Green walking wounded minor. Minor injuries

that can wait for longer period of time prior to
treatment
Yellow delayed transport serious. Potentially
serious injuries, but are stable enough to wait a
short while for medical treatment
Red immediate transport. Critical. Lifethreatening but treatable injuries requiring rapid
medical attention
Black dead or non salvagable no CPR. Death or
lack of spontaneous respirations after airway is
opened

Red immediate transport

Unconscious
Altered mental status
Sever head injury
Open chest wound
Crushing chest injury
Open abdominal
wounds
shock

Crushing abdominal
or pelvic injury
Possible cervical
spine fracture
Fracture with no distal
pulse
Fractured femur
Airway compramised

Yellow delayed transport serious

Sever burns
Spinal injury (except
cervical spine)
Moderate bleeding
(less than two pints)

Conscious patient
with head injury
Multiple fractures
Head injury

Green walking wounded minor.

Minor bleeding
Minor fractures
Minor soft tissue
injury

Moderate or minor
burns
Walking wounded

Black dead or non salvagable no

CPR.
Obvious dead
No pulse, no respiration
Save the ones you can save and dont

waste time on the ones you cannot.

START Triage System

S

Simple
T Triage
A And
R Rapid
T Treatment

START
1. Start where you stand

2. Identify walking wounded (minor)

3. Begin assessing the remaining
victims

START SYSTEM UTILIZES RPM

Respiratory effort
Pulses / Perfusion
Mental status

TRIAGE STEPS
Respirations
1

If absent - reposition airway

absent - tag black
present - tag red
>30 tag red
<30 go to step 2

TRIAGE STEPS
2

Perfusion-Capillary refill
>2 seconds tag red
<2 seconds go to step 3
OR
2 Perfusion-Pulse (radial)
no palp tag red
palp go to Step 3
(control any gross bleeding)

TRIAGE STEPS
3.

Mental status
Unable to obey commands
tag red
Able to obey commands
tag yellow

Patient Tracking

The second perforated tag provides for patient

tracking. This part of the tag shall be removed at
the ambulance loading area to record patent
destination. Patients name is recorded on back
of tag. With the bar code capability information
can be recorded electronically as well as by
hand.

Lesson Summary

Regardless of the definition, Multiple Casualty

Incidents stress emergency resources and
responders
The Incident Command System is a
standardized, onscene,
all-hazard incident management concept. Early
implementation will help bring order to a chaotic
situation
Incident Command is assumed by the first unit
on
scene and may be delegated to another person

EMS roles in the multiple casualty incident include,

but are not limited to, Triage, Treatment, and
Transport of casualties
START triage method provides a rapid assessment
tool based on Respirations, Pulse, and Mental status.
This allows limited numbers of responders to
evaluate large numbers of patients
Triage Tags are located in the Diagnostic Pocket of
the EMS Kits
The use of Triage Tags should be considered on all
calls involving 3 or more patients.

INCIDENT COMMAND SYSTEM

Incident Command System

The Incident Command System, or ICS, is a

standardized, on scene, all-hazard management
concept
The ICS is flexible and can grow or shrink to meet
the needs of the incident
The ICS has a top-down organizational structure
which begins when the first responder on the scene
becomes the first Incident Commander and expands
as necessary
The ICS involves the designation and coordination of
elements such as extrication, triage, treatment,
transport, and staging

Incident Commander

First arriving unit assumes command until they

delegate the authority to another person
Establish communications and request
additional resources
Stabilize the incident and provide for life safety,
accountability, and welfare of personnel
Ensure that all patients are extricated,
triage/treated, and transported to medical
facilities

Multiple Casualty Exercise

Patient

states he cant
move or feel his legs
Respirations are 26
Pulse is 110 (Radial)
He is awake and oriented
What Triage Category?
Delayed

Multiple Casualty Exercise

Patient

is soaked with blood

no obvious killer bleed
Respirations are 38
Pulse is weak, no radial
He is awake
What Triage Category?
IMMEDIATE

Multiple Casualty Exercise

Patient

walks over to you and

has an obvious broken arm
Respirations are 22
Pulse is 124 (Radial)
He is awake, alert, and crying
What Triage Category
Minimum

 Patient

is face down in the

field
Not

Breathing
Weak Carotid Pulse
She is unresponsive
What do you do first?
Open The Airway

 Patient

gurgles but cant

maintain an open airway
and Is not breathing
Weak Carotid Pulse
She is unresponsive
What Triage Category?
EXPECTANT

 Patient

has an open head

Wound, bleeding controlled
Respirations are 16
Pulse is 88 (Radial)
He is unconscious
What Triage Category?
IMMEDIATE

THANK YOU