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Mass Casualty Incident
Aka: Mass Casualty Incident, Disaster Medical Management, Disaster Medical Preparedness, Field Trauma Assessment and Treatment, MARCH Field Trauma Protocol
- See Also
- Trauma Team Activation (TTA)
- Trauma Primary Survey
- Trauma Secondary Survey
- Pediatric Trauma
- ABC Management (Cardiopulmonary Resuscitation)
- Emergency Procedure
- Trauma Center
- Trauma Triage in the Field
- JumpSTART Pediatric Multiple Casualty Incident Triage
- SALT Mass Casualty Triage Algorithm
- Simple Triage and Rapid Treatment (START Triage)
- Decontamination
- Contaminated Casualty Management
- Decontamination in Children
- Chemical Weapon
- Biological Weapon (Bioterrorism)
- Biological Neurotoxin
- Toxin Antidotes
- Violence in the Hospital
- Personal Protection Equipment
- Respiratory Personal Protective Equipment
- Preparation
- Mobilize resources
- General surgeons (as well as other surgeons such as OB/Gyn, Urology)
- Protective Equipment
- Personal Protection Equipment
- Respiratory Personal Protective Equipment
- Resuscitation equipment
- Mobilize hospital equipment (crash carts, airway equipment, Ventilators) to the immediate triage area
- Intravenous Fluid bags, Blood Products
- Prepare triage areas
- Prior to mass casualty patient arrival, move non-critical ED patients to other areas of the hospital or ED
- Assign a triage leader who will quickly assess each patient and assign a triage status
- Each patient has a set of initial Vital Signs (Heart Rate, mentation, respiratory status)
- Location and pattern of injury
- Consider using skin marker or sharpie to write triage number on patient (if tags not available)
- Assign a specific, single triage area through which all casualties will flow
- Assign an area for each triage level (minor, delayed, immediate or deceased)
- Exam: Triage
- Children
- JumpSTART Pediatric Multiple Casualty Incident Triage
- Adults
- Simple Triage and Rapid Treatment (START Triage)
- SALT Mass Casualty Triage Algorithm
- Management: Field Trauma Assessment and Treatment (MARCH Field Trauma Protocol)
- Background
- Equivalent of Primary Survey for the field
- Follow with Secondary Survey
- Control Massive Hemorrhage
- See Massive Hemorrhage
- Tourniquets can prevent limb Exsanguination
- Hemostatic Agents (e.g. Combat Gauze) or pressure bandages to trunk
- Airway
- Advanced Airway management including Cricothyrotomy
- Respirations
- Consider 2 rescue breaths in children
- Chest decompression (Tension Pneumothorax)
- Circulation
- Evaluate Vital Signs (Heart Rate, extremity pulses, Blood Pressure)
- FAST Exam (if time permits)
- Rapid transfusers (or inflated Blood Pressure cuff can form a pressure bag)
- Head and Hypothermia
- Evaluate mentation including Glasgow Coma Scale (GCS)
- Consider Altered Mental Status causes
- Traumatic Brain Injury
- Hypoxia or hypercapnia
- Hypovolemia
- Prevent Hypothermia
- Increased mortality risk in major Trauma patients
- Management: Toxin Exposures
- Decontamination
- Contaminated Casualty Management
- Decontamination in Children
- Agents
- Chemical Weapon
- Biological Weapon (Bioterrorism)
- Biological Neurotoxin
- Toxin Antidotes
- Precautions: Children
- Unique physiologic aspects
- See Rapid Cardiopulmonary Asessment in Children
- Children physically decompensate rapidly without significant warning beyond Tachycardia
- Children are more likely to experience multsystem Trauma from blunt injury (large head, immature skeleton)
- Children are most sensitive to chemical or Biological Weapons
- Aerosolized agents have greater effects due to increased Respiratory Rate and decreased body size
- Chemicals are absorbed more easily into a smaller volume of distribution
- Chemical burns involve a greater percentage of surface area
- Unique psychological aspects
- Lack self-preservation and coping skills of adults (more likely to be paralyzed by fear)
- Parent-child separation anxiety is likely to be exacerbated (avoid separating children from families)
- Prevention: Preparedness
- Disaster drills should include patients of all ages including children
- Local protocols should be based on National Incident Management System (NIMS) guidelines
- Equipment, medications and supplies to cover all ages of victim should be at the ready
- Broad involvement of all partners (including hospital systems and transfer agreements as well as EMS)
- Plan for emergency overflow facilities
- Plan for emergency power, utilities
- Plan for legal, Malpractice and documentation issues
- Plan for security issues including unattended children, quarantines
- Plan for patient tracking (pictures, names, descriptions, identification bands)
- Plan for media and communications
- Resources
- National Incident Management System (NIMS)
- https://www.fema.gov/national-incident-management-system
- References
- Seeyave and Bradin (2014) Crit Dec Emerg Med 28(12): 2-13
- Spangler and Nichols in Herbert (2016) EM:Rap 16(12): 5-7