Mass

Casualty

Incident
Presented by:
Jessica Bearmesa
Cristel De Torres

Mass casualty

incident
it is an event which generates more

patients at one time than locally availbale

resources can manage using routine

procedures. It requires exceptional

emergency arrangements and additional

or extraordinary assistance
Mass Casualty incidence

program Emergency

planning process

DEFINE PROJECT
PLANNING GROUP
ANALYZE POTENTIAL PROBLEMS
ANALYZE RESOUCES

ROLE AND RESPONSIBILITIES

DEVELOP STRATEGIES
 EMERGENCY
1. Agencies and
PREPAREDNESS AND
responders
RESPONSE
2. Triage
3. Treatment
4. Transport
1.)Agencies and Responders
2.)Triage

Triage- establishing priorities of patient care for urgent

treatment based on the severity of their condition while

allocating limited resources

Triage: Sorting of Patients

You can't commit to "one-on-one" care

You have to be fast- 30 sec or less per patient
Very limited treatment is provided
1. Manually open airways
2. Clear airway with finger sweep
3. Control major bleeding
 Primary and

Secondary Triage

Primary Triage
1st contact
Assign triage Category
Secondary Triage
ongoing process that takes place after the

patient has been moved to a treatment/

holding area awaiting transport

TRIAGE CATEGORIES

RED (1)= IMMEDIATE- critical patient

YELLOW (2)= DELAYED- serious patient that
could wait until all reds have been transported
GREEN (3)= AMBULATORY/HOLD- minor injuries
BLACK= DECEASED (expectant)
The "START" System of triage

S.M.A.R.T
Simple Triage And Rapid Treatment
The method was developed in 1983 by the staff

members of the Newport Beach Fir Department located

at Hoag Memorial Hospital in Newport Beach, CA

Easy to use
Focus is on signs/symptoms
Fast
START- 4 things to think about....

Ability to follow directions and walk

Respiratory effort
Pulses/perfusion
Mental Status

"RPM"
The "START" System of triage
-using START Triage, evaluate victims and assign them
to one of the following four categories:

Walking wounded/minor (GREEN)

Delayed (YELLOW)
Immediate (RED)
Deceased/ Expectant (BLACK)
TRIAGE TAGS
Types of Triage tags
There are several types of tags on the market
QAEMS System uses the SMART TAG
Advantages of using triage tags
Alerts providers to priorities
Prevents re-triage
Tracking system
Pediatric Modifications for
START= JUMPSTART

Expect children to be part of a disaster

JumpStart- modified START for kids
Designed for children ages 1-8 y/o
3.) Treatment: given in area of incidence if

available or after transporting patients to

health facilities

4.) Transport
Preparation for Mass Casualty

-Pre-planning and training are critical

-Establish guidelines and procedures
-Early implementation of Incident Command
-First five minutes will determine next five
hours
Response Categories for Mass Casualties

Mass Casualties can occur in a variety of ways

Effect on emergency response and community impact
Include transportation, violent crimes and building collapse
Response Categories of Mass Casualties

-Hazardous materials incidents

-Civil disturbances
-Natural disasters
-Major fires
Different Approaches to MCI

1. "Scoop and Run"

2. Classical Approach
3. Mass Casualty Management System
Scoop and Run

-Most common
-Does not require specific technical ability from rescuers -Justified
for small numbers occurring near a hospital
-May just transfer problem to the hospital
Classical Approach
First responders are trained (basic triage and field
care)
Disregard the receiving hospitals from the field
Quickly result to chaos
Mass Casualty Management

-Approach Most sophisticated approach includes pre established

procedures for:

a . resource mobilization
b. field management
c. hospital reception
Mass Casualty Management Approach

-Training of various level of responders

-Incorporates links between field and health
care facilities
-Command Post Multi-sectoral Response
-Dependent on the availability of large
amounts of human & material resources
Activities at various levels of responses:

'E'/ Disaster Site/Scene -

alerting process initial assessment
command/control/ coordinate manage information
search/rescue field care-- mostly health activities
transport /traffic control facility reception at ER/
A&ED hospital mass casualty mgt. & command
system.
Alerting Process

Definition: Sequence of activities implemented to achieve the

efficient mobilization of adequate resources

Aim :
-Confirm the initial warning
- Evaluate the extent of the problems
-Ensure that appropriate resources are informed and mobilized
Field Organization

Alerting Process

Dispatch Center:

-Core of the Alerting Process (Operation/Communication Center)

-Functions:

receives all warning messages (radio/phone)

mobilize a small assessment team (Flying Team ) from police, fire or
ambulance services
Initial Assessment

-Precise location of the event

-Time & type of the event
-Estimated number of casualties
-Added potential risk
-Exposed population
-Resources needed
Pre-Identification of Field Areas

-Impact Zone
-Command Post
-Collecting Area in unstable location
-Advance Medical Post Area (3-T Principle)
-Evacuation Area VIP & Press Area (Information Officer)
-Access Roads (geographical presentations if available)
-Check point for resources (Staging Area)
Safety
Best practice technique to protect victims, responders & exposed population:
immediate/potential risk

Measures:

Direct action :
- risk reduction fire fighting
- contain hazardous material
- evacuation of exposed population

Preventive actions:
-establish field areas
-primary-impact zone
-secondary-rescue/ICP/AMP -tertiary- "buffer zone "tri- media
Command Post (CP / or ICP)

Multi-sectoral control unit to: -Coordinate sectors involved in field / scene

management
-Linked w/ back-up system: provide information & mobilization resources Supervise
victim management

REQUISITE: radio communication network: main criterion to be effective

Purpose: coordination
communication hub of people who don't work routinely (pre-hospital setting)

Location: external boundary of restricted area (impact zone)

Personnel

High ranking officer (government police, fire, health, defense )

-plant manager/ airport manager/ chief security, etc...
-fire officer / police officer skilled in ICS MCM
Identified by name/position, coordinator / commander
May depend on what type of incident
Must be familiar with each other's roles during previous
meetings/ drills/ simulation exercises (policy)
This core group cooperate with volunteer organizations
METHOD
-The communication coordination hub of the pre hospital organization. By constant re-
assessment, CP will identify needs to increase / decrease resources:
-organize timely rotation of rescue workers exposed to stressful/exhausting conditions in
close coordination w/ back-up system -ensure adequate supply of equipment / manpower
-ensure welfare / comfort of rescue workers
-provide info to back-up system, other officials, and tri-media thru an Information Officer
-release as soon as situation allows "E" staff and re establish normal operations
-determine termination of field operations
MANAGEMENT OF VICTIMS

Search & Rescue

-locate victims
-remove victims from unsafe locations collecting area
-assess victim's status (on-site triage)
-provide first aid, if necessary (no CPR on-site in MC Event
-transfer victims to AMP thru entry triage (medical triage)
-under supervision of the CP/IC/ or Commander/Coordinator
-may in special situation, require medical personnel (trained)
-to stabilize/resuscitate/amputate (trapped) victim before extrication.
Management of Victims

Field Care

Pre-established capabilities / inventory : pre-planning

Integrated community plan: practiced w/policy
support
The "Golden Hour" Principle
Recent progress in pre-hospital emergency disaster
medicine

Establish AMP with specially skilled /trained "disaster field medical

teams"

good triage stabilization capacity -specifically trained up- skilled

medical teams
good (radio) communications between the field scene & medical
facility

"Don't transfer chaos in the scene , to the

hospital..."