Principles in Management of

mass causalities
Dr Megha Tandon
MS, DNB,MRCS [UK],FEBS [Europe], FACS[US], FIAGES
 Points to ponder upon!!
• What is Mass Casuality / disaster?
• Triage
• Who is the captain of the ship?
• Emergency Preparedness and Response for Mass
Casualty Incidents -ATLS
• Interdepartment co-operation
• Communication
•
•
 Accidents

Sealdah Kanchanjungha Express was hit by a goods train in Darjeeling district of West Bengal on June 17
Warfare/ Terror Attacks
Natural disasters
Biological
 Mass Casuality??
• An incident resulting in casualties to not fewer than 3 victims,
including—
• (i) an incident that exceeds the normal resources for
emergency response available in the jurisdiction where the
incident takes place
•
• (ii) an incident that results in a sudden and timely surge of
injured individuals necessitating emergency services.
 Causes
• Violence, such as mass shootings

• Chemical, biological, or radiological events

• Extreme weather or natural disasters, such as

tornadoes, floods, and wildfires

• Transportation incidents, such as multi-vehicle car

crashes and train collisions
 Disaster??
• Derived from the French word 'Desastre' meaning a bad or
an evil star.
• Disaster is a sudden accident or a natural catastrophe that
causes great damage or loss of life.
• Mass casualty incidents can be referred to as conventional or
catastrophic
•
 Management
• Preparation for unexpected
• Surge Capacity
• Disastermindset
“do the most good for the greatest number of patients.”
• Within healthcare facilities, staff and specialty
healthcare providers may take on non-traditional roles
to support patient surge
• Common issues: Delayed perimeter establishment,
large crowds, media and political involvement,
inadequate resources
•
 Management
Establish Mass Casualty Management System:
• Purpose: Minimize loss of life and disabilities.
• Location: Set up 50-100 meters from the impact zone (within walking
distance) with direct access to evacuation routes.
• Key components: Establish guidelines, Pre-established procedures,
and early incident command implementation, multi-sectoral
preparation, coordination, and resource maximization
• Remember: The first five minutes are crucial and determine the next
five hours
 Triage
• Effective mass casualty response is founded on the principle of triage
• In mass casualty situations , it is a system of sorting and prioritizing
casualties based on available resources[ATLS]. It establishes order in
chaotic environments.
• Represents a paradigm shift in the provision of medical care.
• From-everything possible for every patient, to doing the best possible for
as many patients as possible.
• Delicate balance between the needs (number of patients and type of
pathology) and the available resources (both material and human)
• During triage, patients are grouped into categories based on decreasing
treatment priority [START Adult triage system]
 Background information

• START was developed by the Newport Beach Fire and Marine Department and Hoag
Hospital in Newport Beach, California in 1983.
• Initially it used the ability to obey commands, respiratory rate, and capillary refill to
assign triage category.
• Modifications to START in 1996 by Benson et. al. substituted radial pulse for capillary
refill, with a report of improved accuracy, especially in cold temperature.
• The Benson revision (START - SAVE [Secondary Assessment of Victim Endpoint]), also
incorporates additional factors that determine "survivability" over time as the event
progresses and assumes limited response resources. 1
• There has been limited rigorous scientific review of various forms of mass casualty
incident triage used around the world.
• New methods of triage using new algorithms have been proposed, but not tested in the
field
• START remains the most commonly used mass casualty triage algorithm in the US.
Types of Triage
 TRIAGE
• In short, Response Phases: Triage, treatment, and transportation.
Initial triage assigns patients to color-coded levels (e.g., START
system)6. Treatment areas are designated by triage category.
• Demobilization: Crucial for resource management. Plan for
demobilization from the beginning to avoid prolonged incidents.