|Year : 2018 | Volume
| Issue : 2 | Page : 23-26
Mass casualty management
Professor, College of Nursing, CMC, Vellore
|Date of Web Publication||5-Jun-2020|
Source of Support: None, Conflict of Interest: None
Mass Casualty Incidents have become an everyday event in India and occur as a result of minor or major and natural or manmade disasters. An increase in morbidity andloss of life can occur if community and heath care centers are not adequately prepared for responding effectively to mass casualty incidents. This paper elaborates on the hospital preparedness activities needed for comprehensive mass casualty management.
Keywords: mass casualty incidents, disasters, preparedness, mass casualty management
|How to cite this article:|
Christopher J. Mass casualty management. Indian J Cont Nsg Edn 2018;19:23-6
| Introduction|| |
Disasters have occurred always. However, over this century the frequency of disasters has increased worldwide. Major disasters have severe negative long term impact on communities, environment and economy of the country. The impact on the community often leads to a Mass Casualty Incident (MCI) which requires a systematic Mass Casualty Management approach to help the community to be resilient. The fundamental concerns of a Mass Casualty Management system are public safety and building resilient communities.
Mass Casualty Incident
MCI is defined as ‘an event that overwhelms the local healthcare system, where the number of casualties vastly exceeds the local resources and capabilities in a short period of time’. Any MCI can rapidly exhaust available resources for not only the MCI but the normal day-to-day tasks of the hospital (DeNolf & Kahwaji, 2018).
Potential Causes of MCI
The following are the examples of various disasters which could be the potential causes of MCI ( Holtz, Coti, & Donaldson, 2017):
- Natural Disaster (e.g., Hurricane, Earthquake, Tornado, Tsunami, etc.)
- Transportation related accidents
- Radiation exposure
- Dirty bomb
- Chemical weapons
- Unintentional large-scale incident (e.g., building collapse)
| Mass Casualty Management (MCM)|| |
MCM denotes a systematic approach used in the management of victims of a MCI aiming at minimizing loss of life and disabilities. A systematic MCM approach is necessary since the human and material resources are limited and communication related issues are expected.
| Principles of MCM|| |
The following principles given by the World Health Organization (WHO, 2007) help the health care institutions to lay down policies and plans for effective mass casualty management.
1. Clear Lines of Responsibility
Each health care member of the MCM team should have designated roles and responsibilities. These are communicated to the team and the team members are trained to perform the same. There should also be designated authorities to scale up the disaster response from local to state, national or international level with no confusion.
2. All Hazard Applicability
The Hazard Identification and Risk Analysis (HIRA) helps to identify the common hazards in the community during MCI and whatever may be the disaster and have plans made prior to reduce the impact of it. A consistent MCM plan across disaster types is needed since different plans for every type of disaster causes confusion.
Preparedness should allow for different scales of disasters both in the community and hospital. Certain activities like triage, first aid, transportation, etc. are common to all disaster events whereas certain activities like chemical decontamination, extrication, etc. are very specific to certain disasters. At such events there should be plans to scale up the type of activities that may be needed.
Medical care should be provided considering the victims as individuals as well as part of families and communities. Strategies to deal not only with death and trauma but also with the other medical needs like maternal and child health, mental health, life style diseases, communicable diseases etc. should be considered. Nurses are the best shelter carers, hence basic and environmental needs such as nutrition, water, sanitation, psychosocial support, etc. in the shelters can be taken care by nurses.
Knowledge on the commonly occurring disasters in the community, issues encountered in the previous disaster management, the demographic characteristics of the community is mandatory to plan and organise MCM. Health care workers’ knowledge on the recent trends in the management of MCI should be updated consistently and continuously.
MCM is always multi-sectoral. Multiple agencies respond to the disaster such as police officials, fire and rescue, health care institutions, social services, communication and media, NGOs etc. The preparations should ensure the ability to work together with all the sectors. There should always be an Incident Commander to coordinate the activities at local level for effective utilisation of resources.
7. National Policies to Enable Local Solutions
The National policies should guide the local authorities to plan and prepare Disaster Management policies and protocols at the local and institutional levels.
| MCM at Health Care Facility Level|| |
Mass casualty incidents place the challenge of’surge’, as victims suddenly arrive to Emergency Department in need of medical attention, in numbers beyond the usual system capacity. Surge can be defined as a demand for health services in a MCI where additional capacities (in terms of the amount of personnel, equipment or supplies) and/or capabilities (in terms of specialized expertise) are required (The CNA Corporation, 2004).
The effectiveness of the MCM in a health care facility depends on the following (WHO, 2007):
- The health care facility’s definition of MCI
- Well-prepared policy and protocol involving the various departments of the facility
- Staff who are trained through drills and exercises
- Well established communication systems
Each health care facility requires to define the term MCI depending on the existing capacity, services available, ability on scalability and availability of local resources. The plans should be made based on the protocol to manage the same. The plans should be in line with national standards and at the same time relevant to the local community needs. All health care professionals involved in the whole-of-health approach should have well-established roles and responsibilities. The planning should consider for coordination with services and authorities external to the health care facility if ‘Continuation of Operations’ becomes necessary. Networking with local health care facilities is an essential part of planning as these facilities may have to be utilised when surge occurs.
Arrangements to deal with surge at the level of individual health care facilities may include the following procedures:
- discharge of less acutely ill patients
- cancelling elective procedures
- adding additional beds to wards and rooms
- setting up cots in open spaces
- pre-established procedures to call back staff” for extra shifts
- maintaining or increasing stocks of equipment, supplies, pharmaceuticals
b. Emergency and Trauma Care Systems
Protocol based emergency and trauma care systems are mandatory in preventing avoidable mortality and morbidity during MCIs right from on-the-spot first aid to operating theatre trauma surgery. The trauma care system should be based on the Advanced Trauma Life Support (ATLS) guidelines. The standards of care appropriate to mass casualty events such as relaxed documentation requirements, reduced testing procedures, and larger staff-patient ratios have to be considered to counteract the workload (Nuyens, 2005).
c. Training and Exercises
Each health care facility should build the capacity of its personnel to deal with MCIs based on well-defined protocol. Drills and exercises are the most effective means of capacity building and should include all the health team members. Training should be evaluated at regular intervals, both to ensure its quality and to modify the protocol as necessary.
Each health care facility should have its own communication plan to activate the MCM protocol, deal with patients, the community and with the media. The plan should include training, not just for designated spokespersons but for all staff who may need to communicate with patients, family and community.
Elements to be considered by a health care facility in developing a MCM plan based on WHO (2007) guidelines are given in [Table 1].
Post MCM debriefing should be done with all involved members as soon as deactivation happens with an aim to reflect on actions that went well or failed as part of MCM. Each member’s feedback is received and appreciated and suggestions for future directions need to be written down. This will help to refine the policies and protocol for future improved management.
| Conclusion|| |
The escalation in catastrophic incidents especially in the developing countries has mandated the need for disaster preparedness and MCM. Mortality and morbidity can be effectively reduced if a health facility is prepared with careful and clear plans that would help in mitigating disasters and responding to emergency when there is a need. Capacity building to meet the surge demands at times of mass causalities is another key to effectively enacting the preparedness plans.
Conflicts of Interest: The author has declared no conflicts of interest.
| References|| |