Mass Casualties

Fanny Indarto, dr., Sp.B

 DISASTER CLASSIFICATION SCHEMES
Mechanism Duration
1. Natural 1. Finite
Weather-related (hurricane, 2. Ongoing
tornado) Level of response
Geophysical (earthquake, 1.Level I: Local resources
tsunami) 2.Level II: Regional resources
2. Man-made 3.Level III: State or national
Intentional (terrorist attack) resources
Unintentional (industrial
accident) Number of casualties
Nature of injuries
Geographic extent
1. Closed
2. Open
 Introduction
Disasters follow no rules.
No one can predict the complexity, time, or location of
the next disaster.
One of the most significant problems in mass casualty
management is that medical providers do not prepare
for disasters, they respond to them.
In reality, all disasters, regardless of cause, have
similar medical and nonmedical consequences.
Disasters differ only in the degree to which these
consequences occur and disrupt the normal medical
and nonmedical infrastructure of the disaster scene.
Trauma Handbook of the Massachusset
General Hospital 2004
 A key characteristic of MCIs is that the
overwhelming majority of casualties sustain
only minor injuries.
Regardless of the etiology or magnitude of the
incident, only about 10-15% of survivors
presenting to a trauma system are severely
wounded.

Trauma, 6th edition, 2008

 Generally, 50% of all disaster casualties that
will present to a hospital will do so within the
first hour of the event, and 75% will arrive
within 2 hours. The first wave of casualties will
not be critically injured and largely not even
require hospital care.

Trauma : Contemporary Principles and

Therapy, 1st edition, 2008
 Principle
The key principle of disaster medical care is to
do the greatest good for the greatest number
of patients
 ABCs of Disaster Response
mass casualty incident can be approached in a
uniformed manner with four basic elements of
medical response.
1. Search and rescue
2. Triage and initial stabilization
3. Definitive medical care
4. Evacuation
 Search & Rescue
Critical interventions include:
1. Airway protection, including intubation under
difficult conditions
2. Vascular access for rapid fluid resuscitation with
cutdown, central, or intraosseous lines
3. Pain control in unstable patients
4. Hypothermia care
5. Immobilization
6. Amputation of injured or trapped extremities
 Triage & Initial Stabilization
Field Triage Goals
Prioritize and categorize casualties so that
patients can receive timely rescue, treatment,
and evacuation in an orderly fashion
Optimize the use of available medical, nursing,
and emergency personnel at the disaster site
Optimize the use of available logistic support
and equipment.
 Level Field Triage
Level 1: On-site Triage
Rapid categorization of victims with severe
injuries needing immediate care
Patients categorized as acute or nonacute
Triage carried out by the first responders to
the disaster site, usually the local population
Level 2: Medical Triage
Rapid categorization of victims at a casualty site
done by the most experienced medical personnel
available
The casualty collection or triage sites should be
located close to the disaster site and be visible for
disaster victims, but provide safety from climactic
conditions and hazards and be upwind from
potentially contaminated environments.
 Patients who do not require immediate life-
saving interventions for whom treatment may
be delayed
Patients who are not expected to survive
because of injury severity complicated by the
conditions and lack of resources at the site
 Red = Casualties who require immediate lifesaving
interventions
Yellow = Casualties for whom treatment can be delayed
or casualties (expectant) who are not expected to
survive due to severity of injuries or lack of resources
Green = Individuals who require minimal or no medical
care
Black = Deceased victims
Level 3: Evacuation Triage
Assigns priorities to disaster victims for
transfer
Goal is to transfer victims to the most
appropriate facility by the most efficient and
appropriate route
Same medical personnel as level 2 triage
 Blast Injury
Patterns of Injury
into four patterns of mechanism of injury, as follows:
Primary mechanism injurycaused by the resultant force of the blast wave
itself and by its effect on air expansion; hence, perforation of the ear drum,
different types of lung and intestinal injuries.
Secondary mechanism injurycaused by the wreckage, i.e., fragments of casing,
metal, glass, masonry, etc. being propelled at high speed by the force of
the explosion.
Tertiary mechanism injurycaused by the rapid passive movement of the
body by the blast wave, inflicting damages ranging from bruising to loss of
limbs, severed at the site by the blast wave.
Flash burns consequent on the heat generated by the explosion.

Trauma management, 2000

 ICS
The Incident Command System (ICS) was
created to allow different agencies (fire,
police, emergency medical services,
hospitals) and/or multiple departments of
organizations to work together effectively in
response to a disaster.
 ICS hierarchy
Incident Commandmaintains overall response
for disaster response
Operationsdirects disaster resources
Planningdevelops action plans
Logisticsprovides personnel and supplies
Financial/Administrativemonitors costs