Mass Casualty Management

MCI Basics & Triage - Sorting the Chaos

• Mass Casualty Incident (MCI): Needs overwhelm resources. Goal: Maximize survivors.
• Triage: Sorts & prioritizes care by severity, survivability.
• Systems:
  • START: Simple Triage And Rapid Treatment.
  • SALT: Sort, Assess, Lifesaving Interventions, Treatment/Transport.
• START Categories (Tags):
  • 🔴 Red (Immediate): Life-threatening, treatable (airway, shock; or 📌 RPM: RR >30/min, CR >2s, no commands).
  • 🟡 Yellow (Delayed): Serious, can wait.
  • 🟢 Green (Minor): Walking wounded.
  • ⚫ Black (Expectant): Deceased or unsurvivable.

⭐ In START triage, 'Yellow' tag (Delayed) is for casualties with systemic but not immediately life-threatening injuries who can wait 45-60 minutes.

Command & Control - Who's the Boss?

• Incident Command System (ICS): Standardized, on-scene management framework.
  • Ensures interoperability & accountability.
• Incident Commander (IC): Single point of command; overall authority & responsibility.
  • Typically senior, most experienced responder on scene.
• Key ICS Structure:
  • Command Staff: Public Information Officer (PIO), Safety Officer, Liaison Officer.
  • General Staff Sections (📌 FLOP):
    • Finance/Administration: Tracks costs, resources.
    • Logistics: Provides personnel, equipment, supplies.
    • Operations: Manages tactical activities.
    • Planning: Develops Incident Action Plan (IAP).
• Unity of Command: Report to ONE supervisor.
• Span of Control: Manageable; typically 3-7 subordinates (optimum 5).

⭐ The Incident Command System (ICS) ensures a standardized approach, with the Incident Commander (IC) having ultimate authority and responsibility.

Treatment & Transport - Heal and Haul

• Treatment Aims: Rapid stabilization, life-saving interventions (LSIs) by triage category.
  • Red (T1): Secure Airway, Breathing support, Control major Bleeding (ABC).
  • Yellow (T2): Splint fractures, wound care, analgesia; prepare for later surgery.
  • Green (T3): Basic first aid, reassurance; encourage self/buddy care.
  • Black (T4): Palliative care, dignity, pain management.
• Core Interventions:
  • Airway: Jaw thrust, OPA/NPA.
  • Breathing: Oxygen, needle/finger thoracostomy for tension pneumothorax.
  • Circulation: IV/IO access, permissive hypotension, early blood products.

  ⭐ Damage Control Resuscitation (DCR) and Damage Control Surgery (DCS) are key strategies in MCI to rapidly stabilize exsanguinating patients for later definitive care.

• Transport Logistics:
  • Evacuation priority: Red → Yellow → Green.
  • Communication with hospitals vital.
  • Patient tracking essential.

Special Scenarios & Aftermath - Beyond the Basics

• CBRNE (Chemical, Biological, Radiological, Nuclear, Explosive) Incidents:
  • ⚠️ Scene safety is paramount; specialized PPE required. Do not enter unsafe zones without training.
  • Decontamination: essential first step; prevents secondary contamination.

  ⭐ For CBRNE incidents, the principle of 'hot, warm, cold zones' dictates decontamination and treatment flow to prevent spread and protect healthcare providers.

  • Antidotes: e.g., Atropine/Pralidoxime for nerve agents; N-acetylcysteine for phosgene.
• Psychological Impact & Support:
  • High risk: Acute Stress Disorder (ASD), PTSD in victims & responders.
  • Interventions: Psychological First Aid (PFA) for early support.
  • Responders: Critical Incident Stress Debriefing (CISD/CISM).
• Post-Incident Operations & Recovery:
  • Debriefing: operational (lessons learned) & psychological.
  • Documentation: vital for legal, epidemiological, and research purposes.
  • Disaster Victim Identification (DVI): Interpol guidelines.
  • Resource management: stock replenishment, long-term care planning.

High‑Yield Points - ⚡ Biggest Takeaways

• Triage (S.T.A.R.T./JumpS.T.A.R.T.) is crucial for prioritizing victims by injury severity.
• Color codes (Red: Immediate, Yellow: Delayed, Green: Minor, Black: Expectant) dictate treatment urgency.
• Incident Command System (ICS) structures on-scene management and resource allocation.
• Clear communication between responders and hospitals is vital for coordination.
• Decontamination is essential in HazMat/CBRNE incidents before medical treatment.
• Hospital surge capacity plans are critical for managing patient influx.
• Promptly address psychological needs of victims and responders.