A dynamic mass casualty incident at sea

Abstract

The primary lessons learned related to difficulties in functioning without effective communication, maintaining command and control, coordinating serial evacuation of casualties who were being triaged in parallel, planning for an event with lengthy evacuation times, resolving real-time ethical dilemmas, and preparing our providers mentally. As MCIs tend to be unexpected, preplanning, using preestablished manuals, and drilling for them may prove crucial in such extreme events. Importantly, the lessons learned from this event, with its unique synthesis of multiple contributing factors, remain relevant even in less austere settings.

Review of On-Scene Management of Mass-Casualty Attacks

“…Inter-agency planning and coordination is regarded as imperative between police, rescue service, emergency medical services, and mental health professionals [2,5,20,29,35,36]. Pre-event collaboration plans may also need to include policies for cross-border medical responses [37] and use of military units [37] or specific sea rescue organizations [35]. Priorities on the incident site should not be viewed as sequential.…”

“…The key to a successful response is effective communication [57], but communication problems have been reported as one of the most common, and most serious, challenges in MCAs [2,9,20,31,35,38,39,44,46,[58][59][60].…”

“…Consequences of equipment breakdown include inability to call in more staff or resources, failure to keep track of units on scene or inform them of safety issues, or prompting staff to drive to the scenes without knowing where to respond and stage [39,42,62,66]. To overcome communication shortfalls on scene, hand-held megaphones, runners, and hand signals can be used, but hand signals would require clear visibility and prior training [20,32,35,42]. Two-way radios with dedicated channels have often provided a good communication alternative, but it can be impeded in some locations, such as the subway, near crash sites, and in buildings [6,44,67].…”

“…Functional communication between and within organizations is important [2] and may be eased through use of a common lexicon to avoid different interpretations of terms used [20]. Language barriers between the responders and casualties as well as temporary deafness of bombing victims have constituted other communication difficulties [20,35,68,69]. Problems with relaying information between responder units have coincided with large incident scenes and units divided into sub-zones [70].…”

“…Information relay has also been problematic due to noise levels, e.g. by helicopters with rotors [35] and heavy machinery [48]. Information relay between the incident site, EMS, and the emergency department (ED) have been lacking repeatedly, e.g.…”