Defining the Problem, Main Objective, and Strategies of Medical Management in Mass-Casualty Incidents Caused by Terrorist Events

Abstract

Based on the experience of managing >20 such events during the last decade, the authors' understanding of a mass-casualty incident is that it is an event in which there may be many victims, but only a few that actually suffer from life-threatening injuries. To make an impact on survival, one must identify those who are severely wounded as quickly as possible and offer those patients opti-mal care. Experienced trauma physicians are the most important resource available to achieve this objective, and they should be allocated to the treat-ment of seriously injured victims instead of more traditional management roles such as triage and incident manager.

Impact of a predefined hospital mass casualty response plan in a limited resource setting with no pre-hospital care system

“…The unprecedented death tolls from such incidents in recent years have bolstered calls for developing disaster response plans that can allow hospitals to cope with a sudden influx of trauma [15,16]. Healthcare facilities in the city of Karachi, Pakistan have historically dealt with several terror-related MCEs in previous years [8,[17][18][19][20][21]; however, this incident, in particular, holds the distinctions of being the biggest such event in terms of devastation and the number of fatalities.…”

Inadequate Mass-Casualty Knowledge Base Adversely Affects Treatment Decisions by Trauma Care Providers: Survey on Hospital Response following a Terrorist Bombing

“…Defining the main objective of medical management is crucial in developing a contingency plan for MCIs. 1 Only half of those surveyed indicated that the main objective of the hospital staff after a MCI is the rapid identification of critically injured patients. Only rapid identification and treatment of critically injured patients can reduce the critical mortality rate.…”

“…3,6 In a recent study of 604 victims of MCIs treated between 1995 and 2003, only three (4%) of the 78 critically injured victims were not identified following initial workup in the emergency department. 1 The secondary transfer of victims from one institution to another may be necessary whenever one medical institu-examination of patients are sufficient diagnostics to exclude unidentified blast lung injury, eliminating the need for more sophisticated tests. Seventy-six percent of responders indicated that victims exposed to explosions should be kept under observation for at least 12 hours.…”

Development of the science of mass casualty incident management: reflection on the medical response to the Wenchuan earthquake and Hangzhou bus fire

“…Two aspects should be considered to achieve this 'paradigm shift' in MCI response research: (1) the dynamic and quantitative relationship between surge capacity and vulnerability, and methods for quantitative identification and characterization of vulnerability of a hazard bearing body should be established to study MCI response; (2) the three-dimension framework of MCI management should be confirmed by more practical applications in MCIs. A key to enhance the MCI surge response capability is to improve the suitability of the MCI response planning (Ashkenazi et al, 2008). Vulnerability is very difficult to present under an ordinary status, but vulnerability of a hazard bearing body may be measured by system destruction as well as casualties after disaster attacks.…”