Review of On-Scene Management of Mass-Casualty Attacks

Abstract

Background: The scene of a mass-casualty attack (MCA) entails a crime scene, a hazardous space and a great number of people needing medical assistance. Public transportation has been the target of such attacks and involves a high probability of generating mass casualties. The aim of the review was to investigate challenges for on-scene responses to MCAs and suggestions made to counter these challenges, with special attention given to attacks on public transportation and associated terminals. Methods: Articles were found through PubMed and Scopus, "relevant articles" as defined by the databases, and a manual search of references. Inclusion criteria were that the article referred to attack(s) and/or a public transportation-related incident and issues concerning formal on-scene response. An appraisal of the articles' scientific quality was conducted based on an evidence hierarchy model developed for the study. Results: One hundred and five articles were reviewed. Challenges for command and coordination on scene included establishing leadership, inter-agency collaboration, multiple incident sites, and logistics. Safety issues entailed knowledge and use of personal protective equipment, risk awareness and expectations, dynamic risk assessment, cordons, defensive versus offensive approaches, and joining forces. Communication concerns were equipment shortfalls, dialoguing and providing information. Assessment problems were scene layout and interpreting environmental indicators as well as understanding setting-driven needs for specialist skills and resources. Triage and treatment difficulties included differing triage systems, directing casualties, uncommon injuries, field hospitals, level of care and providing psychological and pediatric care. Transportation hardships included scene access, distance to hospitals, and distribution of casualties. Conclusion: Commonly encountered challenges during unintentional incidents were augmented during MCAs, implying specific issues for safety, assessment, triage, and treatment, which require training. Effectively increasing readiness for MCAs will likely entail struggles to overcome fragmentation between the emergency services and the broader crisis management system as well as enabling critical and prestige-less, context-based assessments, of needed preparatory efforts.

Exploring the perception of aid organizations’ staff about factors affecting management of mass casualty traffic incidents in Iran: a grounded theory study

“…Negative competition and contrast of interests among these organizations were also evident in our findings. Hence programming and coordinating police, rescue and aid teams, and EMS is an essential measure for managing mass casualty incidents, as suggested by others ( 27 ). The participants believed that having only one emergency and rescue phone number can coordinate the arrival time of different organizations and improve management of incidents.…”

“…Establishment of an EOC can be a good way to create coordination among the organizations. Holgerson also concluded that absence of a centralized command system was one of the problems of onsite management in mass casualty traffic incidents ( 27 ). Lack of centralized command system at crash scene was mentioned by our participants as a managerial problem.…”

Emergency Medical Response in Mass Casualty Tunnel Incidents—with Emphasis on Prehospital Care

“…According to the evidence hierarchy used in the study (c.f. [19]) none of the included literature were systematic reviews or cross-sectional studies, but there were three high-quality modelling studies. Thirteen of the reviewed articles were medium-quality studies; one comparative case study and 12 case studies.…”

Developing a translational triage research tool: part two—evaluating the tool through a Delphi study among experts

“…Different triage systems have been designed for organizational, situational, regional, and national use, and have been presented as crude algorithms, flowcharts, and complex scoring systems [ 6 – 8 , 10 , 15 ]. This heterogeneity constitutes a threat in the event of an MCI, which often involves multinational and multiagency rescue teams with diverse educational and cultural backgrounds [ 2 , 16 , 17 ]. There have been several attempts to achieve a global or even national consensus without any results, partly due to a lack of actual research behind the origin or refinements of the various systems and the anecdotal nature of the evidence of a system’s efficacy [ 11 , 17 – 20 ].…”