This document discusses disaster surgery and mass casualty incidents. It defines mass casualty incidents as those involving hundreds of casualties that strain local hospital capacity. Disasters can be natural, like earthquakes, or man-made, like accidents or terrorist attacks. When they produce more patients than initial responders can handle, triage is critical to sort patients into categories based on need. The goal of triage is to minimize loss of life by providing the most urgent care first. Fundamental steps in management include assessing airway, breathing, circulation, disability and exposure to stabilize patients.

1. DISASTER SURGERY
KUSHAL KUMAR

2.  Any disaster resulting in a number of victims
large enough to disrupt the normal course of
emergency and health care services is known as
mass casualty incidence.

3. They are classified as:
 Multiple casualty incidents: casualty strain beyond
normal daily operation , can be managed by local
hospital
 Mass casualty incidents: involve hundreds of casuality
in a single institute, more than the capacity of ED
 Major medical disaster: thousands of casuality, in this
case an external support in needed,

4. Two type of disaster
Natural disaster
 Earthquake
 Tsunami
 Storm / flooding
 Neighbourhood nuclear plant

5. Manmade disaster
Accident- car, bus, train, etc
Firing, booming, etc
Terroristic attack
Shooting
Bioweapon

6.  Produces several patients
 As few as six or as many as several hundred
 Affects local hospitals
 Patients are greater than resources of the initial
responders
6
Mass Casualty Incident

7. Pre-planning and training are critical
Establish guidelines and procedures
Early implementation of Incident
Command
7
Preparation for Mass Casualty

8. • Management of victim of a mass casualty
event
• Objective is to minimize loss of life and
disabilities
• Triaging the patent
Casualty Management
8

9. TRIAGE
It is a method of sorting out injured patient, during
mass casualty depending on the severity of injury
The term triage is derived from the French word “trier”
meaning “to sort”.
It is activity by trauma team.

10. The Triage Team
 Triage team leader
 Clinical triage officer
 Head nurse
 Nursing groups
 Follow-up medical groups

11. Color coding
 Black/Expectant: eg large body burns,
cardiac arrest
 Red/immediate : cannot wait
 Yellow/observation: requires watching
and re-triage
 Green/wait: require care in hours to
days

12. Category I: Resuscitation and immediate
surgery
Patients who need urgent surgery – life-saving – and
have a good chance of recovery.
(E.g. Airway, Breathing, Circulation: tracheostomy, haemothorax,
haemorrhaging abdominal injuries, peripheral blood vessels)

14. Distal pulse absent

15. Category II: Need surgery but can
wait
Patients who require surgery but not on an urgent
basis.
A large number of patients will fall into this group.
(E.g. non-haemorrhaging abdominal injuries, wounds of limbs
with fractures and/or major soft tissue wounds, penetrating
head wounds)

16. Category I for Airway; Category II for debridement

17. Femoral vessels intact

19. Category III: Superficial wounds
(no surgery, ambulatory treatment)
Patients with wounds requiring little or no surgery.
In practice, this is a large group, including superficial
wounds managed under local anaesthesia in the
emergency room or with simple first aid measures.

20. Multiple superficial fragments

22. Category IV: Very severe wounds
(no surgery, supportive treatment)
Patients with such severe injuries that they are unlikely
to survive or would have a poor quality of survival.
The moribund or those with multiple major injuries
whose management could be considered wasteful of
scarce resources in a mass casualty situation.

24. Triage tags applied to
patients, make one’s
task of sorting much
easier
USA MILTAGS
Front Back

26. Triage Tent

27. Inside the Triage Tent

28. Main Building, Triage Department

29. Triage Department, in use

30. Management
Fundamental step – A B C D E F
 A- Air way management
 B- breathing
 C- circulation
 D- disability and assessment of level of consciousness
 E- exposure of the patient fully for thorough
examination
 F- finger evaluation and tubes

31.  Airway with cervical spine protection:
 rapid assessment of obstruction – forging bodies,
fallen back tongue, etc.
 Lift jaw, introduce airway, good suction throat,
intubation
 Assume cervical spine fracture and cervical collars
applied
 Breathing and o2 administration
 pneumothorax, multiple fracture of ribs and haemothorax
 High flow oxygen required

32.  Circulation and control of bleeding
 Circulation status, evidence of shock and internal and
external bleeding
 Iv fluids
 Pulse, blood pressure, spleen and liver injuries
 CT scan, echo, cradiography, etc
 Disability
 Glasgow coma score
 Finger and tube
 Quick examine all orifices – eg. bleeding from ear, nose,
oral cavity, rectum, vagina, urethra.
 Catheter should be done immediately

33. The aim in a mass casualty situation is
to do the best for the most,
not
everything for everyone.
Thank you