4. • Definition of MCI
• Steps in MCI management
• Principles of Mass Casualty Management
Outlines of presentation
MCI
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5. Mass Casualty Incident (MCI)
• Definition
– An incident which produces
multiple casualties such that
emergency services, medical
personnel and referral systems
within the normal catchment area
cannot provide adequate and timely
response and care without
unacceptable mortality and/or
morbidity.
6. Mass casualty incidence (MCI)
MCI
• An incident which generates more
patients at one time than locally
available resources can manage using
routine procedures.
• It requires exceptional emergency
arrangements and additional or
extraordinary assistance.
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7. • High number of casualties with serious
injuries.
• Insufficient availability of resources and
medical personnel to move in a timely manner.
• Inability to handle the wounded with the usual
criteria.
• One has to do what is practically possible for
the greatest number of victims
MCI
MCI
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8. MCI
• The Objective of MCI is to move all patients
to a medical facility as soon as possible.
The golden hour
• Refers to the amount of time from injury to
definitive care that should be allotted to
maximize survival from traumatic injury. •
• Most studies have shown, if care is given
within first hour of injury morbidity and
mortality can be reduced
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MCI
9. • A mass casualty incident (MCI) is an event
where the number of patients temporarily
exceeds the capability of the first responders
at the scene or of the medical staff at the
hospital to provide optimal care to all victims
simultaneously.
• MCI is a “temporary state of insufficiency .”
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MCI
10. At the prehospital phase, the “state of
insufficiency” may be due to: •
• Insufficient access and evacuation routes for
ambulances
• Insufficient number of ambulances and/or
helicopters during the initial phase
• Insufficient number of personnel (drivers,
paramedics, physicians) during the first hours
• Insufficient amount of equipment and supplies
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MCI
11. At the hospital phase, the “state of
insufficiency” may be due to:
• Insufficient number of personnel (doctors, nurses,
technicians, transporters, clerks, security guards)
during the initial phase •
• Insufficient space in the emergency department
(ED) or intensive care unit(s)
• Insufficient number of operating rooms available
• Insufficient number of available ventilators
• Insufficient amount of supplies and blood units
available for immediate use
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MCI
13. 1. Triage
• A method of quickly identifying victims who
have immediately life-threatening injuries
AND who have the best chance of surviving.
• Aim of triage : To achieve the greatest
good for the greatest number of casualty.
MCI
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Steps in MCI Management
14. MCI
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Steps in MCI Management
2. Primary survey
• The first survey done to assess the life
threatening injuries and simultaneous
treatment.
• Primary survery must be performed in no
more than 2-5 minutes.
• Component of Primary survey : ABCDE
15. 3. Secondary survey
• Secondary survey is undertaken when the
• patient’s ABCs are stable
• To identify all minor injuries missed in
primary survey
• If any deterioration occurs must be
interrupted by Primary survey.
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Steps in MCI Management
16. Mass Casualty Management in ER Principles
1. Policies and Procedures
2. Emergency or Disaster Plan
3. Operating Theatre
4. Staffing Requirements of the ER
5. Overcrowding
6. Equipment & Supplies of the ER
7. Contingency
8. Observation & Holding Area
9. Referral & Transfer
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Principles of Mass Casualty Management
17. Policies & Procedures
• All hospital & emergency department must
have clearly written & disseminated policy &
procedures.
• Policy must be reviewed after each major
emergency or disaster scenario
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Principles of Mass Casualty Management
19. Emergency or Disaster Plan
• Emergency plan has to be well written and contain
important elements such as triage criteria & the incident
command system.
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Principles of Mass Casualty Management
20. Operating Theatre
•Access to functioning OR allows for early
definitive care and minimizes unwanted
morbidity or preventable mortality.
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Principles of Mass Casualty Management
21. Staffing Requirements of ER
Nurses
• Nursing staff in ER must have training in
triage, trauma management, disaster
management.
Emergency Medicine Physicians
The Trauma Team
• Comprises surgeons, anesthesiologist& trauma
nurses.
• Delivers definitive care
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Principles of Mass Casualty Management
22. Overcrowding
• After a mass casualty incident, hospital is
flooded with visitors which makes the working
environment chaotic and difficult which needs
to be controlled
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Principles of Mass Casualty Management
23. Equipment & Supplies
Airway devices
Intubation equipments
Fluids and IV cannula
Emergency Drugs
• The equipments & drugs should be in bulk and
readily available during mass casualty incident
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Principles of Mass Casualty Management
24. Contingency
• Planning is the key to the proper response to a
mass casualty incident.
• Worst case scenario must be thought through
and procedures developed for each possibility
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Principles of Mass Casualty Management
25. Observation & Holding Area
• During an influx of patients to a hospital
temporary patient care areas may have to be
established like lobby areas & corridors.
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Principles of Mass Casualty Management
26. Referral & Transfer
• When the hospital is flooded to its capacity,
the process of referral & transfer to other
hospitals must be considered
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Principles of Mass Casualty Management
27. • Hospitals should be prepared in handling mass
casualty incidents with well written policy and
guidelines.
• Triage system should be followed in ER
• Well equipped ER with skilled manpower can save lives
in mass casualty incident.
• Initial treatment in ER by Emergency staffs is life
saving whereas definitive treatment is delivered by
specialist
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Conclusion
