Mass-Casualty Incident Management: Clinical Issues
In Week 3 we examine logistical, organizational, and communication issues in the clinical management of Mass
Casualty Incidents.

When we think of clinical issues, we must start at the event site and work our way to recovery. To do this, we will have
a network of paths that will work independently and interdependently to recover patients, scene, community, and
disaster responders.

From a scene perspective, we now have fire, EMS, and police, as well as the potential for nurses and doctors to all
converge upon the scene and operate to rescue, treat, and transport mass casualty victims. As noted in content 2, this
organization will occur under the ICS system, but because we can have physicians, nurses, and other medical
professionals working in the field, the protocols and medical actions may contraindicate the normal ICS structure and
pre-arranged protocols utilized by police, fire, and EMS. This coordination will become important as decisions made at
the scene will have downstream effects on hospitals, police investigations, and community recovery efforts.

Currently there are various thoughts on where the centralization of command should reside in a mass casualty event.
This is further complicated by the use of unified command needed for active shooter/active violence events. The best
practice involves the use of an emergency operations center to allow coordination of the various centralized command
structures that will exist at the scene, in the hospitals, and in community government. Attendance at the FEMA G191
EOC/ICS interface course can help to understand the coordination needed to keep all parts of a mass casualty
coordinated.

Patient Flow issues are related to surmounting a large patient influx and the communication process necessary to
determine resource allocation and forecast patient volumes. The knowledge of patient flow patterns is critical to
disaster planning. Recent funding challenges due to no elective surgeries have places some hospitals in a position that
creates subpar staffing daily.

In Mass Casualty Incidents, the creation of the Discharge Unit should be on the same level of importance as the
delineation of the Command Center. Without the Discharge Unit the patients will languish and the hospital will
compromise the ability to provide further care for incoming patients. In a disaster, no patient should leave the hospital
without passing through Discharge unit.

Without a properly planned physical plant design for the emergency department, the performance of a successful
disaster mitigation strategy is challenged. Failure to take the special requirements for Mass Casualty Incidents into
account will present unanticipated problem when a Mass Casualty Incident occurs. The key in disaster management
architectural planning is whiter the proposed design will allow for appropriate patient flow.

The new information management systems enhance patient management and allow hospitals and other health care
and emergency services provides to communicate with hospital core Health Information System. It also enable the
implementation of the National Network for Real-time Syndromic and Bioterrorist Surveillance Systems.

Victim lists are essential tools for hospital response. Victim lists are required, not only to identify victims that have
come into the hospital but also to identify casualties brought to multiple other sites during a disaster. Lists are often
electronic in nature and require the systems to function at the time of a disaster. Plan accordingly.