Mass casualty incident

Mass casualty incident (MCI), also known as a multiple-casualty incident or multiple-casualty situation, is a term used to describe an event in which the medical resources available are overwhelmed by the number and severity of casualties. This can occur in situations such as natural disasters, terrorist attacks, industrial accidents, or large-scale transportation accidents. The primary goal during an MCI is to prioritize victims based on the severity of their injuries to maximize the number of survivors.

Definition

An MCI is defined not just by the absolute number of casualties, but by the capacity of the local healthcare system to provide care. An event that overwhelms a small, rural hospital might not constitute an MCI in a large city with multiple trauma centers. The common thread in all MCIs is the need for rapid triage and treatment beyond the normal capacity of the first responders and medical facilities.

Triage

Triage is the process of determining the priority of patients' treatments based on the severity of their condition. During an MCI, triage is critical and often follows specific protocols, such as the START (Simple Triage and Rapid Treatment) or the SALT (Sort, Assess, Lifesaving Interventions, Treatment/Transport) triage methods. These systems help responders quickly categorize patients into groups (e.g., immediate, delayed, minor, deceased) to ensure that resources are allocated efficiently and effectively.

Response

The response to an MCI involves multiple agencies and disciplines, including Emergency Medical Services (EMS), fire departments, law enforcement, public health departments, and sometimes military units. Coordination among these entities is crucial and is often facilitated by an incident command system (ICS) or a similar framework. This ensures a structured and efficient approach to scene management, resource allocation, and inter-agency communication.

Challenges

One of the primary challenges in managing an MCI is communication. Ensuring that accurate information is shared among all responding agencies and with the public is critical but can be difficult in chaotic environments. Additionally, the availability of resources such as blood, medical supplies, and hospital beds can quickly become a limiting factor in the response effort.

Preparedness

Preparedness for MCIs involves regular training exercises, the development of mutual aid agreements between neighboring jurisdictions, and the establishment of emergency operations plans. Hospitals and healthcare systems also conduct drills to prepare their staff for the surge in patients that accompanies an MCI.

Psychological Impact

MCIs can have a significant psychological impact on survivors, families of victims, and responders. Mental health support and services are an important component of the response to help those affected cope with the trauma and loss.

Legal and Ethical Considerations

The chaotic nature of MCIs can raise complex legal and ethical issues, particularly regarding triage decisions and the allocation of scarce resources. Healthcare providers may be required to make difficult decisions under extreme pressure, which can have legal and ethical implications.