Mass casuality breif presentation for healthcare quality practitioners

Mass casuality breif

2.  Mass casualty situation
–Overwhelming number of seriously injured
individuals.
–Within a limited area and a brief period of time.
–Placed upon locally available medical facilities
quite unable to supply medical care for them.
 Aim of the medical services
– In these circumstances must be to assume care
of greatest benefit to the largest number.

4. • In mass casualty due to disasters the demands
always exceed the capacities of both personnel and
facilities.
• Appearance of several seriously injured patients
over a short time presents a challenge that usually
cannot be addressed with the same intensity that
meets the individual injured patient.

5. • A fundamental difficulty in the formulation of disaster
preparedness plans is the concept that
“IT CAN’T HAPPEN HERE”
• No geographical region is exempt from the possibility of
any disaster, including nuclear accident. Our concept as
regards the occurrence of a disaster must be changed

• Terrorism both foreign and domestic is a current fact.
No one is immune, the key to success is to plan ahead and
be aware of available resources.

7.  Preplanning
–The key to any mass casualty incident response.

–It’s the only effective way to forecast and minimize the multitude of
potential problems that happen during a mass casualty disaster.
–It is the only way to develop an appropriate and timely plan of
action to secure the health and safety needs of all concerned
without delays.
 Preplanning for
–Shortcomings and difficult issues.
–Relaying on teamwork which allow future participants to
successfully meet and complete the challenge.

8. General Principles:
• Each hospital must have a clear plan for mass casualty.
• Good medical response dictates formulation, dissemination and periodic
assessment of a plan to facilitate the triage and treatment of victims of the
disaster.
• Reduction of immediate mortality and morbidity at the expense of long-
term functional results.
• Teamwork at all levels is essential in successful management of mass
disaster.

9. General Principles:
• All physicians involved should be prepared to function as trauma
surgeons independent of their specialty.
• System must be flexible to withstand the challenges of all types of
disasters.
• Sophisticated techniques (eg. microvascular surgery) require extended
services of highly trained individuals using complex equipment are
valuable in terms of enhancing quality of life but do little to preserve
quantity of life in mass casualty.

11. The basic unit of medical care in a disaster is the hospital,
but disaster planning is the responsibility of all segments of
the community.

The community with the hospital’s disaster committee must
consider:
• The location of the disaster site is always the unknown factor.
• Disaster plans must include options for primary and alternate locations
for command control centers and for collection of casualties.

12. • The plan must arrange a clear method of transportation of the injured
persons and also the possibility of transporting emergency mobile
hospitals to the scene of the disaster.
• Must provide the necessary personnel and supplies for the less injured
patients that will be treated at the site of the casualty.
• The disaster may involve the normal communication network, so there
must be an alternate method of communication.

14. • Every hospital that may receive casualties must have a major incident
plan, which detail the organization and actions of staff both in hospital
and at the scene.
• All hospitals must have a well-designated disaster committee composed
of knowledgeable representatives from medical and non-medical
departments.
• The committee must formulate a disaster plan that is flexible enough to
meet the demands of any disaster situation but is practical in terms of the
hospital’s trauma capabilities, location, personnel and equipment.
• The disaster plan director should be a physician experienced in both
administration and trauma care who has the ultimate responsibility for
activation of the disaster plan in a specific catastrophe.

15. Medical Supplies & Equipment
• Hospitals must achieve a reasonable level of preparedness in the
maintenance of stored supplies and equipment for use only in mass
disasters.
• Stored supplies should include intravenous lines and solutions;
dressing supplies; air way equipment; anesthetic agents; drainage
tubes, such as chest tubes, nasogastric tubes, and urinary catheters;
splints; and drugs.
• Well-established procedures should be defined for obtaining
additional blood and blood products and processing emergency blood
donors.
• Hypovolemia continues to be a major cause of death among disaster
victims who arrive at hospital alive.

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18. Level I
• Designates a full-service trauma center that can provide optimal care
of trauma patient.
• One or more experienced emergency physicians, general surgeon,
anaesthesiology services, laboratory, blood bank and an operating room
team must be available in-house 24 hours a day.
• All surgical subspecialty services should be immediately available on
call.
• A commitment to educate and research in trauma must also be
demonstrated.

19. Level II
This trauma center is similar to level I center but do not necessarily
include a commitment to education or research.
Level III
• This trauma center does not have all the resources available at a level I
or II centers.
• May represent the highest level available in a given community.
• Usually initial stabilization and life saving procedures are performed and
the patient is then transferred to a level I or II center.

21. Team Leader
Anaesthetist Other Doctors
Nurses Radiographers

22. Team Leader (Triage Officer)
Overall management of the patient is the responsibility of
the team leader who should ideally not participate in
practical procedures but should:
• Organize the team.
• Assimilate the clinical findings and physical
measurements.
• Devise immediate and definitive plans for management.

23. Team Leader (Triage Officer)

•Constantly evaluate response to resuscitation.
•Check results of airway breathing and circulation
investigations, extent of injuries and priorities for
treatment, patient’s Tetanus State and antibiotic
requirements are of prime importance.
• Responsible for all documentation, which must be
accurate and complete and should write up the case notes.

24. Anaesthetist
• Concerned with airway control: ventilation, venous
canulation and fluid balance.
Other Doctors
• Take care of procedures like chest drain, catheterization,
fractures splinting, etc.
Radiographers
• Take specific radiographs of cervical spine, chest and pelvis
to all patients as soon as possible.
• Coverage of case record (CasRec) on a 24-hours rotation
schedule.

25. Nurses
• Must be skilled in physiological and psychological care of
emergency patients.
• Supportive care, intervention and monitoring of emergency
patients.
• Know how to educate the patient of less injury about self-
assessment and care.
• Capable of public education of injury prevention, first aid
and using emergency facilities.

26. Administration Ministry of Health
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28. Advanced Trauma Life Support management training program (ATLS) is the
Gold Standard in early trauma initial assessment and resuscitation.
It was introduced by Dr. James Styner, an American orthopedic surgeon.
The philosophy of the ATLS management is based on a ‘Treat Lethal Injury
First, then Reassess and Treat Again’ strategy.
The steps of the management are:
• Primary survey: identify what is killing the patient.
• Resuscitation: treat what is killing the patient.
• Secondary survey: proceed to identify all other injuries.
• Definitive care: develop a definitive management plan.
This course is now advanced to include Advanced Trauma Nursing Care
course (ATNC) and Pre-Hospital Trauma Life Support course (PHTLS).

29. • Most hospitals have a written disaster plan, not necessarily
accompanied by an adequate training program referred to as
“The Paper Plan Syndrome”
• Mock disaster trials should be conducted regularly, when a real disaster
arrives it brings chaos, there is no time to read a manual.
• One method of improving performance and keeping skills current when
disaster triage is not used on daily basis is to designate a “Triage Day” on
which every patient is assigned to a triage category.

31. Triage (Sorting) of the wounded into categories of
urgency.
• Rationing system medical units use in coping with large
numbers of casualties that exceed the care, capacity of
doctors, nurses and equipment available.
• Salvage the most salvageable and avoiding wasting time
and resources on dying and others with low survival
probability.
•Apply Damage – Control surgery.

33. The Aim
To identify those likely to die and those requiring minimal aid,
so the serious wounds of those with higher probability of
survival can be treated intensively.
In its simplest form trauma triage system must satisfy 3 R’s:
Must get the right patient to the right hospital at the right
time.
Guiding Principle
Do as little as possible, as quickly as possible, for as many
as possible.

36. Pre-Hospital Triage
• Proper triage at the scene is important in management of multiple-
casualty incident, as victims impose a significant burden on any hospital.
• Admission of several critical patients simultaneously can paralyze the
performance of many elective operations at a major medical center.
• Distribution of such patients among hospitals can alleviate this burden
and achieve better medical care for victims.
• Distribution by centrally controlled Emergency Medical Service system
ensures best treatment of patients and diminishes disruptions to local
medical system.

37. Pre-Hospital Triage
• Triage can be done through telecommunication (Telemedicine), allowing
high resolution-digital video and audio information to be transferred
instantaneously, to other locations.
• Its use today is limited to teleconferences, but within the next decade, it
will include:
• Routine on-site telebroadcasting by ambulance crews using
wireless local area networks (LAN).
• Allow hospital physicians to view trauma victims at scene of
accident, diagnose immediate life-threatening conditions, and direct
treatment by paramedics.

38. Transportation
• At the scene of the disaster, once the initial triage was done, the
patients must be evacuated immediately in a one way system to prevent
congestion of departing ambulances.
• Some countries now apply (START) that means Simple Triage And
Rapid Transfer.
• The police should be asked to control the entry and exit points, and
administrative staff will be needed to help with the documentation of
those survivors that are brought in .

40. Hospital Triage
Category I Green Tag
Casualties requiring minimal treatment as outpatients or domiciliary care.
Category IIRed Tag
Casualties requiring immediate treatment and whose chances of recovery
are good after immediate definitive care.
Category IIIYellow Tag
Casualties requiring treatment but who could tolerate delay, with chances
of recovery considered good after definitive care.
Category IVBlue Tag
Casualties requiring expectant treatment, with poor chances of recovery
due to the magnitude of injury and/or excessive commitment of personnel.

41. Another method
Australian method that creates a system of mass casualty, incident triage that provides a
common language platform for both ambulance and hospital personnel.
The Homebush Triage Standard Taxonomy
I Immediate II Urgent III Not urgent
IV Dying V Dead
Given the phonetic alphabet designations of:
I Alpha II Bravo III Charlie
IV Delta V Echo

• An important aspect of triage: It is a dynamic process and must be continually reassessed.
• At best, triage is 70% accurate and patient condition will change with time.
• When in doubt, it is best to triage to higher level and triage down later.

44. Despite a well - functioning trauma system that maximized
survival from devastating injury, considerable long term
morbidity and disability persists .
Efforts at prevention of mass casualties seem to be the
only potential solution.