mass casualty presentation for hospital.pptx

mass casualty incidents presentation for hospital setting

1. MASS CASUALTY INCIDENTS YUNIA MUMBUA Kigamwa. (NURSING OFFICER INTERN )

2. Objectives By the end of the presentation , you should be able to: 1. Define what a Mass Casualty Incident (MCI) and distinguish it from multiple casualty incident 2. Describe at least four key roles within the Hospital Incident Command System (HICS). 3. List the steps of MCI management 4. Apply the START triage system to accurately classify patients 5. Identify the principles of effective hospital response during an MCI. 2

3. Mass Casualty Incidents A mass casualty incident (MCI) is any incident that injures enough people to overwhelm the resources usually available in a particular system or area. A multiple casualty incident is one in which there are multiple casualties. The key difference from a mass casualty incident is that in a multiple casualty incident the resources available are sufficient to manage the needs of the victims It places great demands on resources including equipment, personnel, and facilities 3

4. These are incidents where resources are stretched to their limits It occurs with an incident having more than three casualties Ask yourself how many patients can you and your team treat and manage? Call for back up 4

5. Types of mass casualty incidents- 1. natural disasters A disaster is a serious disruption of the functioning of a society , causing widespread human , material , or environmental losses that exceed the ability of the affected society to cope using only its own resources (WHO) A disaster results in a demand for services that exceeds available resources All of them bring about mass casualties when they happen. 5

6. Examples of natural disasters Extreme heat or cold Fires Floods Earthquakes Topical Storms / hurricanes Tornadoes Epidemics 6

7. 2.Technical hazards Building collapse Hazardous material incidents Fires & explosions Transportation accidents Major industrial accidents 7

8. 3.Civil and political disorders Demonstrations Strikes Riots Mass shootings Hostage taking Terrorism 8

9. THE FACE OF EVERY DISASTER IS 9

10. Immediately Establish 10

11. Hospital INCIDENT COMMAND SYSTEM Is a management tool for organizing personnel, facilities , equipment and communication for any emergency situation . Under this structure , one person is designated as incident commander (IC) HICS gives each responder a clearly defined role to avoid chaos, duplication of efforts, or confusion during high-pressure events. 11

12. cont. Provides an orderly means of communications & information gathering for decision making Makes interactions with other agencies easier through a well defined organizational structure 12

13. It consists of: 1.Incident Commander (IC) Role: The person in charge of the entire hospital’s emergency response. Activates the Hospital Command Center (HCC)- by announcing the code ( e.g. code blue) Approves the Incident Action Plan (IAP)- procedures that tackle how to handle emergencies Communicates with external agencies (fire department , public health, first responders ) Allocates different responsibilities to team members 13

14. 2 . Safety Officer: Protects the safety of patients, staff, and visitors. Identifies hazards in the hospital during response . Ensures use of PPE (personal protective equipment) 3. Public Information Officer (PIO): Coordinates media releases, public updates. 4. Liaison Officer: Coordinates with outside agencies 14

15. cont. 5 . Operations Section Chief Role: In charge of tactical, hands-on response operations inside the hospital. Supervises units like triage, treatment, security, and patient tracking Directs staff who are giving medical care ensuring every section (nurses, doctors, security) performs their part in sync. E.g. like the conductor of an orchestra 15

16. cont. 6 . Planning Section Chief Role: Manages information and future projections. Develops the Incident Action Plan (IAP) ,Gathers data for decision-making, plans for the next operational period 16

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18. STEPS IN MASS CASUALTY INCIDENTS MANAGEMENT triage Primary survey Secondary survey Treatment Documentation 18

19. triage This is a method of quickly identifying and sorting patients into categories and ordering their treatment based on the severity of their injuries or medical conditions Its purpose is to asses the patients condition ,determine severity of injuries and determine treatment priority The golden hour concept refers to the amount of time from injury to definitive care that should be allocated to survival from traumatic injury 19

20. Priority levels Priority #1 – RED (immediate) All patients with life threatening injuries that can be treatable Airway and breathing difficulties Uncontrolled and severe bleeding Altered mental status severe medical problems Severe burns Patients showing symptoms of shock 20

21. Priority levels Priority # 2 – YELLOW ( delayed) All patients with serious injuries , but not life threatening Burns without airway problems Major multiple bone /joint fractures Back injuries without spinal cord damage 21

22. cont Priority #3 – GREEN (minimal) All patients walking wounded Minor musculoskeletal injuries , but able to move and function properly Minor soft tissue injuries 22

23. Cont. Priority #4 – BLACK All patients who appear to have no life signs : cardiac arrest with no pulse greater than 20 minutes exposed brain matter Severed torso decapitation These are the four priorities on which patients should be assessed under 23

24. The start plan A four stage SIMPLE , TRIAGE AND RAPID TREATMENT program for use in mass casualty incidents (I. )Instruct all victims who are able to ambulate to move to safe area – these are the “walking wounded”, tag them GREEN . 24

25. cont. (II). For the remaining victims, check RPM : Respiration, Perfusion, Mental Status. Each patient who cant walk has to have their airway and breathing checked , if a patient is unconscious , instruct some to secure the airway then proceed to check the respiration 25

26. cont. (III ) check the patients circulation and determine if the patient has a radial pulse A radial pulse indicates a systolic blood pressure of at least 80mmhg Any patient without a radial pulse is priority 1(RED) Quickly asses and control any major bleeding with direct pressure . If showing signs of shock and classed as priority 1( RED TAG) 26

27. Cont. (IV.) Check to see if the patient has adequate ABCs , check the patients mental status If the patient has an altered mental status , this patient is classified as priority 1 even if the ABCs are intact 27

28. Primary survey The first survey done to assess the life threatening injuries and simultaneous treatment . Its performed in no more than 2-5 mins The components of primary survey follows the ABCDE protocol 29

29. cont. A =airway with Cervical -spine B= breathing C = circulation D= disability E = exposur e 30

30. Airway Always assume a C-spine injury – protect the C-spine Assess airway .- can patient talk and breath freely ? If not ; Check for signs of airway obstruction : snoring or gagging *Cyanosis stridor or abnormal breath sound * Fracture i.e. cervical and facial agitation * Injury to the neck (larynx and trachea) 31

31. Airway management Protect cervical spine as you maintain the airway Use head tilt and chin lift maneuvers Manual removal of foreign body if any Suction the airway Put an oropharyngeal airway or nasopharyngeal airway as required Consider a definitive airway I.e. endotracheal intubation(in GCS less than 8) 32

32. Airway opening maneuvers 33

33. Breathing Establish if the patient has adequate ventilation Assessment Look for: feel for : Auscultation * respiratory rate * tracheal shift * decreased breath sounds * broken ribs *cyanosis * percussion *presence of frail chest *Use of accessory muscle 34

34. Breathing management Oxygen via face mask Bag and mask ventilation intercostal chest drain in case of pneumothorax Assess ventilation by checking Chest movement Pulse oximetry 35

35. Circulation Is the patient in shock ? Hemorrhagic or non Hemorrhagic?- loss of blood may cause hypovolemic shock Assess Pulse /heart rate * blood pressure Temperature * capillary refill and skin color Urine output * level of consciousness 36

36. shock Hypovolemic Shock (Most common in trauma) -Assess Blood Loss: -to evaluate the extent of blood loss as it directly impacts tissue perfusion and oxygen delivery. Cardiogenic Shock- Results from the heart's inability to pump effectively, leading to inadequate tissue perfusion. Neurogenic Shock- Occurs due to disruption of the autonomic pathways in the spinal cord, leading to loss of sympathetic tone . 37

37. Circulation resuscitation measures Our aim is to restore oxygen delivery to tissues 2 large bore IV cannula gauge (14-16) Infusion fluid should be warmed to the patients body temperature Avoid solutions that contain glucose –(are hypotonic and can worsen fluid shift and potentially lead to complications) 38

38. Monitor urine output : A minimum of 0.5 ml/kg/hr. 1ml/kg/hr. is adequate Monitor for dynamic fluid response by measuring pulse and blood pressure to check the body's response to the fluid Arrange and crossmatch blood 39

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40. disability Here ,a rapid neurological evaluation is done in the following order : A : Alert/A wake V – verbal response(voice )-call out P –painful response –pinch/tap U-unresponsive assess pupil bilaterally-look for reaction to light and accommodation 41

41. Exposure/environmental control Undress patient for a quick head to toe examination Remember to immobilize if cervical spine injury is suspected Prevent hypothermia- only undress where you are checking 42

42. Secondary survey This is done when the ABCS are stable to identify all minor injuries missed in primary survey If any deterioration occurs it must be interrupted by a primary survey . It contains; patient history Head to toe examination Complete neurological examination Diagnostic tests Re evaluation 43

43. Patient history A -allergies M-medication currently used P-pregnancy /past illness L-last meal E- events 44

44. Head trauma Look for ; scalp and ocular abnormality –racoon eyes ,battle sign (could indicate base of the skull fracture) External ear and tympanic membrane –any discharge , inflammation –leaking CSF Periorbital soft tissue injuries Any skull fractures – could lead to subdural hematoma 45

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46. Nb Isolated head trauma doesn’t cause hypotension For GCS less than 8 is an indication of severe head injury Cushing response is physiological but has poor prognosis (bradycardia, hypertension and irregular respirations) 47

47. Management of head trauma Intubation and hyperventilation Iv fluids(NS, mannitol, RL ) Nurse in head up position 48

48. Chest trauma Examine clavicle and ribs for fracture Breath sounds and heart sounds Early deaths are mostly due to airway obstruction and aspiration 49

49. Abdominal trauma Check for any penetrating wounds Abdominal distention –could indicate blood in peritoneal cavity Tense and tender abdomen Bowel sounds presence 50

50. Abdominal trauma management If patient is stable and has no abdominal sign –observe If stable with abdominal signs – CT scan If pt. unstable with no abdominal sign –Diagnostic Peritoneal Lavage /Focused assessment with Sonography for Trauma (FAST)scan is done to assess hemoperitoneum If unstable with abdominal sign –explorative laparotomy 51

51. Spinal trauma Examination to be done in neutral position Mobilization is done by log rolling Incase of moving the patient , use a spine board 52

52. Limb trauma Look at; feel for : Color * tenderness Deformity * crepitation Any wounds * temperature Swelling *distal neurovascular status- in case of compartment syndrome 53

53. Principles of effective response to mass casualty incidents 1 . policies and procedures – all hospital Eds must have clearly written and disseminated policy and procedures and they should be reviewed after every major emergency or disaster scenario 54

54. Cont. 2. . Emergency disaster plan – this has to be well written and contain important elements e g triage criteria and incident command system ,code name. * In this plan we will know who needs to prioritized for definitive care * Who is In charge * What are the functions of each and every member of the emergency team 55

55. cont. 3. operating theatre –access to a functioning operating theatre allows early definitive care and minimizes unwanted morbidity or preventable mortality 4. staffing of ER – nurses (they should be trained in trauma nursing and able to collaborate with the rest of the team members ) * emergency medicine physicians –should be able institute initial management *trauma team – should collaborate with each other for best outcome 56

56. cont. 5. overcrowding – should be controlled at the ER to ensure the place does not get chaotic and difficult to operate 6. equipment and supplies – the emergency department should be well equipped with airway devices , emergency drugs ,, every aspect needed to manage shock ,fractures etc. . 7. contingency –planning is the key to proper response to a mass casualty incident . Worst case scenario must be thought of and procedures should be developed for each possibility 57

57. cont. 8, observation and holding area- during an influx of patients to a hospital , temporary patient care areas may have to be established like lobby areas and corridors 9. referral and transfer – when the hospital is flooded to its capacity , the process of referral and transfer to other hospitals must be considered Drills and simulation training should be performed for the staff, to ensure they are ready . 58

58. conclusion Hospitals should be well prepared to handle mass casualty incidents with well written policies and guidelines 59

59. references 1. Morgan, O. W., Sribanditmongkol , P., Perera , C., Sulasmi , Y., & Van Alphen, D. (2006). Mass fatality and casualty incidents: 2. Kidd, B. (2010). Mass casualty incidents . SlideShare. Retrieved July 20, 2025, 3. Hosseene . (n.d.). Mass casualty management .SlideShare. Retrieved July 20, 2025, from SlideShare website: | 60

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