Skip to main content

Abstract

Trauma is the most common cause of mortality in the United States in those <46 years old [1]. Although only a small minority of all survivable and non-survivable trauma are the result of a mass casualty event (MCE), highly publicized disasters such as the Boston Marathon bombings, Asiana Airlines crash, and Hurricane Katrina are reminders that at any moment, in any location, multiple mechanisms are capable of producing large numbers of seriously injured patients. Because of the rarity of such large-scale incidents, one of the major obstacles to successful management of MCE’s is a lack of real world experience by the average provider. Rarity, coupled with the very complex nature of a MCE is why preparation and planning play large roles in the navigation of these events. At the most basic level, a mass casualty event is one in which the number of casualties creates imbalance between the medical needs of the patients and the resources available to treat them. Imbalance makes it impossible to provide optimal care for each patient. Thus, the treatment facility is forced to shift from the fundamental principle of providing the greatest good for the individual, to providing the greatest good for the greatest number [2, 3]. The number of casualties needed for an incident to be considered a mass casualty event will vary by institution capabilities and size. Two or three critically injured patients arriving at the same time could easily overwhelm a small rural hospital, whereas a large urban trauma center may be capable of handling several critically injured patients simultaneously before the available resources are exhausted [4]. Regardless of location, it is the duty of the triage officer to determine toward which patients limited resources are directed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Rhee P, Joseph B, Pandit V, Aziz H, Vercruysse G, Kulvatunyou N, Friese RS. Increasing trauma deaths in the United States. Ann Surg. 2014;260(1):13–21.

    Article  PubMed  Google Scholar 

  2. Culley J, Svendsen E. A review of the literature on mass casualty triage systems with a focus on chemical exposures. Am J Disaster Med. 2014;9(2):137–50.

    Google Scholar 

  3. Fyrkberg E, Schecter W. Disaster and mass casualty. Trauma Mattox, Moore, Feliciano eds. McGaw Hill, New York; 2013, pp 123–39.

    Google Scholar 

  4. ACS Committee on Trauma. Mass casualties. Resources for Optimal Care of the Injured Patient 1999: American College of Surgeons, Chicago, IL; 1993, pp. 87–91.

    Google Scholar 

  5. Hammond J. Mass casualty incidents: planning implications for trauma care. Scand J Surg. 2005;94(4):267–71.

    Article  CAS  PubMed  Google Scholar 

  6. Auf der Heide E. The importance of evidence-based disaster planning. Ann Emerg Med. 2006;47:34–49.

    Article  Google Scholar 

  7. Pucher P, Batrick N, Taylor D, Chaudery M, Cohen D, Darzi A. Virtual-world hospital simulation for real-world disaster response: Design and validation of a virtual reality simulator for mass casualty incident management. J Trauma Acute Care Surg. 2014;77(2):315–21.

    Article  PubMed  Google Scholar 

  8. Federal Emergency Management Agency. Exercises. http://www.ready.gov/business/testing/exercises. Accessed 13 Jan 2015.

  9. Hirshberg A, Holcomb J, Mattox K. Hospital trauma care in multiple-casualty incidents: a critical view. 2001;37(6):647–52.

    CAS  Google Scholar 

  10. Brevard SB, Weintraub SL, Aiken JB, Halton EB, Duchesne JC, McSwain NE Jr, et al. Analysis of disaster response plans and the aftermath of hurricane katrina: lessons learned from a level i trauma center. J Trauma. 2008;65(5):1126–32.

    Article  PubMed  Google Scholar 

  11. Brunner, J. et al. The boston marathon bombing: after-action review of the brigham and women’s hospital emergency radiology response. Radiology. 2014;273(1):78–87.

    Google Scholar 

  12. Walls R, Zinner M. The Boston Marathon response. Why did it work so well? JAMA. 2013;309(23):2441–2.

    Article  CAS  PubMed  Google Scholar 

  13. Kelen GD, McCarthy ML, Kraus CK, Ding R, Hsu EB, Li G, Shahan JB, Scheulen JJ, Green GB. Creation of surge capacity by early discharge of hospitalized patients at low risk for untoward events. Disaster Med Public Health Preparedness. 2009;3:S10–6.

    Article  Google Scholar 

  14. Personal conversation with Peter M. Rhee, November 1, 2014.

    Google Scholar 

  15. Mass Casualty and Triage. Emergency War Surgery. Washington DC: Office of the Surgeon General, U.S. Army, Borden Institute, Walter Reed Army Medical Center; 2013 pp. 29–47.

    Google Scholar 

  16. Cone DC, Serra J, Burns K, MacMillan DS, Kurland L, Van Gelder C. Pilot test of the SALT mass casualty triage system. Prehosp Emerg Care. 2009;13(4):536–40.

    Article  PubMed  Google Scholar 

  17. SALT mass casualty triage. concept endorsed by the American college of emergency physicians, american college of surgeons committee on trauma, american trauma society, national association of EMS physicians, national disaster life support education consortium, and state and territorial injury prevention directors association. Disaster Med Public Health Prep. 2008;2(4):245–6.

    Article  Google Scholar 

  18. Kennedy K, Aghababian R, Gans L, Lewis C. Triage: techniques and applications in decision-making. Ann Emerg Med. 1996;28(2):136–44.

    Article  CAS  PubMed  Google Scholar 

  19. Hirshberg A, Frykberg ER, Mattox KL, Stein M. Triage and trauma workload in mass casualty: a computer model. J Trauma. 2010;69:1074–82.

    Article  PubMed  Google Scholar 

  20. Peev MP, Naraghi L, Chang Y, Demoya M, Fagenholz P, Yeh D, et al. Real-time sample entropy predicts life-saving interventions after the Boston Marathon bombing. J Crit Care. 28;(2013). 1109.e19.e1e1ts.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Peter Rhee .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Gerhardt, E., Vercruysse, G., Rhee, P. (2017). Mass Casualty Events and Your Hospital. In: Ecklund, J., Moores, L. (eds) Neurotrauma Management for the Severely Injured Polytrauma Patient. Springer, Cham. https://doi.org/10.1007/978-3-319-40208-6_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-40208-6_3

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-40206-2

  • Online ISBN: 978-3-319-40208-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics