Mass Casualty Events and Your Hospital

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.