The Explosive Mass Casualty Incident: Prehospital Incident Management and Triage

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A mass casualty incident (MCI) is an event that causes casualties in sufficient number or acuity to overwhelm the locally available medical and public health services and resources. Explosives are uniquely suited to cause MCIs due to their ability to affect large areas and numbers of people, cause severe and complicated injuries, produce massive structural damage, and create environmental hazards (e.g., fire, radiation, chemical, dust, and carbon monoxide). Due to the severity and complexity of explosive MCI, clear and effective command and control is essential in optimizing patient care. The Incident Command System (ICS) is a widely applicable management system designed to enable effective and efficient incident management by integrating a combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure. It is the current standard command structure for use in civilian MCIs of any cause. In addition to an appropriate incident command structure, fast and effective on-scene triage is crucial to an effective blast MCI response. The Centers for Disease Control and Prevention (CDC) established standardized triage criteria for MCIs called the Model Uniform Core Criteria for Mass Casualty Triage (MUCC). SALT triage is a MUCC-compliant triage system that uses a two-step process of global sorting, followed by lifesaving interventions (LSI) and individual victim assessment. The unique characteristics of blast MCIs require specific considerations for security, resource allocation, and evacuation priorities.