Table 2 Key challenges and lessons for dealing with a mass-casualty incident
Challenge | Lesson |
|---|---|
Before the event | |
Clear protocols | Have clear protocols for emergency preparedness including the roles of various staff members in an emergency |
Frequent drills | Drill MCI frequently so that the staff is familiar with their roles in an emergency. Make sure to include all sectors |
Consider the best alternative for documentation | Decide whether to use paper records or computer-based records in an MCI and use it as part of the drill. Make sure records are easy to use |
Define the structure of the incident command system | Consider working with a central command desk and emergency complexes dealing with specific issues such as clinical decision, logistics, manpower |
During the event | |
Early declaration of the MCI | Do not wait for external activation; gather information from the outside as soon as possible |
Announcing an MCI | Err on the side of over-stretching the system, rather than be surprised that you are under-staffed for the number of casualties |
Capacity management | Discharge all patients that do not have to stay at the hospital; transfer all patients who can be moved to medical / surgical floor out of the ICU |
Consider secondary evacuation of patients who have been stabilized but require further surgical procedures to other hospitals as early as needed and possible | |
Expect the unexpected | Consider the possibility of a multi-focal event, extensive geographical extent and / or prolonged duration and non-conventional modes of evacuation of casualties (e.g. private vehicles) |
Role of emergency medicine and intensive care physicians | Consider managing the various sites in the emergency department by emergency medicine and / or intensive care specialists, saving the trauma experts for clinical evaluation of individual challenging patients and emergency surgical procedures |
Resource management | Make sure you have enough operating rooms, or use additional sites (e.g. OB/GYN, day-care surgery room) when relevant |
Consider using additional CT scanners such as the CT component of a PET-CT or the simulation CT for radiotherapy. Map hardware and software capabilities in advance | |
Bring additional equipment to the trauma room to increase the number of patients who can be treated simultaneously | |
Communication interruptions | Consider the possibility of local or extensive disruption of cellular communication. Use alternatives such as satellite phones |
Logistics | Make sure you have enough equipment (e.g. surgical supplies) and medications and look for quick solutions for replenishing the stock |
Handling corpses | Locate an alternative site for corpses if the mortuary is overloaded |
Following the event | |
Improve documentation | Complete all missing documentation. If documentation was done in paper records, scan or type (preferred) them into the electronic medical record |
Debriefing | Debrief as early as possible and reflect on what went well and what could have been improved |
Improve your readiness | Based on the debriefing, consider changes to emergency protocols as needed |
Share the knowledge | Share the knowledge with other hospitals in the country and worldwide, to improve emergency preparedness in the future |