2. Any disaster resulting in a number of victims
large enough to disrupt the normal course of
emergency and health care services is known as
mass casualty incidence.
3. They are classified as:
Multiple casualty incidents: casualty strain beyond
normal daily operation , can be managed by local
hospital
Mass casualty incidents: involve hundreds of casuality
in a single institute, more than the capacity of ED
Major medical disaster: thousands of casuality, in this
case an external support in needed,
4. Two type of disaster
Natural disaster
Earthquake
Tsunami
Storm / flooding
Neighbourhood nuclear plant
6. Produces several patients
As few as six or as many as several hundred
Affects local hospitals
Patients are greater than resources of the initial
responders
6
Mass Casualty Incident
7. Pre-planning and training are critical
Establish guidelines and procedures
Early implementation of Incident
Command
7
Preparation for Mass Casualty
8. • Management of victim of a mass casualty
event
• Objective is to minimize loss of life and
disabilities
• Triaging the patent
Casualty Management
8
9. TRIAGE
It is a method of sorting out injured patient, during
mass casualty depending on the severity of injury
The term triage is derived from the French word “trier”
meaning “to sort”.
It is activity by trauma team.
10. The Triage Team
Triage team leader
Clinical triage officer
Head nurse
Nursing groups
Follow-up medical groups
11. Color coding
Black/Expectant: eg large body burns,
cardiac arrest
Red/immediate : cannot wait
Yellow/observation: requires watching
and re-triage
Green/wait: require care in hours to
days
12. Category I: Resuscitation and immediate
surgery
Patients who need urgent surgery – life-saving – and
have a good chance of recovery.
(E.g. Airway, Breathing, Circulation: tracheostomy, haemothorax,
haemorrhaging abdominal injuries, peripheral blood vessels)
15. Category II: Need surgery but can
wait
Patients who require surgery but not on an urgent
basis.
A large number of patients will fall into this group.
(E.g. non-haemorrhaging abdominal injuries, wounds of limbs
with fractures and/or major soft tissue wounds, penetrating
head wounds)
19. Category III: Superficial wounds
(no surgery, ambulatory treatment)
Patients with wounds requiring little or no surgery.
In practice, this is a large group, including superficial
wounds managed under local anaesthesia in the
emergency room or with simple first aid measures.
22. Category IV: Very severe wounds
(no surgery, supportive treatment)
Patients with such severe injuries that they are unlikely
to survive or would have a poor quality of survival.
The moribund or those with multiple major injuries
whose management could be considered wasteful of
scarce resources in a mass casualty situation.
23.
24. Triage tags applied to
patients, make one’s
task of sorting much
easier
USA MILTAGS
Front Back
30. Management
Fundamental step – A B C D E F
A- Air way management
B- breathing
C- circulation
D- disability and assessment of level of consciousness
E- exposure of the patient fully for thorough
examination
F- finger evaluation and tubes
31. Airway with cervical spine protection:
rapid assessment of obstruction – forging bodies,
fallen back tongue, etc.
Lift jaw, introduce airway, good suction throat,
intubation
Assume cervical spine fracture and cervical collars
applied
Breathing and o2 administration
pneumothorax, multiple fracture of ribs and haemothorax
High flow oxygen required
32. Circulation and control of bleeding
Circulation status, evidence of shock and internal and
external bleeding
Iv fluids
Pulse, blood pressure, spleen and liver injuries
CT scan, echo, cradiography, etc
Disability
Glasgow coma score
Finger and tube
Quick examine all orifices – eg. bleeding from ear, nose,
oral cavity, rectum, vagina, urethra.
Catheter should be done immediately
33. The aim in a mass casualty situation is
to do the best for the most,
not
everything for everyone.
Thank you