PTC Course/Management of Mass Casualties

▼Created by Primary Trauma Care Foundation for the Surgical Education Learners Forum.This page is not open edit.

Preparation for a major incident involves planning, training and acquisition of equipment.

The hospital team must be prepared for any kind of crisis, and every hospital should have a disaster/triage plan. The aim of the plan is to organise personnel, space, equipment, supplies, infrastructure and services.

Training of the hospital team, communications and security measures are also very important. The hospital team should hold a series of meetings to discuss the organisation of the disaster/triage plan. Everyone in the hospital should be aware of the plan and their respective role during the crises.

Five critical steps before patients arrive in the Emergency Department:

1. Inform Head of the Hospital Disaster Team
2. Create Space by moving patients by discharge or admission to any empty bed or alternative location in the hospital.
3. Team meeting (Nurses/Doctors)
4. Establish Security Perimeter and Stretcher/Porters
5. Call more staff to Casualty reception area

Essential Roles:

• Doctors – who are team players and will follow the protocols and orders
• Nurses – it may be necessary to move nurses to ED from other areas
• Security Supervisor
• Someone to arrange Ward and ICU beds – Nursing Supervisor
• A person ensuring quick X-Ray turnover.
• Someone looking for stretchers and wheelchairs
• Pharmacist/Store supervisor
• Patient transport force – Porters
• Record Keeper/Manager
• Public Relations Officer – Informing public/press every 15 minutes to hourly
• Blood Product Runner – A person ensuring quick Blood Bank turnaround

The person in charge of the Emergency Department (ED) during a disaster should be a clinician who is familiar with the systems and staff of the department, and is not necessarily the most senior physician or surgeon or the most important professor. They should be clearly identified as the leader in the ED with a name tag or special coloured vest.

The Hospital Command Centre should be situated away from the ED, but be in close communication with what is happening in the ED and what the patient load is. Senior staff can create problems by coming to the ED and not following the command structure at that time.

It is important to ensure the ED is secure during a mass casualty event.

There should be:

• Clear and practiced Security Protocols (including Non-Hospital Personnel)
• Security Perimeters:
  • Outer Perimeter – Combination of Volunteers and Police
  • Medium Perimeter – Hospital Security and Police
  • Inner Perimeter – Police
• A Disaster Drop Off Area
• Hospital Porters at the ambulance drop off
• A 5 second security check before bringing the victims inside

Prior efforts to build relationships/links with the community and to educate the press, can benefit healthcare institutions in the event of a mass casualty scenario.