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Mass casualty incident
A mass casualty incident (often shortened to MCI) describes an incident in which emergency medical services resources, such as personnel and equipment, are overwhelmed by the number and severity of casualties. For example, an incident where a two-person crew is responding to a motor vehicle collision with three severely injured people could be considered a mass casualty incident. The general public more commonly recognizes events such as building collapses, train and bus collisions, plane crashes, earthquakes and other large-scale emergencies as mass casualty incidents. Events such as the Oklahoma City bombing in 1995, the September 11 attacks in 2001, and the Boston Marathon bombing in 2013 are well-publicized examples of mass casualty incidents. The most common types of MCIs are generally caused by terrorism, mass-transportation accidents, fires or natural disasters. A multiple casualty incident is one in which there are multiple casualties. The key difference from a mass casualty incident is that in a multiple casualty incident the resources available are sufficient to manage the needs of the victims. The issue of resource availability is therefore critical to the understanding of these concepts. One crosses over from a multiple to a mass casualty incident when resources are exceeded and the systems are overwhelmed.
A mass casualty incident will usually be declared by the first arriving unit at the scene of the incident, and less usually by an emergency call dispatcher, depending on the information that is provided by emergency units. A formal declaration of an MCI is usually made by an officer or chief of the agency in charge. Initially, the senior paramedic at the scene will be in charge of the incident, but as additional resources arrive, a senior officer or chief will take command, usually using an incident command system structure to form a unified command to run all aspects of the incident. In the United States, the Incident Command System is known as the National Incident Management System (NIMS). According to the Federal Emergency Management Agency, "NIMS provides the template for the management of incidents."
After the proper agencies have arrived, a more detailed assessment of the scene will be performed using the M.E.T.H.A.N.E method, which summarizes information necessary for responders:
There are multiple agencies involved in most mass casualty incidents, which means there are many individuals that require training for these specific situations. The most common types of agencies and responders are listed below.
Trauma centers play a crucial role in the mass casualty incident timeline. A hospital can receive trauma center status by meeting specific criteria established by the American College of Surgeons (ACS) and passing a site review. Trauma centers have levels ranging from level 1 to level 4, with each level varying in different responsibilities and resources provided:
This is not an exhaustive list of agencies, and many other agencies and groups of people could be involved in a mass casualty incident.
Ideally, once an MCI has been declared, a well-coordinated flow of events will occur, using three separate phases: triage, treatment, and transportation.
The first-arriving crew will conduct triage. Pre-hospital emergency triage generally consists of a check for immediate life-threatening concerns, usually lasting no more than one minute per patient. In North America, the START system (simple triage and rapid treatment) is the most common and is considered the easiest to use. Using START, the medical responder assigns each patient to one of four color-coded triage levels, based on their breathing, circulation, and mental status. The triage levels are:
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Mass casualty incident
A mass casualty incident (often shortened to MCI) describes an incident in which emergency medical services resources, such as personnel and equipment, are overwhelmed by the number and severity of casualties. For example, an incident where a two-person crew is responding to a motor vehicle collision with three severely injured people could be considered a mass casualty incident. The general public more commonly recognizes events such as building collapses, train and bus collisions, plane crashes, earthquakes and other large-scale emergencies as mass casualty incidents. Events such as the Oklahoma City bombing in 1995, the September 11 attacks in 2001, and the Boston Marathon bombing in 2013 are well-publicized examples of mass casualty incidents. The most common types of MCIs are generally caused by terrorism, mass-transportation accidents, fires or natural disasters. A multiple casualty incident is one in which there are multiple casualties. The key difference from a mass casualty incident is that in a multiple casualty incident the resources available are sufficient to manage the needs of the victims. The issue of resource availability is therefore critical to the understanding of these concepts. One crosses over from a multiple to a mass casualty incident when resources are exceeded and the systems are overwhelmed.
A mass casualty incident will usually be declared by the first arriving unit at the scene of the incident, and less usually by an emergency call dispatcher, depending on the information that is provided by emergency units. A formal declaration of an MCI is usually made by an officer or chief of the agency in charge. Initially, the senior paramedic at the scene will be in charge of the incident, but as additional resources arrive, a senior officer or chief will take command, usually using an incident command system structure to form a unified command to run all aspects of the incident. In the United States, the Incident Command System is known as the National Incident Management System (NIMS). According to the Federal Emergency Management Agency, "NIMS provides the template for the management of incidents."
After the proper agencies have arrived, a more detailed assessment of the scene will be performed using the M.E.T.H.A.N.E method, which summarizes information necessary for responders:
There are multiple agencies involved in most mass casualty incidents, which means there are many individuals that require training for these specific situations. The most common types of agencies and responders are listed below.
Trauma centers play a crucial role in the mass casualty incident timeline. A hospital can receive trauma center status by meeting specific criteria established by the American College of Surgeons (ACS) and passing a site review. Trauma centers have levels ranging from level 1 to level 4, with each level varying in different responsibilities and resources provided:
This is not an exhaustive list of agencies, and many other agencies and groups of people could be involved in a mass casualty incident.
Ideally, once an MCI has been declared, a well-coordinated flow of events will occur, using three separate phases: triage, treatment, and transportation.
The first-arriving crew will conduct triage. Pre-hospital emergency triage generally consists of a check for immediate life-threatening concerns, usually lasting no more than one minute per patient. In North America, the START system (simple triage and rapid treatment) is the most common and is considered the easiest to use. Using START, the medical responder assigns each patient to one of four color-coded triage levels, based on their breathing, circulation, and mental status. The triage levels are: