Mass Casualty Incident Management for Resource-Limited Settings: Lessons From Central Haiti

Abstract

Objective: Mass casualty incidents (MCIs) have gained increasing attention in recent years due multiple high-profile events. MCI preparedness improves the outcomes of trauma victims, both in the hospital and prehospital settings. Yet most MCI protocols are designed for high-income countries, even though the burden of mass casualty incidents is greater in low-resource settings. Results: Hôpital Universitaire de Mirebalais (HUM), a 300-bed academic teaching hospital in central Haiti, developed MCI protocols in an iterative process after a large MCI in 2014. Frequent MCIs from road traffic collisions allowed protocol refinement over time. HUM’s protocols outline communication plans, triage, schematics for reorganization of the emergency department, clear delineation of human resources, patient identification systems, supply chain solutions, and security measures for MCIs. Given limited resources, protocol components are all low-cost or cost-neutral. Unique adaptations include the use of 1) social messaging for communication, 2) mass casualty carts for rapid deployment of supplies, and 3) stickers for patient identification, templated orders, and communication between providers. Conclusion: These low-cost solutions facilitate a systematic response to MCIs in a resource-limited environment and help providers focus on patient care. These interventions were well received by staff and are a potential model for other hospitals in similar settings.

Minimum data set harmonization in the management of cross-border Multi Casualty Incidents. Modified Delphi (VALKYRIES—H2020 project)

“…The Committee on Disaster Risk Reduction (UNDRR, UN Office for Disaster Risk Reduction) has defined a disaster as a serious disruption of the functioning of a community or society involving widespread human, material, economic or environmental losses and impacts, which exceeds the ability of the affected community or society to cope using its own resources [ 1 ] On that basis, it is noteworthy that disasters that occur in transborder areas are especially complex, especially when international intervention is required [ 2 , 3 ]. In addition to the complexities of multi-victim incidents, cross-border events require the collaboration of different emergency providers, of different nationalities, speaking different languages, with different skills (emergency vehicles with medical staff are not always provided) [ 4 ] and with first responder systems that differ from one another (sometimes police or firefighters, even the military are the first on the scene) [ 5 ] in addition to the differences related to the prevention and promotion programmes of the different countries, the health systems they have (public and/or private) and the implication for the health of the patients attended [ 6 ], which is related to survival in the event of an event of these characteristics.…”