Review of the requirements for effective mass casualty preparedness for trauma systems. A disaster waiting to happen?

Abstract

Mass casualty incidents (MCIs) are diverse, unpredictable, and increasing in frequency, but preparation is possible and necessary. The nature of MCIs requires a trauma response but also requires effective and tested disaster preparedness planning. From an international perspective, the aims of this narrative review are to describe the key components necessary for optimisation of trauma system preparedness for MCIs, whether trauma systems and centres meet these components and areas for improvement of trauma system response. Many of the principles necessary for response to MCIs are embedded in trauma system design and trauma centre function. These include robust communication networks, established triage systems, and capacity to secure centres from threats to safety and quality of care. However, evidence from the current literature indicates the need to strengthen trauma system preparedness for MCIs through greater trauma leader representation at all levels of disaster preparedness planning, enhanced training of staff and simulated disaster training, expanded surge capacity planning, improved staff management and support during the MCI and in the post-disaster recovery phase, clear provision for the treatment of paediatric patients in disaster plans, and diversified and pre-agreed systems for essential supplies and services continuity. Mass casualty preparedness is a complex, iterative process that requires an integrated, multidisciplinary, and tiered approach. Through effective preparedness planning, trauma systems should be well-placed to deliver an optimal response when faced with MCIs.

Emergency medical services preparedness in mass casualty incidents: A qualitative study

“…Law force, fire departments, Red Crescent, specialized organizations of hazardous materials, and so forth are among the partners of the EMS in the management of MCIs. Coordination and collaboration of intra‐ and interorganizations were one of the key components that were extracted from this study 1,10,19 . This important issue in the study conducted by Sadat in Iran in the field of EMS preparedness in mass casualty traffic accidents was one of the important findings of this qualitative study which was consistent with the findings of the present study 20 .…”

“…Coordination and collaboration of intra-and interorganizations were one of the key components that were extracted from this study. 1,10,19 This important issue in the study conducted by Sadat in Iran in the field of EMS preparedness in mass casualty traffic accidents was one of the important findings of this qualitative study which was consistent with the findings of the present study. 20 The findings of the study conducted by Kondo in Japan showed that to provide constant medical assistance at the disaster area, logistic teams, and other disaster medical relief teams must have constant coordination at the medical headquarter command.…”

“…They acknowledged that more technical development was needed before the on‐line system could be recommended for use in major incidents or disasters. However, a comprehensive information system helps the EMS to plan and respond to MCIs 10,22 …”

“…Many studies have been carried out on the effect of time indices on the prognosis of injured patients, and almost all of them have emphasized considering effective strategies to enhance these indices. 10,32 Incident scene operation in MCIs include the incident scene assessment, triage, treatment, transportation, and distribution of the injured. MCIs are usually dynamic scenes; thus, there are many differences in how to manage the scenes.…”

“…However, a comprehensive information system helps the EMS to plan and respond to MCIs. 10,22 The EMS system must pay special attention to the personnel and group empowerment to effectively respond to MCIs. Strengthening the skills, physical and psychological preparation of EMS personnel, and increasing community awareness were the key components.…”