Effective Management of Emergent Mass Casualties

15.07.2020 in Medicine Essay
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This study will focus on the effective management of Emergency Medical Services in cases of emergent Mass Casualty Incidents (MCIs). In addition, the study will be developed in the scope of the subject matter, that is, a description of circumstances that qualify as MCIs. MCI management requires urgency in management, as well as the use of specialized resources and personnel. The extent to which emergency medical service providers are able to manage and arrest the emergencies is determined by the level of damage caused. MCI management requires the provision of expert services and timely management of the incident so as to limit the number of casualties. It is critical for practitioners to facilitate rescue missions through a well-structured plan guide. The plan guide provides the primary triage, casualties extraction, treatment and transfer of patients to health facilities. Additionally, the recovery process that is subsequent to the response and operations of rescue will be addressed in the paper. Furthermore, a focus on quality management through personnel training and education will also be put.

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Scope of Mass casualty Incident

MCIs are circumstances or incidents that have casualty cases that go beyond the capacity of the primary or regular response team. Emergencies can be anticipated or unexpected. Anticipated events include terrorist attacks that were expected, or occurrences of forecasted earth quakes, among other foreseeable occurrences (Viswanathan, 2011). In contrast, unexpected cases include accidents, sudden tornados and any other massive destructions leading to mass casualties. Basically, MCIs comprise but are not limited to multiple motor vehicle accidents, building collapses, war, chemical outbursts, catastrophic natural calamities, and air crash cases among others. This study will focus on effective management of unexpected or emergent MCIs. The extent of damage caused and the number of people included are among the key factors used to declare a situation an MCI. Some emergency cases that involve multiple casualties may not necessarily be defined as MCIs (Viswanathan, 2011). Mass casualties can be identified by a dispatcher; the dispatcher or the personnel who receives alerts from the victims can determine whether the information provided is sufficient to declare a situation an MCI. On the other hand, the situation can be analyzed and determined by emergency medical personnel on the ground. The declaration of an incident as an MCI consequently calls for facilitation of the Incident Command System.

Significance of Effective MCIs Management

Management of MCIs requires efficiency so as to optimize results and maintain casualties and fatalities at a minimum. Emergency preparedness by the medical service unit is critical in ensuring competence in case of any emergencies arising. The presence of the necessary capabilities significantly reduces the number of casualties and deaths that would otherwise occur if no intervention is done (Veenema, 2003). Early management of casualties also aids, immensely, in preventing the death of most victims. In MCIs a significant number of victims die because of lack of proper medical attention. Emergency medical service providers are also able to identify any eventualities that would arise and thus freeze the situation beforehand. For instance, a building collapse would trigger other calamities such as electrocution; thus, having experts on site helps in managing additional problems (Veenema, 2003). The establishment of a rescue unit is vital so as to ensure the facilitation of effective mass casualty management. Additionally, an incident command structure is critical in the management of operations among medical practitioners.

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Response Planning and Management

Effective response planning and management requires provision of resources and facilities necessary in ensuring that medical service delivery for MCIs is well-enacted. A command structure and system should also be implemented so as to ascertain orderliness and proper service delivery. The structure usually entails hierarchical positions based on power and authority. Key components of the structure include the head commander, logistics, finance, operations, and planning department. In addition, there are the transport, triage and treatment branches. The emergency units should facilitate effective training for all personnel. Learning and growth are among the key factors that should be maintained at all times (Veenema, 2003). This initiative in turn promotes quality improvement and proper mass casualty management. Medical unit for emergency management should be structured in a way that facilitates effective decision making and implementation of the identified solutions. On the ground, initial triage, patient extraction, secondary treatment and patient transportation phases are then carried out.

The START System is an example of an effective resolution tool for Emergency Medical Service (EMS) providers, at the initial triage phase. START which stands for Simple Triage and Rapid Treatment is a technique adopted in assessment of an incident. This strategy focuses on identifying the magnitude of injuries, the severity of injuries, and other distinguishable factors that in turn aid in determining the best treatment to be applied (Pollak, 2005). Additionally, other factors such as transportation of patients, resources required, number of personnel required and approximation of fatalities are also identified. Furthermore, the use of START involves categorization of victims based on how they are presented. Firstly, the most severely affected persons or immediate category patients are catered for in the immediate treatment area. These persons comprise all the critically injured victims. The second treatment area is for the delayed, that is, the persons who are injured but are not in a critical condition. The third category comprises the walking wounded, and lastly the deceased. The initial triage encompasses the basic management of cases such as managing excessive bleeding and ensuring the airways are open.

Patients’ extraction involves removal of victims from the incident area and transferring them to the most appropriate treatment area. Extraction is, however, conducted when there are sufficient resources to facilitate the process. Patients’ extraction is done according to the order of priority based on the category of each victim. Subsequently, secondary triage is conducted to enable a more specific and efficient case management than in the initial triage. This process involves re-assessing victims to determine their current condition, and thus taking the most appropriate actions. At this stage, upgrading and downgrading of the patients category can be done depending on the changes (Veenema, 2003). For instance, a victim whose state worsens to a near death situation is upgraded to immediate treatment. The assessment of patients at this point facilitates planning for transportation. Critical cases are considered first, followed by the less critical ones. However, the deceased are left unattended to till after the situation is contained and all other victims are catered for.

Effective management of MCIs by EMS providers requires availability of sufficient resources necessary to effectively manage emergencies. Indeed, in emergent cases, sufficient resources are compulsory if the medical unit is to successfully contain the situation. Undoubtedly, communication channels are key factors to consider (Pollak, 2005). EMS providers should have good communication facilities that enable effective collection of information, as well as receiving the alerts. The automation of communication channels is a key factor to consider. In essence, these channels facilitate communication among medical personnel, both on the ground and within the crisis area (Aghababian, 2011). Furthermore, EMSs should implement systems that are well-adaptive to emergencies. Technology incorporation in the different departments and branches of EMS is a key factor to consider as well. Effective response planning and management is the key determinant factor as to whether mass casualty incidents are contained successfully.

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The recovery process involves the assessment of MCI management processes. EMSs ought to carry out an analysis of the rescue program conducted so as to identify the successes and failures or challenges encountered. The assessment involves identifying personnel efficiency, suitability and sufficiency. This process also involves identifying the need for replacements of personnel or facilitating a rotational program. Additionally, the analysis of resources and equipments is done. This in turn aids in inventory management: ordering, acquisition and restocking. In addition, ambulances are restocked before being set on active status. Critical Incident Stress Debriefing (CISD) is another key element of the recovery phase (Aghababian, 2011). This basically entails addressing the impact of crisis management for disturbed medics. CISD, however, is not compulsory and is done only if a need arises. Tracking of performance at each stage of the triage is critical. This element involves analyzing the initial triage, patients’ treatment, transportation and discharge. In addition, information and data compilation and collection are done in order to ensure accountability.

Training and education for paramedics responsible for delivering EMSs is another important aspect. Learning should be a continuous process for EMSs personnel, as it facilitates the delivery of quality services. In addition, learning aids in acquiring the new skills and knowledge that are superior to some conventional ways of dealing with particular situations. For instance, through education paramedics involved in emergency management are able to readily operate new technologies that facilitate effective service delivery (Elling, 2003). A good training program should encompass both theoretical and practical activities. This is paramount because health care is primarily a service sector. Moreover, practical application of knowledge facilitates the provision of an evidence-based practice that incorporates contemporary developments or conditions.


Effective management of emergent mass casualties is critical in dealing with damage and fatalities that result from calamities. Emergent incidents are especially critical since EMSs ought to be well-equipped for the task at hand (Aghababian, 2011). Effective management of emergencies requires EMSs to have well-structured systems of operations. In essence, MCIs management progresses through determined stages, which include the initial triage, extraction, secondary triage, and transportation. The provision of a system of operation for EMIs facilitates efficiency and effective service delivery (Aghababian, 2011). EMSs should also have distinct departments and branches with clearly stipulated roles and duties to enhance appropriate decision-making. Absence of a good structure with well-aligned duties and responsibilities contributes to occurrence of avoidable fatalities. Implementing systems and formulating a good structure in an EMS promote appropriate resource management, and as a result, resources are available to manage any eventualities that may arise. 

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