Disaster Risk Management: Mass Casualty Management Preparedness
Disasters from natural, technological, military and societal hazards lead to large numbers of fatal and non-fatal casualties. The preparedness of a responsive healthcare facility for disasters begins to immediately determine the weight of the ensuing statistics, outcomes and ultimate impact of the disasters on the individual, the health worker and the victims.
Mass casualty management is the health sectors immediate priority in an emergency. A responsive hospital or healthcare facility in the vicinity of a disaster becomes the mandatory disaster management center by default. Even though not all healthcare facilities are designed or equipped to adequately deal with mass casualties, facilities should have minimum standards in preparedness in dealing with the triaging, stabilizing and directing the transfer of mass casualties to other appropriate interventional facilities with the least risks possible emanating from delayed decision making and poor disaster command and communication implementation.
Many deaths following natural disasters are preventable with rapid medical care. The medical response to a mass casualty event operates at two primary locations: on-site and at the hospital. Minimum health facility disaster preparedness for management of mass casualties should include ability for the hospital to quickly triage casualties in the field (on-site), efficiently direct patients to corresponding trauma facilities, and stabilize any immediate arrivals in its own premises.
A minimum mass casualty disaster management protocol should define pre-hospital search and rescue and triage are procedures that are essential to determining patient treatment and transport priorities to save lives and optimize resources.
What are the health risks?
Immediately after impact, severe trauma and wounds are the most urgent priority for medical management. Maternal and new born emergency care as well as mental health effects are other facets of these dramatic situations.
In these settings, trauma is often related to collapsing infrastructure and transport related injury, though violence and civil unrest can also be a follow-on cause of trauma. In flooding and tsunami, drowning is a major cause of death.
Early interventions are critical for survival and reduced health impacts. Many casualties can be treated both on an outpatient or surgical basis. It is vital that care begin at the site, during search and rescue. In areas where there is a network of trauma surgeons and physicians, first aid and essential surgical care capacities at local level can help to reduce trauma mortality in the short term and long-term morbidity and sequelae, including disabilities.
Risk Management Considerations
Multisectoral action to reduce the risk of mass casualty situations include:
- Safe construction and maintenance of housing, health facilities and other buildings, and road safety measures.
- Public risk communication to promote personal and organizational safe behaviors, including responding to warnings, safe evacuations, shelter plans and protection from extreme events e.g. earthquakes, floods, tsunami.
- Maintaining civil order reduce injuries and trauma that arise from inter-personal violence, escalating to conflict in the extreme. Local response and infrastructure management can help reduce mortality and morbidity in the initial post
- impact period through:
- Identification, assessment and monitoring disaster risks related to trauma and overall mass casualty management.
- Enhancing early warning systems and a responsive community.
- Community first aid and search and rescue which is the first line of the community response to mass casualty events.
- A standardized and well rehearsed incident management system.
- Strengthening pre-hospital and hospital systems to ensure the best outcomes for those severely injured in an event.
- Essential surgery and emergency care capacity at a local level can ensure that injured patients receive immediate life-saving treatment.
- Maternal and new born emergency care.
- Provision of psychosocial support for the affected community, and management of mental health effects.
- Maintenance of good communication to minimize disruptions to response and social support measures, prevent further injury, and maximize effective response outcome.
- Rapid and timely deployment of trained personnel to needed areas.
- Follow up treatment for recovery and rehabilitation, including equipment and devices for people with disabilities
- By conducting training of health facility staff in disaster management command, communication and triage operating procedures, with periodical drills.