How to Be Organized during Chaos

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    A Mass Casualty Incident (MCI) is mass chaos. Its totally unexpected but with practice in simulation trainings, you CAN survive!

    How to Be Organized during Chaos

    You work in the level one ED in a big city - its a fairly normal evening, the usual variety of patients, some that are truly emergency, others not so much and the majority somewhere in the middle. Suddenly the EMS radio starts blaring with the news that there has been a mass shooting incident at a population dense venue. The voice on the radio rings with excited distress and you can hear background noises of screams. The paramedic tells you that many people have been shot and its still happening - they can't tell you how many patients to expect but you can expect a lot.

    What to do? Your mass casualty training kicks in:
    • Notify your supervisor, and initiate the mass casualty plan
    • Incident commander needs to the decided upon
    • Designate all staff as to their roles and responsibilities
    • Have non-clinical staff start calling personnel in from the recall roster
    • Clear out the ED of non-emergent patients, get already admitted patients to the floor
    • Start collecting trauma equipment
    • Assemble beds, cots, monitoring equipment
    • Set up and staff triage area
    • Be ready for the media and set up administrative staff to deal with them
    • Preserve the patients privacy
    • Continue to move patients along a recognized triage protocol

    We are all aware of the recent Las Vegas tragedy. As of this writing over 60 people are confirmed dead and over 500 required ED care. Could your hospital handle an MCI? Have you trained to be on point if this ever happens? Training and simulations are invaluable. This must be practiced though over and over before it becomes routine. ED personnel are used to controlled chaos - however, no one can prepare for hundreds of patients inundating your ED within minutes - many with penetrating trauma.

    In Las Vegas because the shooter was using an automatic weapon, the destruction of human tissue was unheard of except in wartime. This resulted in many patients requiring urgent surgical intervention. Triage was of the utmost importance. Those patients who had injuries incompatible with life or unsurvivable injuries were not taken to the OR. Resources had to be used for those patients who had the highest odds of survival.

    There are many resources to assist in training for an MCI: FEMA offers a comprehensive toolkit.

    Staff from AN recently attended the Emergency Nurses Conference in St Louis. One of the interesting presentations was from Dan Nadworny, MSN who was the point person for the 2013 Boston Marathon Bombing in the level one ED where many of the victims were taken. We also had an earlier interview with Dan.

    Also very important is the aftercare of the staff. This can't be stressed enough. To experience an MCI is to go thru a trauma similar to your patients. Some thoughts from the US Department of Health and Human Services comes these suggestions:
    • It may take some time to return to normal operating procedures
    • Supplies will be low or perhaps nonexistent
    • Staff will need to be rotated in and out to allow for rest, eating, hygiene needs
    • Equipment will need to be cleaned
    • Personal belongings of patients will need to be sorted and returned
    • Debriefing of staff will be necessary

    This video gives a realistic simulation of a mass casualty incident. This scenario involved a tornado. However, the protocols are the same for any mass casualty incident. Your response to a MCI will only be as successful as your MCI training is....



    allnurses staff join in our nation mourning this senseless loss of human life. We offer positive thoughts and gentle hugs to our Las Vegas EMS, police, fire and ED personnel.
    Last edit by Joe V on Oct 12
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    7 Comments

  3. by   brownbook
    I hate that this had to be posted, but thank you for doing it.
  4. by   tnbutterfly
    Very timely article!!
  5. by   traumaRUs
    @brownbrook - yes I hated to post it but like you, feel its necessary.

    We live in a sad world
  6. by   VivaLasViejas
    Sad, and senseless.
  7. by   jag nurse
    I wasn't able to enlarge the screen so couldn't see much, but thank you for the article.
  8. by   OrganizedChaos
    You called???

    Just kidding. Great article!
  9. by   kclady
    Mandatory disaster drills aren't held nearly often enough, IMHO. Sadly, shooting sprees, natural disasters, structural collapses, bus or train wrecks...happen. When they do is not the time to be flipping through the disaster manual trying to figure out what everybody needs to do. Although some of the casualties may not be there for awhile because they have to be extricated from the scene, if your hospital is close to the disaster site some will probably start rolling through your doors within a matter of minutes. When they arrive they may have hazardous materials on their clothing that would put other patients and the staff in danger if they're brought into the ER. Those are things you have to be ready for immediately rather than after the fact.
    When there's a disaster in your city it's important to remember that if your ED is becoming overwhelmed, some of the other hospitals in the city may not be getting anyone. Communication is vital, because even hospitals that aren't trauma centers can take some of the victims whose injuries aren't life-threatening.
    Stay safe.

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