Mass Casualty Incident Preparation

[drollette]

Are there practical measures (training/simulation/policies) in your hospital that have helped you to feel confident should you find yourself receiving an influx of critically injured patients? (i.e. mass shooting[Las Vegas, Orlando] earthquake, etc).

Also, does anyone have any personal experience with mass casualty situations? The resources I've encountered in regard to disasters/mass casualty incidents seem to mostly talk about theoretical stuff, chain of command, and not necessarily hands on practical lessons, and I would like to hear anecdotal stories that I could glean tips from in order to foster mental preparedness.

[Lunah, MSN, RN]

I have experience, in Afghanistan. It is difficult to mentally prepare for mass suffering. Just knowing your processes, roles, and equipment location is huge. Our team commander (surgeon) told us often that "fortune favors the prepared mind."

[JKL33]

Get hooked up with your regional trauma network and you will learn of mock disasters/MCIs which you should be able to attend.

[PeakRN]

You have to trust the process. One of the biggest failures I have seen in mass casualties is when people don't triage correctly (they let their feelings affect their decisions) or begin to freelance. They will begin to panic because their is more needs than resources and stray from the established processes.

From a hospital prospective you need to have surge plans established. Who is on your trauma team? How many trauma reds can you take, what about yellows or greens? Who are you going to resource down to the ED when you have gone past that number? Is the OR ready to take multiple back to back cases? Who is going to recover the patients? Do you have trauma trained ICU staff? Do you have an established MTP?

If you are in a trauma rated system you should have a trauma coordinator who is not only developing these plans but working with your local EMS agencies and other surrounding hospitals to ensure that as a system the best outcomes can be achieved when tragedies occur. If your in a non-trauma rated system I would reach out to one of your level 1 or 2 trauma centers to help develop a plan not only for your ED but how you will transfer patients who require care beyond the capability of your facility.

Confidence comes with training and practice, but don't expect to become comfortable. By definition a MCI has more needs than resources and that should never be comfortable. Classes like TNCC and ENPC are great at building a systematic approach to patient care.

When I was a firefighter we would get a fair number of MCIs, and trusting the triage process is the key to success. You cannot move onto step 2 before step 1. I have found patients under cars and in ditches nowhere near an accident and if I just started to focus on the first victim we would have never gotten care to all of the patients on scene.

We also had a nearby department with a great hazmat program and they put on a mock chemical leak every year. They incorporated the local fire departments, military (they were a military department on a base that neighbored a very large metropolitan area), EMS, LEOs, the local hospitals, and several other groups. It involved everything from chemical identification and mitigation to patient care. We rotated sites and the exposure every year and it was a great training tool (they also made me develop a small hatred for all of the risk at the local universities). I would be willing to bet that your local fire department would be very willing to talk to you about their plans and how they manage MCIs and what they want out of the ED.

As a nurse I haven't had to much exposure to MCIs, although the car full of trauma alerts is never fun. 1:1 doesn't mean the same thing when you get 7 trauma alerts at once at 3 in the morning.