DISASTER + MAJOR INCIDENT
MASS CASUALTY
CSCATT, METHANE, Notify exec!
PromptGoals of distaster triage
ResponseDisaster triage (prehospital):
- Goal is to deliver the greatest good to the greatest number with brief focused assessment
- Dynamic process, repeated at multiple stages
- Performed by disaster-trained senior medical or Ambulance personnel
- Patients sorted into groups requiring immediate, delayed, minimal care or unsalvageable
- ATS categories based on urgency
- Individualised more detailed approach in order of arrival
- Single point of time, in order of arrival
- Performed by senior nursing staff
PromptDescribe Disaster Triage
ResponseSeive and sort triage
Seive: (urgency for treatment)
4 categories in general (Varies state to state – NSW SMART triage shown)
Dead – Airway open, if no breathing = Dead
Critical (1 - Red) - RR<10 or >30
Semi-urgent (2 – Amber) RR11-29, HR >120
Walking (3 – green)
Simple, speedy, no equipment required, minimal training (non clinical personel)
Sort: (urgency for transport)
Triage Revised Trauma Score based on:
GCS
RR
SBP
Triage categories = Immediate, Urgent and Delayed. Score is out of 12, 12=good, 11=bad, 10 or under = priority 1
Goal = greatest good for greatest number
Dynamic process repeated multiple times
Performed by trained disaster personell
Seive: (urgency for treatment)
4 categories in general (Varies state to state – NSW SMART triage shown)
Dead – Airway open, if no breathing = Dead
Critical (1 - Red) - RR<10 or >30
Semi-urgent (2 – Amber) RR11-29, HR >120
Walking (3 – green)
Simple, speedy, no equipment required, minimal training (non clinical personel)
Sort: (urgency for transport)
Triage Revised Trauma Score based on:
GCS
RR
SBP
Triage categories = Immediate, Urgent and Delayed. Score is out of 12, 12=good, 11=bad, 10 or under = priority 1
Goal = greatest good for greatest number
Dynamic process repeated multiple times
Performed by trained disaster personell
PromptWhat is important when speaking to ambulance control (METHANE acronym)
ResponseMass casualty event declared
Exact location
Type of incident
Hazards
Access
Number and type of casualties expected
Emergency services
Exact location
Type of incident
Hazards
Access
Number and type of casualties expected
Emergency services
PromptOn Scene management
ResponseCSCATT
CIC
Safety
Communications
Assessment
Triage
Treatment
Transport
CIC
Safety
Communications
Assessment
Triage
Treatment
Transport
PromptDesignated treatment areas on scene management
ResponseForward command post
Casualty collection area
Patient treatment post
Ambulance loading point
Casualty collection area
Patient treatment post
Ambulance loading point
Prompt“Zones” on scene
ResponseHot
- Actual disaster area (e.g. in & immediately around the trains)
- Specialized & authorised rescue personnel only – search/rescue of victims to be evacuated to warm zone
- Area immediately outside hot zone
- Decontamination area (if required)
- Triage of casualties
- Safe areas for personnel
- Outside warm zone – free of contamination
- Casualty collection & treatment areas
- Transport (road/helo) collection areas
- Assembly point for non-injured/ambulatory
- Perimeter - controlled access
PromptDisaster preparation
ResponseACTIVATE HOSPITAL DISASTER PLAN (+ notify exec)
Then… PASTED
Patient
Area – Establish triage area. clear beds, admit to ward, move stable pts to alternate area. Decant resus area
Staff – notify triage of surge/mass casualty. Code brown, all staff to remain on shift, call in staff.
Teams - Ortho/blood bank/surg/ICU/Radiology. Form teams for red/orange/green patients
Equipment – Disaster triage tags, radios/comms, Vents, splints
Drugs – analgesia, antibiotics
Then… PASTED
Patient
Area – Establish triage area. clear beds, admit to ward, move stable pts to alternate area. Decant resus area
Staff – notify triage of surge/mass casualty. Code brown, all staff to remain on shift, call in staff.
Teams - Ortho/blood bank/surg/ICU/Radiology. Form teams for red/orange/green patients
Equipment – Disaster triage tags, radios/comms, Vents, splints
Drugs – analgesia, antibiotics
PromptDesignated areas required for medical response in a disaster
ResponseForward command post
Casualty collection area
Treatment post
Ambulance loading point
Hot zone – Actual disaster area. Authorised personnel. Evacuatie victims to warm zone
Warm zone – immediately outside of hot zone, decontamination, triage, safe areas for personnel
Cold zone – Casualty collection + treatment areas, transport, assembly point for ambulatory, free of contamination
Casualty collection area
Treatment post
Ambulance loading point
Hot zone – Actual disaster area. Authorised personnel. Evacuatie victims to warm zone
Warm zone – immediately outside of hot zone, decontamination, triage, safe areas for personnel
Cold zone – Casualty collection + treatment areas, transport, assembly point for ambulatory, free of contamination
PromptYou stumble upon a train crash on your day off. How do you manage immediately
ResponseStay safe, call for help - 000, assist others
Don’t enter dangerous environment
Call walking patient to gather in safe location
METHANE call
Don’t enter dangerous environment
Call walking patient to gather in safe location
METHANE call
PromptManagement of end of mass casualty event/standdown
ResponseClarify if total or partial standdown
Reinstitute normal ED function, staffing, flow
Informal Debrief – ID traumatised staff, send feedback
Operational debrief within 1 wk – review response with department heads/exec
Modification of ED disaster response to run better next time
Counselling of staff
Reinstitute normal ED function, staffing, flow
Informal Debrief – ID traumatised staff, send feedback
Operational debrief within 1 wk – review response with department heads/exec
Modification of ED disaster response to run better next time
Counselling of staff
PromptRadiology during mass casualty
ResponseIncrease POCUS utilisation
?POCUS over CT
Obvious fractures may be reduced without XR
Clinical management (eg PTx doesn’t need XR to decompress)
?POCUS over CT
Obvious fractures may be reduced without XR
Clinical management (eg PTx doesn’t need XR to decompress)
PromptExpected problems during mass casualty
ResponseStaff fatigue
Staff rotation
Stock – antibiotics, splints, sutures
Communications overload/failure
Path/radiology overload/failure
OT access limited
Patient tracking/identification
Staff rotation
Stock – antibiotics, splints, sutures
Communications overload/failure
Path/radiology overload/failure
OT access limited
Patient tracking/identification
PromptEbola (or other nasty infectious disease) patients arriving from overseas
ResponseNotify exec
Prehospital – diversion of non-tertiary patients to alternate hospital
Staffing - ? surg capacity
Inpatient units – ID, ICU, Infection control
Path/Imaging/blood bank
PPE
Prehospital – diversion of non-tertiary patients to alternate hospital
Staffing - ? surg capacity
Inpatient units – ID, ICU, Infection control
Path/Imaging/blood bank
PPE
PromptPrinciples in management of Ebola
ResponseMinimise handling
Appropriate location
Meticulous PPE
Minimise invasive procedures
Appropriate location
Meticulous PPE
Minimise invasive procedures
PromptStrategies to prepare dept
ResponseDirect admission to ward
Discharge suitable patients home
Alternate areas for ambulant patients
Clear waiting room
Discharge suitable patients home
Alternate areas for ambulant patients
Clear waiting room