Join Rommie Duckworth and FOAMfrat as we discuss the mental framing and big-picture thought process behind the first five minutes of any mass casualty incident (MCI). Rommie Duckworth, a fire captain and shift commander, is a wealth of knowledge on this topic and speaks globally to prepare emergency responders for these events.
Initial Assessment and Action
Upon arrival at an MCI, the scene can often feel overwhelming. The key is maintaining focus on immediate, actionable goals. Rommie simplifies this into three crucial objectives: stop the killing, stop the dying, and move patients forward. It's almost like an arcade game.
This approach involves eliminating any ongoing threats that could exacerbate the situation, providing essential medical care, and ensuring that patients are moved swiftly to safety or more advanced care facilities.
Stop the Patient Generator
A vital step in managing an MCI is to halt the "patient generator." For instance, in a scenario like a school shooting, this could mean ensuring the threat is neutralized before medical aid is administered. Traffic accidents might involve managing hazards like ongoing traffic or securing dangerous scenes to prevent further injuries. Whatever it is, you will consistently remain in an MCI milieu as long as the patient generator is allowed to continue.
Triage Systems
Triage systems are foundational in MCI management, yet no system has proven superior. The focus should be on simplicity and patient forward movement. The one that seems to be getting the most attention is the "10-Second Triage."
RAMP Triage
10 Second Triage
The UK’s 10-second triage system is highlighted as an efficient method that prioritizes rapid assessment over detailed categorization, which can slow down response efforts.
Treatment and Transport Dynamics
Effective treatment at the scene of an MCI isn't about delivering comprehensive care but about stabilizing patients enough to ensure they can be transported to definitive care facilities. Protocols like the MARCH (Massive hemorrhage, Airway, Respiration, Circulation, Hypothermia) prioritize interventions crucial for stabilizing patients in the critical initial moments.
Managing Resources and Personnel: Proper staging and resource management are essential. Responding units should adhere to established protocols for staging and assignment, which helps prevent self-deployment to the scene and ensures resources are utilized where most needed. This organization is key to avoiding logistical oversights that can hinder transport capabilities.
MCIs require a shift from standard medical procedures to a focus on maximizing overall patient survival through streamlined operations and strategic thinking. As Rommie Duckworth emphasizes, the goal is to manage the chaos effectively, ensuring that emergency services can improve outcomes in these challenging scenarios.
Watch out for this episode, fully illustrated with graphics and animations, coming to the Studio soon!
References
Bazyar, J., Farrokhi, M., Salari, A., Safarpour, H., & Khankeh, H. R. (2022). Accuracy of Triage Systems in Disasters and Mass Casualty Incidents; a Systematic Review. Archives of academic emergency medicine, 10(1), e32. https://doi.org/10.22037/aaem.v10i1.1526
Vassallo J, Cowburn P, Park C, et al. Ten-second triage: A novel and pragmatic approach to major incident triage. Trauma. 2024;26(1):3-6. doi:10.1177/14604086231156219
