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Triage and Resource Management for Mass Casualty Incidents (MCI)

Homepage: EMNote.org ■ 🚩Membership: https://tinyurl.com/joinemnote 🚩ACLS Lecture: https://tinyurl.com/emnoteacls Disaster Medicine: Triage and Resource Allocation in Mass Casualty Incidents Introduction Scenario: Train derailment, 50 injured, 10 staff—what’s your first move? Objective: Learn triage and resource management for mass casualty incidents (MCIs) Why It Matters: Rising frequency of disasters (earthquakes, shootings, bombings) Emergency providers as the frontline Understanding Mass Casualty Events Definition: Event where patient needs exceed immediate resources Examples: 2017 Las Vegas shooting: 58 dead, 500+ injured Hurricane Katrina: Overwhelmed hospitals Challenges: Shortage of staff, equipment, time Communication failures Ethical dilemmas Mindset: Greatest good for the greatest number Principles of Triage – Overview Triage in MCIs: Fast sorting based on severity and survival odds Differs from routine ED triage (speed, simplicity) Goal: Prioritize care in less than 60 seconds per patient Systems Covered: START (Simple Triage and Rapid Treatment) SALT (Sort, Assess, Lifesaving Interventions, Treatment/Transport) START Triage System START: Simple Triage and Rapid Treatment (1980s, California) Assessment: Walking? Breathing? Pulse? Mental status? Categories: Green: Minor (walking wounded) Yellow: Delayed (serious but stable) Red: Immediate (life-threatening) Black: Expectant/Deceased (no pulse/breathing) Example: Unconscious, no breathing after airway opened = Black Strength: Fast, no equipment needed SALT Triage System SALT: Sort, Assess, Lifesaving Interventions, Treatment/Transport (CDC-backed) Steps: Sort: Group by ability to walk Assess: Individual severity Lifesaving Interventions: Airway, tourniquets Tag: Minimal, Delayed, Immediate, Expectant, Dead Comparison: More dynamic than START Slightly longer process Use: FEMA, civilian disasters Triage in Action Speed: 30-60 seconds per patient Tools: Triage tags (Green, Yellow, Red, Black) Emotional Challenge: Black-tagging patients Evidence: 2011 Japan earthquake – triage cut mortality by 20% Resource Allocation – Core Principles Goal: Maximize survival with limited resources Key Areas: Personnel: Assign roles (triage, treatment, transport) Equipment: Ventilators, IV fluids, trauma kits Space: Designate zones (red, yellow, green) Framework: Prioritize high-impact interventions Resource Allocation – Practical Examples Personnel: Use Incident Command System (FEMA standard) Equipment: 3 ventilators, 5 patients? Choose best survival odds Hemorrhage control more important than prolonged CPR (American Trauma Society) Space: Red zone: Immediate care Yellow zone: Delayed care Green zone: Minor injuries Scenario: Bus crash, 20 victims, 1 ambulance – prioritize reds Collaboration in Resource Management Partners: EMS, hospitals, National Guard Example: 2013 Boston Marathon – resource sharing saved lives Tips: Know local mutual aid plans Adapt when plans fail Case Study – 2013 Boston Marathon Bombing Event: 2 bombs, 3 dead, 264 injured Triage: START used on scene Green: Minor cuts Red: Bleeding limbs Black: Unresponsive Response: 127 patients to Mass General in 1 hour Rapid transport, cleared EDs Outcome: 90% critical patients survived Lesson: Speed and teamwork matter Ethical Considerations Dilemmas: Who gets the last bed? (Survival odds vs. fairness) VIPs or kids complicate decisions Real-World: 2005 London bombings – some left behind Guidance: AMA – prioritize survival probability Provider Self-Care Impact: 30% of MCI responders report PTSD (Prehospital and Disaster Medicine, 2019) Strategies: Debrief with team Access mental health support (e.g., Johns Hopkins model) Mindset: “You can’t save everyone, but you can save more” Key Takeaways Triage: START: Fast, simple SALT: Flexible, thorough Resource Allocation: Prioritize high-impact care Collaborate and adapt Preparedness: Practice drills Know local MCI protocols