General Principles in Disasters and Mass Casualty Incidents
A disaster is defined as any event that overwhelms the capabilities of a particular service. For example, a multicar accident on a highway can easily overwhelm the nearest trauma center if there are multiple serious injuries or a power outage in a hospital that is already operating at 110% capacity for patients. At any time during any day where the resources on hand cannot handle the task that needs to be done, a disaster can happen.
Natural disasters are probably the event that is thought of the most when the word disaster is mentioned. These are events like earthquakes, wildfires, floods, hurricanes, and tornados. Damage to infrastructure can occur at the same time that a large volume of patients may be presenting to the local hospital. Terrorist events, like the Boston Marathon bombing in April 2013, create a large number of seriously wounded patients that overwhelm the local EMS and hospital capabilities. Internal disasters happen when a hospital or facility has an event that only affects that facility, like a power outage or fire. In all of these cases, the potential for loss of life is high and exacerbated by the lack of normally available and prepared personnel, equipment, and resources. These types of disasters can lead to a mass casualty incident (MCI).
The response to an MCI needs to be organized and approached in a team effort. Decisions need to be made early, including assignment of roles. Communication is key to any MCI response. It is important to perform an assessment of the scene for both safety and scale of incident and request resources early. A Mass Casualty Incident can be a very chaotic and stressful scene at first. There are many challenges, including location of the incident, scene safety, ongoing disaster, available resources and equipment, available professionals, and untrained first responders. Depending on the MCI, crowd control, traffic control, and media can also be challenging.
The National Incident Management System (NIMS) is a comprehensive, national approach to incident management that is applicable at all jurisdiction levels and across functional disciplines. NIMS provides a common standard for approach to an incident that can be used at any level, including federal, state, tribal, and local. It allows for efficient and effective responses to any incident that can vary from an individual structure fire to a natural disaster.
There are five main components to NIMS. They include preparedness, communications and information management, resource management, command and management, and ongoing management and maintenance. NIMS provides the structure and guidance for these entities to work together to respond to an incident. It allows multiple organizations to use a common language for communication. It encourages organizations to work together to prevent, protect against, mitigate, respond to, and recover from incidents.
