Mass casualty incidents - time to engage
Ben-Ishay et al. World Journal of Emergency Surgery
Mass casualty incidents - time to engage
Offir Ben-Ishay 0 3
Michele Mitaritonno 2
Fausto Catena 2
Massimo Sartelli 1
Luca Ansaloni 4
Yoram Kluger 0 3
0 Surgical Oncology, Pancreatic & Hepatobiliary Surgery Service, Department of General Surgery, Division of Surgery, Rambam Health Care Campus , 8 Ha'Aliyah st., Haifa 35254 , Israel
1 Department of Surgery, Macerata Hospital , Macerata , Italy
2 Department of Emergency and Trauma Surgery of the University Hospital of Parma , Parma , Italy
3 Surgical Oncology, Pancreatic & Hepatobiliary Surgery Service, Department of General Surgery, Division of Surgery, Rambam Health Care Campus , 8 Ha'Aliyah st., Haifa 35254 , Israel
4 Department of General and Emergency Surgery, Papa Giovanni XIII Hospital , Bergamo , Italy
Mass casualty incident continues to overwhelm medical systems worldwide. Preparedness for an MCI is a crucial requisite for the injured better outcome. The World Society of Emergency Surgery initiated a survey in regard to its senior member's personal and institutional preparedness for MCI. The results here in presented indicate that WSES should engage in a formatted and structured preparedness course for medical institutions and individuals.
Although intuitively the number of injured was always
related to the definition of a mass casualty incident
(MCI), today accepted definition refers to an event that
overwhelms the local healthcare system, with number of
casualties that vastly exceeds the local resources and
capabilities in a short period of time. The definitions of a
mass casualty incident depend on the resources of the
admitting institutions. The outcome however depends
on their preparedness.
Many lives could be saved in any MCI if the
affected medical organizations were better prepared
and an organized accessible response system already
primed. Experience show that the public is the first
to provide emergency assistance in such incidents.
For this reason, preparedness planning increasingly
emphasizes the need for building capacity (human,
organizational and infrastructural) at the community
The common gaps in health system preparedness
around the world are well documented. They are often
not addressed in a comprehensive and systematic way.
In particular, many countries have not yet developed
Mass Casualty Management Plans, and medical systems
often develop preparedness and response plans after
they experienced an MCI by themselves without
guidance from experienced authorities.
Along with planning, a well-designed and consistently
updated training program is an essential component of a
successful emergency response. Standards for training
and education are required for health personal involved
in mass casualty management. A great deal of
information already exists to guide the setting of such standards
and the design of training programs.
These information and training are delivered today by
a number of professional organizations, local and
national agencies. The world health organization (WHO)
recognizing the existence of such deficit established a
task force on MCI preparedness. In the year 2006 this
task force recognized guidelines and strategies for
proper building of health sector capacity in case of a
mass casualty incident [
During the summer of 2015, the World Society of
Emergency Surgery (WSES) held its biannual conference in
Jerusalem, Israel. A plenary sessions of the conference
was dedicated to examine the role of the WSES in
strategic planning and preparedness for an MCI. In order to
understand the international needs an international
survey in regard to experience with and preparedness for an
MCI was initiated. The survey included 25 questions
and was sent via e-mail to executive members of WSES
around the world.
Forty six surgeons from 46 different institutions in 31
countries from all around the world complied with the
survey. Most of the surgeons involved in the survey
practice in cities of 100.000-500.000 (39.1 %) and more
than 1 million (34.8 %) habitants. 56.5 % of the
institutions participating in the survey were University
Hospitals and 26.1 % Governmental Hospitals. Ninety one
percent of the hospitals have a trauma service actively
involved in trauma management and most of them
(59.6 %) treat yearly between 100–500 severely
injured patients (ISS >16).
Interestingly 34.4 % of the centers involved in the
survey experienced more than 5 MCI, and 50 %
declared managing at least 3 MCI in the past. 56.3 %
were involved in MCI within the last 5 years and
34.4 % experienced one in the last 5–10 years. 50 %
of the medical centers treated 10–40 injured in
average during the MCI.
Not surprisingly 73.9 % of the centers had a written
MCI protocols and in 67.4 % surgeons (General
Surgeons or Trauma Surgeons) are directly involved in the
management of such event (Table 1). Triage protocols in
MCI are different when compared to routine triage [
Eighty three percent of the institutions reported an
assigned triage officer in MCI management.
Training is an integral part of MCI preparedness and
management plans: it provides a setting in which
operational and even medical details may be critically
examined becoming an important source of feedback regarding
potential problems. Furthermore, drills keep strictly in
contact all professional involved in MCI developing
personal and professional relationships [
Only 47.8 % of the institutions involved in the
survey perform constructed drills. Only 28.3 % of them
perform trainings once a year and 13 % every 2 years.
These figures pose a great concern in regard to
preparedness maintenance of any size and experienced
Although MCI management courses are available
around the world only 28.3 % of the responders have
participated in such a course. Eighty five percent are
extremely interested in joining such an enterprise.
With no doubt mass casualty incidents are of an
immense importance and relevance today more than ever.
If it is for natural disasters, transportation accidents or
manmade terror attacks; the problem remains the same,
a number of casualties that overwhelms the local health
care system in a very short period of time. Although the
importance is well understood still some institutions
around the world are not well prepared as the current
survey shows. Preparedness courses are offered by
various institutions such as FEMA (Federal emergency
management agency), EMS (Emergency medical services)
and local courses in various institutions around the
world but many of these courses are not readily available
for surgeons internationally.
Although the setup is different in every institution, the
basics are quite the same. WSES can establish an
educational platform to share this information and to create a
basic course on MCI related issues such as preparedness
and management. WSES through the involvement in
such an enterprise can offer onsite visits to evaluate the
local setup and needs as well as to conduct together with
local authorities MCI trainings. The survey shows that
only 28.3 % participated in constructed course while
84.3 % are very interested in participating in one.
In conclusion, the vast unfortunate experience of many
countries around the world did not translate into a
massive preparedness of hospitals towards a shattering
event such as an MCI. Although half of the centers
involved in the survey reported managing up to 3 MCI's in
the last 5 years only one third of the responders
participated in an MCI management course. We believe that
international need and the thirst for knowledge of
surgeons around the world creates an opportunity for
WSES to engage in an initiative in regard to MCI
management course and on site preparedness drills.
WSES has the capabilities and personal to create a
uniform MCI management course and to take a role in
the international preparedness for such an event.
None of the authors have any competing interests.
OBI – Collection of data, drafting and critical review of the manuscript.
MM – Collection of data, Drafting of the manuscript. FC – critical review
of the manuscript. MS – Collection of data. LA – Critical review of the
manuscript. YK – Drafting and critical review of the manuscript. All authors
read and approved the final manuscript.
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