How to Organize Extra- and In-hospital Care for Mass Casualty Incident?

Abstract

The occurrence of any crisis exposes public health actors to a massive surge of casualties, carrying along a risk of saturation for the healthcare system, which becomes unable to take care of all of the patients or victims.

Whilst it is impossible to predict the occurrence and characteristics (breadth, number of casualties…) of such a crisis, the drafting of pre- and intrahospital emergency plans has enabled to establish the major guidelines for health care. These guidelines are similar, in their major principles, for all circumstances.

During the pre-hospital phase, the triage and categorization of casualties are mandatory, and the care given is usually limited to rescue actions. The linking between pre- and intrahospital healthcare systems is done around the emergency medical service (SAMU in France), which has a central role, along with other actors of emergency care, in organizing, regulating and guiding the victims. The objective is to avoid shifting the crisis towards hospital structures, while transferring the victims to specialized services adapted to their pathology and severity. Such an organization is based on pre-established emergency plans, and communication between the emergency medical service and hospital structures, allowing for a real-time inventory of available resources and hospital beds.

Upon a major medical crisis exceeding the regular hospitalization capacity, hospitals must be reorganized and all of their activities exclusively focused on taking care of the patients involved in the event, with the priority of emergency care professionals given to the provision of care to the most severe victims. In the more specific field of traumatology, the concepts of “damage control” and “damage control surgery” must be preferred to allow taking care of most victims. In any case, the material and human logistic dimensions of the different plans is essential to their efficient implementation.