Unit
- Mass casualty incident (MCI): An event that overwhelms the local healthcare system's capacity to provide timely care to all victims. The threshold varies by jurisdiction and available resources, but the defining characteristic is a mismatch between demand and capacity.
- Types of MCIs: Natural disasters such as earthquakes and hurricanes, man-made events including industrial accidents and terrorism, and public health emergencies like pandemics. Each type presents unique challenges for response coordination.
- Key indicators: Sudden surge in patient volume, shortage of critical supplies, need for external assistance, and activation of emergency operation plans. Recognizing these indicators triggers the transition from routine to disaster mode.
- Phases of MCI management: Mitigation, preparedness, response, and recovery. Mitigation reduces risk; preparedness builds capacity; response delivers acute care; recovery restores normal operations. Each phase requires specific planning.
- Incident command system (ICS): A standardized management structure used to coordinate response across agencies. ICS provides clear roles, communication channels, and scalability from small events to large-scale disasters.
- Hospital incident command system (HICS): An adaptation of ICS for healthcare facilities. HICS organizes hospital resources, establishes command centers, and integrates with community response networks.
- Scope of practice for administrators: Healthcare administrators oversee resource allocation, staff deployment, and interagency coordination. They do not perform direct patient care but enable clinical teams to function effectively.
- Historical context: Modern MCI management evolved from military triage principles and lessons learned from major disasters. Key events such as the 9/11 attacks and Hurricane Katrina shaped current best practices.
- Disaster triage systems: Standardized triage tools like START and JumpSTART enable rapid patient sorting based on respiratory status, perfusion, and mental status. These systems assign color codes ranging from red for immediate care to black for deceased or expectant. Consistent triage methodology prevents critical treatment delays.
- Communication protocols in MCIs: Redundant communication channels including two-way radios, satellite phones, and dedicated emergency frequencies ensure operational continuity when cellular networks fail. Preestablished radio codes and plain language directives reduce confusion. Regular communication checks maintain situational awareness across all response units.
- Resource management strategies: Just in time inventory systems, mutual aid agreements, and regional stockpiles support rapid equipment and pharmaceutical deployment. Caches of ventilators, personal protective equipment, and medical supplies are strategically positioned. Tracking systems monitor usage rates to trigger timely resupply requests.
Scope of Practice
Role: Emergency Manager in a Hospital Setting
Within scope:
- Developing and updating the hospital emergency operations plan
- Coordinating with local emergency management agencies and public health departments
- Conducting drills and tabletop exercises to test readiness
- Managing the hospital command center during an MCI
- Allocating space, supplies, and personnel resources
Outside scope:
- Performing medical triage or clinical decision-making for individual patients
- Prescribing medications or providing direct patient care
- Assuming authority over clinical protocols or treatment pathways
- Making legal determinations about patient consent or refusal of care
- Representing the hospital in legal proceedings without counsel
Terminology
- Mass Casualty Incident (MCI)
- An event that generates more patients at one time than locally available resources can manage.
- Triage
- The process of sorting patients based on the severity of their condition to prioritize treatment and transport.
- Surge Capacity
- The ability of a healthcare system to expand beyond normal services to meet increased demand during an emergency.
Quick Revision
- An MCI is defined by the imbalance between patient needs and available resources, not by a specific number of casualties.
- MCIs can result from natural, accidental, or intentional events, each requiring tailored response strategies.
- The incident command system provides a standardized framework for multi-agency coordination.
- Healthcare administrators focus on system-level coordination, not direct clinical care.