Disaster Medical Response Coordinating General Surgery, Family Medicine, Nutrition, Nursing, and Radiography in Mass-Casualty Scenarios
DOI:
https://doi.org/10.22399/ijcesen.4084Keywords:
Disaster Medical Response, Mass-Casualty Incident (MCI), Interdisciplinary Coordination, Trauma Surgery, Family MedicineAbstract
In mass-casualty scenarios, effective disaster medical response coordination is paramount to ensuring the optimal delivery of care. General surgery plays a critical role, as surgical teams must be prepared to manage traumatic injuries that are frequently encountered in such situations. Concurrently, family medicine practitioners provide comprehensive care by addressing the holistic needs of patients, including chronic disease management and mental health support. These healthcare providers work collaboratively to triage patients effectively, ensuring that those with the most critical needs receive immediate attention. The coordinated efforts among these specialties not only improve individual patient outcomes but also enhance the overall efficiency of the healthcare response in the face of overwhelming demand. Nutrition and nursing are also essential components of disaster medical response in mass-casualty settings. Nutritionists assist in planning and delivering appropriate nutritional interventions to sustain both patients and healthcare providers, mitigating the impact of stress and trauma through proper nourishment. Meanwhile, nursing staff function as the backbone of the medical response, providing vital support in patient assessment, monitoring, and coordination of care. Nursing roles have expanded to include triage and leadership responsibilities, as they often serve as the primary point of contact for patients and their families in chaotic environments. Additionally, radiography, with its capacity to quickly assess and diagnose injuries through imaging, supports timely interventions and surgical planning. The interdisciplinary collaboration among these fields ensures a comprehensive approach to disaster management, improving resilience and outcomes in mass-casualty incidents.
References
1. Pole T, Marcozzi D, Hunt RC. Interrupting my shift: disaster preparedness and response. Ann Emerg Med 2014; 63: 584–8. doi: 10.1016/j.annemergmed.2013.08.030 DOI: https://doi.org/10.1016/j.annemergmed.2013.08.030
2. Adini B, Aharonson-Daniel L, Israeli A. Load index model: an advanced tool to support decision making during mass-casualty incidents. J Trauma Acute Care Surg 2015; 78: 622–7. doi: 10.1097/TA.0000000000000535 DOI: https://doi.org/10.1097/TA.0000000000000535
3. Kahn CA, Schultz CH, Miller KT, Anderson CL. Does START triage work? An outcomes assessment after a disaster. YMEM 2009; 54: 424–30.e1. doi: 10.1016/j.annemergmed.2008.12.035 DOI: https://doi.org/10.1016/j.annemergmed.2008.12.035
4. Lee JS, Franc JM. Impact of a two-step emergency department triage model with START, then CTAS, on patient flow during a simulated mass-casualty incident. Prehosp Disaster Med 2015; 30: 390–6. doi: 10.1017/S1049023X15004835 DOI: https://doi.org/10.1017/S1049023X15004835
5. Postma IL, Beenen LF, Bijlsma TS, Berger FH, Heetveld MJ, Bloemers FW, et al. Radiological work-up after mass casualty incidents: are ATLS guidelines applicable? Eur Radiol 2014; 24: 785–91. doi: 10.1007/s00330-013-3072-y DOI: https://doi.org/10.1007/s00330-013-3072-y
6. Blom L, Black JJM. Major incidents. BMJ 2014; 348: g1144. doi: 10.1136/bmj.g1144 DOI: https://doi.org/10.1136/bmj.g1144
7. Kearns RD, Cairns BA, Cairns CB. Surge capacity and capability. A review of the history and where the science is today regarding surge capacity during a mass casualty disaster. Front Public Health 2014; 2: 29. doi: 10.3389/fpubh.2014.00029 DOI: https://doi.org/10.3389/fpubh.2014.00029
8. Cross KP, Petry MJ, Cicero MX. A better START for low-acuity victims: data-driven refinement of mass casualty triage. Prehosp Emerg Care 2015; 19: 272–8. doi: 10.3109/10903127.2014.942481 DOI: https://doi.org/10.3109/10903127.2014.942481
9. Connor SB. When and why health care personnel respond to a disaster: the state of the science. Prehosp Disaster Med 2014; 29: 270–4. doi: 10.1017/S1049023X14000387 DOI: https://doi.org/10.1017/S1049023X14000387
10. Körner M, Krötz MM, Wirth S, Huber-Wagner S, Kanz KG, Boehm HF, et al. Evaluation of a CT triage protocol for mass casualty incidents: results from two large-scale exercises. Eur Radiol 2009; 19: 1867–74. doi: 10.1007/s00330-009-1361-2 DOI: https://doi.org/10.1007/s00330-009-1361-2
11. Raja AS, Propper BW, Vandenberg SL, Matchette MW, Rasmussen TE, Johannigman JA, et al. Imaging utilization during explosive multiple casualty incidents. J Trauma 2010; 68: 1421–4. doi: 10.1097/TA.0b013e3181cf7d32 DOI: https://doi.org/10.1097/TA.0b013e3181cf7d32
12. Culley J, McKnight S, Rivish VO, Moneda MD. Mass casualty information decision support. OJNI 2011; 15.
13. Sierink JC, Saltzherr TP, Reitsma JB, Van Delden OM, Luitse JS, Goslings JC. Systematic review and meta-analysis of immediate total-body computed tomography compared with selective radiological imaging of injured patients. Br J Surg 2012; 99: 52–8. doi: 10.1002/bjs.7760 DOI: https://doi.org/10.1002/bjs.7760
14. World Health Organization. Mass casualty management systems: strategies and guidelines for building health sector capacity. Geneva, Switzerland: WHO Press; 2007.
15. Körner M, Geyer LL, Wirth S, Meisel CD, Reiser MF, Linsenmaier U. Analysis of responses of radiology personnel to a simulated mass casualty incident after the implementation of an automated alarm system in hospital emergency planning. Emerg Radiol 2011; 18: 119–26. doi: 10.1007/s10140-010-0922-7 DOI: https://doi.org/10.1007/s10140-010-0922-7
16. Hirshberg A, Holcomb JB, Mattox KL. Hospital trauma care in multiple-casualty incidents: a critical view. Ann Emerg Med. 2001; 37: 647–52. doi: 10.1067/mem.2001.115650 DOI: https://doi.org/10.1067/mem.2001.115650
17. Lerner EB, McKee CH, Cady CE, Cone DC, Colella MR, Cooper A, et al. A consensus-based gold standard for the evaluation of mass casualty triage systems. Prehosp Emerg Care 2015; 19: 267–71. doi: 10.3109/10903127.2014.959222 DOI: https://doi.org/10.3109/10903127.2014.959222
18. Mohammed AB, Mann HA, Nawabi DH, Goodier DW, Ang SC. Impact of London's terrorist attacks on a major trauma center in London. Prehosp Disaster Med 2006; 21: 340–4. DOI: https://doi.org/10.1017/S1049023X00003988
19. Powers R. Evidence-based ED disaster planning. J Emerg Nurs 2009; 35: 218–23. doi: 10.1016/j.jen.2008.03.002 DOI: https://doi.org/10.1016/j.jen.2008.03.002
20. Franc JM, Ingrassia PL, Verde M, Colombo D, Della Corte F. A simple graphical method for quantification of disaster management surge capacity using computer simulation and process-control tools. Prehosp Disaster Med 2015; 30: 9–15. doi: 10.1017/S1049023X1400123X DOI: https://doi.org/10.1017/S1049023X1400123X
21. Jenkins PC, Richardson CR, Norton EC, Cooke CR, Banerjee M, Nathens AB, et al. Trauma surge index: advancing the measurement of trauma surges and their influence on mortality. J Am Coll Surg 2015; 221: 729–38.e1. doi: 10.1016/j.jamscollsurg.2015.05.016 DOI: https://doi.org/10.1016/j.jamcollsurg.2015.05.016
22. VandenBerg SL, Davidson SB. Preparation for mass casualty incidents. Crit Care Nurs Clin North Am 2015; 27: 157–66. doi: 10.1016/j.cnc.2015.02.008 DOI: https://doi.org/10.1016/j.cnc.2015.02.008
23. Boston Trauma Center Chiefs’ Collaborative. Boston marathon bombings: an after-action review. J Trauma Acute Care Surg 2014; 77: 501–3. doi: 10.1097/TA.0000000000000397 DOI: https://doi.org/10.1097/TA.0000000000000397
24. Culley JM, Svendsen E. A review of the literature on the validity of mass casualty triage systems with a focus on chemical exposures. Am J Disaster Med 2014; 9: 137–50. doi: 10.5055/ajdm.2014.0150 DOI: https://doi.org/10.5055/ajdm.2014.0150
25. Zoraster RM, Chidester C, Koenig W. Field triage and patient maldistribution in a mass-casualty incident. Prehosp Disaster Med 2007; 22: 224–9. DOI: https://doi.org/10.1017/S1049023X00004714
26. Kuza CM, McIsaac JH. Emergency preparedness and mass casualty considerations for anesthesiologists. Adv Anesth 2018;36:39–66. 10.1016/j.aan.2018.07.002 DOI: https://doi.org/10.1016/j.aan.2018.07.002
27. Epley EE, Stewart RM, Love P, Jenkins D, Siegworth GM, Baskin TW, Flaherty S, Cocke R. A regional medical operations center improves disaster response and inter-hospital trauma transfers. Am J Surg 2006;192:853–9. 10.1016/j.amjsurg.2006.08.057 DOI: https://doi.org/10.1016/j.amjsurg.2006.08.057
28. American College of Emergency Physicians. Surgical Department response template. Available: [link removed]
29. American Society of Anesthesiologists. Committee on trauma and emergency preparedness (ASA COTEP): OR mass casualty checklist.
30. American College of Surgeons. Resources for optimal care of the injured patient 2022 standards. 2022. Available: [link removed]
31. Mcisaac J. Operating room management during mass casualties: A new checklist. Prehosp Disaster Med 2017;32:S104. 10.1017/S1049023X17002667 DOI: https://doi.org/10.1017/S1049023X17002667
32. U.S. Department of Health and Human Services. Administration for Strategic Preparedness and Response, Technical Resources, Assistance Center, and Information Exchange: Mass Casualty Hospital Capacity Expansion Toolkit, April 2023
33. The Olympic and Paralympic Games MIC Committee, Japanese Society of Anesthesiologists. Practical guidance for in-hospital preparation on operating room management for mass casualty incidents. [link removed]
34. Committee on trauma. Disaster management and emergency preparedness course manual. American College of Surgeons, 2017.
35. Jafari H, Jafari A, Nekoei‐Moghadam M, Goharinezhad S. Morbidity and mortality from technological disasters in Iran: a narrative review. J Educ Health Promot. 2019;8:147. DOI: https://doi.org/10.4103/jehp.jehp_401_18
36. Szmidt A. (Example placeholder) — Note: No, ignore this; continue with actual list.
37. Hart A, Nammour E, Mangolds V, Broach J. Intuitive versus algorithmic triage. Prehosp Disaster Med. 2018;33:355‐361.
38. Adini B, Bodas M, Nilsson H, Peleg K. Policies for managing emergency medical services in mass casualty incidents. Injury. 2017;48:1878‐1883.
39. Zou Y, Jia L, Chen S, et al. Spatial accessibility of emergency medical services in Chongqing, Southwest China. Front Public Health. 2023;10(10):959314. DOI: https://doi.org/10.3389/fpubh.2022.959314
40. Rüter A, Örtenwall P, Vikström T. Comparison of an on‐line information system with a conventional ambulance file system regarding the retrieval of information after missions. Int J Disaster Med. 2005;3(3):37‐40. DOI: https://doi.org/10.1080/15031430500535232
41. Kondo H, Koido Y, Kawashima Y, et al. Consideration of medical and public health coordination‐experience from the 2016 Kumamoto, Japan earthquake. Prehosp Disaster Med. 2019;34:149‐154. DOI: https://doi.org/10.1017/S1049023X19000177
42. Daniel DTG, Alpert EA, Jaffe E. The crowd crush at mount meron: emergency medical services response to a silent mass casualty incident. Disaster Med Public Health Prep. 2022;16:2691‐2693.
43. Hansen PM, Jepsen SB, Mikkelsen S, Rehn M. The Great Belt train accident: the emergency medical services response. Scand J Trauma Resusc Emerg Med. 2021;29:140. DOI: https://doi.org/10.1186/s13049-021-00954-7
44. Tin D, Granholm F, Hart A, Ciottone GR. Terrorism‐related chemical, biological, radiation, and nuclear attacks: a historical global comparison influencing the emergence of counter‐terrorism medicine. Prehosp Disaster Med. 2021;36:399‐402. DOI: https://doi.org/10.1017/S1049023X21000625
45. Carli P, Pons F, Levraut J, et al. The French emergency medical services after the Paris and Nice terrorist attacks: what have we learnt? The Lancet. 2017;390:2735‐2738. DOI: https://doi.org/10.1016/S0140-6736(17)31590-8
46. Sadat SJ, Afrasiabifar A, Khorasani‐Zavarehg D, et al. Exploring barriers and facilitators of inter‐organizational management in response to mass casualty traffic incidents: a qualitative study. Bulletin Emerg Trauma. 2021;9:86‐95.
47. Bazeli J, Aryankhesal A, Khorasani‐Zavareh D. Exploring the perception of aid organizations' staff about factors affecting management of mass casualty traffic incidents in Iran: a grounded theory study. Electron Physician. 2017;9:4773‐4779. DOI: https://doi.org/10.19082/4773
48. Guba EG, Lincoln YS. Epistemological and methodological bases of naturalistic inquiry. Ectj. 1982;30:233‐252. DOI: https://doi.org/10.1007/BF02765185
49. Wehbi NK, Wani R, Yang Y, et al. A needs assessment for simulation‐based training of emergency medical providers in Nebraska, USA. Adv Simul. 2018;3:22. DOI: https://doi.org/10.1186/s41077-018-0081-6
50. DeNolf RL, Kahwaji CI. EMS mass casualty management. StatPearls [Internet]. StatPearls Publishing; 2022.
51. Hart A, Nammour E, Mangolds V, Broach J. Intuitive versus algorithmic triage. Prehosp Disaster Med. 2018;33:355‐361.
52. Santo LD, Ambrosi E, Maragna M, Marognolli O, Canzan F. Nursing students' emotions evoked by the first contact with patient's body: a qualitative study. Nurse Educ Today. 2020;85:104299. DOI: https://doi.org/10.1016/j.nedt.2019.104299
53. Gabbe BJ, Veitch W, Mather A, et al. Review of the requirements for effective mass casualty preparedness for trauma systems. A disaster waiting to happen? Br J Anaesth. 2022;128:e158‐e167. DOI: https://doi.org/10.1016/j.bja.2021.10.038
54. Ahmadi Marzaleh M, Mahmoodi H, Armin H, Shakibkhah I, Ahmadi E, Peyravi M. Terrorist attack in ShahCheragh, Iran: planning for the future. Prehosp Disaster Med. 2023;38:272‐273. DOI: https://doi.org/10.1017/S1049023X22002461
55. Ahmadi MT, Aghakouchak AA, Mirghaderi R, et al. Collapse of the 16‐Story Plasco Building in Tehran due to Fire. Fire Technol. 2020;56:769‐799. DOI: https://doi.org/10.1007/s10694-019-00903-y
56. The Great Belt train incident? — Note: This item has already appeared; ensure all 21 items are present as provided.
57. Winters B, Lund E, Sylvester K, Price L. Lessons learned in a large‐scale mass casualty simulation. J Nurs Educ. 2022;61:50‐52. DOI: https://doi.org/10.3928/01484834-20211129-01
58. Aylwin CJ, König TC, Brennan NW, Shirley PJ, Davies G, Walsh MS, et al. Reduction in critical mortality in urban mass casualty incidents: analysis of triage, surge, and resource use after the London bombings on July 7, 2005. The Lancet. 2006; 368: 2219–25. DOI: https://doi.org/10.1016/S0140-6736(06)69896-6
59. Körner M, Krötz M, Kanz KG, Pfeifer KJ, Reiser M, Linsenmaier U. Development of an accelerated MSCT protocol (Triage MSCT) for mass casualty incidents: comparison to MSCT for single-trauma patients. Emerg Radiol 2006; 12: 203–9. doi: 10.1007/s10140-006-0485-9 DOI: https://doi.org/10.1007/s10140-006-0485-9
60. Brunner J, Rocha TC, Chudgar AA, Goralnick E, Havens JM, Raja AS, et al. The boston marathon bombing: after-action review of the brigham and women’s hospital emergency radiology response. Radiology 2014; 273: 78–87. doi: 10.1148/radiol.14140253 DOI: https://doi.org/10.1148/radiol.14140253
61. Frykberg ER. Medical management of disasters and mass casualties from terrorist bombings: how can we cope? J Trauma 2002; 53: 201–12. doi: 10.1097/00005373-200208000-00001 DOI: https://doi.org/10.1097/00005373-200208000-00001
62. Jones N, White ML, Tofil N, Pickens M, Youngblood A, Zinkan L, et al. Randomized trial comparing two mass casualty triage systems (JumpSTART versus SALT) in a pediatric simulated mass casualty event. Prehosp Emerg Care 2014; 18: 417–23. doi: 10.3109/10903127.2014.882997 DOI: https://doi.org/10.3109/10903127.2014.882997
63. Goh SH. Bomb blast mass casualty incidents: initial triage and management of injuries. Singapore Med J 2009; 50: 101–6.
64. Langdorf MI, Medak AJ, Hendey GW, Nishijima DK, Mower WR, Raja AS, et al. Prevalence and clinical import of thoracic injury identified by chest computed tomography but not chest radiography in blunt trauma: multicenter prospective cohort study. Ann Emerg Med 2015; 66: 589–600. doi: 10.1016/j.annemergmed.2015.06.003 DOI: https://doi.org/10.1016/j.annemergmed.2015.06.003
65. Karner M, Körner MM, Degenhart C, Pfeifer KJ, Reiser MF, Linsenmaier U. Current role of emergency US in patients with major trauma. Radiographics 2008; 28: 225–42. doi: 10.1148/rg.281075047
66. Charbit J, Millet I, Maury C, Conte B, Roustan JP, Taourel P, et al. Prevalence of large and occult pneumothoraces in patients with severe blunt trauma upon hospital admission: experience of 526 cases in a French level 1 trauma center. Am J Emerg Med 2015; 33: 796–801. doi: 10.1016/j.ajem.2015.03.057 DOI: https://doi.org/10.1016/j.ajem.2015.03.057
67. Engel A, Soudack M, Ofer A, Nitecki SS, Ghersin E, Fischer D, et al. Coping with war mass casualties in a hospital under fire: the radiology experience. AJR Am J Roentgenol 2009; 193: 1212–21. doi: 10.2214/AJR.09.2375 DOI: https://doi.org/10.2214/AJR.09.2375
68. West B, Cusser A, Etengoff S, Landsgaard H, LaBond V. The use of FAST scan by paramedics in mass-casualty incidents: a simulation study. Prehosp Disaster Med 2014; 29: 576–9. doi: 10.1017/S1049023X14001204 DOI: https://doi.org/10.1017/S1049023X14001204
69. Körner M, Krötz MM, Degenhart C, Pfeifer KJ, Reiser MF, Linsenmaier U. Current role of emergency US in patients with major trauma. Radiographics 2008; 28: 225–42. doi: 10.1148/rg.281075047 DOI: https://doi.org/10.1148/rg.281075047
70. Hart A, Nammour E, Mangolds V, Broach J. Intuitive versus algorithmic triage. Prehosp Disaster Med. 2018;33:355–361. DOI: https://doi.org/10.1017/S1049023X18000626
71. Adini B, Bodas M, Nilsson H, Peleg K. Policies for managing emergency medical services in mass casualty incidents. Injury. 2017;48:1878–1883. DOI: https://doi.org/10.1016/j.injury.2017.05.034
72. Daniel DTG, Alpert EA, Jaffe E. The crowd crush at mount meron: emergency medical services response to a silent mass casualty incident. Disaster Med Public Health Prep. 2022;16:2691–2693. DOI: https://doi.org/10.1017/dmp.2022.162
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