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INTRODUCTION

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A mass casualty incident (MCI) is an event that produces or has the potential to produce multiple casualties requiring medical care. The goal of prehospital care is to provide the optimal level of care to save the most lives and minimize the morbidity of this type of event. For the purposes of this chapter, we will further define the term mass casualty as an event that challenges the everyday response capacity of a local response system requiring a change in mode of operation. This chapter will attempt to distill the essential elements of prehospital mass casualty management and planning.

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OBJECTIVES

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  • Describe essential elements in planning for response to mass casualty.

  • Describe on-scene responsibilities of EMS assets during a mass casualty response.

  • Discuss the importance of patient tracking.

  • Detail the role of EMS medical director during mass casualty management.

  • Discuss some challenges of a multiagency response.

  • Discuss prearranged roles of area hospitals and health care facilities during a mass casualty.

  • List community and volunteer organizations that can expand the ability to care for patients during a mass casualty disaster.

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SYSTEM EMERGENCY PREPAREDNESS AND PLANNING

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Plans are nothing; planning is everything.

—Dwight D. Eisenhower

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PLANNING

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The planning phase of disaster preparedness is essential to mass casualty resource management. The development of response protocols for EMS, identification of emergency response capabilities, activation of the disaster response system, and regional/local interagency planning will create the framework for an effective response.13 Prehospital medical care requires cooperation and coordination with many partners including government, hospital, and community resources.4 Many communities perform hazard analysis to identify common and catastrophic scenarios that must be prepared for. Understanding the roles, responsibilities, and capabilities of each community, state and federal partner will promote a more efficient response.

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EMS MASS CASUALTY MANAGEMENT TRAINING

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EMS providers should be trained in the implementation of mass casualty scene management and incident command.5 In fact, it is a requirement that first response agencies that receive federal funding are trained in Incident Command Systems (ICS) and National Incident Management Systems (NIMS). ICS, NIMS, and the federal response to disaster are all discussed in details in other chapters; however, it is important to mention here that the ability to have an interoperable, scalable response will allow the rapid incorporation of additional resources into a response effort that traverses local jurisdictions or requires a state or federal involvement.

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DRILLS AND EXERCISES

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Exercises are an essential step in the planning process. All components of a plan should be exercised, and then the interface for those individual components should be assessed in tabletop and full-scale exercises. Such exercises not only promote familiarization with the plans for all involved, but also identify deficiencies or areas for improvement. Subsequently the plans must undergo revisions ...

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