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Mass Casualty
Mark B. Shah, MD, FACEP Emergency Physician, Emergency Physicians; Medical Director, Utah Disaster Medical Assistance Team; Medical Director for Emergency
management, Intermountain Healthcare Urban Central Regsion; Co-Medical Director, Intermountain Center for Disaster Preparedness
Objectives:
Discuss the lessons learned from recent terrorist events
Identify the steps in preparing your hospital for a mass casualty response
Discuss and demonstrate Tactical Combat Casualty Care techniques
Develop an action plan to implement in your facility
Mark Shah, MD FACEPUtah Emergency Physicians
Utah Disaster Medical Assistance TeamIntermountain Center for Disaster Preparedness
Emergency Management, Intermountain Healthcare UCRAdjunctive Faculty, University of Utah, Division of Emergency Medicine
15% of Combat Deaths are
Preventable
• 9% Hemorrhage from extremity wounds
• 5% Tension pneumothorax
• 1% Airway obstruction e.g., maxillofacial
trauma
* Data is extrapolated from Vietnam to
present day Iraq and Afghanistan
From Chris Cook, RN, TEMS
Assessment: C‐ABCDE
•C•Airway
•B•C•D•E
Prehospital External Hemorrhage Control Protocol
Apply direct pressure/pressure dressing to injury
Direct pressure effective (hemorrhage controlled)
Wound amenable to tourniquet placement (e.g. extremity injury)
Apply a tourniquet
Wound not amenable to tourniquet placement (e.g. junctional injury)
Apply a topical hemostatic agent with direct pressure
Direct pressure ineffective or impractical (hemorrhage not controlled)
Doyle and Taillac, Prehospital Emergency Care 2008; 12(2): 241‐ 256
Doyle and Taillac, Prehospital Emergency Care 2008; 12(2): 241‐ 256
Reassess tourniquet for possible replacement with pressure dressing
Focus on effective packing of wounds and good direct pressure
•Chest/abdomen/pelvis
•Early administration of “whole blood” in a
https://www.ict.org.il/Article/77/Terrorist‐Attacks‐against‐Hospitals‐Case‐Studies
POV Arrivals
Spot Check:1. Security2. HAZMAT
EMS Arrivals
Triage Director
Resuscitation Bays ED Bed
DECON
POV Arrivals
Spot Check:1. Security2. HAZMAT3. Nurse Greeter
EMS Arrivals
Triage Director
Comprehensive TriageNot Sick
SickRed
Resuscitation Bays ED Bed Alternate Care Area
YellowGreen
DECON
Expectant
Black
Traffic Director
Disaster
Medical Care falls under Operations Section Chief
Mark Shah: [email protected]
Intermountain Center for Disaster Preparedness:
Facebook: https://www.facebook.com/pages/Intermountain-Center-for-Disaster-
Preparedness
Karen Blackwood, Director: [email protected]
Barb Clark, Training Manager: [email protected]
https://nam.edu/wp-content/uploads/2016/06/Health-and-Medical-Response-to-
Active-Shooter-and-Bombing-Events.pdf
http://emergency.cdc.gov/masscasualties/pdf/surgecapacity.pdf
http://www.euro.who.int/en/health-topics/emergencies/disaster-preparedness-and-
response/publications/2011/hospital-emergency-response-checklist