Mass Casualty

[Modanq]

Have any anesthesiologists or intensivists, ED Physicians, Surgeons here been part of a mass casualty simulation or event in your training or practice? Given the frequency of events over the past several years; Boston, Orlando, San Bernardino, Vegas - I have been contemplating what kinds of actions I would do if caught in a quagmire both in the hospital or on the ground.

On site:
Would you recommend setting up a triage area?
What kinds of directions would you give to lay first responders...

In Hospital:
How would you run the OR board?
Are there sedation / anesthetics / operations that can be done in the ER - setting fractures, airway etc. Even ex lap damage control...
What is the chain of command like?
How can we improve, what has been learned?
Are there resources for this kind of simulation...

Thanks

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[Twiggidy]

Have any anesthesiologists or intensivists, ED Physicians, Surgeons here been part of a mass casualty simulation or event in your training or practice? Given the frequency of events over the past several years; Boston, Orlando, San Bernardino, Vegas - I have been contemplating what kinds of actions I would do if caught in a quagmire both in the hospital or on the ground.

On site:
Would you recommend setting up a triage area?
What kinds of directions would you give to lay first responders...

In Hospital:
How would you run the OR board?
Are there sedation / anesthetics / operations that can be done in the ER - setting fractures, airway etc. Even ex lap damage control...
What is the chain of command like?
How can we improve, what has been learned?
Are there resources for this kind of simulation...

Thanks

On the surface I do know that most of time elective procedures will be cancelled. During 9/11 even my little community hospital which was no where near the tragedies cancelled cases for that day. I'd imagine in the instance of events like today a good handful of hospitals would do the same. Additionally, it tends to be an "all hands on deck" type situation, meaning, everyone tends to make themselves available to work.

 

[zzsleepytinizz]

I completed my residency at NYU/Bellevue hospital and while I have not been involved in responding to a mass casualty situation, I have help provide care in emergency situations where there have been multiple victims at a time, and during hurricane sandy. I remember that there was a command center which was controlled by the higher ups in multiple departments who triaged the work to be done, and decided which group of physicians were responsible for specific aspects of care. Pretty much they just told us all what to do. We always have multiple emergency ORs available.

 

[Modanq]

Just thinking out loud...From a practical standpoint regarding something as routine in our practice as blood product administration goals. I also work at a busy trauma center and we all know those nights were we are transfusing 10, 20, 30, even 40 units of blood in a single patient but occasionally we cross the clinical threshold were we all know its really futile care. In a situation like this after 10 - 20 units in one individual patient I would think that in the setting of limited supply of pRBC, FFP, Plts etc these resources may be better served for a patient with a single limb extremity injuries that may have a better outcomes with 1-2 units...
I hate to be so cynical but Im just trying to imagine what I would do intraoperatively.

 

[Onefellswoop87]

Just thinking out loud...From a practical standpoint regarding something as routine in our practice as blood product administration goals. I also work at a busy trauma center and we all know those nights were we are transfusing 10, 20, 30, even 40 units of blood in a single patient but occasionally we cross the clinical threshold were we all know its really futile care. In a situation like this after 10 - 20 units in one individual patient I would think that in the setting of limited supply of pRBC, FFP, Plts etc these resources may be better served for a patient with a single limb extremity injuries that may have a better outcomes with 1-2 units...
I hate to be so cynical but Im just trying to imagine what I would do intraoperatively.

That’s not cynical. It’s realistic. A mass casualty isn’t only an extreme like Las Vegas over the last 24 hours. I’ve done military mass cas training and at a base, simplistic definition it’s any time your demand (patient number or type) exceeds your supply (personnel or equipment resources). The hypothetical shootout leaving two dying outside your ambulatory surgery center? That’s a small, localized mass casualty event. It’s all about appropriate triage and utilization of resources.

 

[AdmiralChz]

So these things are best left to EMS professionals who get ongoing training in mass casualty responses - as a physician, you are better utilized at the hospital to be honest.

I have a background in EMS, when a mass casualty happens the first thing is to secure the area (making it safe for first responders to even get there). Establishing triage is an early goal as well and figuring out who needs the highest level of care first, and who can wait. It takes coordination with hospitals - Level 1s will take the sickest of course but orthopedic injuries or lesser problems can be sent to other hospitals, even if they are some distance away. Even community non-trauma hospitals can be destinations for more
Minor complaints.

We had a few major incidents (mostly bus crashes) in residency - some cases are definitely put on hold (typically general surgery, mostly so those surgeons can help with trauma). There is constant communication with incident command to get an idea of how many patients are left that will need emergent care. On the weekend calls/texts/emails went out for emergency coverage if anyone was able to step up (think Orlando club shooting). Those of us that moonlit with some frequency in the ER were asked to come down and help as well.

Hope this answers your questions to some degree!

 

[dingdong28]

What would be an anesthesiologist's role in a mass causality event? Are all the above mentioned physicians just start assessing and stabilizing patients? I work in the lab/blood bank during those critical times and was wondering what the anesthesiologists role would be. I'm also in the Air Force and we do mass causality training every so often. Obviously I don't get to directly see what's happening since I'm running stat labs and setting up blood coolers and such. I'm a premed that's really interested in anesthesia and have been able to shadow anesthesiologists that I've worked with during MTPs and emergency events. All the cases I've seen shadowing have been pretty routine with nothing of the ordinary/emergency. I did some shadowing in the ED and was able to see a full code arrive so I have a small idea of what they'll do. Thanks for reading and do appreciate all of your feedback!