Guide: Mass casualty preparedness and response in emergency units – World



The World Health Organization defines mass casualty incidents (MCI) as disasters and major incidents characterized by quantity, severity, and diversity of patients that can rapidly overwhelm the ability of local medical resources to deliver comprehensive and definitive medical care.
A mass casualty incident occurs when the demand for clinical services brought on by a sudden event exceeds the capacity of a health care system to supply them. It can happen anywhere and at any time and impacts not only those directly involved in the incident, both patients and healthcare workers, but also the entire community.
For all hazards that cause mass casualties, a robust pre-existing emergency care and trauma system is essential to provide an effective initial response to mass casualty management (MCM) and vital for continuity of care for everyday emergencies. Emergencies arising from diverse hazards trigger mass casualty incidents affecting large groups of people and causing excess mortality, not only through direct effects of the event but prominently via disruption of essential healthcare services. In the immediate aftermath of a large-scale disaster, the ECS is likely to be the major functioning platform for maintaining general health care services for acute complaints.
Careful planning and preparation will minimize the risk of ECS disruption and will save lives. If needed, well prepared, emergency care systems can rapidly scale up efforts to respond to further health crises that may arise as a result of the disaster.
During an MCI, hospital-based Emergency Units (EU) often represent the frontline of the health system and are key to an effective emergency response. In particular, the EU may be the first point of contact with the health system for many people, providing timely recognition of timesensitive conditions, resuscitation and referral for severely wounded patients. In certain contexts, deployed EMTs may play the role of a frontline health facility.
The WHO Academy has developed the Mass Casualty Management Programme for frontline healthcare staff working in emergency units.
These include doctors, nurses, logistics support staff, management and technicians. MCM competence related micro and macro-credentials can be obtained through the Academy’s digital platform.
In order to better support governments, training institutions, professional societies and NGOs to enhance local capacity to manage a mass casualty incident, whenever possible the MCM Guide should be integrated into medical, paramedical and nursing undergraduate and postgraduate training programmes. Professional Societies have a paramount role in achieving this goal.
MCM is a complex multifaceted process and although the WHO Academy MCM programme is an EU centred programme, it also recognises that the EU alone is not independently adequate to address all aspects of an emergency. A successful mass casualty outcome requires coordination and collaboration from multiple governmental and organizational structures as well as all stakeholders within the response, which might include first responders, healthcare workers, hospital management, local, regional and in some instances, national authorities or Emergency Medical Teams.
Whenever available, WHO standards are applied in this document. Special considerations on MCM standards, and their applicability to deployed Emergency Medical Teams, have been added to each of the key MCM components. MCM training for EMTs, may be included as part of a wider package of training, for example Emergency Medical Teams Coordination Cell (EMTCC) training.


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