This post details the steps in a mass casualty critical assessment.

A mass casualty is when you don't have enough resources to treat the injuries sustained. In the case of disaster, there is a good chance of mass casualty.

If you choose to help your goal is to help as many people as possible whilst keeping rescuers safe.

There are three major steps when dealing with a mass casualty first aid scenario:

IMPORTANT: No amount of reading can compare to a medical course with a professional trainer. A standard first aid course is good. A wilderness first aid course or higher is best.

This step is almost identical to the normal DRABC danger assessment.

You want to slow down so you can assess the entire situation. With many casualties, it will be more complex, but with some practice, you will be able to do it quite fast.

Next, you need to identify the cause of the incident. This will help you predict the type of injuries you are more likely to come across. For example, if it is a fire, you can expect more burns and breathing problems.

Knowing the cause is also very useful to prevent everyone else getting hurt by the same thing.

These first two assessments happen quite fast. The last one can take some time. You need to assess the number of patients, the need for more rescuers, and what resources you have or need.

If you have a team of responders, you (the team leader) must stay in one spot. Fight the urge to try to help everyone. You will be more useful as the "central brain", directing the other rescuers in what to do. Have them assess individual patients, gather equipment, find help, etc.

Once you have a plan of action you can get hands-on.

Now that you have a good idea of the situation, you can sort the casualties. Quickly go through them and "tag" each one in order of priority. You can tag with numbers or colors. There is no international standard, but the following are well recognized (US Standard):

Depending on your situation and/or resources, red or yellow tags may become black. Lack of advanced medical care is a big factor here.

Fix critical problems quickly if possible, but do not spend very much time on any one patient. 30 seconds or less is a good guide.

Tell each patient who you are and that you are there to help. Stay calm and reassure them.

If you have a team and you are the "central brain", each rescuer must asses the casualties they see and report back to you. You will then assign patients to each rescuer in order of priority.

If you have enough rescuers, pair them up. One treats the patient. The other does the legwork such as reporting back to you, getting equipment, etc.

Now you have a good plan of attack. Start fixing patients! Here are some useful articles on that:

Open airway if necessary:

If breathing is normal, check pulse and perfusion:

If a pulse is present and capillary refill is normal, move to mental status:

While doing the above, consider the following:

Dealing with a mass casualty situation can overwhelm even experienced responders. Remember to slow down and assess the situation. The safety of you and your team trumps all else. Next, take the time to make a good plan of attack. This will save you time in the long run, and lives.

If you are the team leader, give clear and confident instructions. You can take advice, but in these situations, dictatorships are better than democracies. If you can't handle it, swallow your pride and let someone who can take over.

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