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 3 major steps when dealing with a mass casualty first aid scenario:
- Assess the risk
- Sort the casualties
- Treat the casualties
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Mass Casualty Critical Assessment
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.
Assess for Danger
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.
First look for any general dangers which may cause harm to you, fellow rescuers, the public, and the patients. The priority of wellbeing is in the order I have listed. Yes, patients come last!
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.
Sort the Casualties
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):
- 1 or Red: Highest priority. Probable loss of life or limb if immediate medical care is not given.
- 2 or Yellow: Needs medical care but can wait 2 to 4 hours. The patient may enter Red over time.
- 3 or Green: Minor injuries. Referred to as the “walking wounded”. Can help with other patients.
- 4 or Black: No chance of saving. Do not start CPR unless the cause is lightning.
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.
Treat the Casualties
Now you have a good plan of attack. Start fixing patients! Here are some useful articles on that:
Mass Casualty Primary Assessment Flow Chart
- Open airway if necessary:
- If victim begins breathing once the airway is clear, tag red.
- If patient’s respirations are too slow or fast, tag red.
- Tag black if the airway is open but they are not breathing.
- If breathing is normal, check pulse and perfusion:
- Tag red if there is no pulse or capillary refill takes longer than 2 seconds.
- If a pulse is present and capillary refill is normal, move to mental status:
- If patient is unconscious or disorientated, tag red. Explosions may cause temporary hearing loss, which is different from disorientation.
- If they can follow commands but are unable to get up, tag yellow.
- Tag green if they follow commands and can get up.
While doing the above, consider the following:
- Elevate legs if there are signs of shock.
- If there is any doubt about the category, always tag the highest priority triage level. For example, if you’re not sure between yellow and red, tag red.
- Once you have identified someone as level 1/red, tag them and move immediately to the next patient. The only exception is if you have major bleeding to stop.
- Only administer CPR if you have enough resources.
- Protect the spine only if resources are available.
- Stop severe bleeding. Use a bystander if available. If bleeding doesn’t stop, tag Red.
- Once you finish tagging, move patients in order of priority. Put them in a safe area for further treatment and secondary exams.
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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.
Photo Credit: By Alejandro Pena [Public domain], via Wikimedia Commons
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