5. Mass Casualty Management and Medical Care

5.3. Organization of Hospitals

The mass casualty management system needs specific organization at the receiving hospital. This organization allows the active mobilization and management of available or needed resources, communicates with pre-hospital providers, and facilitates the management of inpatients and the flow of incoming victims. Other management tasks include secondary evacuations, departments, operating rooms, laboratory, radiology, and intensive care unit, have to be reinforced. It is also important to prepare sequential reinforcements and allow a rapid rotation of the staff in those areas where the workload will be most demanding. This prevents overburdening the staff during an influx of casualties and ensures the prompt return to normal operations with an adequate staff.

As part of the coordinated efforts, hospital security should be reinforced with police officers stationed at the gates and in the reception area. In every hospital, there should be a well-equipped command post for use in emergency situations.

Reception of victims

In order to accommodate the influx of new patients, discharge all patients that can be cared for on an outpatient basis. Adding hallway beds or opening up inhospital clinics can help with surge capacity. If victims bypass the on-scene medical triage and arrive at the hospital on their own, they should be triaged appropriately as with any other arriving victim. When prehospital management has been efficient, an experienced emergency nurse can do the triage. If this is not the case, triage should be performed by an experienced emergency physician, anesthesiologist or surgeon. All arriving victims, whether or not they’ve been previously triaged, should be re-triaged upon arrival to the hospital. 

The on-scene command post, the advanced medical post, and the hospital command post should all be in communication continuously, providing updates on number and severity of injured victims, transport time, and current hospital capacity.
Treatment Areas

Clearly establish the treatment areas in the hospital and provide the necessary staffing. Treatment area designation should reflect triage levels, e.g., red treatment area for victims triaged in the red category. An emergency medicine physician or an anesthesiologist should be in charge of the red treatment area and should be prepared to treat patients with extremely severe injuries. An additional triage can determine the order of these red patients that need operative interventions. Victims triaged as yellow should be reevaluated by a physician and provided care or observation as needed. If their condition worsens, transfer them to the red treatment area. Victims with no hope for survival require only supportive care. These patients should be kept in a separate ward. Have an area ready for deceased victims if the hospital morgue is overwhelmed.