Mass Casualty Management

When disaster strikes, the greatest imperative is to rescue people, save lives, and treat the injured. The objective of mass-casualty management is to organize logistical facilities, search-and-rescue services, and medical resources in such a way as to minimize loss of life and ensure the complete recovery of as many survivors as possible. Conversely, inefficiency in medical response can result in the loss of lives that could have been saved by more timely and effective intervention.

Disaster epidemiology is the study of the human impact of catastrophe in terms of patterns of death, injury, and disease. Recently, despite considerable increases in population, worldwide disaster mortality has remained fairly constant at about 110,000 persons per year. However, very large variations in the numbers of casualties occur from one disaster to another and with the type of event: for example, the Indian Ocean earthquake and tsunami of December 26, 2004 (magnitude 9.2) killed approximately 297,200 people in 12 countries, which was equivalent to the total natural disaster mortality for the previous five years. Generally, deaths in natural disasters outnumber those in technologically and socially generated disasters by a ratio of 10 to one. Death-to-injury ratios vary considerably: although 1:3 has been hypothesized for earthquakes, 1:6 for floods, and 1:15 for tornadoes, data tend to be poorly recorded and show few stable regularities. In seismic disasters, for example, the ratio of serious to light injuries varies from 1:9 to 1:1,000. Injury typologies are dominated by fractured limbs, cranial trauma, suffocating ingestion of dust, depression of the thorax, and crush syndrome.

Disasters Causing Mass Casualties

U.S. Navy Commander Joseph Taddeo treats second-degree burns on a 3-year-old Pakistani boy at a field hospital near Shinkiari, Pakistan, after a massive earthquake struck Pakistan, India, and Afghanistan on November 8, 2005. An estimated 80,000 people died

Earthquakes are the archetypical form of sudden-impact disaster that creates a mass-casualty situation, potentially of huge proportions, without warning and in a matter of seconds. Rescue is imperative and, in order to make any impression on the death toll, must occur [Page 401]within 6–12 hours of the main shock, as survival times under rubble are strictly limited by injury, exposure to the elements, and the risk of further structural collapse in aftershocks. Advances in rescue techniques mean that doctors and paramedics are now routinely included in urban search-and-rescue teams. On occasion, medical care is brought to patients even before they are rescued, as medical staff may accompany SAR specialists into the entrapment area.

Whether they are related to volcanism, industrial hazards, terrorism, or other causes, explosions tend to cause some of the most complicated and life-threatening injuries. Primary effects stem directly from the expanding pressure wave and include “blast lung” (pulmonary barotrauma) and compartmental injuries, the result of pressure on internal organs. Secondary injuries are caused by flying objects and shrapnel. Tertiary effects occur when people are flung around by the force of the blast, and quaternary effects can include burns caused by fireballs, and the effects of noxious gases and toxins carried in dust.