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Mass Casualty
Mark B. Shah, MD, FACEP Emergency Physician, Emergency Physicians; Medical Director, Utah Disaster Medical Assistance Team; Medical Director for Emergency
management, Intermountain Healthcare Urban Central Regsion; Co-Medical Director, Intermountain Center for Disaster Preparedness
Objectives:
Discuss the lessons learned from recent terrorist events
Identify the steps in preparing your hospital for a mass casualty response
Discuss and demonstrate Tactical Combat Casualty Care techniques
Develop an action plan to implement in your facility
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Mark Shah, MD FACEPUtah Emergency Physicians
Utah Disaster Medical Assistance TeamIntermountain Center for Disaster Preparedness
Emergency Management, Intermountain Healthcare UCRAdjunctive Faculty, University of Utah, Division of Emergency Medicine
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15% of Combat Deaths are
Preventable
• 9% Hemorrhage from extremity wounds
• 5% Tension pneumothorax
• 1% Airway obstruction e.g., maxillofacial
trauma
* Data is extrapolated from Vietnam to
present day Iraq and Afghanistan
From Chris Cook, RN, TEMS
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Assessment: C‐ABCDE
•C•Airway
•B•C•D•E
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Prehospital External Hemorrhage Control Protocol
Apply direct pressure/pressure dressing to injury
Direct pressure effective (hemorrhage controlled)
Wound amenable to tourniquet placement (e.g. extremity injury)
Apply a tourniquet
Wound not amenable to tourniquet placement (e.g. junctional injury)
Apply a topical hemostatic agent with direct pressure
Direct pressure ineffective or impractical (hemorrhage not controlled)
Doyle and Taillac, Prehospital Emergency Care 2008; 12(2): 241‐ 256
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Doyle and Taillac, Prehospital Emergency Care 2008; 12(2): 241‐ 256
Reassess tourniquet for possible replacement with pressure dressing
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Focus on effective packing of wounds and good direct pressure
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•Chest/abdomen/pelvis
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•Early administration of “whole blood” in a
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https://www.ict.org.il/Article/77/Terrorist‐Attacks‐against‐Hospitals‐Case‐Studies
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POV Arrivals
Spot Check:1. Security2. HAZMAT
EMS Arrivals
Triage Director
Resuscitation Bays ED Bed
DECON
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POV Arrivals
Spot Check:1. Security2. HAZMAT3. Nurse Greeter
EMS Arrivals
Triage Director
Comprehensive TriageNot Sick
SickRed
Resuscitation Bays ED Bed Alternate Care Area
YellowGreen
DECON
Expectant
Black
Traffic Director
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Disaster
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Medical Care falls under Operations Section Chief
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Mark Shah: [email protected]
Intermountain Center for Disaster Preparedness:
Facebook: https://www.facebook.com/pages/Intermountain-Center-for-Disaster-
Preparedness
Karen Blackwood, Director: [email protected]
Barb Clark, Training Manager: [email protected]
https://nam.edu/wp-content/uploads/2016/06/Health-and-Medical-Response-to-
Active-Shooter-and-Bombing-Events.pdf
http://emergency.cdc.gov/masscasualties/pdf/surgecapacity.pdf
http://www.euro.who.int/en/health-topics/emergencies/disaster-preparedness-and-
response/publications/2011/hospital-emergency-response-checklist