Jonah Patel
A mass casualty incident (MCI) is an incident in which emergency medical services are overwhelmed by the number and severity of casualties. The first unit to arrive at the scene of an MCI will usually declare it, and a senior paramedic will initially be in charge. As more resources arrive, a senior officer will take command, and a well-coordinated response will be implemented, consisting of three phases: triage, treatment, and transportation. The extent of an MCI is influenced by factors such as limited scene accessibility, biohazard contamination, and the lack of on-scene resources, known as MCI Multipliers. Hospitals with emergency departments will have MCI protocols in place, such as calling in more staff and clearing non-acute patients.
| Characteristics | Values |
|---|---|
| Declaration of an MCI | Made by the first unit that arrives at the scene, or less commonly, by an emergency call dispatcher |
| Formal declaration of an MCI | Made by an officer or chief of the agency in charge |
| Command | Initially, the senior paramedic at the scene; as additional resources arrive, a senior officer or chief will take command |
| Incident command system | In the US, the National Incident Management System (NIMS) |
| Assessment of the scene | Using the M.E.T.H.A.N.E method |
| Hospitals | Preparations in place to receive a large number of casualties, including calling in more staff and clearing non-acute patients |
| Trauma centers | Varying levels ranging from Level 1 (complete care) to Level 4 (varying responsibilities and resources) |
| First-arriving crew | Conduct triage, checking for immediate life-threatening concerns, lasting no more than one minute per patient |
| Triage system | In North America, the START system (simple triage and rapid treatment) is the most common |
| MCI extent | Not solely dependent on the number of patients, but also on "MCI Multipliers" such as limited scene accessibility, biohazard contamination, and lack of resources |
| MCI levels | Varying from Level 1 (local resources) to Level 5 (statewide resources) |
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What You'll Learn
Mass casualty incident protocol
A mass casualty incident (MCI) is an incident in which emergency medical services resources, such as personnel and equipment, are overwhelmed by the number and severity of casualties. The first arriving unit at the scene of the incident or, less commonly, an emergency call dispatcher, will usually declare an MCI. A formal declaration is typically made by an officer or chief of the agency in charge. The senior paramedic at the scene will initially be in charge, but as more resources arrive, a senior officer or chief will take command, typically using an incident command system structure.
The protocol for an MCI is typically structured into three phases: triage, treatment, and transportation. The first-arriving crew will conduct the triage, which involves checking for immediate life-threatening concerns, usually taking no more than one minute per patient. In North America, the START system (Simple Triage and Rapid Treatment) is the most common method used. Patients are assigned to one of four colour-coded triage levels based on their breathing, circulation, and mental status:
- Immediate (Red): Patients with major life-threatening injuries but are salvageable with available resources.
- Delayed (Yellow): Patients with non-life-threatening injuries who require assistance.
- Minor (Green): Patients with minor injuries who can be treated at a later stage.
- Expectant (Black): Patients with severe injuries who are unlikely to survive.
During the treatment phase, medical personnel will provide stabilising care to casualties until they can be transported to a hospital or interim care centre. Interim care centres are temporary treatment facilities often set up in large spaces like schools or community centres, where patients can receive further assessment and treatment before being discharged or transported to a hospital. Hospitals with emergency departments will initiate their MCI protocols, which may include calling in more staff, preparing extra equipment, and clearing non-acute patients.
Transportation involves coordinating the efficient movement of patients to appropriate medical facilities. This may include transporting those with less severe injuries to local hospitals or interim care centres to create space for emergency personnel and those with more critical conditions. MCI Multipliers, such as limited scene accessibility, biohazard contamination, or lack of resources, can impact the response and management of an MCI. To address these challenges, early role establishment and a clear hierarchy, such as the National Incident Management System Incident Command System, are crucial.
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Declaring an MCI
In some cases, an emergency call dispatcher may declare an MCI based on the information provided by the first responders. However, a formal declaration of an MCI is usually made by a senior official, such as an officer or chief of the agency in charge. As the incident unfolds and more resources arrive, the command of the incident may be transferred to a senior officer or chief, who will establish a unified command structure to manage all aspects of the MCI.
The declaration of an MCI initiates a well-coordinated response involving multiple agencies and groups. Hospitals with emergency departments will activate their MCI protocols, which may include calling in additional staff, preparing necessary equipment, and creating space for incoming patients. Some hospitals may even send doctors to the scene to assist with triage, treatment, and transportation of patients.
The severity and complexity of an MCI can be influenced by various "MCI Multipliers," such as limited scene accessibility, biohazard contamination, or insufficient resources. These multipliers highlight the importance of early-on-scene role establishment and effective incident command to manage the response effectively. The Incident Commander of the National Incident Management System plays a crucial role in controlling the operations and ensuring a coordinated flow of events during an MCI.
It is important to note that the declaration of an MCI is not solely based on the number of casualties but also considers the severity of injuries and the available resources to manage the incident. The response to an MCI is typically structured into three phases: triage, treatment, and transportation, with the primary focus on stabilizing and providing definitive care to the casualties.
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Triage, treatment, and transportation
Once an MCI has been declared, a coordinated sequence of events will occur, consisting of three phases: triage, treatment, and transportation. The first crew on the scene will conduct the triage, which involves a quick check for immediate life-threatening concerns, lasting about a minute per patient. The North American START system (simple triage and rapid treatment) is a widely used and straightforward method for triaging patients. Patients are assigned to one of four colour-coded triage levels based on their breathing, circulation, and mental status: immediate (red), delayed (yellow), minor (green), and expectant (black).
The triage officer will determine the patient's priority for treatment and transportation. The treatment phase involves stabilising patients with temporary care until they can be transported to a hospital or interim care centre. Trauma centres play a crucial role in the MCI timeline, and their level (1–4) dictates their responsibilities and resources. Level 1 facilities, for example, can offer complete care to patients from initial care to discharge.
In some cases, the incident commander may choose to transport those with minor injuries to local hospitals or interim care centres to create space for emergency personnel and provide easier access to those with severe injuries. Interim care centres can be set up in locations such as schools, community centres, or hotels, providing a temporary assessment and treatment area until patients can be discharged or transported elsewhere.
Transportation of patients is coordinated by the transportation officer and carried out by ambulance services, first responder units, and EMS personnel, following regional policies and communications. The first responder squad plays a crucial role in assessing the extent of the MCI, providing a scene report, and alerting nearby hospitals to determine bed and resource availability. MCI Level 3 and 4 incidents may require additional resources from adjacent regions, while Level 5 incidents will require statewide resources.
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Stabilising casualties
During an MCI, the first-arriving crew typically conducts triage, which involves rapidly assessing and categorising patients based on the severity of their injuries and the resources required. This process helps stabilise casualties by identifying those with immediate, life-threatening injuries who require urgent medical attention. The simple triage and rapid treatment (START) system is commonly used in North America and involves assigning patients to one of four colour-coded triage levels: minor (green), delayed (yellow), immediate (red), and expectant (black).
To streamline the stabilisation process, incident identification vests are distributed to key personnel, including the incident commander (IC), safety officer, staging officer, medical supervisor, and triage officer. These vests help identify the roles and responsibilities of each individual, ensuring efficient and coordinated care. Establishing safe areas, including a staging area, specialty vehicle loading zone, and a triage and treatment zone separate from the accident scene, is also crucial for effective stabilisation.
In some cases, incident commanders may choose to transport those with less serious injuries to local hospitals or interim care centres to create more space for emergency personnel to treat severely injured casualties. Interim care centres are temporary treatment facilities set up in locations like schools, community centres, or hotels, providing assessment, stabilisation, and treatment until patients can be discharged or transported to hospitals.
Additionally, hospitals with emergency departments initiate their MCI protocols upon notification of an incident, preparing to receive a high volume of casualties. This includes calling in additional staff, preparing equipment, and creating bed capacity. In certain situations, hospitals may even deploy doctors to the scene of the incident to assist with triage, treatment, and patient transport, further contributing to the stabilisation process.
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MCI Multipliers
The extent of a multiple-casualty incident (MCI) is not solely dependent on the total number of casualties but is exacerbated by other complicating factors known as "MCI Multipliers". These are factors that can quickly overwhelm emergency medical services (EMS) resources, such as personnel and equipment.
One such MCI Multiplier is limited scene accessibility. For example, an incident may occur in a crowded area, making it difficult for EMS personnel to reach the scene. Another factor could be the presence of a biohazard, such as a chemical spill or radiation leak, which would require specialized equipment and training to handle safely.
Self-deploying responders who are not equipped or experienced for the current scenario can also act as an MCI Multiplier. In such cases, well-intentioned but ill-equipped individuals or groups may arrive at the scene and require assistance themselves, further straining resources.
A lack of on-site or surrounding hospital resources can also contribute to an MCI. This could include a shortage of personnel, equipment, or bed availability. In such cases, patients may need to be transported to more distant hospitals, delaying treatment and potentially overwhelming those facilities.
To effectively manage an MCI, it is crucial to identify and address these MCI Multipliers as early as possible. This may involve establishing clear roles and a hierarchy of command, coordinating with multiple agencies and resources, and making difficult decisions regarding patient triage and transportation.
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Frequently asked questions
A multiple-casualty incident (MCI) is any incident where the number and severity of casualties overwhelm the available emergency medical services (EMS) resources, such as personnel and equipment.
MCI levels range from 1 to 5, with Level 1 requiring local resources and responding agencies, and Level 5 requiring statewide resources. Higher levels may also require additional resources from adjacent or multiple regions.
Hospitals with emergency departments will initiate their MCI protocols upon notification of an incident in their community. This includes calling in more staff, preparing extra equipment, and clearing non-acute patients. Some hospitals may also send doctors to the scene to assist with triage, treatment, and transport of injured persons.
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