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close this bookNatural Disasters - Protecting the Public's Health (PAHO-OPS, 2000, 133 p.)
close this folderChapter 6. Mass Casualty Management
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View the documentPrehospital Emergency Care
View the documentHospital Reception and Treatment
View the documentRedistribution of Patients Between Hospitals

Hospital Reception and Treatment

At the hospital, triage should be the responsibility of a highly experienced clinician, as it may mean life or death for the patient, and will determine the priorities and activities of the entire staff.

Organizational Structure

Spirgi notes that effective management of mass casualties demands an organization of services that is quite different from that found in ordinary times. He states that a “hospital disaster plan designates the command structure to be adopted in case of disaster... [A] command team (consisting of senior officers in the medical, nursing, and administrative fields)... will direct people where to work according to the plan and mobilize additional staff and additional resources as required.”1

1 Edwin H. Spirgi, Disaster Management: Comprehensive Guidelines for Disaster Relief (Bern. Hans Huber, 1979).

Standardized Simple Therapeutic Procedures

Therapeutic procedures should be economical in terms of both human and material resources, and should be chosen accordingly. Health personnel and supplies should support these procedures. First line medical treatment should be simplified and aim to save lives and prevent major secondary complications or problems. Preparation and dissemination of standardized procedures, such as extensive debridement, delayed primary wound closure, or the use of splints instead of circular casts, can produce a marked decrease in mortality and long-term impairment.

Individuals with limited training can, in many instances, carry out simple procedures quickly and effectively. Certain more sophisticated techniques requiring highly trained individuals and complex equipment and many supplies (e.g., treatment of severe bums) are not a wise investment of resources in mass casualty management. This shift in thinking and action from ordinary practice to mass medical care is not easy to achieve for many physicians.