Mass Casualty
Incident (MCI)
Response
Objectives
Purpose: This module will educate staff on mass casualty triage incident
response, including how to:
• Define mass casualty triage
• Determine considerations for adults and pediatrics
• Understand the importance of a patient tracking system
• Recognize and implement the patient admission/ discharge MCI triage
process
• Determine how to appropriately handle the deceased in a large- scale
MCI
• Recognize the range of incidents that may cause MCIs
What is an MCI?
• A mass casualty incident
(MCI) is an incident where
the number of patients
exceeds the amount of
healthcare resources
available.
•This number varies widely
across the institutions, but
is typically greater than 10
patients.
Types of MCI Notifications
During a large scale incident such as a mass casualty, it is important to
have a mass notification system. Successful mass notification systems
will:
• Internally: alert staff to activate MCI protocols and prepare for a
potential surge of patients.
• Externally: increase community awareness.
Assisting in MCI Response Considerations
for hospital staff in an MCI:
• Some patients may arrive to the hospital without having been
assessed/ triaged at the scene.
• MCI response requires efficiency and coordination.
• Non-clinical personnel (including hospital volunteers) can assist in
moving patients to designated areas based on level of care.
• Help gather patient information in the emergency treatment area.
• Staff should review patients in clinical assignment for any potential
discharges/ transfers to make room for potential MCI admissions, a
process known as “surge discharge”.
Definition of MCI Triage means “to sort.”
• Triage in an MCI is the
assignment of
resources based on
the initial patient
assessment and
consideration of
available resources.
MCI Triage
• MCI triage differs from day-to-day triage due to potential resource limitations.
• Evidence based triage systems have been developed using these documented
triage basics: Triage prioritizes identification of those in need of immediate
intervention.
• Triage must be modified for children.
• “Triage requires situational awareness, decisiveness, and clinical expertise.”
• Ethical justifications need to be made in order to save large numbers instead
of caring for each individual need.
• No-notice, dynamic incident scenes with exceedingly large numbers of
patients may result in altered triage processes.
MCI Triage
Triage Considerations
There are three types of triage:
-Primary
•Performed at the first encounter with the patient.
•May be done by EMS, first responders, or hospital staff.
–Secondary
•Reevaluation of primary triage after additional assessment and/or interventions.
•Often used at the hospital to prioritize patients for operative care or advanced
studies, but should be conducted on the scene, if transport is delayed.
–Tertiary
•Performed during ongoing definitive care. Patients may arrive on foot or via non-EMS
transport and require primary triage at the hospital.
Triage Considerations
•As additional resources become available, patient status should be
continually reassessed.
•If sufficient transportation resources are available, transport should
not be delayed to conduct triage.
•If sufficient patient care resources are available at the hospital, care
should not be delayed to conduct a formal triage.
•An MCI in the field, may not be an MCI at the hospital –MCI is
determined by available resources to handle the number of patients at
a given location.
Transfer to Health Care Facility
SALT MCI Triage Tool Used primarily on
scene
• Sort-Sort based on whether victim can walk, wave, or is still
• Assess–Complete an individual assessment to determine need for any
lifesaving interventions
• Lifesaving interventions –Control hemorrhage, open airway, etc. and follow
algorithm
• Treatment and/ or transport
Expectant: head injury with exposed brain matter, carotid artery
hemorrhage or burns to 90 percent of the total body surface area.
Delayed: proximal long bone fracture.
Immediate: tension pneumothorax.
COLOR CODE - PRACTICAL
• 1- Gun Shot Wound to
the chest. Bleeding.
• Not walking -CRT > 2 sec
-Responds to pain,
COLOR CODE - PRACTICAL
• 2- BLAST- lower limb
torn off, below the
knee. Catastrophic
bleeding.
• Not Walking -RR : 14 -
CRT > 2 sec -
Unconscious,
COLOR CODE - PRACTICAL
• 3- GSW to the
head.
• Not Walking -
RR : 3 - CRT < 2
sec -
Unconscious,
COLOR CODE - PRACTICAL
• 4- Closed femur
fracture
• Not Walking -RR :
15 -CRT < 2 sec -
Alert,
COLOR CODE - PRACTICAL
• 5- GSW to the
abdomen.
Evisceration.
• RR : 28 -CRT > 2 sec -
Alert,
DEAD (BLACK TRIAGE TAPE OR TAG)
Patients with injuries incompatible with life or without
spontaneous respirations are triaged as deceased. Assess the
following:
• Adult patient is not breathing after opening airway.
• Child is not breathing after opening airway and giving 2
breaths.
• Patients tagged Dead do not move forward from the point of
injury to the casualty collection point.
IMMEDIATE (RED TRIAGE TAPE OR
TAG)
Patients with severe injuries, but high potential for survival with treatment
such as victims of tension pneumothorax, assess the following:
• Does the patient have a peripheral pulse?
• Is the patient not in respiratory distress?
• Is hemorrhage controlled?
• Does the patient follow commands or make purposeful movements?
A "no" answer to any of these questions and a field provider judgement
that the patient is likely to survive given the available resources means the
patient should be tagged Immediate.
Immediate patients move forward to the casualty collection point first.
EXPECTANT (GRAY TRIAGE TAPE OR
TAG)
• A "no" response to any of the questions about pulse, breathing,
hemorrhage and mental status, but the patient is unlikely to survive
given the available resources means the patient should be tagged
Expectant.
• These patients should receive treatment resources only after the
Immediate patients have been moved forward.
• Examples of expectant patients include head injury with exposed
brain matter, carotid artery hemorrhage or burns to 90 percent of the
total body surface area.
DELAYED (YELLOW TRIAGE TAPE OR
TAG)
Patients with serious injuries, such as a long bone fracture, that will require
eventual forward movement to definitive treatment, but not immediate
forward movement and care are tagged Delayed. To determine if a patient is
Delayed assess the following:
• Does the patient have a peripheral pulse?
• Is the patient not in respiratory distress?
• Is hemorrhage controlled?
• Does the patient follow commands or make purposeful movements?
A "yes" response to all of these, but the injuries are still significant, such as a
proximal long bone fracture, then the patient should be tagged Delayed.
MINIMAL (GREEN TRIAGE TAP OR TAG)
• "Yes" to all of the same questions about pulse, breathing, hemorrhage
and mental status, but the patient’s injuries are minor, such as minor
abrasions and lacerations and the patient should be tagged Minimal.
• Most Minimal patients should have moved forward during the sort of
Walkers from the Wavers and the Still.
• Remaining Minimal patients are the last to move forward and they
may help move other patients forward to treatment and transport.
TREATMENT AND TRANSPORT
• As patients receive their tags from the SALT process, they should
move forward to a casualty collection point. Patients continue to
move forward from there to a treatment area and eventually to an
ambulance for transport to a receiving facility..
• The treatment area is the destination for all incoming personnel and
equipment from responding EMS agencies. It is also only to
temporarily hold patients until they can be transported forward to
receiving facilities.
MASS INCIDENT CASUALTY
