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Chapter 180: Mass Casualty and Crisis Management

Joseph Mueller

INTRODUCTION

Following the traumatic events of September 11, 2001, the public health sector has focused on disaster emergency preparedness. Mass Casualty Events (MCEs) can be categorized by chemical, biological, radiological, nuclear, explosive emergencies, and natural disasters. MCEs can stress and overwhelm first responders and the healthcare system charged with caring for the affected patients. Medical professionals must expand their scope of care and emergency preparedness to better respond to these traumatic situations. Hospital and departmental planning will assist healthcare facilities with effective triage and care for large-scale public health emergencies.

The multidisciplinary collaboration of emergency room teams, perioperative staff, and critical care personnel is of fundamental importance. Anesthesiology departments play an integral role within this framework and must be prepared for both operative and resuscitative care for these patients. It is difficult to predict the role that anesthesiologists may fulfill in treating victims of MCEs. They are most likely to be used in the operating room but they are skilled to manage patients in triage areas, emergency departments, and intensive care units.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has established guidelines to help establish systems to create and sustain community wide emergency preparedness (Table 180-1). These guidelines focus on community preparedness coordination response and a local approach to take care of patients and protect the medical staff.

TABLE 180-1Emergency Management Standards for Hospitals
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TABLE 180-1 Emergency Management Standards for Hospitals

  • Develop a management plan that addresses emergency management

  • Mitigation

  • Preparedness

  • Response

  • Recovery

  • Perform a HVA

  • Establish emergency procedures in response to a HVA

  • Define the organization’s role with that of other community agencies

  • Notify external authorities of emergencies

  • Notify hospital personnel when emergency procedures are initiated

  • Assign available personnel to cover necessary positions

  • Manage the following activities

  • Patient/resident activities

  • Staff activities

  • Staff/family support

  • Logistics of critical supplies

  • Security

  • Evacuation of the facility if necessary

  • Establish internal/external communication systems

  • Establish an orientation/education program

  • Monitor ongoing drills and real emergencies

  • Determine how an annual evaluation will occur

  • Provide alternative means of meeting essential building and utility needs

  • Identify radioactive and biologic isolation and decontamination sites

  • Clarify alternative responsibility of personnel

  • Involve the community in the response

  • Reestablish and continue operations after a disaster

(Reproduced with permission from Miller RD, Pardo MC, eds. Basics of Anesthesia. 6th ed. W.B. Saunders, Philadephia. 2011: Table 42-1.)

HOSPITAL PREPAREDNESS PROGRAM

Hospital disaster policies and plans should be made in conjunction with city, state, and national disaster plans as well as the surrounding area’s hospital facilities. The hospital plan requires an annually revised Hazard Vulnerability Analysis (HVA) that prioritizes a list of potential hazards based on the likelihood versus the impact depending on the institution’s ability to respond.

During a disaster, healthcare teams will be strained from three major areas: supplies, staffing, and ...

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