Mass Casualty

• General Information
• See also:
  • Preparedness and Response Planning
  • Surge Capacity
  • Initial On-site Activities
  • Hospital Activities
  • Triage Guidelines
  • Fluid Replacement Guidelines
  • Develop a Radiation Response Plan
  • Nuclear Detonation Scarce Resources Working Group publications list: medical and public health guidance for planners and responders (March 2011)

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General Information

• Initially, after a large mass casualty radiation event, local-regional medical response assets may be diminished significantly, including response personnel, medical facilities, equipment, transportation, communication infrastructure, and availability of countermeasures, including drugs.
• Usual "standards of care" for medical activities may need to be modified to reflect actual conditions and reduced availability of resources. Recently, these modifications have been called "crisis standards of care." It is important to remember that initial shortages of resources will change over time as replacement resources are brought to the affected area. However, some heavily damaged facilities may not be brought back on-line quickly or at all.
  • The complexity of providing care with scarce resources after a nuclear detonation has been addressed in a group of publications from 2011.
• Guidance on creating, and implementing these "crisis standards of care" is the subject of an important series of 7 monographs from the IOM (National Academies) cited on the REMM standards of care page.
• Protective Action Guides (PAGS) for radiation mass casualty events have been proposed by various organizations.
  • PAG Manual: Protective Action Guides and Planning Guidance for Radiological Incidents, EPA-400/R-17/001 (PDF - 1.48 MB) (EPA, January 2017)
• Local event response leaders will decide when to initiate medical mass casualty protocols reflecting "crisis standards of care" in facilities like hospitals and public arenas in order to meet surge capacity. These plans should be developed and practiced in advance by all partners and stakeholders. (See REMM information about medical surge capacity, and resources from HHS/AHRQ.)
• To meet local needs, event response leaders may need to procure additional supplies, including drugs, from the Strategic National Stockpile and/or regional partners.
• Mass radiation decontamination of large numbers of ambulatory victims, if needed, will probably need to be performed at home or in large staging areas away from the acute medical facilities, which will be needed for the acutely ill. (See REMM information on decontamination.)
• For large mass casualty radiation events, procedures for "monitoring" large populations will need to be implemented. (See CDC guidance on population monitoring. (PDF - 3.66 MB))
• In a large mass casualty incident associated with radiation, the traditional triage categories assigned to patients may also need to be modified.

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References

1. Waselenko JK, MacVittie TJ, Blakely WF, Pesik N, Wiley AL, Dickerson WE, Tsu H, Confer DL, Coleman CN, Seed T, Lowry P, Armitage JO, Dainiak N; Strategic National Stockpile Radiation Working Group. Medical management of the acute radiation syndrome: recommendations of the Strategic National Stockpile Radiation Working Group. Annals of Internal Medicine 2004 Jun 15;140(12):1037-51. [PubMed Citation]
2. Planning Guidance for Response to a Nuclear Detonation, Second edition, 6/2010 (PDF - 2.62 MB) (National Security Staff, Interagency Policy Coordination Subcommittee for Preparedness & Response to Radiological and Nuclear Threats)
3. Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations: A Letter Report, (NAS/IOM, National Academies Press, 2009)
4. Key Response Planning Factors for the Aftermath of Nuclear Terrorism (PDF - 4.52 MB) (Lawrence Livermore National Laboratory, August 2009)
5. Hrdina CM, Coleman CN, Bogucki S, Bader JL, Hayhurst RE, Forsha JD, Marcozzi D, Yeskey K, Knebel AR. The "RTR" medical response system for nuclear and radiological mass-casualty incidents: a functional TRiage-TReatment-TRansport medical response model. Prehosp Disaster Med. 2009 May-Jun;24(3):167-78. [PubMed Citation]
6. Nuclear Detonation Scarce Resources Project Working Group Publications