SU17.3 | Mass Casualty Management — Summary & Reflection

KEY TAKEAWAYS

A mass casualty incident (MCI) is one whose casualties overwhelm the available resources, so the aim of care changes from doing everything for the individual to 'the greatest good for the greatest number'. The response is built on incident command, scene zones (hot/warm/cold), and the linked functions of triage → treatment → transport. Triage rapidly sorts casualties by priority and likelihood of benefit, most often using START (Simple Triage And Rapid Treatment): first send the walking wounded away as GREEN, then assess each casualty by RPM — Respiration (not breathing after airway opened = BLACK; >30/min = RED), Perfusion (no radial pulse / capillary refill >2 s = RED), and Mental status (cannot obey commands = RED; can obey = YELLOW). The four categories are RED (immediate), YELLOW (delayed), GREEN (minor), BLACK (expectant/dead). Field care delivers only seconds-long life-savers (airway, haemorrhage control); patients are then transported by priority and distributed across hospitals, each of which activates its hospital disaster/surge plan. Triage is dynamic and repeated.

REFLECT

Imagine you are genuinely the senior clinician arriving at that bus crash. The most uncomfortable part of triage is the BLACK category — deliberately not pouring resuscitation into a casualty with no signs of life so that several others can be saved. Could you make that decision under pressure, and could you explain it afterwards to a grieving family or to yourself? Think about the GREEN trap, too: would you have the discipline to send the walking, shouting wounded aside and turn first to the silent casualties, against every instinct to comfort the people demanding your attention? Reflect on one habit you will carry from this module — perhaps the RPM sequence, or the rule that triage is repeated, not a single verdict — and on how you would prepare your own hospital so that, when the buses arrive, the response is ordered rather than chaotic.