Ver el código de «Mass casualty incident»

==Background==
*Mass Casualty Incident (MCI) defined as an incident where the number of patients (or the rate of their arrival to a medical facility) overwhelms local resources (and the ability to immediately supplement them).<ref name="Briggs">Briggs SM. Disaster management teams. Curr Opin Crit Care. 2005 Dec;11(6):585-9.</ref><ref name="Lee">Lee JS, Franc JM. Impact of a Two-step Emergency Department Triage Model with START, then CTAS, on Patient Flow During a Simulated Mass-casualty Incident. Prehosp Disaster Med. 2015 Jun 24:1-7.</ref>

==Potential Causes of MCI==
{{MCI types}}

==Management==
[[File:ICS org chart.bmp|thumbnail|ICS Organization Structure]]

===Initial Triage===
*In an MCI, triage differs slightly from normal Emergency Department triage.
**Based not only on severity of injury/illness, but also on prognosis/survivability in the setting of limited resources<ref>Pesik N, Keim ME, Iserson KV. Terrorism and the ethics of emergency medical care. Ann Emerg Med. 2001 Jun;37(6):642-6.</ref>
*[[Mass casualty incident triage|START triage]] is the most common triage system utilized in the United States.
**Several other triage systems exist, but all (including START) lack validation or strong evidence (likely impossible given nature of MCIs)<ref name="Cross">Cross KP, Petry MJ, Cicero MX. A better START for low-acuity victims: data-driven refinement of mass casualty triage. Prehosp Emerg Care. 2015 Apr-Jun;19(2):272-8. doi: 10.3109/10903127.2014.942481.</ref><ref name="Kahn">Kahn CA, Schultz CH, Miller KT, Anderson CL. Does START triage work? An outcomes assessment after a disaster. Ann Emerg Med. 2009 Sep;54(3):424-30, 430.e1. doi: 10.1016/j.annemergmed.2008.12.035.</ref>
*Triage should be ongoing process, with patient statuses (and triage designations) updated as they change.

===Incident Command System (ICS)===
*An Incident Command System (ICS) is designed to allow for coordination of response to an MCI by providing for an integrated organizational/command structure<ref name="FEMA">FEMA IS 0100.b - Introduction to the Incident Command System (ICS), Student Manual. http://training.fema.gov/emiweb/is/is100b/student%20manual/02ics100b_sm_october2013.pdf. Accessed 07/24/2015.</ref>
**ICS has been in use since the 1970's.
**Designed to expand or contract in size in response to scope of incident. 
*After the September 11, 2001 terrorist attacks, the Department of Homeland Security proposed the National Incident Management System (NIMS) in response to perceived deficiencies in coordination between emergency responders.<ref>Jensen J, Youngs G. Explaining implementation behaviour of the National Incident Management System (NIMS). Disasters. 2015 Apr;39(2):362-88. doi: 10.1111/disa.12103.</ref>
**NIMS mandates the use of ICS in the United States for MCI response<ref name="FEMA" />

==External Links==
*[http://training.fema.gov/emiweb/is/icsresource/index.htm FEMA ICS Resource Center]
*[https://training.fema.gov/is/nims.aspx FEMA Online NIMS Training]

==See Also==
*[[GEMC:Prehospital_/_Disaster_/_Mass_Casualty_Medicine]]
*[[Mass casualty incident triage]]

==References==
<References/>

[[Category:Misc/General]]
[[Category:EMS]]