A mass casualty incident (often shortened to MCI) describes an incident in which emergency medical services resources, such as personnel and equipment, are overwhelmed by the number and severity of casualties. For example, an incident where a two-person crew is responding to a motor vehicle collision with three severely injured people could be considered a mass casualty incident. The general public more commonly recognizes events such as building collapses, train and bus collisions, plane crashes, earthquakes and other large-scale emergencies as mass casualty incidents. Events such as the Oklahoma City bombing in 1995, the September 11 attacks in 2001, and the Boston Marathon bombing in 2013 are well-publicized examples of mass casualty incidents. The most common types of MCIs are generally caused by terrorism, mass-transportation accidents, fires or natural disasters. A multiple casualty incident is one in which there are multiple casualties. The key difference from a mass casualty incident is that in a multiple casualty incident the resources available are sufficient to manage the needs of the victims. The issue of resource availability is therefore critical to the understanding of these concepts. One crosses over from a multiple to a mass casualty incident when resources are exceeded and the systems are overwhelmed.
Declaration
A mass casualty incident will usually be declared by the first arriving unit at the scene of the incident, and less usually by an emergency call dispatcher, depending on the information that is provided by emergency units. A formal declaration of an MCI is usually made by an officer or chief of the agency in charge. Initially, the senior paramedic at the scene will be in charge of the incident, but as additional resources arrive, a senior officer or chief will take command, usually using an incident command system structure to form a unified command to run all aspects of the incident. In the United States, the Incident Command System is known as the National Incident Management System (NIMS). According to the Federal Emergency Management Agency, "NIMS provides the template for the management of incidents."
Scene assessment After the proper agencies have arrived, a more detailed assessment of the scene will be performed using the M.E.T.H.A.N.E method, which summarizes information necessary for responders:
M Mass incident declared E Exact location T Type of incident H Hazards present A Access and egress N Number of casualties and severity E Emergency services required
Agencies and responders
There are multiple agencies involved in most mass casualty incidents, which means there are many individuals that require training for these specific situations. The most common types of agencies and responders are listed below.
Emergency medical services (EMS)
Certified first responders or emergency medical responders may arrive as part of local emergency medical services, or may arrive on their own. They will assist with all aspects of patient care, including triage and treatment at the scene, and transport from the scene to the hospital. Paramedic and emergency medical technician (EMT) personnel may arrive in ambulances, in their personal vehicles, or from another agency. They will have control of all aspects of patient care, as assigned by the medical officer or incident commander. Ground ambulances will be assigned to the transport sector to transport patients and personnel to and from the incident scene, emergency departments of hospitals, and a designated helipad. These ambulances may be municipal services, volunteer services, or from private corporations. Air ambulances will transport patients from the scene or from designated helipads to receiving hospitals.
Fire and rescue
Firefighters or rescue paramedics will perform all initial rescue-related operations, as well as fire suppression and prevention. They may also provide medical care if they are trained and assigned to do so. They may arrive on a fire truck or from another agency. Many areas near airports will have automatic mutual aid agreements with airport fire departments in the event of a plane crash outside of the airport boundaries.
Public Safety Police officers will secure and control access to the scene, to ensure safety and smooth operations. Utility services will ensure that utilities in the area are turned off as necessary, in order to prevent further injury or damage at the scene. Emergency Management Agencies may assist with procuring additional equipment and supplies for the incident. Emergency Management Incident Support Teams may assist with activities such as Planning, Logistics, Operations, and Recovery. Community Emergency Response Teams, or CERT, are civilians trained in basic emergency response and used to assist in disasters. These teams are usually trained and maintained by Emergency Management Agencies but may also be part of Fire Departments or EMS Agencies. Amateur Radio Emergency Services (ARES) or Radio Amateur Civil Emergency Services (RACES) are Amateur Radio operators trained to provide emergency communications during a disaster. Often in a disaster communication systems are overloaded or completely shut down and Amateur Radio operators use special frequencies to assist with disaster communications.
Specialized teams
Specialized rescue teams may be part of the local fire department; they may be associated with the state, provincial, or federal governments; or they may be privately operated teams. These teams are specialists in specific types of rescue, such as urban search and rescue (USAR), confined space rescue, or ski patrol. Hazmat teams are responsible for cleaning up and neutralizing any hazardous materials at the scene. Sometimes these will be specialized CBRNE (chemical, biological, radiological, nuclear and high-yield explosives) teams. National Guard units have medical responders specifically trained in mass casualty triage who may be called in to respond to a disaster-related incident.
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