Predicting Casualty Severity and Hospital Capacity
Predicting Triage Severity
The majority of
terrorist attacks against Americans involve conventional weapons
(for example, bombs, rockets, and missiles). Terrorist bombings
have caused, and can be expected to cause, the following pattern
- 1/3 of acute casualties are critical (dead on scene, die at hospital, require emergency surgery, or require hospitalization)
- 2/3 of acute casualties are treated and released from the emergency department.
| Severity Predictor for
Mass Trauma Events *
Casualty Victims ------»
Critical Casualties ------»
Red I, II
Non-Critical Casualties ----»
* The following factors can change the pattern of casualties:
- Use of manufactured weapons (i.e., military ordinance),
- Explosion in a confined space or,
- Collapse of buildings or other structures
If one of these factors is present,
the pattern of casualties can change and the number of
critical casualties may double.
Predicting Hospital Capacity
to Care for Critical
The number of available operating rooms (ORs) is a major factor in determining a hospital’s capacity to care for critically injured casualties.
Capacity to Care for Critical Casualties ~ Number of Available Operating Rooms
When the number of predicted or actual casualties exceeds the number of ORs that are available, consider transferring or diverting critical casualties to other hospitals.
Predicting Hospital Capacity
to Care for Non-Critical
The capacity of the
radiology department is a major factor in determining a hospital’s capacity to
provide timely care for non-critical casualties. It is recommended
that each casualty exposed to a blast have a chest X-ray to screen for fractures, foreign bodies, blast lung, or other injuries.
Each X-ray should take around 10 minutes of X-ray machine time.
Therefore, the radiology department should be able to see
approximately 6 patients per hour for each available machine.
Capacity to Care for Non-Critical Casualties / hour ~ (# of X-ray Machines*) X (6 patients/hour)
* available fixed and portable X-ray machines
When actual or predicted number of non-critical casualties exceeds the radiology capabilities of the hospital, consider transferring or diverting non-critical casualties to other nearby hospitals with capacity.
Emergency Medical Treatment and Active Labor Act (EMTALA)
The Department of Health and Human services Secretary's Advisory Committee on Regulatory Reform has recommended changes in EMTALA that will improve community mass casualty management. The changes
“use of community based EMS protocols (e.g., established 911 protocols) is not a violation of
“in the event of bioterrorism, or the threat of bioterrorism, EMTALA does not apply to those hospitals directly
“where hospitals follow a community based, regional or CDC directed protocol (especially for highly contagious outbreaks like small pox) EMTALA does not apply.”
information about the EMTALA
is available from the Centers for Medicare and Medicaid Services website.
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