Skip to main content

Organization of Urgent Medical Aid, Including Mass Casualty and Triage

  • Chapter
  • First Online:
Armed Conflict Injuries to the Extremities

Modern armed conflict is notable in that the violence of today’s weaponry and the profound severity of wounds create frequent situations in which trauma care providers are faced with situations that severely strain available resources. When those resources are strained beyond existing capacity to treat the sheer volume of wounded, the event becomes a mass casualty incident.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Baker, M.: Creating order from chaos: Part I: Triage, initial care, and tactical considerations in mass casualty and disaster response. Mil. Med. 172(3), 232–236 (2007)

    PubMed  Google Scholar 

  2. Peleg, K., Kellermann, A.L.: Enhancing hospital surge capacity for mass casualty events. JAMA 302(5), 565–567 (2009)

    Article  PubMed  CAS  Google Scholar 

  3. Hick, J., Barbera, J.A., Kelen, G.D.: Refining surge capacity: conventional, contingency, and crisis capacity. Disaster Med. Public Health Prep. 3(2 Suppl), S59–S67 (2009)

    Article  PubMed  Google Scholar 

  4. Lynn, M., Gurr, D., Memon, A., Kaliff, J.: Management of conventional mass casualty incidents: ten commandments for hospital planning. J. Burn Care Res. 27(5), 649–658 (2006)

    Article  PubMed  Google Scholar 

  5. Grathwohl, K., Venticinque, S.G.: Organizational characteristics of the austere intensive care unit: the evolution of military trauma and critical care medicine; applications for civilian medical care systems. Crit. Care Med. 36(7 Suppl), S275–S283 (2008)

    Article  PubMed  Google Scholar 

  6. Jen, H., Shew, S.B., Atkinson, J.B., Rosenthal, J.T., Hiatt, J.R.: Creation of inpatient capacity during a major hospital relocation: lessons for disaster planning. Arch. Surg. 144(9), 859–864 (2009)

    Article  PubMed  Google Scholar 

  7. Macintyre, A., Barbera, J.A., Brewster, P.: Health care emergency management: establishing the science of managing mass casualty and mass effect incidents. Disaster Med. Public Health Prep. 3(2 Suppl), S52–S58 (2009)

    Article  PubMed  Google Scholar 

  8. Born, C., Briggs, S.M., Ciraulo, D.L., Frykberg, E.R., Hammond, J.S., Hirshberg, A., Lhowe, D.W., O’Neill, P.A., Mead, J.: Disasters and mass casualties: II. Explosive, biologic, chemical, and nuclear agents. J. Am. Acad. Orthop. Surg. 15(8), 461–473 (2007)

    PubMed  Google Scholar 

  9. Matzo, M., Wilkinson, A., Lynn, J., Gatto, M., Phillips, S.: Palliative care considerations in mass casualty events with scarce resources. Biosecur. Bioterror. 7(2), 199–210 (2009)

    Article  PubMed  Google Scholar 

  10. King, D., Patel, M.B., Feinstein, A.J., Earle, S.A., Topp, R.F., Proctor, K.G.: Simulation training for a mass casualty incident: two-year experience at the Army Trauma Training Center. J. Trauma Inj. Infect. Crit. Care 61(4), 943–948 (2006)

    Article  Google Scholar 

  11. Baker, M.: Creating order from chaos: Part II: Tactical planning for mass casualty and disaster response at definitive care facilities. Mil. Med. 172(3), 237–243 (2007)

    PubMed  Google Scholar 

  12. Born, C., Briggs, S.M., Ciraulo, D.L., Frykberg, E.R., Hammond, J.S., Hirshberg, A., Lhowe, D.W., O’Neill, P.A.: Disasters and mass casualties: I. General principles of response and management. J. Am. Acad. Orthop. Surg. 15(7), 388–396 (2007)

    PubMed  Google Scholar 

  13. Briggs, S.M.: Disaster management teams. Curr. Opin. Crit. Care 11, 585–589 (2005)

    Article  PubMed  Google Scholar 

  14. Ciraulo, D., Barie, P.S., Briggs, S.M., Bjerke, H.S., Born, C.T., Capella, J., Cancio, L., Dennis, A., DiGiacomo, J.C., Gross, R.I., Hammond, J.S., Holcomb, J.B., Jenkins, D., Knuth, T.E., Letarte, P.B., Lynn, M., O’Neill, P.A., Salomone, J.P., Shatz, D.V., Eastern Association for the Surgery of Trauma: Disaster and Medical Special Operations Committee, (DMSOC): An update on the surgeons scope and depth of practice to all hazards emergency response. J. Trauma Inj. Infect. Crit. Care 60(6), 1267–1274 (2006)

    Article  Google Scholar 

  15. Aylwin, C.J., Konig, C.T., Brennan, W.N., Shirley, J.P., Davies, G., Walsh, S.M., Brohi, K.: Reduction in critical mortality in urban mass casualty incidents: analysis of triage surge, and resource use after the London bombings on July 7, 2005. Lancet 368, 2219–2225 (2006)

    Article  PubMed  Google Scholar 

  16. Beekley, A., Martin, M.J., Spinella, P.C., Telian, S.P., Holcomb, J.B.: Predicting resource needs for multiple and mass casualty events in combat: lessons learned from combat support hospital experience in Operation Iraqi Freedom. J. Trauma Inj. Infect. Crit. Care 66(4 Suppl), S129–S137 (2009)

    Article  Google Scholar 

  17. Holcomb, J.B., et al.: Damage control resuscitation: directly addressing the early coagulopathy of trauma. J. Trauma 62(2), 307–310 (2007)

    Article  PubMed  Google Scholar 

  18. Schreiber, M.A., Perkins, J., Kiraly, L., et al.: Early predictors of massive transfusion in combat casualties. J. Am. Coll. Surg. 205, 541–545 (2007)

    Article  PubMed  Google Scholar 

  19. Soffer, D., Klausner, J., Bar-Zohar, D., et al.: Usage of blood products in multiple-casualty incidents: the experience of a level I trauma center in Israel. Arch. Surg. 143, 983–989 (2008)

    Article  PubMed  Google Scholar 

  20. Epstein, R., Ekbatani, A., Kaplan, J., Shechter, R., Grunwald, Z.: Development of a staff recall system for mass casualty incidents using cell phone text messaging. Anesth. Analg. 110(3), 871–878 (2010)

    Article  PubMed  Google Scholar 

  21. Hick, J., Chipman, J., Loppnow, G., Conterato, M., Roberts, D., Heegaard, W.G., Beilman, G., Clark, M., Pohland, J., Ho, J.D., Brunette, D., Clinton, J.E.: Hospital response to a major freeway bridge collapse. Disaster Med. Public Health Prep. 2(Suppl 1), S11–S16 (2008)

    Article  PubMed  Google Scholar 

  22. Hess, J.R., Holcomb, J.B., Hoyt, D.B.: Damage control resuscitation: the need for specific blood products to treat the coagulopathy of trauma. Transfusion 46(5), 685–686 (2006)

    Article  PubMed  Google Scholar 

  23. Beekley, A., Sebesta, J., Blackbourne, L., Herbert, G., Kauvar, D., Baer, D., Walters, T., Mullenix, P., Holcomb, J.: Prehospital tourniquet use in operation Iraqi freedom: effect on hemorrhage control and outcomes. J. Trauma Inj. Infect. Crit. Care 64(Suppl), S28–S37 (2008)

    Article  Google Scholar 

  24. Blackbourne, L.: Combat damage control surgery. Crit. Care Med. 36(Suppl), S304–S310 (2008)

    Article  PubMed  Google Scholar 

  25. Blackbourne, L.: The next generation of combat casualty care. J. Trauma Inj. Infect. Crit. Care 66(Suppl), S27–S28 (2009)

    Article  Google Scholar 

  26. Butler, F.: Tactical combat casualty care: combining good medicine with good tactics. J. Trauma Inj. Infect. Crit. Care 54(Suppl), S2–S3 (2003)

    Google Scholar 

  27. Butler, F., Hagmann, J., Butler, E.: Tactical combat casualty care in special operations. Mil. Med. 161(Suppl), 1–16 (1996)

    Google Scholar 

  28. Butler, F., Holcomb, J., Geibner, S., McSwain, N., Bagian, J.: Tactical Combat Casualty Care 2007: evolving concepts and battlefield experience. Mil. Med. 172(11), S1–S19 (2007)

    Google Scholar 

  29. Champion, H.: Combat fluid resuscitation: introduction and overview of conferences. J. Trauma Inj. Infect. Crit. Care 54(Suppl), S7–S12 (2003)

    Google Scholar 

  30. Champion, H., Bellamy, R., Roberts, C., Leppaniemi, A.: A profile of combat injury. J. Trauma Inj. Infect. Crit. Care 54(Suppl), S13–S19 (2003)

    Google Scholar 

  31. Covey, D., et al.: Orthopaedic war injuries: recent developments in treatment and research. AAOS Instr. Course Lect. 58, 117–129 (2009)

    Google Scholar 

  32. Hoey, B., Schwab, C.: Level I center triage and mass casualties. Clin. Orthop. Relat. Res. 422, 23–29 (2004)

    Article  PubMed  Google Scholar 

  33. Holcolmb, J., Stansbury, L., Champion, H., Wade, C., Bellamy, R.: Understanding combat casualty care statistics. J. Trauma Inj. Infect. Crit. Care 60, 397–401 (2006)

    Article  Google Scholar 

  34. Hospenthal, D., et al.: Guidelines for the prevention of infection after combat-related injuries. J. Trauma Inj. Infect. Crit. Care 64(Suppl), S21–S22 (2008)

    Article  Google Scholar 

  35. Kragh, J., Walters, T., Baer, D., Fox, C., Wade, C., Salinas, J., Holcomb, J.: Survival with emergency tourniquet use to stop bleeding in major limb trauma. Ann. Surg. 249(1), 1–7 (2009)

    Article  PubMed  Google Scholar 

  36. Mabry, R., McManus, J.: Prehospital advances in the management of severe penetrating trauma. Crit. Care Med. 36(Suppl), S258–S266 (2008)

    Article  PubMed  Google Scholar 

  37. Sambasivan, C., Schreiber, M.: Emerging therapies in traumatic hemorrhage control. Curr. Opin. Crit. Care 15, ­560–568 (2009)

    Article  PubMed  Google Scholar 

  38. Stewart, R., et al.: Transparent and open discussion of errors does not increase malpractice risk in trauma patients. Ann. Surg. 243(5), 645–651 (2006)

    Article  PubMed  Google Scholar 

  39. Tien, H., Jung, V., Rizoli, S., Acharya, S., MacDonald, J.: An evaluation of tactical combat casualty care intervention in a combat environment. J. Am. Coll. Surg. 207(2), ­174–178 (2008)

    Article  PubMed  Google Scholar 

  40. White, C., Simmons, J., Holcomb, J., Adeylotte, J., Eastridge, B., Blackbourne, L.: Impact of extremity amputation on combat wounded undergoing exploratory laparotomy. J. Trauma Inj. Infect. Crit. Care 66(Suppl), S86–S92 (2009)

    Article  Google Scholar 

  41. Triage. In: Emergency War Surgery, pp. 3.1–3.17 (ed. Burris, D. et al. 3.1–3.17), Borden Institute, Washington, DC (2003)

    Google Scholar 

  42. Mitchell, G.: A brief history of triage. Disaster Med. Public Health Prep. 2(1), S4–S7 (2008)

    Article  PubMed  Google Scholar 

  43. Antietam on the Web. Edited, 2010

    Google Scholar 

  44. Act of Congress – No. 22: An act to establish a uniform set of ambulances in the armies of the United States. 11 March 1864. Edited by War, 1864

    Google Scholar 

  45. Blagg, C.: Triage: Napoleon to the present day. J. Nephrol. 174(4), 629–632 (2004)

    Google Scholar 

  46. Driscoll, R.: U.S. Army Medical Helicopters in the Korean War. Mil. Med. 166(4), 290–296 (2001)

    PubMed  CAS  Google Scholar 

  47. Letterman, J.: The war of the rebellion: a compilation of the official records of the union and confederate armies. In: Official Report, US War Department, 1, pp. 106–117. Edited by Department, U. W., 106–117, 1880 to 1901

    Google Scholar 

  48. Sasser, S., et al.: Guidelines for field triage of injured patients. Recommendations of the National Expert Panel on Field Triage. Morb. Mortal. Wkly Rep. Recomm. Rep. 58(RR-1), 1–35 (2009)

    Google Scholar 

  49. Bradley, A.: Extreme conditions triage. Penn Bioeth. J. 4(2), 27–30 (2008)

    Google Scholar 

  50. Moskop, J., Iserson, K.: Triage in medicine, Part II: Underlying values and principles. Ann. Emerg. Med. 49(3), 282–287 (2007)

    Article  PubMed  Google Scholar 

  51. Jenkins, J., McCarthy, M.L., Sauer, L.M., Green, G.B., Stuart, S., Thomas, T.L., Hsu, E.B.: Mass-casualty triage: time for an evidence-based approach. Prehosp. Disaster Med. 23(1), 3–8 (2008)

    PubMed  Google Scholar 

  52. Iserson, K., Moskop, J.: Triage in medicine, Part I: Concept, history, and types. Ann. Emerg. Med. 49(3), 275–281 (2007)

    Article  PubMed  Google Scholar 

  53. Holcomb, J.B., et al.: Causes of death in U.S. Special Operations Forces in the global war on terrorism: 2001–2004. Ann. Surg. 245(6), 986–991 (2007)

    Article  PubMed  Google Scholar 

  54. Kelly, J.F., et al.: Injury severity and causes of death from Operation Iraqi Freedom and Operation Enduring Freedom: 2003–2004 versus 2006. J. Trauma 64(2 Suppl), S21–S26 (2008). discussion S26–7

    Article  PubMed  Google Scholar 

  55. American College of Surgeons, C. o. T.: Advanced Trauma Life Support For Doctors: Student Course Manual, 7th edn. Edited, Chicago, IL, American College of Surgeons (2004)

    Google Scholar 

  56. Teasdale, G., Jennett, B.: Assessment of coma and impaired consciousness. A practical scale. Lancet 2(7872), 81–84 (1974)

    Article  PubMed  CAS  Google Scholar 

  57. Fox, C.J., Gillespie, D.L., Cox, E.D., Kragh Jr., J.F., Mehta, S.G., Salinas, J., Holcomb, J.B.: Damage control resuscitation for vascular surgery in a combat support hospital. J. Trauma 65(1), 1–9 (2008)

    Article  PubMed  Google Scholar 

  58. Porter, J.M., Ivatury, R.R.: In search of the optimal end points of resuscitation in trauma patients: a review. J. Trauma 44(5), 908–914 (1998)

    Article  PubMed  CAS  Google Scholar 

  59. Roberts, C.S., Pape, H.C., Jones, A.L., Malkani, A.L., Rodriguez, J.L., Giannoudis, P.V.: Damage control orthopaedics: evolving concepts in the treatment of patients who have sustained orthopaedic trauma. Instr. Course Lect. 54, 447–462 (2005)

    PubMed  Google Scholar 

  60. Bottlang, M., Krieg, J.C., Mohr, M., Simpson, T.S., Madey, S.M.: Emergent management of pelvic ring fractures with use of circumferential compression. J. Bone Joint Surg. Am. 84(A Suppl 2), 43–47 (2002)

    PubMed  Google Scholar 

  61. Bottlang, M., Simpson, T., Sigg, J., Krieg, J.C., Madey, S.M., Long, W.B.: Noninvasive reduction of open-book pelvic fractures by circumferential compression. J. Orthop. Trauma 16(6), 367–373 (2002)

    Article  PubMed  Google Scholar 

  62. Krieg, J.C., Mohr, M., Ellis, T.J., Simpson, T.S., Madey, S.M., Bottlang, M.: Emergent stabilization of pelvic ring injuries by controlled circumferential compression: a clinical trial. J. Trauma 59(3), 659–664 (2005)

    PubMed  Google Scholar 

  63. Shafi, S., Kauder, D.R.: Fluid resuscitation and blood replacement in patients with polytrauma. Clin. Orthop. Relat. Res. 422, 37–42 (2004)

    Article  PubMed  Google Scholar 

  64. Hadley, M.: Management of acute spinal cord injuries in an intensive care unit or other monitored setting. Neurosurgery 50(3 Suppl), S51–S57 (2002)

    Google Scholar 

  65. Vaccaro, A.R., An, H.S., Betz, R.R., Cotler, J.M., Balderston, R.A.: The management of acute spinal trauma: prehospital and in-hospital emergency care. Instr. Course Lect. 46, 113–125 (1997)

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to James R. Ficke .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Berlin Heidelberg

About this chapter

Cite this chapter

Ficke, J.R., Johnson, A.E., Hsu, J.R. (2011). Organization of Urgent Medical Aid, Including Mass Casualty and Triage. In: Lerner, A., Soudry, M. (eds) Armed Conflict Injuries to the Extremities. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-16155-1_1

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-16155-1_1

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-16154-4

  • Online ISBN: 978-3-642-16155-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics