Mass Casualty Incident: Definitions and Current Reality

  • Laura Lomaglio
  • Luca Ansaloni
  • Fausto Catena
  • Massimo Sartelli
  • Federico Coccolini
Part of the Hot Topics in Acute Care Surgery and Trauma book series (HTACST)


A Mass Casualty Incident (MCI) is an overwhelming event, which generates more patients at a time than locally available resources can manage using routine procedures. It requires exceptional emergency arrangements and additional or extraordinary assistance. MCIs can occur as a consequence of a wide variety of events: disasters (both natural and man-made), terrorist attacks, motor vehicle collisions, etc. Whatever the causing event is, the characterizing feature of an MCI is the number of victims large enough to disrupt the normal functioning of health care services. MCIs can be classified into different levels, according to either the number of potential victims or the entity of the response—in terms of resources—required to face them. This classification is a useful tool when redacting an MCI management plan. In fact, preparedness is the key to success in these situations; it implies consciousness that risk and vulnerability exist, and awareness by both government and local community of the benefit to plan and to have appropriate legislation. An optimal MCI/disaster management plan should consider all four phases of the so-called disaster cycle: mitigation, planning, response, and recovery.


Mass casualty incident MCI management plan Disasters Disaster cycle Incident command system 


  1. 1.
    World Health Organization. Mass casualty management systems. Strategies and guidelines for building health sector capacity. Geneva: The Organization; 2007.Google Scholar
  2. 2.
    Directorate General of Health Services, Government of the People’s Republic of Bangladesh. A guide book on mass casualty management. Aalpoth Media; 2010.Google Scholar
  3. 3.
    Furin MA. Disaster planning. Medscape. 2016. Updated 10 May 2016.
  4. 4.
    Guha-Sapir D, Hoyois P, Below R. Annual disaster statistical review 2015: the numbers and trends. Brussels: CRED; 2016.Google Scholar
  5. 5.
    Doocy S, Daniels A, Dooling S, Gorokhovich Y. The human impact of volcanoes: a historical review of events 1900-2009 and systematic literature review. PLoS Curr. 2013.
  6. 6.
    Doocy S, Dick A, Daniels A, Kirsch TD. The human impact of tropical cyclones: a historical review of events 1980-2009 and systematic literature review. PLoS Curr. 2013.
  7. 7.
    Schultz CH, Koenig KL, Noji EK. A medical disaster response to reduce immediate mortality after an earthquake. N Engl J Med. 1996;334(7):43844.CrossRefGoogle Scholar
  8. 8.
    Ramesh AC, Kumar S. Triage, monitoring, and treatment of mass casualty events involving chemical, biological, radiological, or nuclear agents. J Pharm Bioallied Sci. 2010;2(3):239–47.CrossRefGoogle Scholar
  9. 9.
    Massachusetts Department of Public Health. The Massachusetts Emergency Medical Services (EMS) Mass Casualty Incident (MCI) Plan. 2016.Google Scholar
  10. 10.
    CDC. Deaths in world trade center terrorist attacks New York City, 2001. Morb Mortal Wkly Rep. 2002;51(Special Issue):1618.Google Scholar
  11. 11.
    Institute for Economics and Peace. Global terrorism index 2017: measuring and understanding the impact of terrorism. Sydney: Institute for Economics and Peace; 2017.Google Scholar
  12. 12.
    Ben-Ishay O, et al. Mass casualty incidents—time to engage. World J Emerg Surg. 2016;11:8.CrossRefGoogle Scholar
  13. 13.
    Goodwin J. NAEMT National Survey on EMS preparedness for disaster and mass casualty incident response. 2017. Accessed X.
  14. 14.
    Benson M, Koenig KL, Schultz CH. Disaster triage: START, then SAVE—a new method of dynamic triage for victims of a catastrophic earthquake. Prehosp Disaster Med. 1996;11(2):11724.Google Scholar
  15. 15.
    Garner A, Lee A, Harrison K, Schultz CH. Comparative analysis of multiple casualty incident triage algorithms. Ann Emerg Med. 2001;38(5):5418.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Laura Lomaglio
    • 1
  • Luca Ansaloni
    • 2
  • Fausto Catena
    • 3
  • Massimo Sartelli
    • 4
  • Federico Coccolini
    • 2
  1. 1.General Surgery Residency ProgramUniversity of MilanMilanItaly
  2. 2.Unit of General and Emergency SurgeryBufalini Hospital, AUSL RomagnaCesenaItaly
  3. 3.Emergency Surgery DepartmentParma University HospitalParmaUSA
  4. 4.General SurgeryMacerata HospitalMacerataItaly

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