Mass Casualty Incidents
A mass casualty incident (MCI) is defined as an event in which the need for emergency care exceeds the available medical resources, including personnel and equipment. With the rise of global and domestic terrorism, MCIs have unfortunately become more commonplace. Unless physicians have had prior experience treating battlefield injuries, they have undergone little training in the management of wounds arising from an MCI. An understanding of the mechanisms of injury, appropriate triage, and primary goals of initial surgery is needed to properly treat an MCI. These incidents often involve high-velocity weapons (eg, improvised explosive devices and assault rifles) that cause a pattern of injury different from the wounds resulting from low-velocity weapons that a trauma center would typically see. In addition, hospitals are seldom prepared for the large number of injured patients seeking treatment after an MCI occurs.
Lessons learned from physicians who have worked in combat zones have greatly improved the understanding of these types of injuries and enabled the application of these management principles in the civilian sector. On the battlefield, medics triage injured soldiers into 4 categories of urgency. The injured are stabilized accordingly and prepared for urgent medical evacuation to a combat-support hospital, where a team of specialists evaluate and surgically stabilize them. Once patients are hemodynamically stable, ophthalmic evaluation and primary surgical repair can be performed within hours of the injury. In the combat operations Iraqi Freedom and Enduring Freedom, ocular injuries were the fourth most common injury observed. Of the soldiers sustaining ocular trauma, 85% had other systemic injuries.
In the management of an MCI, similar principles of triage and identification of immediate life-threatening injuries, with a focus on airways, breathing, and circulation, are required. Following the 2013 Boston Marathon bombing, 62% of the casualties were transported to level I trauma centers, and 13.4% of those patients required ophthalmology consultation. These combat-medic principles allow physicians to provide the greatest benefit to the highest number of patients.
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Yonekawa Y, Hacker HD, Lehman RE, et al. Ocular blast injuries in mass-casualty incidents: the marathon bombing in Boston, Massachusetts, and the fertilizer plant explosion in West, Texas. Ophthalmology. 2014;121(9):1670–1676.e1.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.