Mass Casualty Surge Protocol

How happy were you to learn about little Sarah Gordon? I can't talk about the rest of the 200 passengers on the 757 because it makes me incredibly sad, so I focus on Sarah Gordon. Sarah Gordon, the unaccompanied minor, the one survivor. The hope in this terrible tragedy that comes to Seattle Grace. By the way, have you ever researched plane crashes with one sole survivor? (A word of warning: Don't research it, because it's very depressing). In May 2010, a young Dutch boy was the only survivor of a plane crash in Libya. According to Airsafe.com Foundation, that was the fifteenth time since 1970 that there has been one survivor of a plane crash. And out of those fifteen survivors? Twelve have been either kids or crew members.

Weird... And depressing, right?

Especially since the events of 9/11, most large hospitals and healthcare providers maintain a safety protocol in preparation for a potential mass casualty disaster.

These plans exist to serve as a guideline for hospitals to efficiently respond to a medical crisis that possibly involves massive numbers of injured persons. In order to remain familiar with the procedures, hospitals should run scheduled drills that all staff must attend. Disasters can produce surges of patients within minutes, so hospitals must be prepared at all times to handle the influx, regardless of the type of event. The procedures should work for a wide variety of events and subsequent injuries from:

- Natural disaster and severe weather events.
- Radiation emergency.
- Terrorist bombing.
- Chemical emergency.
- Bioterrorism.
- Isolated events (Explosions, structure collapses, mass transportation accidents).

Each hospital center creates their own protocol, based on their community's needs, but common features are seen in each program.

The CDC recommends having resources to hold and treat up to 300 injured patients for twelve to twenty-four hours because outside assistance can be delayed up to seventy-two hours. How do hospitals mobilize?

- Set up a hospital command center.
- Determine if facility should be locked down or given limited access.
- Communicate status and resource needs to local EMS.
- Accelerate discharges (Except in the OB department).
- Transfer patients if needed to smaller hospitals.
- Cancel elective, routine, or non-essential surgery.
- Call in additional staff.
- Install additional beds within facility.
- Pull extra supplies and extend Pharmacy hours.
- Check the blood bank.
- Ensure all hallways and traffic areas are clear of carts, gurneys, supplies.
- Call local clergy as requested.

Hospitals will also typically designate a location to become the Visitor Control Center for victims' families to gather together. It could be in the cafeteria or lobby, but hospital staff members (usually Social Services) will be present in order to collect a list of names for each possible patient and attempt to answer questions as best as they can. Normal visiting hours will obviously be suspended during a crisis.

Depending on available space, hospitals also assign a location for public communication to the press.

Based on the severity of the incident or event, the hospital may have different levels of Surge Protocol.

For example, Kern County of California runs four different surge levels – Surge 3 and Surge 4 being the most complex. The usual procedures (as listed above) will be put into place as well as a few others to accommodate even more victims:

- Establish an external perimeter for security control.
- Set up external areas (For triage, discharge, registration, holding, and treatment).
- Mobilize an external morgue if appropriate.
- Plan for all necessary patient transport in and out of the county.

For more information on Hospitals and Mass Casualty Events, please visit:

http://www.bt.cdc.gov/masscasualties/injuriespro.asp