Procedure in the event of a mass casualty incident

Both the people on site and the regional emergency services quickly reach the limits of their capacity in the event of a mass casualty incident. Due to the number of injured people and the external circumstances, chaos often reigns at first. The most important measure is therefore to create order. Only then can all patients be treated efficiently. In the event of an MANV, the senior emergency physician takes over the medical management and coordination of the operation.

All patients are collected at a patient drop-off point. Ideally, this point should be outside the danger zone. Only then can patients be treated and cared for safely. If patients are contaminated, it is necessary to decontaminate them first. This is the only way to prevent further spread.

If there are not enough means of transport available to distribute patients to neighbouring hospitals, treatment takes place on site at a separate treatment station.

What should you do in a MANV scenario?

Unfortunately, this question is becoming increasingly important in view of the ongoing risk situation. Once the alarm has been raised, it is important that the people helping at the scene remain calm and try to gain an overview. The patients should then be seen and the scene of the accident explored.

Conventional dressings do not usually help with severe bleeding. Haemostyptic dressings or tourniquet systems are usually used here. Emergency bandages can also be used for direct wound care. In order to carry out the most necessary measures in an emergency, we have put together an appropriate trauma kit with experienced paramedics. The WERO trauma kits are handed out to the assisting persons in the event of a MANV. This means that wounds that are bleeding heavily can be treated quickly and optimally.

The stages of a MANV

Before the patients are actually treated, they are first counted and categorised. The procedure goes back to military medicine. The aim here is to prioritise the scarce rescue forces. The focus is initially placed on patients with a high chance of survival.

In an MANV, patients are numbered with a felt-tip pen and categorised into one of four categories. This categorisation is called "triage" and is based on the urgency of care or treatment. Marking is usually done using coloured injury tag cards.

A distinction is made between the categories blue (no chance of survival), red (acute, immediate treatment), yellow (seriously injured, postponed urgency) and green (slightly injured, later treatment).

The STaRT scheme for a mass casualty incident

The STaRT scheme is used for categorisation and triage. The abbreviation stands for Simple Triage and Rapid Treatment. The STaRT scheme is carried out by medical staff and takes approx. 60 seconds per patient.

• At the beginning, all able-bodied patients are asked to go to the assembly point. There they are automatically categorised in SC 3 and are therefore only slightly injured.
• If respiratory arrest persists, even after the airway has been cleared, patients are categorised as dead.
• Patients with a respiratory rate of over 30/min or a recapillarisation time of over 2 seconds are assigned to SC 1.
• In the event of unconsciousness or an inadequate response to a response, patients are assigned to SC 1.
• All other patients belong to SC 2.
• Assignment to SC 4 only takes place if resources are extremely limited.

The importance of MANV for companies and public institutions

Good preparation and regular training are the be-all and end-all. All employees, guests and visitors should know how to behave in the event of a MANV emergency. Preparations can be made by having specially designed trauma kits ready. This enables a quick response in an emergency and first aiders always have the most important materials for rapid first aid to hand.