A mass casualty incident is any event where the number of patients overwhelms available resources, so care shifts to doing the most good for the most people. Triage systems such as START and SALT sort patients quickly by priority using simple checks.
Key symptoms
- Many injured people at one scene
- Walking wounded who can follow commands
- Patients with breathing, bleeding or perfusion problems
- Patients who do not breathe after the airway is opened
- Stress and confusion among bystanders and responders
What you find on exam
- Scene size-up, safety and a call for more resources
- Patients who can walk: green (minor)
- Breathing over 30 per minute, capillary refill over 2 seconds or no radial pulse: red (immediate)
- Unable to follow simple commands: red
- Not breathing after the airway is opened: black (expectant or dead)
Tests
- A triage tag or ribbon for every patient
- Repeat triage as conditions change
- SALT: global sorting, lifesaving interventions, then assessment
- Patient tracking and counts for incident command
Treatment basics
- Set up incident command and treatment areas
- Only quick lifesaving actions during triage: open the airway, tourniquet, antidote auto-injector
- Transport red first, then yellow, then green
- Retriage in the treatment area
- Coordinate with hospitals to spread the patient load
Red flags
- Unsafe scene: secondary devices or hazardous materials
- Uncontrolled bleeding
- Undertriage of patients who look stable but are deteriorating
Practice it in Making Synapses
Making Synapses cases
Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; NREMT psychomotor skill sheets (EMT and Paramedic); National EMS Education Standards (2021). Written by Making Synapses. Making Synapses is not affiliated with these organizations.