Module 7

MASS CASUALTY MANAGEMENT

SURGE CAPACITY

EIGHTH INTER-REGIONAL TRAINING COURSE ON

PUBLIC HEALTH AND EMERGENCY MANAGEMENT IN ASIA AND THE PACIFIC

PHEMAP 8
 Learning Objectives

By the end of this module, the participant should be

able to:

• Identify the components of mass casualty

management and the potential contribution of
each key component
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• Discuss the surge capacity for mass casualty

management and the contribution of the health
sector

• Discuss role of the health emergency manager in

emergency response planning

PHEMAP 8 | MODULE 7. MASS CASUALTY MANAGEMENT

 Health Sector - Management of Services in MCI

• Casualty management (first aid, triage, transport,

pre-hospital care, in-patient care, out-patient care)
• Communicable disease control (surveillance,
tracking, treatment, prophylaxis, isolation and
quarantine) and other PH critical services
• Management of the dead and missing (contribution)
3
• Management of information (public information;
support activities; health info system)
• Mental health
• Environmental health

What do you want to add ?

PHEMAP 8 | MODULE 7. MASS CASUALTY MANAGEMENT 3

 4

PHEMAP 8 | MODULE 7. MASS CASUALTY MANAGEMENT

 What is Medical Surge Capacity

The ability to provide adequate medical evaluation and

care during events that exceed the limits of the normal
medical infrastructure of an affected community

Medical surge capacity

• Evaluate and care for increased volume of 5
patients
• Extend beyond direct patient care

Medical surge capability

• The ability to manage patients requiring unusual or
very specialized / medical evaluation and care

PHEMAP 8 | MODULE 7. MASS CASUALTY MANAGEMENT

 What Is Surge Capacity and Capability System ?

• Strategy to promote integration of existing

programs into an overarching management
system
• Strategy to define basic requirements for health
assets participation
• A management system – functional relationships –
systematic approach to organize and coordinate
available health and medical resources 6

• Mechanism for coordinating relationship between

Hospitals and other services providers and the
government response
• Adoption of Emergency Planning Process
principles and information management
( incorporating IMS)
• Provision of platform for effective training

PHEMAP 8 | MODULE 7. MASS CASUALTY MANAGEMENT

 A complex partnership……

PHEMAP 8 | MODULE 7. MASS CASUALTY MANAGEMENT

 Tiered approach and scalability of the response

• Tier 1 Individual Hospitals and other institutions

• Tier 2 Networks of the stakeholders of Tier 1

• Tier 3 Local level and Provincial level

• ICP ; EOC
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• Tier 4 National level

• ECC (National EOC when a “national contingency
plan is activated”)

PHEMAP 8 | MODULE 7. MASS CASUALTY MANAGEMENT

 Why to Discuss Surge Capacity?

• Management responsibilities in disasters

• Medical care
• Responder safety
• Information management
• Coordination diverse operating systems 9

• Resolving intergovernmental issues

• Medical assets support
• Addressing time constraints
• Incorporating health and medical assets into public
safety response

PHEMAP 8 | MODULE 7. MASS CASUALTY MANAGEMENT

 National Policy on Medical Surge Capacity

• Assist Hospitals, other acute-care medical assets,

emergency response services (EMS)
 Establishing & integrating management
systems
• Provide concrete operational direction – guidance
• Integrate the principles of IMS 10

• Promote coordination between medical and other

emergency services
• Delineate information management system
• Management system connected to M, P, R, R +
training efforts
• Promote consistency with the national IMS

PHEMAP 8 | MODULE 7. MASS CASUALTY MANAGEMENT

 Case study

• National policy of a MOH for MCM (Cambodia)

• Discuss the strategies and especially the strategy
on “surge capacity”
• Each group has a “Tier” to discuss (15 minutes)
 Strengths?
 Weaknesses? 11

 What could be relevant for your country?

• Prepare a short report back
• Plenary session and discussion

PHEMAP 8 | MODULE 7. MASS CASUALTY MANAGEMENT

 Urban Search and Rescue Teams

Integrated multi-agency response, which is beyond the

capability of normal rescue arrangements to locate,
provide initial medical care and remove entrapped
persons from damaged structures and other
environments in a safe and expeditious manner.

USAR is a specialized technical rescue capability for the

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location and rescue of entrapped people following a

structural collapse : search component; rescue
component; medical component; technical component.

PHEMAP 8 | MODULE 7. MASS CASUALTY MANAGEMENT

 Field Hospitals and mobile hubs

A mobile, self contained, self-sufficient health care

facility capable of rapid deployment and expansion or
contraction to meet immediate emergency requirements
for a specified period of time (WHO)

Use of “local” Field Hospitals or mobile “hubs”

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Possible use of FFH

• Essential requirements
• Optional criteria

PHEMAP 8 | MODULE 7. MASS CASUALTY MANAGEMENT

 Possible flow chart for training activities

HEALTH SECTOR (not limited to MOH)

Heath Care Delivery in MCIs
Generic introductory training courses

Pre-hospital activities and

Hospitals Public Health in MCIs
EMS in MCIs

Inter-sectoral training
Implementation workshop and workshops Training courses (box 1)
(box 1) Targeted training (box 1)

Development of the Development Management of the dead and missing 14

Emergency Response of pre-hospital capacity Psychosocial support activities
Plan Progressive implementation Public Health for IDPs, others
of the EMS System

Validation Validation Validation

Training Training Training
Monitoring Monitoring Monitoring
Revision Revision Revision

Synergy; complementarities; linkage as much as possible of the training activities; promote integration
strategy intra-sectoral and inter-sectoral (Health Sector can contribute to some training programs developed
by other sectors: community awareness and education; training of First Responders; First-Aid, BLS, etc

PHEMAP 8 | MODULE 7. MASS CASUALTY MANAGEMENT

 Medical Surge Capacity - STRATEGY

National capacity versus local capacity ?

• What do we need; how; what resources; what coordination

mechanisms…?
• Centralized versus decentralization (Response plans /
systems)
• Transfer of patients versus transfer of staff?
 Advantages and constraints 15

 Resources and systems needed

• Development of on-site capacity versus hospital capacity -
Disaster Management Teams / Trauma Teams; EMS ?
 Complementarities; synergy; coordination
• Use of existing resources: integration strategy ?
 How to develop; coordination; what training?
• The components of MCM : who, what, how……

PHEMAP 8 | MODULE 7. MASS CASUALTY MANAGEMENT

 Group Work

Using the conceptual framework and the notes:

What could be the advantages and the challenges of

discussing surge capacity in your country ?

What could be the training programs that would be 16

necessary to promote the concept or to make it

workable?

What can you do to contribute to the surge capacity in

MCM in your country (contribution of the Health
Sector)?

PHEMAP 8 | MODULE 7. MASS CASUALTY MANAGEMENT

 Questions and Answers

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What ……?

PHEMAP 8 | MODULE 7. MASS CASUALTY MANAGEMENT

 Thank You!
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PHEMAP 8 | MODULE 7. MASS CASUALTY MANAGEMENT