Conference Coverage

STS: Planning for mass casualties builds on routine trauma care




PHOENIX – Surgeons are the logical choice for taking the lead in formulating a hospital plan for dealing with mass casualties, and when doing so they should use their usual trauma-management practices as the cornerstone, Dr. Kenneth L. Mattox recommended at the annual meeting of the Society of Thoracic Surgeons.

“The disaster plan is built on the trauma plan, and surgeons are at the heart of it,” said Dr. Mattox, chief of staff and surgeon in chief at Ben Taub Hospital in Houston, during a session on disaster preparedness and mass casualties. “When it’s not built on the trauma plan, it can be a nightmare,” he warned.

Dr. Kenneth L. Mattox

Dr. Kenneth L. Mattox

“Disasters are local. One size [of disaster response] does not fit all. A hurricane in Miami is not like an earthquake in San Francisco or a shooter in Colorado,” which is why each hospital and community needs to devise its own, localized plan. “Surgeons know their community’s organization,” and the vast majority of mass casualty events result in no more patients and are not more daunting than a busy Friday night of injuries at urban trauma centers, Dr. Mattox said. It’s also critical that a hospital leader be in charge at the center and recognize that the hospital’s resources will need to suffice to meet a mass-casualty challenge.

“The ‘cavalry’ will not come over the hill, and even if the cavalry were to arrive, they won’t be credentialed in your state, they won’t know how to deal with your crisis, and they won’t know your local resources. You are the boss.”

Dr. Mattox recommended that interested surgeons get involved with their community’s disaster plan and set up their mass-casualty protocols in advance, but he warned against trying to come up with anything special. “Treat it like you do the Friday night crisis,” he suggested. “Use your routine triage criteria, the way you handle trauma patients all the time, and don’t try to do anything special. If you try to do something special, it always comes back to bite you.”

Although the idea of a disaster and mass casualties may sound daunting, Dr. Mattox noted that history has repeatedly supported the 10% rule: Only 10% of the survivors of a mass-casualty event need hospitalization, and of that 10%, it is only another 10% (1% of the starting population) who need attention in the operating room or ICU. That puts a premium on accurate and effective triage, which initially can be handled by nurses or emergency personnel, and then ultimately by surgeons to identify the small number of patients who truly need immediate surgical attention.

Recent world developments have shown that hospitals handling mass casualties must also think about and guard against a new challenge: the terrorist or shooter who targets the hospital itself. As a consequence, mass-casualty drills at hospitals should include practicing steps to better safeguard the surgical wing at a hospital from attack. This could be as simple as shoving door stops under doors to help keep them securely closed, said Dr. Mattox, who is also a distinguished service professor at Baylor College of Medicine in Houston. He recommended that surgical units rehearse their disaster drills often enough to refine their approaches and make them automatic, but not so often as to numb the staff to an actual event.

Dr. Mattox and his colleagues conduct an annual, 1-day course on medical disaster response.

He had no disclosures aside from serving as program director for an annual course on medical disaster response.

On Twitter @mitchelzoler

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