Medical Care - Hospital Care

Initial notification

The first 15-30 minutes of planning and activities after a mass casualty disaster can be chaotic and daunting.  Various plans and protocols address the need for organization of thoughts and actions to prepare for the influx of mass casualties. The Hospital Incident Command System (HICS) is designed for the roles, actions and has job action sheets to assist in the organization and lines of supervision and communication of these incidents. The following mnemonic "" has been developed by Dr. Tom Blackwell (Medical Director of Charlotte-Mecklenberg EMS of Charlotte, North Carolina) to assist in planning and to address questions and concerns to be addressed on the initial radio/dispatch notification.

First 3 "w's" deal with the incident, the "md" medical needs and the "com" refers to the Emergency Department status.

Initial immediate questions, concerns and needs are:

  • "What" happened at the scene? (i.e. explosion, agent release etc.)
  • "When" did this happen? (Immediately vs. hours ago)
  • "Where" did this happen? (Public or populated area, residential vs. commercial for casualty estimation)
  • "Medical" What are the major medical injuries/illnesses of the victims? (E.g. multiple traumas, respiratory compromise, ambulatory status)
  • "Decontamination" Is decontamination required (Initially done on scene or required at hospital?)
  • "Casualties” Estimate of number of casualties involved, with or without priorities. (Other countries that have experience with bomb incidents utilize an estimate system of a dozen, dozens or hundreds)
  • "Other” Consideration to be given of the current patients in the Emergency Department and their care disposition (i.e. Emergent admission, moved to a different area of the hospital or rapidly discharge from the department)
  • "Mutual Aid” Is mutual aid assistance or resources needed? (Additional staff, patient transporters, specialized assistance (i.e. radiation safety officer).
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