PEM Playbook – Mass Casualty Incident (MCI)

Originally published at Pediatric Emergency Playbook on June 1, 2019 – Visit to listen to accompanying podcast. Reposted with permission.

Follow Dr. Tim Horeczko on twitter @EMTogether

No one ever wants to find himself in this situation. A factory explodes. A building catches fire. A multi-vehicle traffic collision. Or an act of terrorism.

Very quickly, we have to scrap business as usual. We have to adapt to our new circumstances.

Definition of a mass casualty incident (MCI):

An incident which produces multiple casualties such that emergency services, medical personnel and referral systems within the normal catchment area cannot provide adequate and timely response and care without unacceptable mortality and/or morbidity.

In other words, our demand far outpaces our resources.

If you can hear the sound of my voice, follow me“. Those patients are GREEN, minor.

Otherwise, we need a system to distinguish those who can be DELAYEDIMMEDIATE, or EXPECTANT (soon to be deceased).

Use Simple Triage and Rapid Treatment (START) for 8 or older, JumpSTART for less than 8 years of age.

An MCI drill

For Older Children, Adolescents, and Adults (8 or greater) — START:

For Children less than 8 years of age (Infants Use Pediatric Assessment Triangle) — JumpSTART:

Selected References

Briggs SM. Disaster management teams. Curr Opin Crit Care. 2005 Dec;11(6):585-9.

Culley JM, Svendsen E. A review of the literature on the validity of mass casualty triage systems with a focus on chemical exposures. American journal of disaster medicine. 2014; 9(2):137-150.

FEMA IS 0100.b – Introduction to the Incident Command System (ICS), Student Manual. Accessed 03 MAY 2019.

Jensen J, Youngs G. Explaining implementation behaviour of the National Incident Management System (NIMS). Disasters. 2015 Apr;39(2):362-88. doi: 10.1111/disa.12103.

Lee JS, Franc JM. Impact of a Two-step Emergency Department Triage Model with START, then CTAS, on Patient Flow During a Simulated Mass-casualty Incident. Prehosp Disaster Med. 2015 Jun 24:1-7.

Lerner EB, Schwartz RB, Coule PL, et al. “Mass Casualty Triage: An Evaluation of the Data and Development of a Proposed National Guideline.” Disaster Medicine and Public Health Preparedness 2(Suppl. 1) 2008, pp S25-S34.

Check out this beautiful piece highlighting this very post by our very own Kathy Hanson from Hanson’s Anatomy:



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