Trauma centers: Prepare for mass casualty incidents by understanding the 10 predictable stages of disruption

BY CONNIE J. POTTER RN MBA-HCA ON JULY 22, 2016 
​PROGRAM MANAGEMENT for Trauma System News

Mass casualty incidents (MCIs) seem to strike at random. That is one reason why these incidents — particularly mass shootings — are so frightening. But while the timing and location of most MCIs are unpredictable, the way these events play out at a trauma center is not.

Mass casualty incidents (MCIs) seem to strike at random. That is one reason why these incidents — particularly mass shootings — are so frightening. But while the timing and location of most MCIs are unpredictable, the way these events play out at a trauma center is not.

Longstanding research shows that no MCI is truly unique — whether it is a natural disaster such as an earthquake, hurricane, flood or tornado, or the result of human violence. At the receiving hospital, an MCI triggers a sequence of disruptions that follow a predictable pattern.

Not every disruption occurs in every event, but all of them are possible. And the larger the MCI, the more likely it is that the trauma center will experience every one of these problems:

1. Communication breakdown creates confusion at trauma center
2. Minimally injured arrive in first wave of patients
3. “Convergers” descend on hospital
4. Medical volunteers begin to appear
5. Demand surges for supplies and equipment
6. Demand surges for rooms and beds
7. Recordkeeping systems become overloaded
8. The need for compassionate care increases
9. Caregiver needs return to the forefront
10. The trauma center becomes the victim

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