Managing mass-casualty incidents

As first responders, emergency medical services (EMS) play a key role in the management of mass-casualty incidents, being responsible for the triage, treatment, and transportation of patients to emergency care. Sadly 2015 has been littered with reports in the media of incidents involving large numbers of casualties. For example, the US alone has seen 353 mass shootings this year, the most recent on 2 December at the Inland Regional Center in San Bernardino, California, where 14 people were killed and 17 injured (Mass Shootings Tracker, 2015). Additionally, November will be remembered for the worst attack on France since World War II and the deadliest in the European Union since the Madrid train bombings in 2004. On Friday 13 November, multi-site terrorist shootings in Paris left 130 people killed and over 300 in intensive care. A state of emergency was declared by President François Hollande, and temporary border checks introduced.

Beyond mass shootings, the extent of natural disasters will be most remembered by the 7.8-magnitude earthquake that hit Nepal’s capital Kathmandu and its surrounding areas on 25 April. Here thousands of people lost their lives with many more thousands left injured and homeless.

While the difference between the types of mass-casualty incidents and number of casualties attended by EMS can vary considerably, their fundamental role remains the same. Key to the effective management of these situations is leadership, teamwork and professionalism. Although the outcome of the attacks in Paris left the country devastated, it is worth highlighting the proficiency at which the EMS organised an effective medical response to the attacks, which ensured that many lives could be saved. Triage and pre-hospital care for victims of the attacks was organised by the emergency medical services (service d’aide médical d’urgence, SAMU). SAMU were mobilised immediately following discovery of the attacks, and the crisis cell at the Assistance Publique-Hôpitaux de Paris (APHP) was opened. The APHP crisis unit has the ability to coordinate 40 hospitals with a total of 100 000 health professionals, a capacity of 22 000 beds and 200 operating rooms (Hirsche et al, 2015). Remarkably, it was reported that there were only four deaths (1%) among the 302 injured patients, including two deaths on arrival at hospital (Hirsch et al, 2015).

What is clear from reading about the medical response to these attacks is that professionalism and preparedness lay at the heart of the successful patient outcomes. It is also worth noting that many lessons can be learned from the subsequent scientific publications following mass-casualty incidents, and the role they play in the improvement of medical strategies. Additionally, the importance of effective and unified EMS in mass-casualty situations cannot be underestimated. While the challenge for EMS in managing scenarios involving multiple casualties will remain, through teamwork, adequate training and effective leadership, we can ensure the maximum number of lives can be saved.


Hirsch M, Carli P, Nizard R et al (2015) The medical response to multisite terrorist attacks in Paris. Lancet. Published online first. doi: 10.1016/S0140-6736(15)01063-6

Mass Shooting Tracker (2015) Mass shootings in 2015. (accessed 16 December 2015)

Taken from International Paramedic Practice, published 22 December 2015.

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