Biomedical Engineering Reference
In-Depth Information
Chapter G.2 Health and Medical
Care Delivery in a Mass-Casualty
Event
Health and Medical Care Standards in
the Context of a Mass-Casualty Event
Substantial work has already been done and
continues to be undertaken throughout the country
to improve the ability of health systems to respond
to acts of terrorism or other public health emergen-
cies. Much of the planning in this area focuses on
increasing the surge capacity of affected delivery
systems through the rapid mobilization and deploy-
ment of additional resources from the community,
State, regional, or national levels to the affected
area. However, few of these plans specifically
address a situation in which the delivery system
is unable to respond (even if only temporarily)
according to established standards of care due to
the scope and magnitude of a mass-casualty event.
A key issue upon which the experts agreed is
that the goal of the health and medical response to
a mass-casualty event is to save as many lives as
possible. There is consensus that, to achieve this
goal, health and medical care will have to be deliv-
ered in a manner that differs from the standards
of care that apply under normal circumstances.
This issue is not addressed in a comprehensive
manner in many preparedness plans.
1
Finally, the
experts also agreed that for health and medical
care delivered under these altered standards to be
as effective as possible in saving lives, it is crit-
ically important that current preparedness plan-
ning be expanded to explicitly address this issue
and to provide guidance, education, and training
concerning these altered care standards.
Standards of health and medical care, broadly
defined, address not only what care is given, but to
whom, when, by whom, and under what circum-
stances or in what places. A comprehensive set of
standards for health and medical care specifies the
following:
What
—what types of interventions, clinical proto-
cols, standing orders, and other specifica-
tions should be used in providing health and
medical care?
To whom
—which individuals should receive
health and medical care according to their condi-
tion or likelihood of response?
When
—with what urgency should health and
medical care be provided?
By whom
—which individuals are certified and/or
licensed to provide care within a defined scope
of practice and other regulations?
Where
—what facility and system standards (pre-
hospital, hospital, alternate care site, etc.) should
be in place for the provision of health and
medical care?
Under normal conditions, current standards of
care might be interpreted as calling for the alloca-
tion of all appropriate health and medical resources
to improve the health status and/or save the
life of each individual patient. However, should
a mass-casualty event occur, the demand for
care provided in accordance with current stan-
dards would exceed system resources. In a small
1
In preparation for the expert meeting, information and a sample of existing triage protocols and preparedness models were collected
and reviewed. A brief summary of that review is provided in Appendix G.II.
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