Biomedical Engineering Reference
In-Depth Information
Chapter G.3 Framework and
Guiding Principles When Planning
for Health and Medical Care in a
Mass Casualty Event
thus requiring increasing alterations in standards.
This staged model approach allows for the devel-
opment of care guidelines for each stage that are
consistent with the overall goal of maximizing the
number of lives saved.
Although Figure G.4 is based on a disease
model, this graded response could be adapted
easily to other types of mass-casualty events (e.g.,
chemical releases or explosions) by compressing
the stages according to the magnitude and velocity
of the event. High magnitude, high velocity events
will require the system to adopt altered standards
more quickly than smaller or slower-developing
events. However, it is also important to recognize
that as the impact of the event wanes and resources
become more available, it may be possible to return
to established standards of care used in normal
situations.
Framework
The expert panel suggested that a framework for
planning should take into account the ways in
which response to a mass-casualty event is both
similar to and different from responses to current
surge capacity issues in health care facilities. The
goal is to devise a framework that is applicable
to both ordinary (“daily routine”) and extraordi-
nary situations. To this end, they recommended
that plans for a medical care response to a mass
casualty event should:
•
Be compatible with or capable of being inte-
grated with day-to-day operations.
•
Be applicable to a broad spectrum of event
types and severities.
•
Be flexible, to permit graded responses based
on changing circumstances.
•
Be tested, to determine where gaps in the frame-
work exist.
Guiding Principles for Developing
Altered Standards of Care to Respond
to a Mass Casualty Event
In addition to offering suggestions for a framework
for the development of plans to respond to a mass
casualty event, the expert panel also articulated
five principles that should steer the development
of such guidelines. Incorporating these five princi-
ples will ensure that standards of care are altered
sufficiently to respond to issues arising from a
mass-casualty event.
A model reflecting the concept of a graded
response that is sensitive to changing circum-
stances was shared with the panel and is depicted in
Figure G.4. This matrix illustrates how the release
of a biological agent resulting in mass casualties
would require that health and medical care stan-
dards be altered over time as the disease progresses
within the population and demands on the health
system grow. The disease progresses from a pre-
release state (upper left) through death, at each
stage placing greater demands on the system, and
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