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Mass Casualty Incidents: Lessons learnt from Israel - Project Mada 2014

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Tan Valerie

on 8 October 2014

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Transcript of Mass Casualty Incidents: Lessons learnt from Israel - Project Mada 2014

Learning from the past, preparing for the future
Capacity Building
Central Control (Government)
Adapted from,
Guy Caspi,
Chief MCI Instructor and Director of HAZ-MAT Exercises and Operational Training Department Operations Division, MDA
Bruria Adini Wiesel PhD,
Ben-Gurion University of the Negev, Israeli Ministry of Health

Command of operations
Coordination & Cooperation

only with proper planning can one build adequate&relevant capacity
Ministry of Health
Joint communication systems
sharing of information & database (
ADAM system)
Appointed point of contact (liaison officer) in MCI
Joint drills/exercises
(capacity building)
Public patient identifier system (
ADAM system)
Information centre: it is a
with all the
patients information
all hospitals
, connected to computerized admitting system in hospitals

Information regarding casualties
admitted to hospitals in MCI are
sent to different hospitals

Patient’s relatives can
call a public number
to find out which hospital their relatives are admitted to

Ensures that communication lines are not overloaded by public enquiry, especially in MCIs

individual EMS/Hospitals reports their AAR to the supreme health authority
Manpower: Professional trainers
Training Tools

National stockpiling of ED equipment (at hospital/regional level)
E.g. Decontamination equipment

Identifying Photo of unidentified casualty
Casualty Number
Transfer of casualty
Annual Evaluation of Preparedness

Objective review of preparedness, based on objective parameters
Central computerized database
Periodic assessment in hospitals and EMS

Hospital preparedness for toxicological events
Education of personal "know how"
Emergency Preparedness
The 5C Model

Causes of MCI

Any incident in which :

medical services & resources
eg. personnel& equipment are
by the
number and severity of casualties
that occurs within a short period of time
Conventional Multi Casualty Incident
Mega MCI (>500 Casualties)
Hazardous Materials/Toxological
Biological events ( infectious diseases, pandemics)
Conflicts (War time)
Natural disasters (earthquakes, droughts, floods)
Lessons learnt
Policies + Doctrines
Supreme Health Authority
Emergency Medicine Divisions
Fire Brigade
search and rescue

Command of
medical operations
on site
Casualty evacuation
Notifying hospitals

Site of Incident
Intra Government
ADAM system
Hospitals Number code

Project Mada

is comprised of 15 students from the
National University of Singapore
. The content presented here is purely our own interpretation. We do not represent any organization.

Mass Casualty Incidents: Lessons learnt from Israel
A presentation by Project Mada
King Edward VII Hall
for their generous sponsorship and support
Singapore Civil Defence Force
for the local paramedic attachment
Vicki Angel, Resource Director of MDA in Israel
, who arranged the fantastic 2 week attachment programme for us from 20-30may2014
We would like to thank our collaborators & supporters once again:
Lennquist S, editor. Medical response to major incidents and disasters: a practical guide for all medical staff. Berlin: Springer; 2012.
imbalance between
immediate needs of victims
local availability of care
People run through the New York streets as the World Trade Center collapses, National Geographic, Sept 11.
Regardless of cause, they all share one same characteristic
Preparedness for mass-casualty incidents should be
based on objective analyses of past events,
so that
insights gained
from each response can be i
ntegrated into
for the future
(Eliott, 2010)
Most challenging yet most important
Elliott D, Macpherson A. Policy and practice: recursive learning from crisis. Group Org Manage. 2010;35(5):572–605.
AAR (after every event)
Continous Debriefing

National Scale
Homefront command

Content experts from county/hospitals to setup SOPs
Content experts submits SOPs to SHA
ED submits AAR + Recs to SHA
approves SOP
ED tweaks SOP to fit, details plan for stockpiling resources
SOP disseminated to ED
MOH ensures plan is suitable for hospital&Nation
approves plan
ED to proceed with plan
Learning from the past, preparing for the future
With govt $, can start building capacity
Active Learning
Instructive Feedback
Assimiliation of knowledge amongst personnel
Equipment & Infrastructure
- Development of instruction kits for local training
- Educational films (MCI, Chemical warfare)
- District training courses for all scenarios
- Clinical training in Medical Simulation Center

Training Tools

Expansion of
Surge capacity
for Hospital Beds
Daily monitoring: Reserves of
of the hospital's usual bed capacity (Sahar, 1976)
Expandable facilities
(Oxygen/power lines along hospital corridors)
ED management
- avoiding crowding, allow prompt clearance, reinforced workforce
Guy Caspi,
The Israeli Experience 20
Practice makes perfect
Simulation of realistic scenarios
Collaboration between MDA, hospital, police, homefront
Joint Drills!
Nationally coordinates resources
Overall medical responsibility
Logistic support
AAR + Debriefing
identifying content experts to constantly update SOPs
Daily Follow Up

Data sent to Director General of Medical Services (DMS) –
Transmitted 2x/day
Number of unoccupied Beds, Ventilators, ICU
Incident Commander
If needed, medical incident commander activates blood bank.
Blood Bank
Blood bank checks(through
ADAM system - Communication)
inventory levels of hospitals with casualties , and will deliver blood accordingly

7pRBC/moderately-severe casualty

This ensures that the
supply of blood
from the blood bank will reach the patients in need
as fast as possible

credits to Prof. Eilat Shinar MD, Director of National Blood Service
Directs paramedics
Directs Firebrigade
Command chief (first paramedic
who arrives on site directs other paramedics
Medical Chain of Commands
Dispatch centre
directs ambulances to selected hospitals (
of injuries),
to prevent the nearest trauma centre from being overwhelmed. (Bloch 2007)
sends patients to
Directs homefront
Directs secondary relocation to hospitals
In the event of MCI, to allow
EMS Dispatch Centre
to direct evacuated casualties to hospitals with the most resources
of hospital capacity
Physicians, Nurses, Paramedical staff, Logistic and Administrative professionals
Adini B, Peleg K. On Constant Alert: Lessons To Be Learned From Israel's Emergency Response to Mass-Casualty Terrorism Incidents.
Health Affairs.
2013; 32(12):2179-2185
"To ensure that any large-scale challenge is met from a national point of view, planning and coordination are handled by Israel’s National Supreme Health Authority. " (Peleg, 2009)
Nationally Coordinate Resources
Peleg K, Kellermann AL. Enhancing hospital surge capacity for mass casualty events. JAMA. 2009;302(5): 565-7
Sahar. Committee for Hospital Preparedness. Tel Aviv, Israel: Israel Ministry of Health 1976.
priority is to determine the
number of patients each hospital must be prepared to receive and treat
during the initial hours of a mass casualty event. This estimate gives planners an explicit goal. (Peleg, 2009)
Peleg K, Kellermann AL. Enhancing hospital surge capacity for mass casualty events. JAMA. 2009;302(5): 565-7
Appoints Leader to prep staff for MCI
Hospt has EMS Liaison
Bloch YH, Schwartz D, Pinkert M et al. Distribution of casualties in Mass Casualty Incident with three local hospitals in the periphery of a densy populated area: lessons learned from the medical management of a terrorist attack. Prehosp Disaster Med. 2007;22(3):186-192
Every hospital is required to
conduct a
full-scale mass casualty event exercise
. The
Ministry of Health determines the scope
, type (conventional, chemical, or biological), and timing of all exercises. (Peleg, 2009)
Ensure place is safe
Deploy bomb squad (secondary bombs)
Liase with Israel Defence Forces if necessary
Direct others
immediately reinforces EMS resources from neighboring districts
If a hospital is found to have a
low level of emergency preparedness
, the director general of the Ministry of Health is notified and
(Adini, 2013)
command of operation requires good communication systems and techniques to be successful
Ultimately, there needs to be one chief commander - the Ministry
Full transcript