3.8. Mass casualty management

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manejo victimas en masaSaving lives and providing early care to disaster victims is the highest priority in response operations. However, as with other activities, this requires prior planning. In the preparedness phase, national authorities and health disaster institutions responsible for disaster management at various levels should take the necessary actions so that when disasters strike, the country and community will be as self-sufficient whenever possible. This will also involve training at the community level.

Care for disaster victims can be divided into several stages:

  • Pre-hospital care: Search and rescue is conducted in the first hours. In most cases, the local community takes the initial action. In some instances, well-trained, specialized teams and professionals are required for complex situations (for example, in earthquakes, rescuing people trapped in rubble.

    Medical attention at the disaster site is necessary to save lives, provide first aid, and stabilize vital functions before transferring patients to health facilities, where they will be triaged and receive further care. Triage is the classification of the injured persons according to the severity of injuries. with the use an internationally accepted colour coding system. Many countries have institutionalized a pre-hospital system for emergency to treat disaster victims with an ambulance network, trained staff, and a single communications center. An effective system to handle victims at the site of the disaster prevents taking the disaster to the hospital, and increases the opportunity to save lives. Click on this link for more information on creating a mass casualty system.

  • Hospital care: Health care facilities should be organized and equipped to care for the massive influx of victims. Proper hospital disaster plans include measures for health care, organization of logistical support, communications, and safety, as well as provisions for alternate sources of energy and water for operation. To prepare a hospital emergency plan, we suggest reviewing the course on hospital planning (which is only available in Spanish). This excellent resource has valuable contributions to make on developing a plan, training personnel, and conducting simulations. Based on a range of scenarios, it traces step by step the elements needed to organize and conduct simulations.

    It is important to take other types of health facilities into account. Laboratories and blood banks have a critical role during disaster response, and must also be prepared.

  • Identification of bodies: The management of the dead bodies requires established and well organized procedures for the recovery, identification, storage, and final disposal of the cadavers. Immediate cremation or burying of corpses in common graves is not recommended. Instead, all possible efforts should be made to identify the dead and deliver the bodies to family members for burial in accordance with cultural traditions and beliefs. Read more on on the myths that persist about dead bodies in the Disasters: Preparedness and Mitigation in the Americas newsletter. For in-depth reading on this subject, including legal, sociocultural, and psychological implications, we recommend the publication Management of Dead Bodies: a field guide for first responders that emerged from the work of a group of experts in the Americas who analyzed the role of the State as organizer and collaborating actor in the handling of cadavers.