“Although HICS and CSC protocols exist in most hospitals, gaps in knowledge of these protocols have been demonstrated in physicians, and staff education has been inconsistently implemented.”
Although HICS and CSC protocols exist in most hospitals, gaps in knowledge of these protocols have been demonstrated in physicians, and staff education has been inconsistently implemented (J Emerg Med 2016;48:685-92). A study of anesthesiology residents and faculty demonstrated that clinicians felt poorly prepared and desired additional training in MCI protocols (Anesth Analg 2017;124:1662-9). Several studies have demonstrated the importance of intra-hospital disaster preparedness exercises (Disaster Med Public Health Prep 2009;3:S74-S82; Prehosp Disaster Med 2017;32:662-6). Errors in disaster triage can lead to increases in mortality and have a significant financial impact during a disaster response (J Emerg Med 2016;48:685-92).
While it is not possible to prepare for every MCI eventuality, attention should be paid to vulnerable populations when preparing for MCIS. While pediatric patients account for approximately 25% of the population, many adult hospitals lack appropriate staff, equipment, or protocols meant for children. For many reasons, children are at greater risk of morbidity and mortality during mass casualty events, including the fact that triage scoring systems do not take age into consideration (Br J Anaesth 2021;128:e109-19). Similarly, pregnant patients need careful triage, and attempts should be made to send them to facilities capable of both delivery and neonatal care. Geriatric and mental health patients are also at higher risk. Reunification with family members is a complex problem, particularly when children or adults cannot identify themselves. Care should be taken to mitigate inequities affecting individuals with disabilities and people of color (N Engl J Med 2020;383:e16). There is also concern that palliative care standards of care will not be offered during MCI surges (Crisis Standards of Care: Summary of a Workshop Series. 2010). Finally, hospital staff are vulnerable. Mental health care for staff and patients is an essential consideration for all MCIs with issues of exhaustion, depression, grieving, and post-event stress to be expected (Crisis Standards of Care: Summary of a Workshop Series. 2010). The COVID-19 pandemic has illuminated these risks to hospital staff (Eur J Psychotraumatol 2020;11:1810903; Curr Psychiatry Rep 2020;22:43; Anesthesiology 2021;134:518-25).
“We cannot predict the nature or timing of the next MCI [but] anesthesiology departments can and must prepare.”
Although we cannot predict the nature or timing of the next MCI, anesthesiology departments can and must prepare. Education of staff members is a documented need (Anesth Analg 2017;124:1662-9; Br J Anaesth 2021;128:e168-79). Time and resources related to training are challenges to be dealt with but must not derail preparatory efforts. Education and rehearsals must be implemented, policies and procedures must be updated and useable, and individuals must be empowered to prepare teams to deliver the best possible care in difficult circumstances (Br J Anaesth 2022;128:e65-7). Education and rehearsals can range from classroom-based teaching, such as lectures, workshops, game-based learning and table-top simulations, to small- and large-scale hospital simulations (Br J Anaesth 2022;128:e213-15; Br J Anaesth 2022;128:e210-12; Br J Anaesth 2021;128:e168-79), and should include repeated combinations of those techniques to inform hospital systems and keep hospital staff nimble. The time to prepare is now. The ongoing pandemic does not preclude the next mass shooter, industrial accident, tornado, or terrorist attack.