Management of mass casualty incidents in the shock room: the role of the trauma team

Managing mass casualty incidents (MCI) is a challenging task, demanding coordination, teamwork, and expertise from healthcare professionals. MCIs can result from natural disasters, terrorist attacks, and mass shootings, which can lead to a large number of casualties and require an efficient and rapid response. The trauma team, comprising trauma surgeons, anesthesiologists, emergency physicians, nurses, radiologists, and technicians, plays a crucial role in managing major emergencies. Effective planning and guidelines are necessary to manage MCIs, and a company plan, such as Italy’s PEMAF, should be created, validated, and implemented to organize the process. During an MCI, the trauma team should possess specific skills and interventions to stabilize patients quickly and efficiently, such as securing the airway, controlling the circulatory system, and managing bleeding. Effective triage protocols, such as START, must be used to prioritize patients and direct them to appropriate care centers, and patient sorting should continue even after accessing a facility. When dealing with MCI, it is essential to optimize patient flow while ensuring a minimum level of acceptable care, even when patient volume surpasses normal system capacity. To manage MCIs, a well-established activation chain for the trauma team is necessary, including the triage nurse, head trauma surgeon, and director of the trauma team. Each healthcare facility should be aware of its capacity threshold, and the chief surgeon should alert the operating rooms and coordinate with the director to plan and verify the availability of operating rooms. Coordinated extra-hospital transport and triage are also necessary, and advanced multi-specialty facilities should transport stabilized patients or patients with low-severity to less crowded or lower-level care facilities when the patient load exceeds their capacities.