Multiple Patient Events and Mass Casualty Incidents — ED Clinical Pathway for Mass Casualty Incidents — Clinical Pathway: Emergency Department

ED Clinical Pathway for Mass Casualty Incidents

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Multiple Patient Events Algorithm
  • Command Center opened by Emergency Preparedness (x47300)
    • Coordinate information between external sources and CHOP ED MCI team
    • Coordinate needs with ED Physician in Charge ED Charge Nurse and ED Resource Nurse
  • Mass Casualty Incident
    (8 or more seriously ill/injured children)
    • ED and supporting departments assume MCI roles
    • Print, or hand out pre-printed copies of role specific job aids
  • Create Space for MCI Patients
    • Critical and acute patients are placed in resuscitation or behavioral health rooms or cohorted in Team 1 rooms 8-11
  • Decompress quickly
    • PSPF and NSPF report to ED to assist with admissions
  • Gather Supplies
    • 12 units of O neg blood, 12 units of O pos blood and 4 disaster carts from SPD are automatically delivered to ED
    • Triage cart
    • Wheelchairs and stretchers
Patient Sustaining Injuries in MCI
Arrives by EMS or Personal Vehicle
  • Non HAZMAT Incident: Patients enter via ambulance bay
  • Perform SALT Triage   in ambulance bay
    • Administer life saving treatment
PSR's to register all patient's using MCI guidelines so orders can be placed
After hazardous decontamination
  • Perform SALT Triage   outside of room 4
    • Administer life saving treatment
Green (Minimal)
Enter via ED waiting room entrance
Yellow (Delayed)
Enter via ED waiting room entrance
Red (Immediate)
Enter via ambulance entrance
Black (Expectant)
Move to ambulance bay or designated ED space
(consider decon room if not HAZMAT event)
  • To Waiting Room for Routine ESI Triage
    • Treatment in waiting room by APP and discharged or to EDECU/ED Urgent care rooms for procedures such as sutures or management of fractures.
  • To Waiting Room for Routine ESI Triage
    • Assigned to any available ED room
  • To charge “command post” outside Room 7
    • Assigned to one of the following locations:
      • Resuscitation room
      • Behavioral Health room
      • ED cohort event rooms 8-11
  • MCI Charge Nurse and Physician in Charge to Coordinate Patient Disposition
    • Prioritize with lead Anesthesia Physician & lead surgeon order of patients going to OR, PACU, PICU, Radiology
    • Coordinate inpatient admissions with the Nursing Supervisor for Patient Flow (NSPF)
  • Communicate Resource Needs to ED MCI Resource Nurse
    • Supplies
    • Staffing (coordinate with ED Personnel Pool Leader)
      • Request staffing for future shifts via command center
    • Pharmacy
    • Blood products
  • Patients with Minor Injuries
    • Hemodynamically stable without need for admission
    • Discharge
  • Patients Require Hospitalization and May or May Not Need Surgery
    • Hemodynamically stable; surgical injuries that do not require immediate surgical attention, however require admission or surgical care within 48 hours e.g., large laceration repairs; closed reductions/fractures; washouts of wounds; pneumothorax with chest tube placement
    • Admit to 4E/4S or PICU
  • Patients Require Non-Emergent Surgery
    • Hemodynamically stable; surgical injuries are not life threatening e.g. thoracic or abdominal injury with stable vital signs and lab values; open/closed fractures with adequate perfusion to extremity;
    • To PeriOp or PICU or 4E/4S
  • Patients Require Immediate Surgery
    • Hemodynamically unstable; emergent need for OR; e.g. traumatic head injury; thoracic/abdominal injuries without stable vital signs
    • ED Physician in charge works with lead surgeon and anesthesiologist to decide order of surgeries
    • To PeriOp
  • End MCI
    • Operations lead in the Command Center (x47300) determines when to enter recovery phase
    • Emergency Preparedness sends Everbridge Communication that event has concluded
    • Command center closed