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

ED Clinical Pathway for Multiple Patient Events

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Mass Casualty Incidents Algorithm
  • Multiple Patient Event (3-7 seriously ill/injured children)
    • ED and supporting departments assume MPE roles
    • Print, or hand out pre-printed copies of role specific job aids
  • Create Space for MPE Patients
    • Critical and acute patients are placed in resuscitation or behavioral health rooms or cohorted in rooms T1 8-11
  • Decompress quickly
    • PSPF and NSPF report to ED to assist with admissions
  • Gather Supplies
    • 12 units of O neg blood, 12 units O pos blood, 4 supply carts and 1 PPE cart from SPD are automatically delivered to ED
Patient Sustaining Injuries in MPE
Arrives by EMS or Personal Vehicle
  • Non HAZMAT Incident: Patients enter via ambulance bay
  • MPE Charge Nurse to sort patients outside rooms 6/7
    • Assigned to one of the following locations:
      • Resuscitation room
      • Behavioral Health room
      • ED cohort event room (rooms 8-11)
After hazardous
decontamination
  • MPE Charge Nurse and Physician in Charge to Coordinate Patient Disposition
  • Prioritize with Lead Anesthesiologist & 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 MPE Charge Nurse
  • Supplies
  • Staffing
  • Pharmacy
  • Blood products
Patients requiring emergent radiology imaging may return to ED or proceed directly to PICU/PeriOp as clinically appropriate
  • Patients with Minor Injuries
  • Hemodynamically stable: cared for in any available ED room and then discharged
  • Patients Require Hospitalization and May or May Not Need Non-Emergent 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; open/closed fractures with adequate perfusion to extremity; washouts of wounds; pneumothorax with chest tube placement
  • If appropriate, move patient to a regular ED patient room while awaiting inpatient bed
  • 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 MPE
  • Physician in Charge and MPE Charge Nurse determine when to communicate an end to the MPE
    (no additional patients expected)
  • They may contact Emergency Preparedness at x47300 or by sending a secure chat to:
    • Emerg Prep Escalate 1st Contact (Groups folder)
  • Emergency Preparedness will send a notification to end the MPE response