Managing mass casualties

The issue of mass casualty associated with terrorism has gained tremendous public interest, but only modest medical interest, in the past 2 years. This review examines recent medical literature and outlines a practical approach to managing the mass casualty situation on the basis of a doctrine developed and extensively practised in Israeli hospitals.

A large portion of recently published articles deal with the preparedness for 'conventional', biological or chemical mass casualty situations. Accounts of past events reveal serious discrepancies between well-designed contingency plans and the disappointing management of actual mass casualty situations. The 'Israeli doctrine' is a general 'master plan' for managing mass casualty situations that is adjusted by every hospital to its specific characteristics. Its major principles and features, as well as practical 'tips' are described.

The world medical community, being in the forefront of any natural or man-made disaster, should prepare itself for its effective management. Contingency plans should be comprehensive, and should follow certain general guidelines, but should be specific for different causes of mass casualty situations and be adjusted to each medical system or hospital. Medical personnel should become familiar with these plans through repeated drills. Experience gained in actual mass casualty events should be analysed and published to improve contingency plans and their implementation.