The impact of multiple casualty incidents on clinical outcomes

Multiple casualty incidents (MCI) highlight discrepancies between patient needs and available resources. It is generally thought that heavy patient loads adversely affect trauma health care delivery. The purpose of this study was to identify the impact of multiple casualty situations on the clinical outcomes of injured patients.

All severely injured trauma patients (Injury Severity Score [ISS] > or = 12) who presented during a 12-month period to a regional trauma center were retrospectively reviewed. MCIs were defined as treating and admitting three or more trauma patients within a maximum of 3 hours. This cohort was compared with all other patients who did not meet MCI criteria.

Ten percent (88/861) of all trauma patients were treated in an MCI setting. Groups did not vary among sex, age, ISS, or mechanism of injury (p > 0.05). MCI patients displayed a greater length of hospital stay, time to first surgical procedure, time to emergency laparotomy, and time spent in the emergency room (p < 0.05). MCI and non-MCI patients did not differ in ICU length of stay, postadmission morbidity, or mortality (p > 0.05).

The impact of a MCI on the quality of trauma care has not been previously defined. MCI events delay definitive care and prolong a patient's length of stay. This is particularly concerning in the emergency department where a trauma center's ability to treat MCI patients effectively via an increased surge capacity relies on swift patient triage and flow. We are now investigating these issues in other trauma centers.