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Table 5 Comparison of major adaptations between contextual situations in the mass-casualty incidents

From: Rethinking preparedness planning in disaster emergency care: lessons from a beyond-surge-capacity event

Context Notable typical adaptation examples Cascade effects
Number of burn specialists:
None-burn specialist /plastic surgeon hospital (C1)
A few-burn specialists hospital (C2)
Unique to C1:
F0-1: Anticipation and proactively initiated to mobilize ED and surgical managers before receiving EOC’s call
F1: Triage was performed by triage nurses and ED physicians
F3-1: Burn dressing in ED and intubation in ICU
Unique to C2:
F1: Triage by ED physicians and plastic surgeons or burn specialists
F3-1: Intubation in ED and burn dressing in wards
Common to C1 & C2:
F3-1: Team structure was flexible, and nurses were trained in time on burn care in the ED
F14: Simplified transfer of burn patients to other hospitals from ED or wards
Approaching run out burn ointment
Approaching the gridlock of ED space, and quick shortage of intubation devices and equipment
Congested ED space
Farer hospital continuously receiving burn patients with uncertainty (C3)
Closest hospital continuously receiving mass casualties with uncertainty (C4)
Unique to C3:
F5: Three types of mass relocation: 1) Initial relocation of few non-FFCDE patients inside ED, followed by mass relocating all non-FFCDE patients into hospital lobby; 2) one-time mass relocation of non-FFCDE patients into a separated area from victims in ED; 3) located all mild-injured burn patients in hospital lobby adjacent to ED, moved them all back to ED afterward
F2-1: Use of mass casualty registration numbering protocol from the first burn patient
Unique to C4:
F5: Stepwise relocation—ED physicians kept looking space and relocating patients in ED until gridlock was noticed
F2-1: First, use of emergency registration procedure, then switched to MCI registration numbering protocol
F3-1: Minor injured were first treated in triage area outside ED, allow low-acuity patients to flush their own burns, deferred coating
F10: Reconfigured patients’ layout and asked to hang a visible ID paper of burn patients to the drip stand of each bed, moved out the chairs in waiting room, and strictly asked ED access control
Mitigated getting overcrowded ED
Congested ED space impacted on F3-1
Deferred coating ointment led the shortage of burn ointment later
Recovered ED order made patients transfer smoothly
Duplicate or missed patient IDs were created
Shortage of medical materials
Materials shortage in ED (C5)
Materials shortage in wards (C6)
Unique to C5:
F6: Mobilization and deployment of internal materials bypassed standard inventory procedures including admission of control drug, borrowing burn materials, tubes, Ambu, and portable ventilator equipment from other units. borrowed stretchers from 119 ambulances, requested for ambulances by formal and private channels
Unique to C6:
F7: A top manager and a young physician anticipated run out of medical materials for burn care to proactively mobilized external materials
Deferred coating in ED
Arranged burn patients to sit in chairs and waiting for stretchers
No shortage of burn materials in wards
Insufficient staff for burn care, registration and documentation in ED
(Common situation across hospitals)
Common adaptation: maximization of staff capacity
F4: Use of flexible team structure, nurses assisted the triage for non-burn patients and registration, staff worked overtime to extend care from ED to wards. senior physicians volunteered to escort the transferred patients in ambulances
F9: Multiple channels (formal and informal) to call for offsite staff, senior managers called the EOC to stop sending
F13, F14, F17: Simplified transfer procedures through oral handoff, plus limited documents provided afterword
F15: Discharged relatively lower risk non-FFCDE patients
F16: Medical documentation was deferred and simplified, reporting mass causally list to MOHW on line was deferred
Faster treatment
Duplicate or missed patient IDs were created
Incomplete medical documentation
Incomplete and imprecise mass casualties list in time
  1. ICU, intensive care unit; MOHW, Ministry of Health and Welfare; EOC, emergency operation center