Page 26 - JSOM Fall 2024

Rethinking Prehospital Response to Mass Casualty Events

Move, Treat, and Transport

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Stephen Rush, MD ; Michael J. Lauria, MD ; Erik DeSoucy, DO *;
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Eric Koch, DO ; Jonathan Kamler, MD ; Michael A. Remley ; Nate Alway ;
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Fredrick Brodie ; Paul Barendregt ; Keary Miller ; Richard Hines ; Mathew Champagne ;
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Lorenzo Paladino, MD ; Stacy Shackelford, MD ; Ethan Miles, MD ; Warren Dorlac, MD ;
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Jennifer Gurney, MD ; Douglas Robb, DO ; Ricky Kue, MD, MPH 19
ABSTRACT
Herein, we present a simplified approach to prehospital mass account for the safety and security of casualties or responders
casualty event (MASCAL) management called “Move, Treat, and tend to under-triage at the disaster scene. Using termi-
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and Transport.” Prior publications demonstrate a disconnect nology and concepts unique to MASCAL management (e.g.,
between MASCAL response training and actions taken during black, red, expectant, immediate, delayed, etc.) adds complex-
real-world incidents. Overly complex algorithms, infrequent ity to dangerous operating conditions and further degrades
training on their use, and chaotic events all contribute to the tactical and medical efficacy. An intuitive triage system based
low utilization of formal triage systems in the real world. A on the existing scope of practice with terminology already in
review of published studies on prehospital MASCAL man- everyday general medical use may improve triage performance
agement and a recent series of military prehospital MASCAL during these events.
responses highlight the need for an intuitive MASCAL man-
agement system that accounts for expected resource limita- Published triage systems typically comprise three common
tions and tactical constraints. “Move, Treat, and Transport” is components. First, they use a clinical algorithm that directs
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a simple and pragmatic approach that emphasizes speed and a physical examination in a specific order to determine the
efficiency of response; considers time, tactics, and scale of the status of a casualty. The physical exam typically includes some
event; and focuses on interventions and evacuation to defini- combination of mental status, pulse rate, and respiratory rate.
tive care if needed. Second, the system assigns priority through a color (red, green,
yellow, and blue or black) or name (immediate, delayed, min-
Keywords: MASCAL; mass casualty incident; prehospital care; imal, and expectant) based on the physical exam findings and
triage; emergency preparedness the stepwise conclusion of the algorithm. Finally, a colored
triage category tag is placed on the casualty to identify and
prioritize treatment and evacuation before moving on to the
next casualty needing triage.
Introduction
Mass casualty events (MASCALs) are inherently chaotic and The authors of this manuscript have published three key pa-
dynamic. Even the most established triage systems are, at best, pers on MASCAL management. These publications include a
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an exercise in injury severity classification and, in practice, discussion of time considerations during trauma management,
difficult to apply during chaos and uncertainty. The current a review of the civilian literature examining the efficacy of var-
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availability of multiple triage systems reinforces the notion ious triage systems and their use in training and real-world
that no universally accepted best practice exists. Triage events, and a case series review of combat MASCALs. Critical
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methods that require linear assessment of each casualty do not findings from these three publications focused on evaluating
*Correspondence to Erik DeSoucy 6010 Abu Dhabi Place, Dulles, VA 20189 or TBRMTrauma1@gmail.com
1 Lt Col Stephen Rush is a member of the USAF Reserves, 308th Rescue Squadron, Patrick Space Force Base, FL, and Clinical Associate Professor
of Radiation Oncology and Neurosurgery, NYU Langone Medical Center, NY, NY. Capt Michael J. Lauria is a member of the USAF Reserves,
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Assistant Professor in the Department of Emergency Medicine Divisions of Critical Care and EMS at the University of Washington, Seattle, WA,
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and Associate Medical Director/Flight Physician for Airflift Northwest. Lt Col Erik DeSoucy is a member of the Trauma, Burn and Rehabilitative
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Medicine Team, Sheikh Shakhbout Medical City, Abu Dhabi, UAE. CDR Eric Koch is affiliated with the Department of Emergency Medicine,
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Navy Medicine Readiness and Training Command, Portsmouth, VA. Dr. Jonathan Kamler is affiliated with Weill Cornell Department of Emer-
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gency Medicine, New York Presbyterian Hospital, New York, NY. 1SG Michael A. Remley is affiliated with the Army Medical Department.
7 SFC (Ret) Nate Alway was affiliated with the U.S. Army. HMC (Ret) Fredrick Brodie was affiliated with the U.S. Marine Corps. CMSgt (Ret)
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Paul Barendregt was affiliated with the Alaska Air National Guard. MSgt (Ret) Keary Miller was affiliated with the Kentucky Air National
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Guard. MSG (Ret), Richard Hines was affiliated with the U.S. Army. SMSgt Matthew Champagne is affiliated with the 306th Rescue Squadron,
Tucson, AZ. Lt Col Lorenzo Paladino is affiliated with 106th Rescue Wing, Westhampton Beach, NY, and is Associate Professor, Department of
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Emergency Medicine State University New York Downstate and Kings County Hospital Medical Center, New York, NY. Col Stacy Shackelford is
Trauma Medical Director, Defense Health Agency Colorado Market, Colorado Springs, CO. COL (Ret) Ethan Miles was affiliated with the U.S.
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Army. Col (Ret) Warren Dorlac is Medical Director, Pre-hospital Trauma Life Support and Associate Clinical Professor of Surgery, University of
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Colorado, Trauma and Acute Surgery, Medical Center of the Rockies, Loveland, CO. COL Jennifer Gurney is Chief, Joint Trauma System, San
Antonio, TX. Lt Gen (Ret) Douglas Robb is affiliated with the Uniformed Services University for Health Sciences, Washington, DC. COL Ricky
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Kue is Brigade Surgeon, 86th IBCT (MTN), VTARNG, Medical Officer FEMA US&R MA-TF1, and Deputy Medical Officer FEMA RED IST.
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