Mass Casualty Response

Mass casualty incidents (MCIs), where the number of patients exceeds hospital resources and capacity, in the military commonly range from in the military active battle to roadside bombs or terrorist attacks. In the civilian sector, active shooter and terrorist attacks easily come to mind, but natural disasters such as wildfires or hurricanes, major motor vehicle collisions, and even a derailed Amtrak train can instantly strain a hospital system, especially if occurring in a small town whose population is less than the number of passengers affected by the crash. “Command structure is key in MCI events like the Amtrak crash,” Dr. Stilley says. “That’s something we learned from the military—directing resources where they’re needed, evacuating the scene, and managing the collaboration of multiple EMS systems and hospitals.”

Dr. Stilley

Lessons learned from military medicine have helped civilian communities develop response plans, including anticipatory guidance for second-wave victims, and refine training programs.¹ When health care systems are overwhelmed in disasters, they may also have to resort to damage control resuscitation (attempts to achieve quick hemostasis until definitive care can be given) and damage control surgery (saving definitive surgery for later while controlling bleeding quickly to prevent fatal metabolic derangements from prolonged surgeries, or to care for large volumes of patients).^2-4 Dr. Fontenette says that another damage control strategy he is starting to see utilized in civilian medicine is Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA). “Military EPs paved the way for civilian EPs to place REBOAs,” Dr. Fontenette says. While there was initially hesitancy about EPs placing REBOAs in the civilian setting, the military model was based on the idea that when there were multiple casualties an EP could place a REBOA while the surgeon was in the midst of surgery.⁵ The data on ideal patient population and efficacy of REBOA use in the civilian setting is still being defined.⁶

Trauma Care and Resuscitation

In the battlefield, hemorrhage control is a life-saving intervention, but the usefulness of tourniquets, hemostatic dressing, and TXA have also been realized by civilian health care workers dealing with trauma.¹ While tourniquets have proven beneficial in the military setting, civilian prehospital care has been slow to adopt this change.^7-10 However, many communities are realizing the benefits of this hemorrhage prevention technique which saves limbs and lives with few complications if used appropriately, and are incorporating it into their bystander intervention education, such as through the Stop the Bleed program, and their prehospital care.^7-10 “The Stop the Bleed program, which teaches the public about pressure and tourniquet use, is one of the most valuable things we integrated from the military,” Dr. Stilley says. “It’s simple first aid, but giving that knowledge to everyone, like the military did in its training, saves countless lives.”