 What comes in nursing school explained in today's video on disaster management and mass casualties? Typically in nursing or in the medical field in general, we want to attend to the patient that is the most critical or the most unstable first. However, when there is a mass casualty, when there are many victims and this can be due to any kind of disaster that might be a train that derailed. An earthquake or really most recently some hospitals also had to go into disaster management mode with the recent outbreak of COVID and the sheer number of patients that arrived in critical condition to their hospital. But typically when we talk about a mass casualty event, it's very different from normal triage where we usually attend to the most critical patients first. In disaster management, the principle of utilitarianism applies, which means that we are going to do the greatest number of good for the greatest number of people. So unfortunately, patients that are the most unstable that would usually require a high level or a high number of resources are the least priority because we have so many victims that we're dealing with. So the priorities really change and most counties have a protocol that they follow for mass casualties and there are usually drills where the county as a whole or maybe just a city practices this mass casualty response so that they are prepared in case a disaster happens. The most commonly used strategy or approach here is called START, which is simple triage and rapid treatment. And really when it comes to mass casualties, there are three parameters that are assessed in 60 seconds or less. So very quickly, we are assessing the patient's respirations, their perfusion and their mental status. So those are the only three parameters that matter. Everything else that we know about how we usually prioritize our patient care goes out the window in a mass casualty. And there are only two basic interventions that the AMS or first responders will provide and those will be direct pressure to control bleeding, so to deal with the perfusion, or basic airway opening to deal with their respirations. And then clearly we'll constantly re-vigorating and re-triaging the patients based on the available resources in the area and also the patient status because that can always change. And then there are tags, as you can see here, that are labeled red, yellow, green and black and they have a perforation where really we can just attach the tag to the patient, tear off whatever doesn't apply so that the patient now gets categorized with whatever label they've been assigned. And red always means most immediate attention, yellow means delay in care can occur, green is minor injuries that are also called the walking wounded, and then black means the patient is deceased and we're going to not put any more efforts into attempting to save their lives. Now over here there is usually in the field, as from the first responder side, there is usually an incident command center that's on the scene and somebody will be put in charge of dealing and triaging and prioritizing and allocating the resources that are available to this mass casualty. They will be closely working with the MICN, which is the radio nurse, the mobile intensive care nurse, and radio nurses undergo special training so that they are prepared to deal with these mass casualties and then of course they'll closely work together with the hospitals in the area and any other care facilities because maybe there are 500 victims but the hospitals can only take 400 so maybe a lower level of care, maybe like a skilled nursing facility, a rehab facility, maybe they can take the walking wounded and provide this emergency or first aid that is needed so really the whole area will work together to help the people that have suffered from this mass casualty. And so this start simple triage and rapid treatment really number one, all ambulatory victims are moved or they actually are asked to move themselves to a safe area because if they can move, they can usually breathe, there's no immediate threat to life and they are those walking wounded that are automatically labeled as green that can have a definite delay in care. And those will usually, if they need care, take themselves to the hospital. Number two, patients with no respirations. The intervention is to reposition the air reposition the airway like we talked about over here. If the patient is happening after repositioning the airway automatically, they get labeled as black. There is no rescue breathing. There is no CPR because it's going to require a lot of resources to save that one patient when we might be needing to save 499 other patients or victims. If after repositioning the airway, the patient breathes, then if the respiratory rate is greater than 30, so critical, can breathe for greater than two seconds, going back into the profusion here, or they are unable to follow simple commands, mental status exam, then they're categorized as red, so immediate category. And then when their breathing is controlled after repositioning their airway, but they don't fall into these categories, all other patients are in the yellow category, which are the delayed category. And then the incident command post or the incident commander will determine who goes where and again work closely with the MICN because one hospital might say, I can take three reds, five yellows and 15 greens. The next hospital might say I can take five reds, two yellows and 25 greens. So you get my drift here, it depends on the availability and so really everybody that's involved in managing this from the scene as well as the different hospitals in the area, everybody works closely together to get the greatest number of good to the greatest number of people, to save the greatest number of people from this mass casualty. So the main point here is to remember that it's very different from a basic triage where usually we attend to the most critically ill patient first when mass casualties, we don't have the luxury, we only have limited resources. And if the patient has no breathing after we repositioning the airway, automatically we consider them in the black category. So thank you for watching this video on mass casualties and disaster management. Please also watch the other video on triaging where I go into the details of assigning a patient an emergency severity index and also my ER and trauma assessment videos where I go into the details of how we assess a patient when it's not a mass casualty. Thanks for watching this video. Please follow me on Instagram. Subscribe here on YouTube. Give me a thumbs up if you enjoyed this video and I'll see you soon here on Nursing School Explained. Thanks for watching.