E2006. Learning from Disaster: What Past Events Can Teach Us About Radiology Planning for a Mass Casualty Incident
  1. Jared Okun; Rutgers NJMS
  2. Humaira Chaudhry; Rutgers NJMS
  3. Robert Dym; Rutgers NJMS
-To review the experiences of several radiology departments with mass casualty incidents (MCI). -To explore the various challenges that these radiology departments encountered during these incidents. -To review the conclusions/recommendations that these departments arrived at following the mass casualty incidents. -To outline what an ideal radiology department mass casualty plan should look like upon the incorporation of these recommendations.

Educational Goals / Teaching Points
-Reserve staff should be available to be called in when an MCI occurs (radiologists, technologists, nurses, etc.). -Direct all possible hospital imaging systems to the ED (portable ultrasound machines, portable X-ray, etc.). -Establish adequate communication from the outset. -Alternative communication lines may be needed when telephone lines are overloaded, such as two-way walkie-talkie systems. -Improve patient ID system (including revision of naming convention). -Designate single provider to submit orders on each patient. -Implement IT fail-safes to reduce duplicate orders. -Use standardized imaging protocols. -Implement an MCI protocol including guidelines for staff as to what is required for each patient undergoing CT in terms of patient preparedness. -Create expedited or specialized MCI order entries for radiology studies to improve surge capacity during an MCI. -Minimum acceptable care (MAC) should replace normal routines in mass casualty incidents. -During the MCI, CT in the ED should be prioritized for (or restricted to) suspected severe head injuries. -In general, priority should be given to patients with severe injuries. -Consider standardized whole-body CT examination for most or all patients to have a clear workflow and enable rapid patient work-up. -The presence of digital radiography units with wireless image transfer allows plain films to be used more liberally. -Although FAST as a screening tool in the ED may lead to some diagnostic uncertainty, its use is still justified as it puts little demand on radiology resources compared to CT.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques

It is important to have an emergency response plan in place before an MCI occurs. Any plan must enable adequate Radiology Department staffing in a reasonable period of time. Adequate communication from the outset is critical during an MCI (specifically between Radiology, ED, and Surgery departments). Safe and efficient methods for patient identification are vital. The plan may require shifting the use of resources to minimal acceptable care and may grant priority to unstable patients and those with head injuries. Expedited ordering and standardized protocols are helpful in streamlining patient throughput. The utilization of FAST exam within the Emergency Department may be an important component of an emergency response plan.