An epidemiological approach to mass casualty incidents in the Principality of Asturias (Spain)

Abstract

Background: Mass Casualty Incidents (MCI) have been rarely studied from epidemiological approaches. The objective of this study is to establish the epidemiological profile of MCI in the autonomous region of the Principality of Asturias (Spain) and analyse ambulance deployment and severity of patients.

Methods: This is a population-based prospective study run in 2014. Inclusion criteria for MCI is "every incident with four or more people affected that requires ambulance mobilisation".

Results: Thirty-nine MCI have been identified in Asturias in 2014. Thirty-one (79%) were road traffic accidents, three (7.5%) fires and five (12.8%) other types. Twenty-one incidents (56.7%) had four patients, and only three of them (8%) had seven or more patients. An average of 2.41 ambulances per incident were deployed (standard error = 0.18). Most of the patients per incident were minor injured patients (mean = 4; standard error = 0.2), and 0,26 were severe patients (standard error = 0.08). There was a positive significant correlation (p < 0.01) between the total number of patients and the total number of ambulances deployed and between the total number of patients and Advanced Life Support (ALS) ambulances deployed (p < 0.001). The total number of non-ALS ambulances was not related with the total number of patients.

Discussion: Population based research in MCI is essential to define MCI profile. Quantitative definition of MCI, adapted to resources, avoid selection bias and present a more accurate profile of MCI. As espected, road traffic accidents are the most frequent MCI in our region. This aspect is essential to plan training and response to MCI. Analysis of total response to MCI shows that for almost an hour, we should plan extra resources for daily emergencies. This data is an important issue to bear in mind when planning MCI response. The fact that most patients are classified as minor injured and more advanced life support units than needed are deployed shows that analysis of resources deployment and patient severity helps us to better plan future MCI response.

Conclusions: Road traffic accidents with minor injured patients are the most frequent MCI in our region. More advanced life support units than needed have been initially deployed, which might compromise response to daily emergencies during an MCI.

Fig. 1

Monthly MCI occurrence and trend in 2014. This figure shows monthly distribution through the year. Although more MCI happens in summer, no statistical significance has been found

Fig. 2

Daily MCI occurrence and trend throughout the month. This figure shows number of MCI each day of the month

Fig. 3

Hourly distribution of MCI (24 h). This figure shows hourly distribution of MCI through the day, with more MCI at noon and late afternoon

Fig. 4

Number of patients per incident. Most of the incidents had only 4 patients, and only a few had more than 7 patients