The Multiple Casualty Scenario: Role of the Anesthesiologist

Abstract

Purpose of review: Mass casualty disasters (natural and man-made) present an acute, critical situation that taxes healthcare resources and clinician acumen. This review summarizes the characteristics and management skill sets that anesthesiologists possess that make them valuable clinicians during mass casualty events and why we as anesthesiologists must continually educate ourselves on this important topic.

Recent findings: Anesthesiologists should be involved in all aspects of emergency preparedness-mitigation, planning, response, and recovery. The anesthesia department should have a plan for how it will deal with managing patients during natural and man-made (unintentional or intentional) disasters, one that takes into account a risk hazard analysis and institutional goals. Unfortunately, most practicing anesthesiologists have not had training and ongoing education for such events, and few academic centers train anesthesiology residents and staff to prepare for mass casualty scenarios.

Summary: The everyday clinical practice of anesthesiologists involves the utilization of some of the skills (vascular access, tracheal intubation) commonly required to successfully manage mass casualty scenarios. Anesthesiologists' knowledge of anti-cholinesterases makes them subject matter experts on nerve agent poisoning, and their experience managing trauma patients will serve them well, depending on the nature of the mass casualty event. Practicing anesthesiologists however need to continually educate themselves on their role during mass casualty events. and current anesthesiology residency programs should develop a curriculum and incorporate simulation training to better prepare future generations of anesthesiologists.

Keywords: Anesthesiologist in austere environments; Anesthesiologists and emergency preparedness; Anesthesiologists and major disasters; Anesthesiologists and mass casualty scenarios; Anesthesiologists and nerve agents; Anesthesiologists and resuscitation.

Fig. 1

Annual incidence of natural disasters in the USA over the past five decades

Fig. 2

Incidence of man-made disasters. a Annual number of mass shootings in the USA within the past four decades. b Annual number of worldwide terrorist explosive events within the past five decades