Managing large numbers of patients from mass casualty incidents

Today’s hospitals are challenged to become better prepared to manage large numbers of patients from mass casualty incidents (MCI), hazardous material incidents (HAZMAT), or in extreme cases, attacks using weapons of mass destruction (WMD). As reported in the April 2004 issue of the journal Disaster Management & Response (DMR), which is published by the Emergency Nurses Association, Robert Wood Johnson University Hospital (RWJUH) in New Jersey initiated an emergency department based Special Operations Team to help prepare staff for these possible patient populations. Kathleen Zavotsky, MS, RN, CCRN, CNS, C, CS; Michael Valendo, BSN, RN; and Peter Torres, MSN, RN, authored the article. All serve on the staff of RWJUH.

RWJUH is an urban, Level I Trauma Center in central New Jersey. It is surrounded by chemical plants and industrial parks, and has a separate, fully equipped decontamination room with an outside entrance. Many local companies rely on RWJUH to treat employees exposed to hazardous materials. This reliance, coupled with a re-evaluation of disaster planning after September 11, 2001, prompted the hospital to expand its planning and response capabilities with the creation of an emergency department Special Operations Team (EDSOT). The function of EDSOT is to serve as a resource for the emergency department staff and help raise their awareness of HAZMAT/MCI/WMD events.

The EDSOT consists of registered nurses, pharmacists, security officers, technicians, and EMS personnel. Some of the group had experience as firefighters, pre-hospital providers, specialists in toxicology, and members of a federal disaster medical assistance team. The group found it helpful to collaborate with agencies outside the hospital (e.g., EMS, fire, police, and HAZMAT departments) to gain access to more resources.

Staff feedback improves operations. Staff suggested a warning sign outside the ED that directs exposed patients not to enter, but to instead use a telephone to communicate with ED staff. They also suggested a policy and procedures checklist, which can be used to document care and appropriate agency notifications.

Staff commitment brings greater recognition and expanded roles. The EDSOT has seen a four-fold increase in HAZMAT/MCI/WMD experts to serve as resources to novice personnel. EDSOT members gain monetary awards and peer recognition.

The EDSOT has provided opportunities for increased education and collaboration. The county HAZMAT team solicited the help of RWJUH to develop an MCI/WMD plan in collaboration with local police and fire departments. Representatives from all groups wrote the plan and executed a drill using local high school “victims.”

Community and state officials have recognized the efforts made to the RWJUH EDSOT, and are actively working with them to increase services to a greater geographic area.

The Emergency Nurses Association (ENA) is the only professional nursing association dedicated to defining the future of emergency nursing and emergency care through advocacy, expertise, innovation, and leadership. Founded in 1970, ENA serves as the voice of its more than 23,000 members and their patients through research, publications, professional development, injury prevention, and patient education. Additional information is available at ENA’s Web site, at


The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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