Multiple Patient Events and Mass Casualty Incidents Clinical Pathway — Emergency Department

Clinical Pathways Home Emergency ICU Inpatient Outpatient Specialty Care Primary Care

Goals and Metrics

Provider Resources

Related Pathways

ED Notified of Multiple Incoming Patients
- Determine number of patients that can be accepted
- Below numbers are a guideline, ED Charge and T1
- Attending can increase or decrease numbers as needed:
  - 5 Red Critical, life threatening injuries
  - 20 Yellow Seriously injured but stable
  - 40 Green Mild injuries

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KOPH MPE/MCI

ED Roles at CHOP PHL
- MPE and MCI Job Aids, CHOP PHL
Additional Resources
- Important Phone Numbers
- Hospital-wide Notification and Actions
Family Resources
- Family Reunification Plans
- Family Reunification Algorithm
HAZMAT Resources
- Response to Chemical Exposure Events
- Response to Radiologic Events

Team 1 Attending & Charge RN Initial Notifications
- Determine type of alert to be sent: Standby or Multiple Patient Event (MPE) or Mass Casualty Incident (MCI) (See descriptions below)
- Consider trauma level/known injuries, stabilization at OSH, ETA relative to each other, current ED census and time of day/day of week
- If assistance is needed with determining type of alert, staff should contact Emergency Preparedness On-Call by sending a secure chat to:
  - Emerg Prep Escalate 1st Contact (Groups folder)

MCI Standby Alert

Multiple Patient Event (MPE) Alert

Mass Casualty Incident (MCI) Alert

Vague Initial Reports Lacking Details
e.g. MVA with unknown number of illness/injuries

Suspicion or Concern for 3-7 Seriously Ill/Injured Children
e.g. MVA or shooting with 3-7 children involved

High Suspicion or Concern for 8 or More Seriously Ill/Injured Children
e.g. School shooting with multiple seriously injured pediatric patients or any active shooter in an environment with children

Activate Appropriate Alert
Use 4CODE app or dial 4CODE from a desk phone to contact Communication Specialists to send Everbridge alert
Communication Specialists will send the appropriate Everbridge alert

ED Team Huddle Outside Resuscitation Room
- Team 1 Attending and/or Charge RN sends secure chat to PHL ED Leaders
  to request that they huddle immediately in Team 1
- Provide briefing on situation, including expected patient numbers and their ETA
- Team 1 attending and Charge Nurse assign MPE/MCI leader roles including Physician in Charge and determine resource availability

Standby
- Ask staff whose shift is ending to remain in the hospital until further information determines if a MPE or MCI needs to be called
- As more information is learned, Team 1 attending to call Communication Specialists to either upgrade to MPE or MCI alert or cancel the Standby Alert

Multiple Patient Event
- ED and supporting departments assume MPE roles
- Print, or hand out pre-printed copies of role specific job aids

Mass Casualty Incident
- ED and supporting departments assume MCI roles
- Print, or hand out pre-printed copies of role specific job aids

Command Center opened by Emergency Preparedness (x47300)
- Coordinate information between external sources and CHOP ED MCI team
- Coordinate needs with ED Physician in Charge, ED Charge Nurse and ED Resource Nurse

Cancellation of Standby Alert
- Communication specialist notified to cancel the standby alert

Upgrade to MPE or MCI
- Communication specialist notified to upgrade alert to:
  - Multiple Patient Event or
  - Mass Casualty Incident

Posted: December 2020
Revised: March 2024

Authors:
- R. Scarfone, MD;
- MK. Abbadessa, ACCNS-P;
- L. Bernardo, CRNP;
- A. Dragon, RN;
- J. Ercolani, RN;
- P. Janoff-Groffie, RN;
- R. Jones;
- S. Kalamar, CRNP;
- S. Myers, MD;
- M. Schucker, CRNP;
- A. Bytheway, CRNP

Editors: Clinical Pathways Team

Evidence

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

ED Clinical Pathway for Multiple Patient Events and Mass Casualty Incidents

Evidence

ED Clinical Pathway for Multiple Patient Events
and Mass Casualty Incidents