Mass Casualty Scenarios: What Are Your Portable Suction Unit Needs?

As we kick off the new year, and make plans for emergency preparedness, it behooves us to take a glimpse in the rearview. The prior year, 2017, was not pretty; we saw a plethora of natural disasters, from earthquakes in Mexico, to flooding in Bangladesh, to a hurricane leaving thousands without power on Puerto Rico, months after the rains have moved on.

Natural disasters make up many of the mass casualty scenarios that play out across the globe. But plenty of man-made scenarios can prove just as deadly, with mass shootings as a prime example.

As emergency responders, mass casualty scenarios or incidents (commonly referred to as MCIs) are always in the forefront of preparedness. Disaster management requires extensive preplanning to ensure adequate manpower, resources, and coordination. So, before we discuss the need for portable suction units in mass casualty scenarios, let’s explore some of the nuts and bolts of disaster preparedness.

Hazard Types

The Federal Emergency Management Agency (FEMA) groups types of hazards into three general categories.¹ These include:

Natural Hazards

• Avalanche
• Disease outbreak
• Drought
• Earthquake
• Epidemic
• Flood
• Hurricane
• Landslide
• Tornado
• Tsunami
• Volcanic eruption
• Wildfire
• Winter storm

Technological Hazards

• Airplane crash
• Dam/levee failure
• HAZMAT incident or release
• Power failure
• Radiological release
• Train derailment
• Urban conflagration

Human-Caused Hazards

• Civil disturbance
• Cyber events
• Terrorist acts
• Sabotage
• School violence

Any one of these scenarios can produce mass casualties, requiring the coordination of local, state, and federal resources. Preplanning for such incidents is a strategy contained within FEMA's five phases of emergency management, categorized as follows:²

• Mitigation: activities that take place before and after a disaster, aimed at preventing or minimizing the effect of future emergencies.
• Preparedness: occurs before an event, including plans or preparation steps to save lives and encourage response and rescue operations.
• Protection: efforts to protect our nation’s constitutional form of government, including a system established to warn citizens of impending hazards.
• Response: occurs during an event, including actions taken to save lives and prevent further property damage.
• Recovery: occurs after an event, including actions taken to return to a normal or safer situation following an emergency.

Your Role in MCIs

On the local level, mass casualty events will require rapid decision-making and immediate action. Normal response guidelines must be tailored to the event. In general, medical concerns during a mass casualty scenario will include these four types:³

• Search and Rescue – systematically looking for victims and rescuing them from hazardous situations; specialty teams may be employed.
• Triage and Initial Stabilization – evaluating and categorizing each victim to identify life or limb-threatening injuries.
• Definitive Medical Care – directing patients to appropriate facilities.
• Evacuation – transporting disaster victims away from the site, either to a safe location or definitive care facility.

Suction Needs During MCIs

Disaster management preplanning must include adequate life-saving equipment provided for responders, and portable suction units make up a critical part of mass casualty equipment assemblages. Disasters produce a wide range of traumatic injuries. Active bleeding, especially in unresponsive patients, can clog airways, requiring immediate evacuation to ensure patency. The simple task of suction can alleviate airway obstructions caused by bodily fluids, potentially reducing the number of casualties. The key is to have plenty of suction units available within your MCI trailer.

Along with suction units, you must ensure a large assortment of supplies on hand to treat a large number of patients: batteries (alkaline and rechargeable, depending on the style of unit), catheters, and plenty of disposables (tubing, canisters, syringes, gloves).

Addressing the need for portable suction units in mass casualty scenarios is an integral part of disaster preplanning. Making available an appropriate number of units is key to ensuring that no matter the disaster, your airway needs will be met.

1 2010 Developing and Maintaining Emergency Operations Plans, Comprehensive Preparedness Guide 101, Version 2.0, FEMA, https://www.fema.gov/media-library-data/20130726-1828-25045-0014/cpg_101_comprehensive_preparedness_guide_developing_and_maintaining_emergency_operations_plans_2010.pdf

2 2010 The Federal Emergency Management Agency, U.S. Department of Homeland Security, https://www.fema.gov/media-library-data/20130726-1823-25045-8164/pub_1_final.pdf

3 2011 Prehospital Trauma Life Support, American College of Surgeons, Committee on Trauma, MOSBY JEMS, Elsevier.