1. MAJOR INCIDENT MEDICAL
MANAGEMENT AND SUPPORT
Paleerat Jariyakanjana, MD
Faculty of Medicine, Naresuan University
1 Apr 2013

3. Definition
 Major Incidents: any incident where the number,
severity, type or location of live casualties
requires extraordinary resources
 Disaster: need > resource
 Mass casualty incident: Healthcare need >
resource

4. Disaster Management Cycle

5. Major Incident Medical Management and
Support (MIMMS)
 major incident training
course
 systematic, 'all
hazards' approach to
the principles of pre-
hospital, multiple-
casualty incident
medical management

6. DISASTER Paradigm
 Detection
 Incident command
 Scene security and safety
 Assess hazards
 Support
 Triage and Treatment
 Evacuation
 Recovery

7. Management and Support Principles
DISASTER Paradigm MIMMS
 Detection  Command
 Incident command  Safety
 Scene security and safety  Communication
 Assess hazards  Assessment
 Support  Triage
 Triage and Treatment  Treatment
 Evacuation  Transport
 Recovery

8. CSCATTT
Command

9. CSCATTT
Safety
The 1-2-3 of Safety
1. Staff
2. Situation
3. Survivors

12. CSCATTT
Communication

13. CSCATTT
Assessment
 My call sign/Major incident declared
 Exact location: Grid ref.
 Type of incident
 Hazards: Present/Potential
 Access: Roads, Landing area
 Number of casualties: Type, Severity
 Emergency services: Present and Required

14. CSCATTT
TRIAGE

15.  Aim: provide the best possible care for the
greatest number of patients

16. PRIORITIES

17. Triage sieve

18. Triage sort

19. Triage sort

20. START (Simple triage and rapid treatment)

21. SALT (Sort, Assess, Life-Saving
Interventions, Treatment and/or Transport)

22. CSCATTT
Treatment
 Aim: “do the most for the most”

23. CSCATTT
Transport
 Aim: get the right casualty to the right place in
the right time
 Casualties should be dispersed to different
hospitals, most appropriate to their need.
 Mechanism of injury
 Injury found or suspected
 Signs (vital signs)
 Treatment given

24. Take home message
 Sieve disability pt mental status
change P1
 death sort

25. Reference
 Ppt ,
,
 https://sites.google.com/site/dimersarred/disaste
r-management-cycle
 https://sites.google.com/site/sarbook1/excerpt-
incident-command

26. ANY QUESTIONS?