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IntroductionTrauma patients in the extremes of age may require a specialized approach during a multiple-casualty incident (MCI).ProblemThe aim of this study was to examine the type of injuries encountered in children and elderly patients and the implications of these injuries for treatment and organization.MethodsA review of medical record files of patients admitted in MCIs in one Level II trauma center was conducted. Patients were classified according to age: children (≤12 years), adults (between 12-65 years), and elders (≥65 years).ResultsThe files of 534 were screened: 31 (5.8%) children and 54 (10.1%) elderly patients. One-third of the elderly patients were either moderately or severely injured, compared to only 6.5% of the children and 11.1% of the adults (PConclusionsInjury at an older age confers an increased risk of complications and death in victims of MCIs.AshkenaziI, EinavS, OlshaO, Turegano-FuentesF, KrauszMM, AlficiR. The impact of age upon contingency planning for multiple-casualty incidents based on a single center’s experience. Prehosp Disaster Med. 2016;31(5):492–497.

Healthcare professionals require a unique knowledge base to function effectively during a hospital's response to a mass-casualty incident (MCI). A survey of 128 physicians, nurses, and emergency medical technicians involved in trauma care was conducted to assess their knowledge base and how it affected their decision-making in response to a MCI following a terrorist bombing. Three-quarters of the study group responded that ≥20% of the surviving victims were critically injured. Only half of the responders indicated that the main objective of medical management is identifying and treating patients with critical injuries. Forty percent of responders indicated that they would not triage a critically injured victim to immediate care. This survey indicates that further education in the principles of MCI management should be based on critical evaluation of the literature.

Earthquakes continue to exact a heavy toll on life, injury, and loss of property. Survival of casualties extricated from under the rubble depends upon early medical interventions by emergency teams on site. The objective of this paper is to review the pertinent literature and to analyze the information as a practical guideline for the medical management of casualties accidentally buried alive.

Based on the experience of managing >20 such events during the last decade, the authors' understanding of a mass-casualty incident is that it is an event in which there may be many victims, but only a few that actually suffer from life-threatening injuries. To make an impact on survival, one must identify those who are severely wounded as quickly as possible and offer those patients opti-mal care. Experienced trauma physicians are the most important resource available to achieve this objective, and they should be allocated to the treat-ment of seriously injured victims instead of more traditional management roles such as triage and incident manager.

Introduction:Proper management of mass-casualty incidents (MCIs) relies on triage as a critical component of the disaster plan.Objective:The objective of this study was to assess the precision of triage in mass-casualty incidents.Methods:The precision of decisions made by two experienced triage officers was examined in two large MCIs. These decisions were compared to the real severity of injury as defined by the Israeli Defence Forces (IDF) classification of severity of injuries and the Injury Severity Score (ISS).Results:Two experienced trauma physicians triaged a total of 94 casualties into 77 mild, seven moderate, and 10 severe casualties. Based on the IDF criteria, there were 74 mild, five moderate, and 15 severe casualties. Based on ISS scoring, there were 78 mild (ISS Conclusion:Primary triage, even when carried out by experienced trauma physicians, can be unreliable in a MCI.