MASCAL Management from Baghdad to Boston: Top Ten Lessons Learned from Modern Military and Civilian MASCAL Events

•• Beekley AC, Martin MJ, Spinella PC, Telian SP, Holcomb JB. Predicting resource needs for multiple and mass casualty events in combat: lessons learned from combat support hospital experience in Operation Iraqi Freedom. J Trauma. 2009;66(4 Suppl):S129–37. Key lessons learned from a large series of military MASCAL events, including blood product requirements and systems for predicting resource needs during these events.

Alfici R, Ashkenazi I, Kessel B. Management of victims in a mass casualty incident caused by a terrorist bombing: treatment algorithms for stable, unstable, and in extremis victims. Mil Med. 2006;171(12):1155–62.

Ashkenazi I, Kessel B, Olsha O, Khashan T, Oren M, Haspel J, et al. Defining the problem, main objective, and strategies of medical management in mass-casualty incidents caused by terrorist events. Prehosp Disaster Med. 2008;23(1):82–9.

Ashkenazi I, Kessel B, Khashan T, Haspel J, Oren M, Olsha O, et al. Precision of in-hospital triage in mass-casualty incidents after terror attacks. Prehosp Disaster Med. 2006;21(1):20–3.

Coughlan J, Eatock J, Patel N. Simulating the use of re-prioritisation as a wait-reduction strategy in an emergency department. Emerg Med J. 2011;28(12):1013–8.

King DR, Patel MB, Feinstein AJ, Earle SA, Topp RF, Proctor KG. Simulation training for a mass casualty incident: two-year experience at the Army trauma training center. J Trauma. 2006;61(4):943–8.

•• Gates JD, Arabian S, Biddinger P, et al. The initial response to the Boston marathon bombing: lessons learned to prepare for the next disaster. Ann Surg. 2014;260(6):960–6. Excellent review of experience from the 2013 Boston Marathon bombing, including key aspects of scene and hospital triage that led to the resounding successes in this MASCAL event.

Hupp JR. Important take-aways from the Boston marathon bombing. J Oral Maxillofac Surg. 2013;71(10):1637–8.

Nessen SC, Cronk DR, Edens J, Eastridge BJ, Blackbourne LHUS. Army split forward surgical team management of mass casualty events in Afghanistan: surgeon performed triage results in excellent outcomes. Am J Disaster Med. 2009;4(6):321–9.

Briggs S. Triage in mass casualty incidents: challenges and controversies. Am J Disaster Med. 2007;2(2):57.

• SALT mass casualty triage: concept endorsed by the American College of Emergency Physicians, American College of Surgeons Committee on Trauma, American Trauma Society, National Association of EMS Physicians, National Disaster Life Support Education Consortium, and State and Territorial Injury Prevention Directors Association. Disaster Med Public Health Prep. 2008;2(4):245–246. Review of the SALT system for initial triage categorization and formal endorsement of this approach by the major organizations responsible for MASCAL care.

Sztajnkrycer MD, Baez AA, Luke AFAST. Ultrasound as an adjunct to triage using the START mass casualty triage system: a preliminary descriptive system. Prehosp Emerg Care. 2006;10(1):96–102.

Eastridge BJ, Butler F, Wade CE, et al. Field triage score (FTS) in battlefield casualties: validation of a novel triage technique in a combat environment. Am J Surg. 2010;200(6):724–7. discussion 727

Engel CC, Locke S, Reissman DB, DeMartino R, Kutz I, McDonald M, et al. Terrorism, trauma, and mass casualty triage: how might we solve the latest mind-body problem? Biosecurity and bioterrorism: biodefense strategy, practice, and science. 2007;5(2):155–63.

Armstrong JH, Hammond J, Hirshberg A, Frykberg ER. Is overtriage associated with increased mortality? The evidence says "yes". Dis Med Public Health Prep. 2008;2(1):4–5. author reply 5-6

Frykberg ER, Tepas JJ 3rd. Terrorist bombings. Lessons learned from Belfast to Beirut. Ann Surg. 1988;208(5):569–76.

Lehmann RK, Arthurs ZM, Cuadrado DG, Casey LE, Beekley AC, Martin MJ. Trauma team activation: simplified criteria safely reduces overtriage. Am J Surg. 2007;193(5):630–634; discussion 634-635.

• Frykberg ER. Medical management of disasters and mass casualties from terrorist bombings: how can we cope? J Trauma. 2002;53(2):201–12. Outline of key lessons learned from primarily civilian bombing MASCAL events, including the importance of minimizing over-triage in the initial response and care phase after a bombing event.

Sohn VY, Eckert MJ, Martin MJ, Arthurs ZM, Perry JR, Beekley A, et al. Efficacy of three topical hemostatic agents applied by medics in a lethal groin injury model. J Surg Res. 2009;154(2):258–61.

Martin M, Beekley A. Front line surgery: a practical approach. New York: Springer; 2011.

Moe DM, Lallemand MS, McClellan JM, et al. Three versus four-factor prothrombin complex concentrates for "factor-based" resuscitation in a porcine hemorrhagic shock model. J Trauma Acute Care Surg. 2017;83:1114–23.

Holcomb JB, McMullin NR, Pearse L, et al. Causes of death in U.S. special operations forces in the global war on terrorism: 2001-2004. Ann Surg. 2007;245(6):986–91.

Savage E, Forestier C, Withers N, Tien H, Pannell D. Tactical combat casualty care in the Canadian forces: lessons learned from the Afghan war. Can J Surg. 2011;54(6):S118–23.

Barron MR, Kuckelman JP, McClellan JM, et al. Smartphone-based mobile thermal imaging technology to assess limb perfusion and tourniquet effectiveness under normal and blackout conditions. J Trauma Acute Care Surg. 2017;83:1129–35.

Rasmussen TE, Dubose JJ, Asensio JA, Feliciano DV, Fox CJ, Nuñez TC, et al. Tourniquets, vascular shunts, and endovascular technologies: esoteric or essential? A report from the 2011 AAST military liaison panel. J Trauma Acute Care Surg. 2012;73(1):282–5.

Rossaint R, Bouillon B, Cerny V, Coats TJ, Duranteau J, Fernández-Mondéjar E, et al. The STOP the bleeding campaign. Crit Care. 2013;17(2):136.

• Ashkenazi I, Olsha O, Schecter WP, Kessel B, Khashan T, Alfici R. Inadequate mass-casualty knowledge base adversely affects treatment decisions by trauma care providers: Survey on hospital response following a terrorist bombing. Prehosp Dis Med. 2009;24(4):342–7. Survey study examining mass casualty knowledge and treatement decisions by trauma providers. Demonstrated concerning deficits among significant proportions of providers regarding triage, initial care, and system-wide response to MASCAL events.

Brunner J, Rocha TC, Chudgar AA, Goralnick E, Havens JM, Raja AS, et al. The Boston Marathon bombing: after-action review of the Brigham and Women's Hospital emergency radiology response. Radiology. 2014;273(1):78–87.

Campion EM, Juillard C, Knudson MM, Dicker R, Cohen MJ, Mackersie R, et al. Reconsidering the resources needed for multiple casualty events: lessons learned from the crash of Asiana airlines flight 214. JAMA Surg. 2016;151(6):512–7.

Mueck FG, Wirth K, Muggenthaler M, Kreimeier U, Geyer L, Kanz KG, et al. Radiological mass casualty incident (MCI) workflow analysis: single-centre data of a mid-scale exercise. Br J Radiol. 2016;89(1061):20150918.

Dick EA, Ballard M, Walker HA, et al. Bomb blast imaging: bringing order to chaos. Clin Radiol. 2018.

Abu-Zidan FM. Ultrasound diagnosis of fractures in mass casualty incidents. World journal of orthopedics. 2017;8(8):606–11.

Paddock MT, Bailitz J, Horowitz R, Khishfe B, Cosby K, Sergel MJ. Disaster response team FAST skills training with a portable ultrasound simulator compared to traditional training: pilot study. West J Emerg Med. 2015;16(2):325–30.

Stawicki SP, Howard JM, Pryor JP, Bahner DP, Whitmill ML, Dean AJ. Portable ultrasonography in mass casualty incidents: the CAVEAT examination. World journal of orthopedics. 2010;1(1):10–9.

Bolster F, Linnau K, Mitchell S, Roberge E, Nguyen Q, Robinson J, et al. Emergency radiology and mass casualty incidents-report of a mass casualty incident at a level 1 trauma center. Emerg Radiol. 2017;24(1):47–53.

Rupp J, Cooper W, Ferre R. Systematic sonography for detection of occult wounds in trauma. J Ultrasound Med. 2017.

Wydo SM, Seamon MJ, Melanson SW, Thomas P, Bahner DP, Stawicki SP. Portable ultrasound in disaster triage: a focused review. Eur J Trauma Emerg Surg. 2016;42(2):151–9.

West B, Cusser A, Etengoff S, Landsgaard H, LaBond V. The use of FAST scan by paramedics in mass-casualty incidents: a simulation study. Prehosp Dis Med. 2014;29(6):576–9.

Zhang S, Zhu D, Wan Z, Cao Y. Utility of point-of-care ultrasound in acute management triage of earthquake injury. Am J Emerg Med. 2014;32(1):92–5.

Halpern P, Goldberg SA, Keng JG, Koenig KL. Principles of emergency department facility design for optimal management of mass-casualty incidents. Prehosp Dis Med. 2012;27(2):204–12.

El Sayed M, Chami AF, Hitti E. Developing a hospital disaster preparedness plan for mass casualty incidents: lessons learned from the downtown Beirut bombing. Dis Med Public Health Prep. 2017:1–7.

Pinkert M, Bloch Y, Schwartz D, Ashkenazi I, Nakhleh B, Massad B, et al. Leadership as a component of crowd control in a hospital dealing with a mass-casualty incident: lessons learned from the October 2000 riots in Nazareth. Prehosp Dis Med. 2007;22(6):522–6.

Landman A, Teich JM, Pruitt P, Moore SE, Theriault J, Dorisca E, et al. The Boston Marathon bombings mass casualty incident: one emergency department's information systems challenges and opportunities. Ann Emerg Med. 2015;66(1):51–9.

Chan TC, Griswold WG, Buono C, Kirsh D, Lyon J, Killeen JP, et al. Impact of wireless electronic medical record system on the quality of patient documentation by emergency field responders during a disaster mass-casualty exercise. Prehosp Dis Med. 2011;26(4):268–75.

Tami G, Bruria A, Fabiana E, Tami C, Tali A, Limor AD. An after-action review tool for EDs: learning from mass casualty incidents. Am J Emerg Med. 2013;31(5):798–802.

• Boston Trauma Center Chiefs Collaborative. Boston marathon bombings: an after-action review. J Trauma Acute Care Surg. 2014;77(3):501–3. Detailed presentation of key after action review items from the Boston Marathon response, including the lack of commercially available tourniquets, hemostatic dressings, limitations of the EMR, and organization/execution of triage at the scene of the event.