Mass Casualty Incidents

Bombings are becoming not so rare an incident in today’s society. If you decide to write a novel surrounding a mass casualty incident related to a bombing– consider using this injury: Blast Lung.

Blast Lung is the most common fatal injury related to bombings. It’s reported to be more common in patients with skull fracture, >10% burns and impaled trauma to the head/chest.

A patient can present with some of the following diagnoses as well that fall under this umbrella of injury:

Bruise to the lung (Pulmonary Contusion).
Blood or air in the chest cavity (Hemo/Pneumothorax).
Traumatic Emphysema (tight lungs with poor oxygen exchange).

It’s caused by the blast wave pummeling the lung (and other air-filled organs.) If the patient is in a confined space when the bomb explodes they have a much higher degree of mortality/morbidity because the blast wave can pass through them several times as it bounces off walls. The more times the blast wave passes through a patient, the more likely they are to die.

Blast lung should be suspected if the patient presents with difficulty breathing, shortness of breath, cough, coughing up blood, chest pain and low oxygen levels. On chest x-ray a distinctive butterfly pattern can be seen.

Treatment is supportive in nature. Oxygen, giving fluid to prevent shock but not too much as to overload the lungs, and a ventilator if the patient is in impending respiratory distress/failure.

To read more about mass casualty incidents check out the following link:

Mass Casualty Incident: An Overview

Sometimes, as an author, you need something unusual to inflict your character with so this week I thought I’d focus on two injuries that can be unique to mass casualty incidents.

Mass casualty incidents (MCI’s) are defined as those that overwhelm equipment and personnel by the number casualties. It’s not necessarily the same for every organization. If a rural EMS crew comes upon a three-car accident with three patients– that might be a mass casualty incident for them but this same accident happening in downtown New York would not be.

Often times, when we think of mass casualty incidents, we recall the big things like tornadoes, earthquakes and terrorist attacks (bombings, nerve gas release) and school shootings.

For this post I’m focusing on a unique infection related to Acts of God weather events and next post I’ll do an injury related to bombings.

Mucormycosis is a soil fungus that comes out to play when it is dredged up from the earth with events like flooding and tornadoes. Usually a person comes into contact with the fungus via an impaled object. It is a necrotizing bug (meaning is devours flesh) so aggressive debridement and treatment with broad spectrum antibiotics and antifungals is necessary.

After the Joplin, MO tornado in 2011– thirteen cases were identified of which five (38%) died. Most had accompanying fractures. Interesting to note is that all the patients were located in the zone that sustained the most damage. Infection was associated with penetrating trauma and multiple wounds. You can read further about this rare infection by reading this piece as well.

What also could have contributed to the number of infections was the devastation to the medical system that happened during the tornado as well. The main hospital was damaged and several off-site clinics were set-up so the above news piece surmises that wounds may not have been adequately treated (which would be serious irrigation.) This is understandable considering what the town was dealing with.

What about you? Have you ever been in a natural disaster?