Disaster preparedness of Canadian trauma centres: the perspective of medical directors of trauma

Mass casualty incidents (MCIs) occur as a result of natural disasters, transportation incidents, terrorism or other means and result in more patients than locally available resources can generally manage.1 Owing to a variety of human and natural factors, such events have been occurring with increasing frequency and with increasingly devastating consequences.2,3 Detailed analyses of prior MCIs have provided insight into the management of these incidents. The US Department of Homeland Security has developed 15 plausible natural and manmade disaster scenarios that would result in large numbers of casualties. Most of these scenarios predict hundreds to thousands of critically injured patients, who would overwhelm existing disaster responses.4,5 Canada’s role in international affairs might not make it a prime target for terrorism; however, a review of the Canadian Disaster Database suggests that an all-hazards plan capable of dealing with natural, technological and terrorism-related MCIs is required (Table 1).6 Table 1 Deaths and injuries from disasters since 1980 in Canada* As a result of their constant readiness to treat injured patients, trauma centres and the trauma systems of which they are a part are an essential resource for regional responses to MCIs.7 This readiness is based on the availability of skilled personnel, life-support equipment, blood and blood products and diagnostic tools.8 On a smaller scale, trauma centre preparedness is tested with large-scale industrial accidents, high-speed motor vehicle collisions and shootings all involving multiple patients, such that multiple-casualty events and emergency department surges are challenges met daily in all of the country’s trauma centres. It is commonly believed that trauma centre disaster pre-paredness is a priority and that it has been optimized to the greatest extent possible. However, reviews of a number of recent MCIs, such as the 9/11 New York terrorist attacks, the London and Madrid bombings and Hurricane Katrina, suggest that trauma centres’ preparedness is limited in several critical domains. These domains include leadership,9 hazard planning,9 communications,9–14 sustainability of peak operations,15 education,16 interagency cooperation17 and funding.18 These vulnerabilities have been identified previously by the World Health Organization (WHO)1 and by centres that have provided assistance during MCIs.9–15,17 These deficiencies also indicate that the medical and surgical response to disasters is heavily dependent on an array of nonmedical institutions and external services and needs to be integrated into a regional response. With this background, we set out to evaluate Canadian trauma centres’ MCI preparedness and the extent of their integration into a regional response to MCIs.