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Mass Casualty Incidents Fact Sheet

Main Points

  • Emergency physicians are at the front lines of any disaster, whether it’s a mass shooting or a multi-car crash on the highway.
  • Emergency physicians are critical to America’s ability to respond to disasters like the Las Vegas mass shooting, the Philadelphia train accident and diseases, like Ebola.[i]
  • There are legitimate concerns about U.S. disaster readiness. The 2014 Report Card[ii] on America’s emergency care environment gave the nation a C- for disaster preparedness
  • ACEP has a Family Disaster Guide at to help you prepare.

Q. How can emergency departments be prepared to respond effectively to mass casualty events?

A.  Emergency physicians, nurses, EMS and all first responders must be well trained to detect and treat the disaster victims.   Training in the management mass casualty events needs to be uniformly incorporated into medical school curriculum and residency training.

The nation also needs a real-time disease surveillance system linking emergency departments across regions with state public health departments and nationally with the Centers for Disease Control and Prevention (CDC) to serve as an early warning system for biological agents. 

The emergency response to the Boston Marathon bombings in 2014 was very effective largely because emergency medicine leaders had prepared and trained staff ahead of time.  Scores of emergency staff were already on scene for the marathon and emergency department personnel quickly ramped up and prepared to receive casualties.    Even though three people tragically died at the bombing site, all of the more than 170 victims who were rushed to hospital emergency rooms survived. [iii]

Q. How are emergency physicians able to handle serious disease outbreaks like Ebola or measles?

A. Emergency physicians are well trained and experienced to identify and manage infectious disease, and have practiced standard protocols to protect against blood-borne pathogens, such as Ebola and HIV for at least 30 years.  The two initial Ebola patients, who were taken from Africa to the United States were treated in an Atlanta hospital, they recovered and were discharged without infecting others.  America has the expertise and infrastructure to prevent the massive spread of Ebola as seen in West Africa.  U.S. hospitals have equipment to care for patients with infectious disease and the ability to isolate them for treatment. [iv] 

Q. Are there any concerns about the nation’s disaster response readiness?

A. There are legitimate concerns about U.S. disaster readiness that must be addressed. The 2014 Report Card[v] on America’s emergency care environment gave the nation a C- for disaster preparedness, a drop from C+ in 2009.  Despite real and present threats, states continue to experience great variability in planning and response capabilities.  In many communities, patient capacity is already stretched to the limit, and hospital surge capacity, staffing, and resources are inadequate to respond to the extraordinary demands precipitated by any disaster. 

We must continue to devote consistent federal and state funding to ensure adequate and sustainable local and regional disaster preparedness.

Q:  What role will information technology play in responding to disasters?

A:  Advanced warning of a medical or public health emergency could significantly improve readiness to detect and treat patients.  For this reason, a real-time syndromic surveillance system linking emergency departments across regions with state public health departments and nationally with the CDC to serve as an early warning system for epidemics or biological attacks could be very helpful.  Such a system would give emergency physicians and other health care personnel the ability to track real-time patient data from a city or region allowing them to immediately detect symptoms or conditions occurring in patients due to a biological agent.  Existing data collection systems are currently limited in their capacity and ability to provide information to health authorities and the public. 

Most hospitals have a policy to respond to hazardous materials (HAZMAT) incidents[vi]. The current HAZMAT model, which serves as a planning framework for community response, emphasizes a sentinel event occurring, the expectation of rapid detection and identification of the offending substance, and reliance on decontamination, especially on the scene by first responders. Because of the unique characteristics of some terrorist agents, a HAZMAT policy may be insufficient.

Q. What can the public do?

A.  No one expects or knows when emergency care will be needed. Emergency departments are ready to serve and care for anyone, at any time, for any reason. To prepare any kind of disaster, it’s important to maintain a disaster supply kit, including such items as water, food, battery-powered radio, flashlights and extra batteries, first aid kit and manual, blankets, duct tape, matches in a waterproof container, medications and photocopies of prescriptions, list of important phone numbers, special items for babies and the elderly, a spare set of car keys, credit card and cash, and area map. 

The CDC maintains stockpiles of medications.   People should not personally stockpile antibiotics or gas masks. The length of time that antibiotics remain useful varies, and increased use by the public could result in bacterial infections resistant to antibiotics — another significant public health problem. Antibiotics for treating anthrax also are expensive, have side effects and must be taken for long periods of time to be effective. Gas masks would be useless against biologic agents unless people wear them at all times. They also can be dangerous when used improperly. 

For a complete list of items to keep in a disaster supply kit, see ACEP’s Family Disaster Guide at

[ii] ACEP, 2014, “America’s Emergency Care Environment: A State-by-State Report Card”

[iii] The New Yorker, “Why Boston’s Hospitals Were Ready,” Gawande, Atul,

[v] ACEP, 2014, “America’s Emergency Care Environment: A State-by-State Report Card”