Casualty Evacuation Resources in Disaster Situations: Does the Quantity really matter?

During a mass casualty incident (MCI), the quick distribution of victims to medical treatment facilities (MTF) can have a tremendous impact on mortality of casualties. In the case of an inadequate response like when the number of available medical resources (personnel, supplies etc.) is insufficient, delays to medical care mount and preventable mortality can increase. To quantify the shift in timelines of treatment and arrival to hospitals, computer simulation makes it possible to test disaster medical management practices and to better quantify the effect of a constrained response in a practical way. As such we studied the evacuation of multiple casualties in a hypothetical scenario of an artillery strike, using thereby a routing algorithm applied to the map of Belgium. While the Emergency Medical Services (EMS) system was alerted to bring victims as fast as possible to a nearby MTF, we varied the number of ambulances responsible for evacuation and simulated the outcome in terms of arrival times to the MTF of final destination and mortality. These data were then compared using a different approach providing all ambulances available for direct hospital evacuation. The results show a delay in arrival at the hospital of 180 minutes on average as well as an increase in mortality of 27.36 %, when reducing the amount of used ambulances to a quarter. Results recommend the allocation of sufficient ambulances able to transport victims directly form the disaster and the quick distribution of victims to MTFs with the management of peripheral hemorrhage if necessary.