Issue: December 2019
December 03, 2019
3 min read

Mass casualty incidents: A growing challenge for the orthopaedics and traumatology community

Issue: December 2019
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In recent years, the incidence of natural casualties, such as tsunamis, hurricanes earthquakes, and human disasters, such as industrial accidents, military actions and terrorist acts, has been growing continuously around the world. The resulting casualties affect large populations; most of the injuries are orthopaedic, bringing to the forefront the key role and responsibility of the orthopaedics and traumatology practitioners in delivering an immediate and appropriate medical intervention for wounded patients.

The severity and complexity of mass casualty injuries demand the use of specialized treatment approaches within a limited time period and, in most of the cases, with restricted resources. While these treatment methods are unique to the management of these types of incidents, these are also applicable to industrial, train and natural catastrophic accidents.

However, the treatment methods employed for such high-energy injuries require a distinct approach not often used in daily medical practice and, therefore, it is necessary for all orthopaedics and trauma surgeons to become proficient in the specificities of these driving principles. For instance, particular instructions need to be ensured at an early stage: administration of prophylactic antibiotics to avoid infections, sterile coverage to the wound and quick transportation to the hospital, as well as primary surgical stabilization by external fixation in case of fractures, to mention a few examples. Indeed, the plan of action in this context is based on damage control principles. The most important overarching rule of mass casualty handling is “life before limb.”

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Presenters of the symposium “Mass Casualty Incidents Within The Orthopaedics & Trauma Community” planned for the upcoming EFORT 2020 Congress will share their rich experiences and expertise in treating high-energy injuries resulting from war trauma, terror attacks, natural catastrophes and high-energy road trauma incidents, among others. Emphasis will be placed on the immediate treatment and transportation of injured persons, hospital preparations for the treatment of mass casualties, triage, damage control, primary immobilization and functional limb salvage.

Thursday 11 June 2020 | 13:15-14:45
Mass Casualty Incidents Within the Orthopaedics & Traumatology Community
Session Chair: Alexander Lerner (Israel)

  • Trauma Care After Peace-Time Explosions | Vladimir Khominets (Russia)
  • Limb Salvage in Patients After Multiple Trauma| Iztok Gril (Slovenia)
  • Post-Traumatic Lower Limb at the Risk: When and How I Decide to Limb Salvage |Botjan Sluga (Slovenia)
  • Limb Salvage in Trauma to Lower Limbs With Extensive Tissue Loss | Gerald Wozasek (Austria)
  • Extensive High-Energy Trauma to Limbs in Pediatric Patients | Alexander Lerner (Israel)

The term “mass casualty” refers to a combination of patient numbers and care requirements that challenge or exceed the medical community’s ability to provide adequate patient care using the usual day-to-day material and facilities. In any community, a mass casualty incident has the potential to quickly run down the resources available for an adapted response. Indeed, the hospital capacity is always dependent on a well-defined comprehensive emergency management plan that should include the worst-case scenario. This type of plan is built to enhance the level of preparation required to respond to exceptional health care needs. The sudden arrival of a surge of patients also presents a logistical challenge to process many casualties through the hospital administrative system.


A complete update of all the key logistical points to consider for debridement and wound care, through the personal experience of several speakers from different countries, will contribute to improve the treatment and outcomes of patients in these settings. For instance, several resources are essential in the management of the situation and need to be recognized: coaching and training; damage control resuscitation; second review of any X-ray exam; continuous monitoring of early and late vascular injuries; and the availability of large spaces for admission and triage of patients, among others.

The shared experience of colleagues who directly faced exceptional mass casualty incidents will allow a deep analysis of extremely complex situations, which are both unexpected and difficult to cope with because of the resources needed and the psychological burden generated. Important principles to follow, medical interventions to prioritize and key points to integrate in the surgeon’s training will emerge from the discussion, raising the awareness of this topic within the orthopaedics and traumatology community.

The symposium “Mass Casualty Incidents Within the Orthopaedics & Traumatology Community” is part of the core scientific program of the EFORT Congress and is open to all fully registered attendees. The EFORT official registration platform to sign-up for the upcoming Vienna meeting will available as of January 2020. Visit the congress website on a regular basis for more updates.