Mass Casualties and Health Care Managers

By Sharon Buchbinder, RN, PhD
Author of Introduction to Health Care Management, 3rd Edition
(This article originally published May 2015)

When we think about mass casualty events, we usually think about natural disasters, such as tornadoes, hurricanes, wildfires, and earthquakes. As noted in my blog on bioterrorism, we healthcare management educators tend not to dwell on or prepare for these and other disasters, such as chemical, biological, radiological, nuclear, and civil unrest. Living in Baltimore, Maryland, recent events have brought the matter home to our healthcare organizations in a way we have not seen since 1968. Peaceful marches and protests simmered in rage and boiled over into violence and fires. Currently, all the players—politicians, gang leaders, pastors, and community members are struggling to pull together to keep our beloved city calm and to support community members who are suffering from mental health issues associated with this tumult. As it became evident that mass casualties could occur, local hospitals were put on alert to receive injured protestors and police officers. But were they prepared?

Hsu, et al. (2004) reviewed articles on the effectiveness of hospital disaster drills, computer simulations, and table top exercises. They found:

  • “Good internal and external communications were critical to success;
  • A well-defined incident command center was a necessity;
  • Accurate phone numbers for key players were required;
  • Disaster drills improved clinicians’ knowledge of hospital disaster procedures;
  • Computer simulations educated key hospital decision makers before implementation of a full-scale drill;
  • Tabletop exercises motivated hospital staff to learn more about disaster preparedness; and,
  • Regional exercises with top government officials helped to increase awareness of the need for better disaster response planning” (Hsu, 2004, p. 2).

It is clear from the literature that we educators must create more opportunities for our students to practice simulations of emergencies in interdisciplinary teams. A 2012 review of the interprofessional simulation-based education (IPSE) literature indicated:

“…IPSE scenarios and debriefing can be effective in facilitating appropriate individual professional responses within the scenarios and reflection on their own and others professional roles…” and “debriefing was vital to delivering the learning outcomes and emphasised the need to utilize faculty experienced in both simulation and debriefing activities.” (Gough, Hellaby, Jones, & MacKinnon 2012, p. 166).

Per the American College of Healthcare Executives, health care managers are expected to be prepared to take action in times of disaster. In an already crowded curriculum and with heavy teaching loads, it can be a challenge to find resources and add disaster preparedness to our to-do list. The Centers for Disease Control and Prevention Office of Public Health Preparedness and Response has online resources for health care managers across a wide array of settings (hospitals and healthcare systems, outpatient settings, long term care, etc.) to plan for and respond to all types of emergencies. These resources can be used to complement textbooks in planning coursework and interprofessional simulations for healthcare management students. Additional resources are available from:

In the face of an upsurge of natural and manmade disasters, hospitals and emergency departments must be prepared. Mass casualties can occur at any given time, even on days when we are celebrating an athletic event. People who made it to the hospital after the bomb went off at the Boston Marathon survived because the hospitals and trauma centers in the city had practiced simulated mass casualty drills well ahead of the terrorist attack (Biddinger, Baggish, Harrington, d’Hemecourt, Hooley, Jones,… Dyer, 2013). As healthcare management educators, it is incumbent upon us to prepare our students to expect the unexpected.


Sharon Buchbinder is Professor and Program Coordinator for the MS in Healthcare Management at Stevenson University in the Graduate and Professional School and former chair of the Association of University Programs in Health Administration (AUPHA). She is also the author of three books from Jones & Bartlett: Introduction to Health Care Management, Cases in Health Care Management, and Career Opportunities in Health Care Management.


Here are some resources if you are interested in this topic:

Agiv-Berland, A., Ashkenazi, I., & Aharonson-Daniel, L. (2012). The Cross-National Adaptability of EMS Protocols for Mass Casualty Incidents. Journal of Homeland Security & Emergency Management, 9(2), -1. doi:10.1515/1547-7355.2036

American College of Healthcare Executives (ACHE). (2013, November 16) Healthcare executives’ role in emergency preparedness: Policy Statement. http://www.ache.org/policy/emergency_preparedness.cfm

Buchbinder, S. (2014, October 6). Bioterrorism and health care managers. Retrieved from http://blogs.jblearning.com/health/2014/10/06/bioterrorism-and-health-care-managers/

Biddinger, P. D., Baggish, A., Harrington, L., d’Hemecourt, P., Hooley, J., Jones, J., & … Dyer, K. S. (2013). Be prepared — The Boston Marathon and mass-casualty events. New England Journal Of Medicine, 368(21), 1958-1960. doi:10.1056/NEJMp1305480

Gough, S., Hellaby, M., Jones, N., & MacKinnon, R. (2012, September). A review of undergraduate interprofessional simulation-based education. Collegian: The Australian Journal of Nursing Practice, Scholarship and Research 19(3), 153-170.

James, J.J., Lyznicki, J.M., & Subbarao, I. (2012). Education and training of health professionals for mass fatality events. In Gursky, E.A. & Fierro, M.F. (2012). Death in large numbers: The science, policy, and management of mass fatality events (pp.427-458). Chicago, IL, American Medical Association..

Homeland Security. (2008). National incident management system. Homeland Security. Retrieved from http://www.fema.gov/pdf/emergency/nims/NIMS_core.pdf

Hsu, E.B., Jenckes, M.W., Catlett, C.L., Robinson, K.A., Feuerstein, C.J., Cosgrove, S.E,, Green, G., Guedelhoefer, O.C., Bass, E.B. (2004, April).Training of hospital staff to respond to a mass casualty incident. Summary, Evidence Report/Technology Assessment No. 95. (Prepared by The Johns Hopkins University Evidence based Practice Center.) AHRQ Publication No. 04-E015-1. Rockville, MD: Agency for Healthcare Research and Quality.

Kelly, M. & Jeffries, P. (2012, September). Clinical simulation in health care: Contemporary learning for safety and practice. Collegian: The Australian Journal of Nursing Practice, Scholarship and Research 19(3), 115-186.

Knudson, L. (2014). Hospital preparedness for a mass casualty event. AORN Journal, 100(3), C1. doi:10.1016/S0001-2092(14)00851-5

Nixon, R. & Shane, S. (2015, April 29). Taking to the Baltimore streets, but for peace and progress. The New York Times. http://www.nytimes.com/2015/04/30/us/taking-to-thebaltimore-streets-but-for-peace-and-progress.html?emc=edit_th_20150430&nl=todaysheadlines&nlid=36799837&_r=0

Reilly, M.J. & Markenson, D.S. (2011). Health care Emergency management: Principles and practice. Sudbury, MA: Jones & Bartlett Learning. http://www.jblearning.com/catalog/9780763755133/

Williams, J-J. (2015, April 30) Mental health help for residents affected by turmoil. The Baltimore Sun. Retrieved from http://www.baltimoresun.com/features/bs-hs-trauma-help-freddie-gray-riots-20150429-story.html

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