Recommendations for nonantidote medications needed in the emergency department during a mass casualty incident

Extract

Mass casualty incidents (MCIs) encompass any scenario that can dramatically impact emergency medicine or healthcare systems by causing a large number of casualties or other stressors to the system, including personnel, medications, and equipment burden.¹ This can include acts of terrorism (eg, explosions, chemical exposures, cyberterrorism), mass-transit incidents, natural disasters (eg, earthquakes, floods), and fires. While health systems, as well as governmental organizations, often proactively develop plans to respond to certain threats, unanticipated barriers to their deployment and confusion surrounding who is ultimately responsible for activating, allocating, and distributing resources may lead to delays that have the potential to adversely impact patient care. Appropriate planning on behalf of local healthcare systems and governments is essential to ensure that patients’ needs are met during these overwhelming events.

Although expert consensus guidelines for the stocking of antidotes have been published, discordance remains among hospitals with regard to the extent of their planning and stocking for medication needs outside of antidote-specific guideline recommendations.² The purpose of this article is to describe nonantidotal medication use in MCI literature and provide recommendations addressing anticipated needs during the early management of affected patients. These recommendations are intended to serve as a starting point for the development of protocols and processes for managing medication needs, which is just one component of the multifaceted action plan, which also requires optimization of patient registration and tracking systems, treatment prioritization, family reunification plans, and coordination with external emergency entities. This article represents an opinion of the Emergency Medicine Practice and Research Network of the American College of Clinical Pharmacy.