Abstract

A mass casualty (MASCAL) event is different to a major incident. The crux of this difference is that in a major incident, by the adoption of special measures, normal or near-normal standards of care can be maintained. In a MASCAL, irrespective of what special measures are instituted, standards of care inevitably drop. This is a, currently unmet, challenge for medical planning and planning policy. Twenty-First century weaponry is capable of producing thousands of causalities a day over a period of several days in peer-on-peer conflict. In this chapter, we propose that medical planning for military events on this scale should include the following: explicit acceptance that ‘gold standard’ care cannot be given to patients who are triaged for treatment, a better understanding how to identify those patients who will not be triaged for treatment, a focus on ensuring patient flow (which includes diversion, self-care and remote monitoring), and implementation of the principle that care should be given by the lowest capable provider. We attempt to begin to develop some principles for planners to consider drawing on historical precedents and explore some of the ethical implications of our proposals.