Description of procedures performed on patients by emergency medical services during mass casualty incidents in the United States

Abstract

Background Emergency medical services (EMS) preparedness is essential to reduce morbidity and mortality from mass casualty incidents (MCIs). Objectives We sought to describe types and frequencies of common procedures performed during MCIs by EMS providers at different service levels. Methods This study was carried out using the 2012 US National EMS Public-Release Research Dataset maintained by the National Emergency Medical Services Information System. Emergency medical services activations coded as MCI at dispatch or by EMS personnel were included. The Center for Medicare and Medicaid Services service level was used for the level of service provided. A descriptive analysis characterizing the most common procedure types and frequencies by service level was carried out. Results Among the 19 831 189 EMS activations in the 2012 national data set, 53 334 activations had an MCI code, of which 26 110 activations were included. There were 8179 advanced life support (31.3%), 5811 basic life support (22.3%), 399 air medical transport (air transport fixed or rotary) (1.5%), and 38 specialty care transport (0.2%) activations. A total of 107 different procedure types were reported. The most common procedures by procedure count were "spine immobilization" (21.8%) followed by "venous access extremity" (14.1%) and "assessment adult" (13.4%). A similar order was found for procedure frequencies by included EMS activations (24.1%, 19.3%, and 18.3%, respectively). Top 20 procedures had different frequencies by levels of care except for "medical director control" (P =.19). Conclusions Advanced EMS interventions are not frequent during MCIs in the United States. Emergency medical services systems with other types of providers or MCI response patterns might report different findings.