How does the principle of prioritisation differ between ordinary emergency care and a mass casualty incident? ANSWER: ORDINARY The SICKEST patient is treated first. This works because resources are adequate — treating them does not prevent anyone else being treated. MASS CASUALTY The GREATEST NUMBER WHO CAN BE SAVED comes first, because resources are NOT adequate. WHY THE REVERSAL: the most severely injured patient may absorb a theatre, the surgical team and the available blood — and still die — while five salvageable patients deteriorate untreated. CONSEQUENCE: a patient who would receive full resuscitation on a normal day may instead receive analgesia and comfort. That is arithmetic under conditions nobody would choose, not a judgement about their worth.

What does the EXPECTANT triage category mean, and what care do those patients receive? ANSWER: injuries not survivable WITH THE RESOURCES AVAILABLE. The qualifier is essential — the same injury might well be survivable in a fully staffed hospital on an ordinary day. The category is a statement about the situation, not only about the patient. THEY ARE NOT ABANDONED. Expectant patients receive: - analgesia - comfort and shelter - someone with them where staffing allows AND THEY ARE REASSESSED: an expectant patient may become salvageable when a surgical team arrives or transport becomes available. Failing to provide comfort care is a failure of care, not a consequence of triage.

What is the commonest operational failure during triage at a mass casualty incident? ANSWER: the triaging clinician STOPS TO TREAT a patient. WHY IT IS SO DAMAGING: 1. The moment they stop, nobody is sorting the remaining casualties. 2. The system reverts to first-come-first-served — which is precisely what triage exists to prevent. 3. The casualties who most need identifying are the ones not yet seen. IT IS ALSO ENTIRELY HUMAN: every instinct of clinical training says treat the person in front of you. MITIGATION: triage should be performed by the MOST SENIOR available clinician — the judgement is difficult — and that person must keep moving. Re-triage at every stage: scene, arrival, after treatment, and when resources change.

Two weeks after an earthquake, what are the leading causes of death among survivors? ANSWER: NOT trauma. Deaths from crush injury are concentrated in the first hours and days. The later deaths come from DISPLACEMENT AND CROWDING: - diarrhoeal disease from unsafe water and poor sanitation - respiratory infection - measles outbreaks among crowded unvaccinated children - malnutrition in children and the elderly - INTERRUPTED CHRONIC TREATMENT — insulin, antiepileptics, TB and HIV therapy stopped when pharmacies and clinics are destroyed PRIORITIES THAT FOLLOW: water, sanitation, shelter, food, measles vaccination and disease surveillance — plus restoring chronic medication supply, which is routinely overlooked in favour of visible trauma.

Do unburied dead bodies after a natural disaster cause epidemics? ANSWER: No. This is a persistent and harmful myth. 1. Victims of trauma were not infectious at the moment of death. 2. The organisms of decomposition are not epidemic pathogens. THE HARM THE MYTH CAUSES: rushed anonymous mass burial means families cannot identify their dead, and legal processes — death registration, inheritance, remarriage — become impossible for years. WHAT SHOULD HAPPEN: bodies handled with dignity and identified where possible. WHERE THE REAL EPIDEMIC RISK LIES: with the LIVING survivors — their water supply, sanitation and crowding.

Why is community preparedness more important than the speed of external rescue teams? ANSWER: because MOST RESCUES ARE PERFORMED BY LOCAL PEOPLE in the first hours. 1. Survivors trapped in rubble are usually freed by neighbours, using their hands and whatever is at hand. 2. External teams arrive after the most critical hours have passed — travel, mobilisation and access all take time. 3. Therefore basic first aid training and community preparedness save more lives than specialist teams arriving later. RELATED PREPAREDNESS POINTS: - A plan nobody has REHEARSED is not a plan; staff must have practised their own role. - The HOSPITAL must survive the event — a collapsed or flooded hospital removes response capacity at the moment of greatest need. - A single clear command structure, and a plan for when phones fail.