Date Published

May 13, 2014

Updated For

ALS PCS Version ALS PCS Version 5.2


Question: I have a question regarding an MCI scenario. There is a total of 10 patients; 3 patients are dead from trauma and 7 patients are cleared off scene from other ambulances. You now have the 3 black tag patients left. Do we need to re-assess these patients and get trauma TOR for each one?


 Thanks for your question. This is very similar to another ASKMAC question posted on Sept 4, 2012.

This exact scenario was actually the focus of a live rounds discussion on MCI patient management last year.

The power point and Webinar can be found on our website here under MCI Jan 2011:

What we would suggest is to first consider your triage scheme. In mass casualty triage, your resources are overwhelmed (10 patients and one paramedic crew). In this circumstance and triage mode, your care must be directed to the most injured patients who have the highest chance of survival (not the VSA patients initially). Once however more crews arrive, your resources will no longer be overwhelmed and you should now revert back to multiple casualty triage where your care is now directed to the patients who are most unwell.

In the scenario you describe, this would now mean that (once you have adequate resources) you attend to the patients who are VSA assuming that they do not meet the criteria for obviously dead. These patients require assessment regardless as they have not been pronounced, and the trauma TOR would most likely be the result. The alternative would be to leave three patients VSA on scene who have had no medical assessment or pronouncement and this would not seem reasonable.



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