Sooner or later, ten casulties, or fifty, or even a hundred or more will arrive in your hospital after a bus accident, a fire or some civil disturbance. What are you going to do? The first principle is to approach the problem calmly and thoughtfully, avoiding undue hurry. The second is to have a practical plan prepared and know what it is. With luck, you will have warning of the disaster. More often, your first awareness of it will be the sudden arrival of many patients. The first half hour will be the worst, and if this goes smoothly, the rest of the plan probably will too.
Your first requirement will be space. One way to obtain it is to evacuate a ward, and, if necessary, to remove the beds. There will be room for more patients if you put mattresses for them in rows on the floor.
The most surgically experienced person should ‘triage‘ (grade) the casualties. First, separate the living from the dead. Then grade the living into three groups. Priority One patients have life threatening injuries, such as penetrating wounds of the chest or abdomen, head injuries, or hypovolaemic shock. These are the patients whose lives you might save and who need an immediate operation. Priority Two patients have such severe injuries that they are likely to die anyway. Priority Three patients have only minor injuries and will probably recover, even if treatment is delayed. Operate on them last.
The decisions as to what to do with each patient should be made by the triage officer. It is the task of the non–surgeons to set up drips and take blood, etc. In a big disaster, and if you have enough staff, divide them into two shifts, each of which works for 12 hours, and then has 12 hours rest. There will be plenty to do, so make sure that everyone has some useful task and does it.