Lack of hospital beds could hinder response to mass casualty incident, meeting told

The extraordinarily high level of bed occupancy in Irish hospitals would cause great difficulty if the country faced a major terrorist attack or natural disaster, attendees at a talk on planning for a mass casualty incident heard on Friday.

"Bed occupancy should only be at 90 per cent capacity but there is currently a crisis in beds in the HSE," said Dr Morgan P McMonagle, vascular and trauma surgeon at University Hospital Waterford.

At the Royal College of Surgeons 2022 charter meeting on planning for a mass casualty incident, some experts pointed to bed occupancy levels at more than 110 per cent in Dublin hospitals.

Acknowledging the problem, Dr Ciaran Browne, national emergency planning lead for acute hospitals operations in the HSE, said it is still important all hospital staff know the details of the HSE's approach to dealing with a mass casualty incident.

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“We should lower the threshold of how we declare a major incident so hospital personnel can run through [the plan] two or three times a year,” he said.

The HSE’s mass casualty incident plan deals with everything from on-scene management of people injured following a train crash or a building fire to alerting hospitals to instigate surge capacity. It also deals with putting support services in place, managing communications and the psychosocial response.

Poor communications

Dr David Menzies, consultant in emergency medicine at St Vincent's University Hospital, said poor communications between agencies and personnel has almost always been identified as the biggest failing following terrorist attacks or natural disasters that resulted in large numbers of people injured and/or dead.

Speaking about international experiences of dealing with mass casualty incidents, Dr Harold Veen from the World Health Organisation (WHO) said crowd control is a top priority. "Nobody without a specific role should be in areas where a mass casualty incident is managed. The moment that the chaos of the incident is transferred into emergency departments, medical personnel can't work properly and the results will be poor," he said.

The HSE is planning to do a simulated mass casualty incident involving all Dublin hospitals later in 2022. “While the Covid pandemic helped hospitals manage patient flow, it is important to stress test the mass casualty incident plan so each hospital can look at its own major emergency plans,” said Dr Browne.

He added that planning how less critically ill patients in major hospitals can be transferred to other hospitals and how adult hospitals could deal with children if Children's Hospital Ireland hospitals were overwhelmed is important. "It is not just like a busy day in the emergency department," he added.

The three major trauma centres on the island of Ireland in Dublin, Belfast and Cork will partake in the WHO Academy training programme on mass casualty management in June.