Between Issues

Can We Apply the Lessons We Have Learned (or not) From Our Recent Pandemic to Mass Casualty Readiness?

June 24, 2024

Balbino E. Lopez, MD; Nisha Jain, MD; Melissa Chang, MD

Medical Readiness

Anesthesia professionals are uniquely poised in handling challenging scenarios, while also triaging rapidly evolving conditions based on our training. Adaptation and resilience are instinctive, and moreover we learn to anticipate and embrace unpredictability with composure. These are desirable attributes during disastrous scenarios when the population relies on us to assist with a myriad of needs.

We have seen poor preparation for major catastrophic events in the past. If we look at initial responses to the COVID-19 pandemic, we see how under-prepared we were to deal with that crisis, and it led to many facilities experiencing mass casualty like incidents/events.1 Many experienced a failure in preparedness from the U.S. government at both the federal and state levels, as well as from our local healthcare institutions in our response to COVID-19. This lack of preparedness was present despite having recent examples of devastating pandemics around the world (e.g. SARS –CoV in 2003 and H1N1 influenza in 2009). These events have shown how dangerously and how quickly a respiratory virus can spread and devastate a population. The concern for lack of greater preparation to deal with future inevitable pandemics was raised by many after 2009.2,3 However, caution was also raised as “Lessons-learned reports” argued that the global response to H1N1 influenza was too comprehensive, requiring too much resource allocation for preparedness for an event that may never come and the rigidity of the disaster planning did not allow for smaller events to use those resources.3 The disagreement in philosophies for increased vigilance and preparation for future pandemics versus overreaction causing hysteria, economic downturn, and the inconvenience of a shutdown to our infrastructure left us underprepared for the global devastation wrought by the COVID-19 pandemic.

As anesthesia professionals, we should be active participants in disaster/mass casualty preparedness for our hospitals. We should become a part of our institutions’ multidisciplinary crisis team/committee that is tasked with the planning and executing a prepared response to disaster scenarios. These teams will have command of the resources of the hospital during mass casualty situations. Simulations and discussions on how to combat sudden unexpected events should be part of the curriculum. Providing and organizing full scale simulation of a mass casualty event is very difficult and can be resource intensive, which is not viable for many systems. However, targeted simulations to only 1 or 2 aspects of a mass casualty event, such as dealing with blood bank shortages or first line sedative shortages, could be a viable way to practice certain aspects of a mass casualty response.

We can potentially ameliorate the difficulty of mass casualty training and readiness by using our planned measures and resources during instances that would not classify as mass casualty events, but to still treat them as such. For example, using public health medical countermeasures that would normally be needed for bioterrorism, during small scale local/regional events. These events will provide training on the established plans/protocols for designated entities that would be expected to respond.4 In Rhode Island, in 2015 there were two cases of a rare serogroup B meningococcal strain at Providence College. The Rhode Island department of health declared an outbreak and was able to mobilize post-exposure prophylaxis and vaccination to 3,745 students by activating their incident command system and medical emergency distribution system which allowed for quick mobilization of resources to deal with the outbreak and prevent further infections. This provides an excellent opportunity for real-world training and utilization of actual emergency resources during more controlled scenarios, without the need for a fully dedicated simulation. Creating these additional opportunities to test a hospital system’s response will improve performance during actual mass casualty situations. Just as the field of anesthesiology requires standardized simulations for anesthesia trainees, anesthesia professionals should require similar diligence for mass casualty scenarios by our health systems and local/regional authorities. Moreover, it would be prudent for anesthesiology departments to have internal mass casualty preparedness committees as well. These committees would allow for the organization of staff into tiered response teams based on their level of training, subspecialties, and geographic proximity to the institution. Developing phone call/paging lists for staff and creating a protocol for activating these teams will allow efficient mobilization and clear communication during broader triaging efforts by the institution.

In conclusion, an increase in anesthesiology presence during disaster preparation is essential, as our specialty lends itself to crisis management. Anesthesia professionals have a broad skillset that can assist with management starting from triage to critical care management.


Balbino Lopez is an Assistant Professor at University of California Irvine, Orange, California, USA.

Melissa Chang is an Assistant Professor at University of California Irvine, Orange, California, USA.

Nisha Jain is an Assistant Professor at University of Chicago, Chicago, Illinois, USA.

The authors have no conflicts of interest.


  1. Lam CM, Murray MJ. The Multiple Casualty Scenario: Role of the Anesthesiologist. Curr Anesthesiol Rep. 2020;10(3):308-316. doi: 10.1007/s40140-020-00398-2. Epub 2020 Jun 29. PMID: 32837341; PMCID: PMC7322219
  2. Fineberg, Harvey V. Pandemic Preparedness and Response- Lessons from the H1N1 Influenza of 2009. N Engl J Med 2014; 370:1335-1342. DOI: 10.1056/NEJMra1208802
  3. Bourrier MS, Deml MJ. The Legacy of the Pandemic Preparedness Regime: An Integrative Review. Int J Public Health. 2022 Dec 5;67:1604961. doi: 10.3389/ijph.2022.1604961. PMID: 36545404; PMCID: PMC9760677.
  4. Perry IA, Noe RS, Stewart A. Use of Medical Countermeasures in Small-Scale Emergency Responses. Am J Public Health. 2018 Sep;108(S3):S196-S201. doi: 10.2105/AJPH.2018.304491. PMID: 30192656; PMCID: PMC6129655.
  5. WHO. Valuing Health for All: Rethinking and Building a Whole-Of-Society Approach – the WHO Council on the Economics of Health for All – Council Brief No. 3 (2022). Available at:‐‐‐the-who-council-on-the-economics-of-health-for-all‐‐‐council-brief-no.-3