American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Disaster and Mass Casualty Bibliography

Blast | Burn Mass Casualty Events | General/Epidemiology/History | Natural Disasters | Planning/Incident Command | Psychosocial/Stress/Aftermath | Terrorism: General | Training | Triage/Surge Capacity | WMD: Chemical/Radiological


Aylwin CJ, Koenig TC, Brennan NW et al. Reduction in critical mortality in urban mass casualty incidents: Analysis of triage, surge, and resource use after the London bombings of July 7, 2005. Lancet. 2006;368:2219-2225

A comprehensive analysis of the hospital-based response to the London subway bombings, this paper focuses on the consolidation and definitive care phase of the disaster response and the ongoing workload imposed on the trauma center and system.

Frykberg ER, Tepas JJ. Terrorist bombings: Lessons learned from Belfast to Beirut. Ann Surg. 1988;208:569-576

A now classic paper that establishes a pattern of injury exists subsequent to blast events. Established the concept of critical mortality rate (CMR) and defines the case for appropriate triage by linking increased CMR with overtriage.

DePalma RG, Burris DG, Champion HR, et al. Blast injuries. New Engl J Med. 2005;352:1335-1342.

A useful overview of the physics and pathophysiology of blast injury, and how this construct relates to the proper evaluation and care of blast casualties.

Born CT. Blast trauma: The fourth weapon of mass destruction. Scand J Surg. 94:279-285.

A comprehensive review of the history of major explosive disasters, the physics and biodynamics of blasts, and how this construct relates to the injuries that should be anticipated for effective disaster planning and management.

Sheffy N, Mintz Y, Rivkind AI, Shapira SC. Terror-related injuries: A comparison of gunshot wounds versus secondary-fragments-induced injuries from explosives. J Am Coll Surg. 2006;203:297-303.

A retrospective review of mass casualty victims from terrorist events in Israel showing a significantly increased rate of complications and mortality among those critically injured from bomb blast fragments compared with those from gunshot wounds, thus, indicating that the complexity of wounds and decision-making from terrorist bombings is a surgical challenge requiring education and preparation for their proper handling.

Burn Mass Casualty Events

Mahoney EJ, Harrington DT, Biffl WL, Metzger J, Oka T, Cioffi WG. Lessons learned from a nightclub fire: Institutional disaster preparedness. J Trauma. 2005; 58:487-491.

An organized account of the distribution and care of more than 200 victims of a major fire in the state of Rhode Island. It documents the contribution of a statewide disaster system, based on its trauma center network and active planning efforts, to the successful outcome of the medical response. Barriers to the disaster response were also identified and solutions proposed for the future.

Tekin A, Namias N, O’Keeffe T, et al. A burn mass casualty event due to boiler room explosion on a cruise ship: preparedness and outcomes. Am Surg. 2005;71:210-215.

An account of 15 burned patients presenting to a major Level I trauma center in Miami, FL, following a boiler room explosion and fire in 2003, with 45 percent critically burned, of whom 86 percent died. Injury patterns, prognostic factors, and the importance of disaster preparedness to handle such a casualty load are well reviewed by the authors.

Rosenberg B, Sternberg N, Zagher V, et al. Burns due to terroristic attacks on civilian populations from 1975 to 1979. Burns. 1982;9:21-23.

A landmark account of burn injury patterns in a mass casualty setting from Israel.


Arnold JL. Disaster medicine in the 21st century: Future hazards, vulnerabilities and risk. Prehosp Disast Med. 2002;17:3-11.

Study author reviews the conditions, both natural and man-made, which predispose a population to an increased likelihood of disasters and mass casualty events. Discusses common myths of disaster medicine.

Ciraulo DL, Barie PS, Briggs SM, et al. An update on the surgeon’s scope and depth of practice to all hazards emergency response. J Trauma. 2006;60:1267-1274.

A position paper of the Eastern Association for the Surgery of Trauma in which the authors review the major mass casualty disasters likely to confront medical providers, and the importance of surgeon leadership in disaster planning and management.

Gutierrez de Ceballos JP, Turegano Fuentes F, Perez Diaz D, et al. Casualties treated at the closest hospital in the Madrid, March 11, terrorist bombings. Crit Care Med. 2005;33:S107-112.

This report describes how a large university hospital coped with a large-scale urban mass casualty incident in Madrid, 2005. It emphasizes the concept that only a small fraction of the casualty load consists of critically injured patients, and very few require immediate surgery.

Klein JS, Weigelt JA. Disaster management: lessons learned. SCNA. 1991;71:257-266

A critical review of the experience of Parkland Hospital (Dallas,TX) in response to major airline crashes. Authors identify common and repeated obstacles to performance such as planning and communications, and make a strong case for the value of incident command.

Mahoney LE, Reutershan TP. Catastrophic disasters and the design of disaster medical care systems. Ann Emerg Med. 1987;16:1085-1091.

A landmark article that reviews the elements of medical systems that are essential for a successful medical response to mass casualty disasters.

O’Neill PA: The ABC’s of disaster response. Scand J Surg. 2005;94:259-266.

An excellent review of the basic principles and issues of disaster response at the prehospital and hospital levels, with a description of the structure, role, and importance of the Incident Command System.

Waeckerle JF: Disaster planning and response. NEJM. 1991;324:815-821.

A concise review of basic principles of disaster planning and response that serves as a useful guide for all who wish to become acquainted with this field. 

Natural Disasters

Norcross ED, Elliott BM, Adams DB, Crawford FA. Impact of a major hurricane on surgical services in a university hospital. Am Surg. 1993;59:28-33.

An informative account of the medical management of victims of Hurricane Hugo in Charleston, SC, in 1989, and what problems and resources should be anticipated in the wake of these disasters.

Noji EK. The medical consequences of earthquakes: coordinating the medical and rescue response. Disaster Management.1991;4:32-40.

An excellent review of general patterns of destruction and injury found after major earthquakes, and the implications for the medical and rescue response, by one of the world’s leading authorities in this field.

Cocanour CS, Allen SJ, Mazabob J, et al. Lessons learned from the evacuation of an urban teaching hospital. Arch Surg. 2002;137:1141-1145.

An account of the impact of Hurricane Alison and subsequent flooding in Houston, TX, on the delivery of medical services, providing important lessons for future similar events.

Abramson, DM, Park YS, Stehling-Ariza, T, Redlener, I. Children as Bellwethers of Recovery: Dysfunctional Systems and the Effects of Parents, Households, and Neighborhoods on Serious Emotional Disturbance in Children After Hurricane Katrina. September 2010.  Disaster Medicine and Public Health Preparedness.

Planning/Incident Command

Auf der Heide E. The importance of evidence-based disaster planning. Ann Emerg Med. 2006;47:34-49.

Author reviews seven common flawed assumptions of occurrences and behaviors in disaster responses, with an overview of current research from actual events that dispels many of these myths. The need for continued research into disaster principles and management is emphasized to develop realistic plans that can optimize disaster response.

Burnett DJ, Balicer RD, Blodgett D, et al. The application of the Haddon Matrix to public health readiness and response planning. Environ Health Perspect. 2005;113:561-566.

Authors provide a novel application of an established injury prevention tool to emergency preparedness.

Hirshberg A, Holcomb JB, Mattox KL. Hospital trauma care in multiple-casualty incidents: A critical view. Ann Emerg Med. 2001;37:647-652.

This review is a first attempt to address the specific implications of disaster preparedness on trauma care for severely injured patients. It addresses planning and training issues, triage, and quality of trauma care in disasters.


Hammond JS, Brooks J. The World Trade Center Attack: Helping the helpers: The role of critical incident stress management. Crit Care 2001; 5:315-317.

Authors provide an introduction to the rationale and methodology of critical incident stress management as an effective tool to assure the welfare of disaster responders.

Terrorism: General

Arnold J, Halpern P, Tsai M, Smithline H. Mass casualty terrorist bombing: A comparison of outcomes by bombing type. Ann Emerg Med. 2004;43:263-273.

Authors provide a review of 29 bombings over past 30 years which resulted in less than 30 casualties, and describe patterns of injury and health system use.

Slater MS, Trunkey DD. Terrorism in America: An evolving threat. Arch Surg. 1997;132:1059-1066.

Authors present a comprehensive review of the emerging threat of terrorism in the U.S., and issue a call to action by surgeons.


Lennquist S. Education and training in disaster medicine. Scand J Surg. 2005;94:300-310.

Lennquist presents an excellent review of the rationale and methodology for effective training in disaster preparedness and management, including a list of some major training programs in the world.

Hirshberg A, Stein M, Walden R: Surgical resource utilization in urban terrorist bombing: A computer simulation. J Trauma. 1999;47:545-550.

Authors present a unique study of proper preparedness for disaster response using a computer simulation of a disaster based on data from actual events. They illustrate the typical problems with conventional disaster planning and how this information may be used to more realistically anticipate hospital resource needs

Triage/Surge Capacity

Ashkenazi I, Kessel B, Khashan T, Haspel J, Oren M, Olsha O, Alfici R. Precision of in-hospital triage in mass-casualty incidents after terror attacks. Prehosp Disas Med. 2006;21:20-23.

Authors present a retrospective study of the accuracy of triage decisions rendered to mass casualties from two large incidents in Israel, showing high levels of inaccuracy even from the most experienced trauma surgeons, as compared to objective measures of injury severity. This study emphasizes the need for backup mechanisms of continual reassessment.

Frykberg ER. Triage: principles and practice. Scand J Surg. 2005;94:272-278.

Author reviews the essential principles of triage, and the unique applications of this concept that must be applied in mass casualty events, including the importance of triage accuracy, error-tolerant systems of response, the role of the triage officer, and decision-making.

Hirshberg A, Scott B, Granchi T et al. How does casualty load affect trauma care in urban bombing incidents? A quantitative analysis. J Trauma. 2005;58:686-695.

The authors present an objective review of terror bombings, and employ a computer model of trauma center response. They identify factors that will contribute to the degradation of quality of care as patient volume increases.

Lerner EB, Schwartz RB, Coule PL et al: Mass casualty triage: An evaluation of the data and development of a proposed national guideline. Dis Med and Pub Health Prep. 2008;2:S25-S34

Study compares and contrasts nine international triage schema and critiques current practices, and describes how a multi-disciplinary work group developed and proposes a simplified approach entitled SALT (Sort, Assess, Life-saving treatment, Transport).

WMD: Chemical/Radiological

Chambers JA, Purdue GF. Radiation injuries and the surgeon. J Am Coll Surg. 2007;204:128-139.

Authors present a thorough review of acute care and surgical/critical care issues after radiological injury and acute radiation syndrome and provide 73 references.

Fry DE, Schecter WP, Parker JS, et al. The surgeon and acts of civilian terrorism: biologic agents. J Am Coll Surg. 2005;200:291-302.

Authors present a comprehensive and useful review of principles and agents of bioterrorism, and discuss the role of surgeons in mass casualty events involving this mechanism. This is the first of three articles on unconventional civilian disasters contributed by the Board of Governors of the American College of Surgeons.

Eachempati SR, Flomenbaum N, Barie PS. Biological warfare: current concerns for the health care provider. J Trauma. 2002;52:179-186.

Authors provide a collective review of the relevant aspects of bioterrorism that all health care providers should know to optimize casualty outcomes from mass casualty biological events.

Kiem ME. Terrorism involving cyanide: The prospect of improving preparedness in the prehospital setting. PreHosp Dis Med. 2006;21:s56-s60.

Author provides a good review of the pathophysiology and management of cyanide toxicity.

Schecter, WP, Fry DE: The surgeon and acts of civilian terrorism: chemical agents. J Am Coll Surg. 2005;200:128-135.

This article is the second in the American College of Surgeons series on terrorist disasters, and addresses the pathophysiology and the principles of evaluation and management of mass casualty events from chemical agents. 

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