Lynchburg Journal of Medical Science

Lynchburg Journal of Medical Science


Emergency Medicine


Professor Tom Colletti, DHSc, PA-C


Introduction (Background and Objectives):

Multi casualty incidents (MCIs) have increased in frequency, overwhelming emergency departments which have a finite amount of resources. Point-of-care ultrasound is commonly incorporated in the evaluation and re-evaluation of acute trauma patients. The purpose of this study was to determine point-of-care ultrasound diagnostic advantages and effects upon mis-triaged patients.

Methods: (Design and Main Outcome Measures)

A review of the published literature was conducted regarding ultrasound use in MCIs. The utility of ultrasound was evaluated to determine its significance for the triage process and the potential to propose ultrasound use in an algorithm for patient care and flow in the emergency department during an MCI.


Focused Assessment with Sonography for Trauma (FAST) ultrasound techniques consistently demonstrated high specificity in its diagnostic capabilities with low sensitivities. False negatives being approximately 10% cumulatively in the MCI setting.


The FAST ultrasound protocol has a limited utility in an MCI due to its inability to rule out abdominal trauma. Ultrasound’s anticipated benefits in the management of patients in an MCI are in the extended-FAST (eFAST) protocol for the evaluation of pneumothoraces and the assessment of the inferior vena cava in the prediction for patient progression to shock.


Insufficient evidence has been found in the literature to recommend ultrasound use in MCIs when utilizing the FAST protocol. Further research is needed in the areas of eFAST protocol and the evaluation of the inferior vena cava, which shows promise in the management of MCIs.


FAST, mass casualty incident, MCI, START, triage, ultrasound.


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