Original Publication
Open Access

Multiple Casualty Scenario from a Bomb/Blast Injury

Published: April 1, 2015 | 10.15766/mep_2374-8265.10065

Included in this publication:

  • Instructor's Guide.docx
  • Blast Injury Simulation Mass Casualty Scenario.docx
  • Neg US FAST Bladder.jpg
  • Neg US FAST Cardiac.jpg
  • Neg US FAST Splenorenal.jpg
  • Neg US FAST Hepatorenal.jpg
  • Pos US FAST Hepatorenal.jpg
  • Pos US FAST Cardiac Tamponade.jpg
  • US Thorax No Sliding.jpg
  • US Thorax Normal Sliding.jpg
  • Pediatric CXR Negative.jpg
  • CXR Adult Negative.jpg
  • CXR Pneumothorax Deep Sulcus Sign.jpg
  • Pelvis X-ray Negative.jpg

To view all publication components, extract (i.e., unzip) them from the downloaded .zip file.

Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.


The purpose of this resource is to provide emergency medicine residents with an opportunity to practice triaging and caring for patients in a mass casualty situation. This scenario includes seven high-fidelity simulators and five standardized patients as casualties. The learners have an opportunity to improve their skills in managing and prioritizing multiple casualties, including patients with less commonly seen injuries in civilian practice, such as amputations and junctional (femoral/axillary) wounds with significant hemorrhage. The implementation of this mass casualty scenario requires a large amount of time, manpower, and energy for execution. This involves coordinating approximately 20 persons involved in the scenario as confederates, staging managers, etc. This emphasizes the importance of all personnel arriving prepared and very familiar with the scenario and their roles. It also highlights the importance of having a functional and robust backchannel communication system, as in our experience, we required at least five active channels to work seamlessly without a problem. The importance of improvisation, as in any simulation, is also important in a scenario with seven simulators and five live patients, as the increased number of mannequins and actors increases the likelihood that things may not go exactly as planned. Despite all of these logistics that can be challenging to coordinate, we feel the return on investment of giving our trainees this experiential learning experience is worth the time and effort invested, as this is an experience that they will not get very frequently and may be relied on as the chief decision maker in future mass casualty situations.

Educational Objectives

By the end of this session, learners will be able to:

  1. Manage and prioritize multiple casualties from a bomb/blast incident concomitantly.
  2. Organize team and individual roles in order to care for all casualties effectively.
  3. Prioritize which patients need to go to the operating room expediently.
  4. Be aware of scene safety.
  5. Manage patients in hemorrhagic shock; volume resuscitation with crystalloid and packed red blood cells
  6. Manage amputations-demonstrate correct technique when applying tourniquet.
  7. Manage exsanguinating junctional wounds-demonstrate correct technique when packing a junctional wound with purposes of hemorrhage control.
  8. Manage pneumothoraces.
  9. Manage severe traumatic brain injury patients requiring intubation.
  10. Manage pregnant patients with severe blunt abdominal trauma.
  11. Manage children with blunt trauma.
  12. Manage patients with penetrating neck wounds and airway compromise.
  13. Effective and expedient use of ultrasound in trauma.

Author Information

  • Benjamin Weston, MD: Hennepin County Medical Center
  • Nicholas Simpson, MD: Hennepin County Medical Center
  • Danielle Hart, MD: Hennepin County Medical Center
  • Lisa Fitzgerald-Swenson, RN: Hennepin County Medical Center
  • John Hick, MD: Hennepin County Medical Center

None to report.

None to report.


Weston B, Simpson N, Hart D, Fitzgerald-Swenson L, Hick J. Multiple casualty scenario from a bomb/blast injury. MedEdPORTAL. 2015;11:10065. https://doi.org/10.15766/mep_2374-8265.10065