Expectant casualty

EXPECTANT The expectant casualty is one for whom medical care cannot be provided at the medical treatment facility and cannot be evacuated for more advanced care in time to save his life. This category is used only during mass casualty situations. This category does not mean that these casualties will receive medical care. 

Total Expected Casualties = (Number of casualties arriving in one hour window) x 2... 

Expectant casualties with severe life-threatening injuries who would not survive with optimal medical care, or casualties whose injuries are so severe that their chance of survival does not justify expenditure of resources. 

The Threat Cannot Be Defined Solely by the Number of Expected Casualties... 

Typical events that are considered are fire, explosion, ship collision, and the failure of pressurized storage vessels for which historical data established the failure frequencies. Assessment of consequences was based partly on conservative treatment of past experience. For example ilic assessment of the number of casualties from the release of a toxic material was based on past histoiy conditioned by knowledge of the toxicology and the prevailing weather conditions. An altemati. e used fault trees to estimate probabilities and identify the consequences. Credit is taken in this process for preventative measures in design, operation, and maintenance procedures. Historical data provide reliability expected from plant components and humans. 

At the end of World War I, medical thought was turning to the possibility that soldiers who had been gassed with mustard, chlorine, phosgene, and other agents would develop tuberculosis. In the early postwar years, publications described efforts to identify cases of tuberculosis among gas casualties. The expected epidemic failed to appear, and attention subsided. More extensive studies, such as that of Beebe, were initiated.1 Gradually, mustard gas became the... 

Hughes reviewed mainly British and European reports and cited official British data estimating that 75-90% of mustard gas casualties had some degree of ocular Injury. A rough estimate, based on information reported by Case and Lea,13 indicates a little over 100,000 cases of eye Injury. Hughes stated that about 10% of these injuries resulted In corneal erosion, which he considered predictive of visual degeneration. Corneal transplants or contact lenses could be expected to help many patients. 

The British army had ample experience in the Boer War of how accurate rifle Are could inflict heavy casualties and bring a frontal attack to a halt, and the Russo-Japanese War had confirmed that modem artillery could be expected to be very effective against troops in the open. Even before war ceased to be mobile in 1914, troops would dig impromptu Are pits. What was not anticipated was that the unprecedented size of the armies on the Western Front would make it possible to build and defend continuous series of trenches from the Channel to the Swiss border, or that rifles would be supplemented by machine guns in the ratio of 1 to every 20 infantry by 1918 compared with 1 to every 500 in 1914. 

Accidents, such as that in Bhopal or the explosion of an ammonia lorry in Dakar, involve a very large number of casualties. The time to set up the emergency services and the complexity of a 15-min rinse with water require the use of active solutions to reduce the time to action and expect a sufficient reliable effect by stopping the action of the chemical, pending possible management in suitable hospital facilities. 

As expected, attacks on crowded facilities such as airports result in a higher proportion of casualties than attacks on such people-free targets as idle construction equipment. It is significant, though again not unexpected, that there is a relatively high proportion of fatalities in attacks on vehicles... 

A very significant part of the work experience is the friendships that develop from close associations over long periods of time. These friendships become one of the major casualties of retirement. If you have social contact with colleagues outside the workplace, you can expect these friendships to continue. However, if you only see people at work, you can expect these relationships to end with your retirement. Single people who have not developed a social life beyond the workplace find this a particularly frightening prospect. 

There are some facts that are indisputable such as the use of toxic chemicals in the 1914-1918 World War and more recently in the Iran/ Iraq conflict. Although many casualties resulted, the numbers were not exceptionally high in comparison with those from more conventional warfare. Also the use of chemicals was not decisive even in the World War against poorly protected soldiers in a trench warfare scenario in which chemical weapons might be expected to be most effective. 

As nurses try to determine how many casualties a hospital can expect after a mass casualty event, it is important to remember that casualties present quickly and that approximately half of all casualties will arrive at the hospital within a 1 -hour window. 

To predict the total number of casualties your hospital can expect, double the number of casualties the hospital receives in the first hour. 

The total expected number of casualties will be an estimate. Many fac tors may affect the accuracy of this prediction, such as transportation difficulties and delays, security issues that may hinder access to vie tims, and multiple explosions or secondary effects of explosion (such as a building collapse). 

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