title: Development of the science of mass casualty incident management: reflection on the medical response to the Wenchuan earthquake and Hangzhou bus fire.
abstract: OBJECTIVE
  In this paper, we review the previous classic research paradigms of a mass casualty incident (MCI) systematically and reflect the medical response to the Wenchuan earthquake and Hangzhou bus fire, in order to outline and develop an improved research paradigm for MCI management.
  
  
  METHODS
  We searched PubMed, EMBASE, China Wanfang, and China Biology Medicine (CBM) databases for relevant studies. The following key words and medical subject headings were used: 'mass casualty incident', 'MCI', 'research method', 'Wenchuan', 'earthquake', 'research paradigm', 'science of surge', 'surge', 'surge capacity', and 'vulnerability'. Searches were performed without year or language restriction. After searching the four literature databases using the above listed key words and medical subject headings, related articles containing research paradigms of MCI, 2008 Wenchuan earthquake, July 5 bus fire, and science of surge and vulnerability were independently included by two authors.
  
  
  RESULTS
  The current progresses on MCI management include new golden hour, damage control philosophy, chain of survival, and three links theory. In addition, there are three evaluation methods (medical severity index (MSI), potential injury creating event (PICE) classification, and disaster severity scale (DSS)), which can dynamically assess the MCI situations and decisions for MCI responses and can be made based on the results of such evaluations. However, the three methods only offer a retrospective evaluation of MCI and thus fail to develop a real-time assessment of MCI responses. Therefore, they cannot be used as practical guidance for decision-making during MCI. Although the theory of surge science has made great improvements, we found that a very important factor has been ignored-vulnerability, based on reflecting on the MCI response to the 2008 Wenchuan earthquake and July 5 bus fire in Hangzhou.
  
  
  CONCLUSIONS
  This new paradigm breaks through the limitation of traditional research paradigms and will contribute to the development of a methodology for disaster research.
authors.affiliation: Department of Emergency Medicine, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China.
authors.forename: Wei-feng
authors.initials: WF
authors.lastname: Shen
authors.forename: Li-bing
authors.initials: LB
authors.lastname: Jiang
authors.forename: Guan-yu
authors.initials: GY
authors.lastname: Jiang
authors.forename: Mao
authors.initials: M
authors.lastname: Zhang
authors.forename: Yue-feng
authors.initials: YF
authors.lastname: Ma
authors.forename: Xiao-jun
authors.initials: XJ
authors.lastname: He
mesh_terms: D002681:China; D003657:Decision Making; D004189:Disaster Planning; D055866:Earthquakes; D004632:Emergency Medical Services; D005390:Fires; D006801:Humans; D054527:Mass Casualty Incidents; D017146:Models, Organizational; D012189:Retrospective Studies; D055872:Surge Capacity
keywords: Earthquake; Fire incident; Mass casualty incident; Surge; Vulnerability