title: Indoor fire in a nursing home: evaluation of the medical response to a mass casualty incident based on a standardized protocol.
abstract: OBJECTIVE
  This retrospective study reports the outcome of a mass casualty incident (MCI) caused by a fire in a nursing home.
  
  
  METHODS
  Data from the medical charts and registration system of the Major Incident Hospital (MIH) and ambulance service were analyzed. The evaluation reports from the MIH and an independent research institute were used. The protocol for reports from major accidents and disaster was used to standardize the reporting [Lennquist, in Int J Disaster Med 1(1):79-86, 2003].
  
  
  RESULTS
  The emergency services were quickly at the scene. The different levels of pre-hospital management performed a tight coordination. However, miscommunication led to confusion in the registration and tracking of patients. In total, 49 persons needed medical treatment, 46 were treated in the MIH. Because of (possible) inhalation injury nine patients needed mechanical ventilation and nine patients were hospitalized to exclude delayed onset of pulmonary symptoms. No incident related deaths occurred. The intensive care unit of the MIH was initially understaffed despite the efforts of the automated calling system and switchboard operators. The handwritten registration of incoming staff was incomplete and should be performed digitally. Some staff members were unfamiliar with the MIH procedures. The medical chart appeared too extensive. Miscommunication between chain partners resulted in the delayed sharing of (semi) medical information.
  
  
  CONCLUSIONS
  The different levels of incident managers performed a tight coordination. The MIH demonstrated its potency to provide emergency care for 46 patients and 9 intubated patients. No deaths or persistent disabilities occurred. Areas of improvement were recognized both in the pre-hospital as the hospital phase.
authors.affiliation: Major Incident Hospital, University Medical Center Utrecht, Utrecht, The Netherlands, swkoning@gmail.com.
authors.forename: S W
authors.initials: SW
authors.lastname: Koning
authors.forename: P M
authors.initials: PM
authors.lastname: Ellerbroek
authors.forename: L P H
authors.initials: LP
authors.lastname: Leenen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002056:Burns / Q000401:mortality / Q000628:therapy*; D004189:Disaster Planning / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D005390:Fires; D006801:Humans; D008297:Male; D054527:Mass Casualty Incidents / Q000706:statistics & numerical data*; D009426:Netherlands / Q000453:epidemiology; D009735:Nursing Homes; D012189:Retrospective Studies; D015208:Smoke Inhalation Injury / Q000401:mortality / Q000628:therapy*; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy*