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The initial response to mass casualty incidents is usually informal as uninjured and injured survivors and passersby assist the injured and take them to medical centers. This creates some problems, for example, most victims go to one or two hospitals and the least injured arrive first; but, on the whole, it works. However, the same response does not work when victims are contaminated, and some of the solutions that work when victims are only injured do not work when victims are contaminated. This article suggests an approach that accepts the reality of what happens—the first receiving hospital becomes contaminated—and suggests how planning can begin with that as a starting point. It stressed that current plans are based on false assumptions and that this can lead to inadequate preparation.

Original publication




Journal article


American Journal of Disaster Medicine


Weston Medical Publishing

Publication Date





95 - 105