Who should worry for the "Worried Well"? Analysis of mild casualties center drills in non-conventional scenarios

Introduction: A mass toxicological event (MTE) caused by an act of terrorism or an industrial incident can create large numbers of ambulatory casualties suffering from mild intoxication, acute stress reaction (ASR), and exacerbation of chronic diseases or iatrogenic insult (such as atropine overdose). The logistical and medical management of this population may present a challenge insuch a scenario. The aim of this article is to describe the concept of the Israeli Home Front Command (HFC) of a "Mild Casualties Center" (MCC) for a chemical scenario, and to analyze the results of two large-scale drills that have been used to evaluate this concept. Methods: Two large-scale drills were conducted. One MCC drill was located in a school building and the second MCC drill was located in a basketball stadium. These medical centers were staffed by physicians, nurses, and medics, both military (reservists) and civilian (community, non-hospital teams). Two hundred simulated patients entered the MCC during each of the drills, and drill observers assessed how these patients were managed for two hours. Results: Of the casualties, 28 were treated in the "medical treatment site", 10 of which were relocated to a nearby hospital. Only four casualties were treated in the large "mental care site", planned for a much higher burden of "worried well" patients. Documentation of patient data and medical care was sub-optimal. Conclusion: A MCC is a logistically suitable solution for the challenge of managing thousands of ambulatory casualties. The knowledge of the medical team must be bolstered, as most are unfamiliar with both nerve gas poisoning and with ASR. Mild casualties centers should not be located within hospitals and must be staffed by non-hospital, medical personnel to achieve the main task of allowing hospital teams to focus on providing medical care to the moderate and severe nerve gas casualties, without the extra burden of caring for thousands of mild casualties.