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PC 4 - Mass casualties
Emergency Imaging Forensic Imaging Medico-legal Education
Wednesday, February 28, 16:00 - 17:30
Room: E2
Moderator: S. Vaidya (London/UK)

Chairperson's introduction
M. Scaglione1, S. Vaidya2; 1Castel Volturno/IT 2London/UK
Learning Objectives

1. To understand about the need of a new plan for emergency hospitals.
2. To became familiar with the range of imaging findings related to MCI.
3. To learn about new roles and challenges for radiologists in Europe.


Recent mass casualty incidents have raised many problems in the western world, requiring a wide revision of many aspects of the civil life, ranging from the public order to medical facilities. More specifically, this “new” emergency needs planning, governance, education and specifically, a new team work mentality. In this Session, not only the strength and limits of imaging in massive attacks from Paris to Brussels, Thai tsunami and migrant victims drowned in the Mediterranean sea will be discussed, but also the need for a plan and areas of improvements will be illustrated. Finally, the new roles and challenges for the radiologists in A&E will be pointed out.

Mass casualty incidents: the London framework for planning
S. Vaidya; London/GB
Learning Objectives

1. To understand the objectives of the plan.
2. To appreciate the role of imaging in mass casualty.
3. To provide an overview of the major incident planning in London.


Mass casualty events challenge and have a capacity to rapidly overwhelm healthcare systems. Over recent years, we have felt the need to have an organized response to major events, to effect better patient care and flow. Collaboration, co-operation, and meticulous planning eventually helps save lives and limbs. This talk will outline some of the guiding principles of this collaboration. There is a need for the imaging department to adapt to the altered demands in such situations. Our experiences, successes and inefficiencies will be shared with a view to understand the challenges.

Lesson learned from the Paris attacks
P. A. Grenier; Paris/FR
Learning Objectives

1. To learn from the terrorist attacks in Paris and Nice.
2. To understand the planning for pre-hospital damage control, medical strategy for quick mobilisation of resources, training and multidisciplinary simulation exercises, and post-trauma psychological care.
3. To appreciate the role of imaging in case of massive attack.


Following the multiple mass casualty terrorist attacks on November 13th, 2015 in Paris, several measures have been taken in France to improve our medical capacity to face the unexpected. French Military Medical Service was asked to transfer their expertise into the civilian setting, favouring the concept of prehospital damage control to the civilian prehospital phase. A teaching of civilian surgeons, anesthesiologists, and emergency physicians by their military colleagues about damage control resuscitation and surgery, triage and care “under fire” was organized at national and regional levels. An online course is now accessible on demand. Dedicated teaching for all medical students and dedicated course in trauma management during residency have been implemented. Mobilization of the other regions seems to be essential to activate rapidly distant additional means and to identify quickly additional preserved resources, according to a medical strategy coordinated by experience health care professionals. Hospital trauma teams have improved their ability to triage between absolute and relative emergencies. Some multidisciplinary simulation exercises particularly focused on triage were performed. Identification of the victims was clearly a deficiency during the Paris and Nice attacks particularly those left dead on scene. Priority is given to identification process with the collection of primary identifiers combined with external examinations of deceased victims. During and after the attacks, a large number of individuals required psychological care. It requires a large mobilization of psychiatrists and psychologists able to cope with acute stress and to take on a continuous flow of patients over weeks or months.

Postmortem imaging of migrant victims drowned in the Mediterranean Sea
G. Lo Re; Palermo/IT
Learning Objectives

1. To describe typical findings and pitfalls of virtopsy in mass casualty emergency.
2. To understand the strength and limits of forensic radiological examination.
3. To become familiar with postmortem imaging.


Europe is involved in a large-scale migratory flow coming from Africa and Middle East, and Italy is often the first step towards European countries for migrants. This high number of people may determine some issues related to public security, financial aspects, and ethical issues. In the last years, and until now, we have assisted to numerous shipwrecks in the Sicilian Sea, and sometimes we had the opportunity to study, with radiological images, the dead corps recovered at sea. For example, in 2016, a large number of corpses, more than 150, were studied using a multislice CT scanner; the bodies came from a shipwreck of an overcrowded boat drowned off the Libyan coasts in April 2015. Other corpses were recovered at sea, and in particular near Trapani we recovered two child corpses drowned during transhipment operations. Radiology in these cases could be essential in helping forensic pathologists and police activities, speeding up and making more secure identification of people and diagnosis of eventual pathological events. Study of number, type, congruency, calluses, fractures and anthropometric measurements of bones, teeth, growth-cartilages and of internal/external genitals helped to identify sea victims. Furthermore, study of foreign objects was useful for bodies identification and for a better knowledge of the travel conditions of migrants. Radiology has a pivotal role in mass disasters, especially in migrant victims, and can help in determining age of people died and alive.

Panel discussion: How to be prepared accordingly?
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