EMS and beyond.

coherent matter of indefinite shape or size; a considerable number or quantity. 2 It follows then, that the " local " EMS systems are not be able to manage all of the victims. For events that produce massive numbers of casualties, the system is overwhelmed and many victims whose lives possibly could have been salvaged in a multiple-casualty situation will succumb to their injuries/illnesses as they will not be tended by the emergency medical services personnel. Persons with potentially survivable injuries/illnesses will succumb in a mass-casualty scenario regardless of whether they are in the field or in a medical facility. The population-at-risk must recognize that EMS will not be there to assist all of them. Massive quantities of injured/ill persons produce unique circumstances that are similar in both the prehospital and inhospital settings. Both components may be handicapped by an inability to gain access either to the scene or to the medical facility, damage/destruction of infrastructure, equipment, supplies , and staff, resulting in an inability to function even at the pre-event level, much less deal with the surge of persons requiring medical care. Even if the uninjured/healthy staff are able to report to their respective work setting, there never will be sufficient professional staff to manage the masses. Staff may be injured or ill and unable to work, they may have been killed by the event, they may elect to support their respective families and not report for duty, they may have lost family members, and damage to the transportation infrastructure and short supplies of fuel may compromise their access to the scene or the medical facilities. 3 Inadequate supplies of fuel may further limit access not only by personnel, but also to replacement supplies and equipment including food and water. In addition, many of the societal functions will compete for the same resources. Furthermore, external responses to assist the locals generally will not arrive and become functional for 1–2 days. Instead of tending to victims, the first-responding prehos-pital EMS personnel must assess the situation, request assistance , and establish field coordination and control. In the medical facilities, the " mass-casualty " plan implemented must include the establishment of coordination and control. It should be clear that " just-in-time " supplies will not sustain care for the masses. Persons with potentially treatable injuries or infections may die due to lack of adequate numbers of personnel and supplies. In such circumstances, …