> For years I had been planning how I would handle a MCI, but I rarely shared it because people might think I was crazy. I should state up front I'm ex-militar

> For years I had been planning how I would handle a MCI, but I rarely shared it because people might think I was crazy. I should state up front I'm ex-military and volunteer for a disaster response organisation. I find this to be incredible. Who in their right mind would ostracise a trauma professional for conducting such planning? In fact, who who dare not support such a professional to plan for such eventualities? I actually can't quite believe the implication here, that there is a systemic reluctance to plan for such events. Maybe things are different in my country (UK) but this 'worry' the doctor has seems frankly absurd! > The first thing I did was tell the secretaries I needed every operating room open. I needed every scrub tech, every nurse, every perfusionist, every anesthesiologist, every surgeon—they all need to get here right away. I thought I'd misread the article, maybe I still have, but this sentence seems to back up the claim no MCI plan was already in place. It may be a product of our troubled history and extensive threat of terrorism (including the Irish dissident threat) but here in the UK Major Incident Response planning is practised extensively, and not just for medical emergencies. Planning is in place at almost every level to deal with such incidents. Almost every large institution, let alone just hospitals/emergency services, will deliver a 'Major Incident Response plan' (just Google 'Major Incident Response Plan UK' and you'll get many many examples), which will almost universally include a Mass Casualty Response Plan. Indeed, there is even an NHS Tactical Command Framework in place to deal with Mass Casualty Incidents that will usually span several local health trusts and setup a coordinated response framework dedicated to responding to incidents like these. Equally, all local governments departments have well rehearsed responses, integrating tightly into the UK's Gold/Silver/Bronze Command response coordination structure. Usually our emergency services, military and hospitals will have physically practised inter-operability via joint exercise and will utilise other joint working practices like JESIP and the METHANE reporting system. I know for a fact the US follows the very well planned ICS system which links into both FEMA and local/state level emergency planning. I find it absolutely unfathomable that no well rehearsed and fully scoped plan of similar thoroughness to the UK was ready to go and instead this doctor simply made it up on the hoof. Despite my own disbelief, it seems this Dr. actually did have to make it up as he went along - what an amazing, stunning personal achievement, and what a devastating systemic failure.