330 Original article Disaster preparedness: experience from a smoke inhalation mass casualty incident Siang-Hiong Goh, Ling Tiah, Hoon-Chin Lim and Elaine Kim-Choon Ng Objective We describe a modified triage system used in managing a smoke inhalation mass casualty incident that we recently encountered at our community hospital. Materials and methods The patients were triaged as priority 1, 2 or 3 on the basis of their symptoms, signs and circumstances at scene. In addition, the use of fibre-optic examinations of the upper airway, chest radiography and carboxyhaemoglobin levels with arterial blood gas analyses were used to aid in disposal plans. Results Of the 22 patients evacuated, 15 were triaged as priority 2 and the remaining seven as priority 3. None of the patients was identified as priority 1. All the priority 2 patients underwent further investigations. Those with mild upper airway oedema (four patients) or raised carboxyhaemoglobin levels (two patients) were admitted. Only one patient had both. Another patient who was a known asthmatic developed bronchospasm and was admitted as well. All six were admitted to the general ward with subsequent good recovery and were discharged within 3 days. The remaining nine priority 2 and seven priority 3 patients were discharged from the emergency department. Conclusions These modified triage criteria, with selective use of fibre-optic examinations, chest radiography and arterial blood gas analyses with carboxyhaemoglobin levels, are useful in smoke inhalation mass casualty incidents without dermal burns. Systemic injury and poisoning by toxic fumes often coexist with airway burns and should not be overlooked. Lastly, disaster planning and frequent drills at both local and national levels will optimize the response to future mass casualty incidents. European Journal of Emergency Medicine 13:330–334  c 2006 Lippincott Williams & Wilkins. European Journal of Emergency Medicine 2006, 13:330–334 Keywords: carbon monoxide, cyanide toxicity, discharge criteria, mass casualty planning, toxicity of smoke inhalation, triage Accident and Emergency Department, Changi General Hospital, Singapore, Republic of Singapore. Correspondence and requests for reprints to Dr Goh Siang Hiong, MBBS (Singapore), FRCS Edin (A&E), FAMS, Accident and Emergency Department, Changi General Hospital, No 2, Simei Street 3, Singapore 529889, Republic of Singapore Tel: + 65 850 1687; fax: + 65 260 3756; e-mail: Siang_Hiong_Goh@cgh.com.sg Received 11 January 2006 Accepted 8 March 2006 Introduction Smoke inhalation mass casualty incidents are rarely encountered in Singapore. To date, no such incident has been reported in our local literature. We recently had to deal with a large-scale smoke inhalation incident in which 22 patients were brought to the Emergency Department of Changi General Hospital, which is a 500-bed community-level hospital serving the eastern part of Singapore without an in-house burns unit. We described here the triage criteria that were modified and adopted for such a unique mass casualty incident. Early fibre-optic examinations, chest radiography and measure- ment of carboxyhaemoglobin levels with arterial blood gas analyses were used to designate appropriate treatment and disposal plans. Materials and methods On 8 November 2005, just after midnight, the Emergency Department of Changi General Hospital was alerted to a fire that had broken out at a playground located just next a block of condominiums in a nearby housing estate about 4km away. Some vandals had set fire to the structures of the playground and, as the materials of the swings, slides and ground surface protective mats were being consumed by fire, they released large amounts of billowing smoke. The materials included rubber, plastics, polyurethane foam, wood and paint. According to accounts from the paramedics and patients, the flames rose as high as the first storey while the plume of smoke rose as high as the 10th floor before dispersing. Over the next hour, 22 patients were evacuated to our emergency department. They had various degrees of respiratory symptoms after exposure to the smoke, which formed the basis for the paramedics’ decision to evacuate them. The department was reorganized to cope with the sudden influx and extra staff was called back. Ambulances conveying patients not involved in the incident were diverted. Existing patients in the department were informed of the situation and those with less severe conditions were advised to seek consultation elsewhere or expect to wait should they choose to stay. It became rapidly clear that the usual triage scheme used in mass disasters was not appropriate as that was geared towards physical injuries from mechanical trauma. 0969-9546  c 2006 Lippincott Williams & Wilkins Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.