Mass Casualty events may occur as a result of natural or human-caused disasters or after an act
of terrorism. The planning and response to disasters and catastrophes needs to take into
consideration the distinction between progressive and sudden events. Insidious or slowly
progressive disasters produce a large number of victims but over a prolonged time period with
different peaks in the severity of patients presenting to the hospital. For example radiation
events will produce a large number of victims who will present days weeks months or years
after exposure depending on the dose of radiation received. The spread of a biological agent
or a pandemic will produce an extremely high number of victims who will present to hospitals
during days to weeks after the initial event depending on the agent and progression of
symptoms. On the other hand in a sudden disaster there is an abrupt surge of victims
resulting from an event such as anexplosion or a chemical release. After the sarin gas attack
in a Tokyo subway in 1995 a total of 5500 victims were injured and required medical attention
at local hospitals immediately after the attack. The car bomb that exploded near the American
Embassy in Nairobi Kenya killed 213 people and simultaneously produced 4044 injured patients
many requiring medical care at local hospitals. The Madrid train bombing in March 2004 produced
more than 2000 injured victims in minutes overwhelming the city's healthcare facilities. More
than 500 injured patients were treated at local hospital after the mass shooting in Las Vegas.
Finally earthquakes may produce a large number of victims in areas in which the medical
facilities are partially or completely destroyed. Sudden events bring an immediate operational
challenge to community healthcare systems many of which are already operating at or above
capacity. The pre-hospital as well as hospital planning and responseto sudden mass casualty
incidents (SMCI's) is extremely challenging and requires a standard and protocol driven
approach. Many textbooks have been published on Disaster Medicine although they may serve as
an excellent reference they do not provide a rapid practical approach for management of
SMCI's. The first edition of Mass Casualty Incidents: The Nuts and Bolts of Preparedness and
Response for Acute Disasters dealt exclusively with sudden mass casualty incidents. The second
edition will expand its focus and include planning and response for insidious and protracted
disasters as well. This new book is designed to provide a practical and operational approach to
planning response and medical management of sudden as well as slow progressive events. The
target audience of the second edition will be health care professionals and institutions as
well as allied organizations which respond to disasters and mass casualty incidents. Parts I
and II are essentially the first edition of the book and consist of planning of personnel
logistic support transport of patients and equipment and response algorithms. These 2 parts
will be revised and updated and include lessons learned from major mass shootings that occurred
recently in the United States and other parts of the world Part III will describe the planning
process for progressive disasters and include response algorithms and checklists. Part IV will
handle humanitarian and mental health problems commonly encountered in disaster areas. Part V
will deal with team work and communication both critical topics when handling catastrophes and
mass casualty incidents. This new book will be a comprehensive tool for healthcare
professionals and managers and should
