Introduction
Progress toward the United Nations (UN) healthcare-related Sustainable Development Goals (SDGs) for 2030 requires addressing acute conditions (injury, complicated childbirth, acute abdomen) and non-communicable diseases (neoplasia, cardiovascular events, musculoskeletal disorders).1 Progress towards those SDGs also requires addressing the morbidity/mortality resulting from the healthcare infrastructure failure and delayed response that accompany mass casualty disasters—whether natural (earthquakes, hurricanes, floods) or man-made (building collapse, transportation accidents, terrorist events). These issues are particularly prominent in low-income and middle-income countries (LMICs)—where the majority of the 5 billion people who lack basic surgical care reside.
Over half the deaths and roughly 40% of the disease burden in LMICs are the result of conditions treatable with prehospital and emergency care.2 In preparation for the 72nd World Health Assembly (Geneva May 2019), the WHO Director-General published a report affirming the importance of the emergency care system for global health (for both daily healthcare and mass casualty events)3:
The emergency care system… extends from care at the scene through transport and emergency unit care, and it ensures access to early operative and critical care when needed… Implementing community-based education and first-aid training, certification for prehospital providers and 24 hours availability of emergency unit services at first-level hospitals save lives and maximize the effectiveness of later interventions. Well-organized emergency care is therefore a key mechanism for achieving a range of SDG targets, including those on universal health coverage, road safety, maternal and child health, noncommunicable diseases, infectious diseases, disasters and violence… Besides meeting the everyday health needs of the population, a well-organized, prepared and resilient emergency care system has the capacity to maintain essential acute care delivery throughout a mass event… Everyday emergency care systems are an essential substrate for effective emergency response.3
Mass casualty centres (MCCs) address both acute healthcare conditions and healthcare infrastructure failure in disasters (and ‘routine’ power outages)4 by providing resilient and mobile 24/7/365 healthcare that is an integral part of the ongoing healthcare system. The rationale for MCCs—an extension of the trauma/stroke centre model established decades ago in high-income countries (HICs)—is presented in the companion article (Khan T, Quintana L, Aguilera S, et al. Global health, global surgery and mass casualties: I. Rationale for integrated mass casualty centres in BMJ Global Health).
Progress towards universal health coverage requires addressing both the full continuum of care and the breadth of resources necessary to provide that care. The MCC concept incorporates prevention, prehospital care, acute and critical care, and rehabilitation. The breadth of resources includes the personnel (physicians, dentists, nurses, allied health professionals, administrators, biomedical support staff, information technologists) and the equipment (from self-contained mobile operating rooms and critical care units to data collection and analysis platforms to telemedicine resources to robots and drones) required to impact healthcare significantly. The UN Office for Disaster Risk Reduction (DRR) has published a guide for implementing the Sendai Framework for DRR, including a checklist that in essence describes the MCC concept.5
This article presents aspects of the personnel and equipment of the MCC concept, and requirements for implementation. Progress on the initial MCC models in Peshawar (Pakistan) and Iquique (Chile) is described. Although not exhaustive, sufficient detail is presented to demonstrate that MCCs are a practical and cost-effective strategy towards the healthcare-related SDGs for 2030.