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Global health, global surgery and mass casualties: II. Mass casualty centre resources, equipment and implementation
  1. Sergio Aguilera1,
  2. Leonidas Quintana2,3,
  3. Tariq Khan3,4,
  4. Roxanna Garcia5,
  5. Haitham Shoman6,
  6. Luke Caddell6,7,
  7. Rifat Latifi8,9,
  8. Kee B Park6,
  9. Patricia Garcia10,
  10. Robert Dempsey11,12,
  11. Jeffrey V Rosenfeld13,14,
  12. Corey Scurlock15,
  13. Nigel Crisp16,17,
  14. Lubna Samad18,19,
  15. Montray Smith20,
  16. Laura Lippa21,
  17. Rashid Jooma22,23,
  18. Russell J Andrews3,24
  1. 1Neurosurgery, Almirante Nef Naval Hospital & Valparaíso University, Viña del Mar, Valparaíso, Chile
  2. 2Neurosurgery, Valparaiso University School of Medicine, Valparaiso, Chile
  3. 3World Federation of Neurosurgical Societies, Nyon, Switzerland
  4. 4Neurosurgery, Northwest General Hospital and Research Centre, Peshawar, Pakistan
  5. 5Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  6. 6Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
  7. 7University of Miami School of Medicine, Miami, Florida, USA
  8. 8Surgery, New York Medical College, Valhalla, New York, USA
  9. 9International Virtual eHospital Foundation, Hope, Idaho, USA
  10. 10School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
  11. 11Neurosurgery, University of Wisconsin–Madison School of Medicine and Public Health, Madison, Wisconsin, USA
  12. 12Chair, Foundation for International Education in Neurological Surgery, Madison, Wisconsin, USA
  13. 13Neurosurgery, Alfred Hospital, Melbourne, Victoria, Australia
  14. 14Royal Australian Army Medical Corps, Melbourne, Victoria, Australia
  15. 15Anesthesiology, Internal Medicine, eHealth, Westchester Medical Center, Valhalla, New York, USA
  16. 16House of Lords Parliamentary Group on Global Health, London, UK
  17. 17Nursing Now, London, UK
  18. 18Director, Centre for Essential Surgical Network, Indus Health Network, Karachi, Sindh, Pakistan
  19. 19Center for Global Health Delivery, Harvard Medical School, Dubai, United Arab Emirates
  20. 20Assistant Professor & HSC Health and Social Justice Scholar, University of Louisville School of Nursing, Louisville, Kentucky, USA
  21. 21Neurosurgery, Azienda Ospedaliera Universitaria Senese, Siena, Toscana, Italy
  22. 22Neurosurgery, Aga Khan University, Karachi, Sindh, Pakistan
  23. 23Health Services, Government of Pakistan, Islamabad, Islamabad, Pakistan
  24. 24Nanotechnology and Smart Systems, NASA Ames Research Center, Moffett Field, California, USA
  1. Correspondence to Dr Russell J Andrews; rja{at}


Trauma/stroke centres optimise acute 24/7/365 surgical/critical care in high-income countries (HICs). Concepts from low-income and middle-income countries (LMICs) offer additional cost-effective healthcare strategies for limited-resource settings when combined with the trauma/stroke centre concept. Mass casualty centres (MCCs) integrate resources for both routine and emergency care—from prevention to acute care to rehabilitation. Integration of the various healthcare systems—governmental, non-governmental and military—is key to avoid both duplication and gaps. With input from LMIC and HIC personnel of various backgrounds—trauma and subspecialty surgery, nursing, information technology and telemedicine, and healthcare administration—creative solutions to the challenges of expanding care (both daily and disaster) are developed. MCCs are evolving initially in Chile and Pakistan. Technologies for cost-effective healthcare in LMICs include smartphone apps (enhance prehospital care) to electronic data collection and analysis (quality improvement) to telemedicine and drones/robots (support of remote regions and resource optimisation during both daily care and disasters) to resilient, mobile medical/surgical facilities (eg, battery-operated CT scanners). The co-ordination of personnel (within LMICs, and between LMICs and HICs) and the integration of cost-effective advanced technology are features of MCCs. Providing quality, cost-effective care 24/7/365 to the 5 billion who lack it presently makes MCCs an appealing means to achieve the healthcare-related United Nations Sustainable Development Goals for 2030.

  • disaster response resources
  • global surgery
  • integrated healthcare
  • national healthcare plans
  • resilient/mobile healthcare facilities
  • telemedicine and drones

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  • Handling editor Seye Abimbola

  • Twitter @haitham shoman

  • Contributors All authors contributed to project/concept development, literature search, writing. RJA, LQ and HS contributed to tables and figures.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement There are no data in this work.

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