Securing Prehospital Care and Hospital Capacity in Mass Casualty Incidents: Systemizing Information Sharing for a Coordinated Medical Response

Introduction: To prevent preventable deaths in mass casualty incidents (MCIs), securing prehospital care at the scene and hospital capacity for patient transport is key. For this purpose, the alert function of EMISHP (Emergency Medical Information System in Hyogo Prefecture) was innovated in 2003, allowing fire departments and hospitals to share information over the Internet. With this alert function, fire departments have been able to apprise hospitals of the MCI in a timely way. Methods: Retrospective analysis of MCIs between 2003 and 2024 in which the alert function of EMISHP was activated. For each number of casualties, the duration from emergency call to activation of alert function (activation time), the duration from emergency call to clearance of alert function (S/R time), and the number of destination hospitals were evaluated. Also evaluated was the number of training exercises between 2003 and 2024. Results: In the past 21 years, EMISHP’s alert function has been activated for 330 MCIs. Casualty count ranged from 0 to 662 (median value=5). A Japan Railways derailment accident recorded the highest number of casualties. Activation time ranged from 1 to 417 minutes (median value = 15). S/R time ranged from 13 to 2,556 minutes (median value 73). Several destination hospitals ranged from 0 to 54 (median value = 3). In all cases, information was shared between fire departments and hospitals, while Hyogo Emergency Medical Center (the principal hub hospital for disasters in Hyogo) oversaw and coordinated the medical response, e.g., securing hospital capacity, dispatching EMTs to the scene. A total number of training exercises was 416/21 years (average nearly 20/year). Conclusion: Securing time and medical resources in response to MCIs becomes possible when information is shared between fire departments and hospitals in a timely, organized way. EMISHP’s alert function—its use reinforced through frequent training exercises—has contributed much to this purpose.