Protocol for analgesia in mass casualty incidents of natural and anthropogenic nature
Bulgarian Medical Journal, 2025, 19(1), 47-54.
G. Semovski1, Y. Marinova2, D. Dimov1
1 Department of Disaster Medicine,
2 Department of Neurology, Neurosurgery, Psychiatry, and Psychology, Military Medical Academy – Sofia
Abstract. Mass casualty incidents (MCI, MASSCAL) are defined as the “events that generate more patients at once than the available local resources can accept in their routine activity.” In the cases of occurrence of MCI, prioritizing the lives of victims is of paramount importance. The process of saving people’s lives is most often identifi ed with control of blood loss, which is accompanied by tissue damage and severe pain. Adequate analgesia is one of the main priorities for the delivery of fi rst aid in the fi eld conditions (on the battlefi eld), in casualty collection points and emergency departments. Eff ective analgesia used in extreme conditions (such as mass casualty incidents) depends largely on the prior preparation of the rescue and medical teams. Currently in Bulgaria there is no established single protocol for analgesia in situations of mass destruction. The distinctive characteristics of a similar protocol are: intuitiveness, easy application and orientation to the medical personnel at the scene, in consistence with their professional qualifi cations. In this regard, the development and implementation of an optimized algorithm for managing pain syndrome in disaster situations would be a guarantee for the quality, timely and suffi cient scope of medical care at the scene of the incident.
Key words: pre-hospital analgesia, multiple casualty situations, trauma/management
Address for correspondence: Department “Medicine of Disaster Situations”, Military Medical Academy 3 “Georgi Sofiyski” Str., 1606 Sofia, e-mail: