Role of the Certified Registered Nurse Anesthetist in Mass Casualty Incident Preparedness and Response

Formerly Position Statement Number 2.16 

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Mass casualty incidents (MCI) "generate more patients at one time than locally available resources can manage using routine procedures"1 and these episodes require "exceptional emergency arrangements and additional or extraordinary assistance"1 in order to be successfully managed. MCIs may be triggered in a number of different ways, including naturally occurring pandemics, devastating geological events, and, large-scale community or local accidents. Additionally, events in recent years have brought to the forefront increasing concern of bioterrorism or the use of weapons of mass destruction. Certified Registered Nurse Anesthetists (CRNAs) have unique clinical and cognitive abilities that are valuable to the situational challenges of MCIs. Activation of MCI plans may often present difficult and ethically challenging decisions regarding the use of limited resources. CRNAs should work collaboratively with other healthcare professionals to provide optimal care and maximize patient outcomes within the resource limitations that may exist during MCIs. 

The unique perspective that CRNAs may offer during an MCI arises from the variety of experiences they gain while caring for diverse patient populations undergoing surgical procedures, as well as patients with multiple comorbidities. Nurse anesthesia education and individual clinical experience provide for a strong foundation of skills that may be beneficial during MCIs. For example, CRNAs possess critical thinking and problem solving skills, are adaptable, and are recognized experts in central line insertion, resuscitation, hemodynamic stabilization, pain management, and airway management. These skills and qualities are invaluable assets to the treatment and management of patients during MCIs.

CRNAs should be an integral part of the interdisciplinary team involved in the MCI planning process and response efforts.2-7 CRNAs may contribute valuable insights into the development of response plans, standard operating procedures, and interdisciplinary communication processes that help facilitate allocation of resources in as timely a manner as possible.8-12

The American Association of Nurse Anesthetists (AANA) recognizes the importance of providing safe care during an MCI, and CRNAs play a vital role in the provision of this care.4,6,10,13,14 Adherence to universal precautions, the use of MCI-specific self protection measures, participation in MCI-specific continuing education, and participation in MCI simulations and training exercises are considered vital to an effective MCI response.2,7-9,14-17 Every CRNA should identify and understand his or her role within a facility’s MCI response plan, and CRNAs are encouraged to actively participate in MCI-related training activities. In addition, CRNAs should be part of the interdisciplinary team in order to enhance patient outcomes as well as patient and provider safety.5,8,11 


  1. World Health Organization.  Mass Casualty Management Systems: Strategies and Guidelines for Building Health Sector Capacity. World Health Organization Web site.  Published 2007.  Accessed July 12, 2011.
  2. Baker MS. Creating order from chaos: part II: tactical planning for mass casualty and disaster response at definitive care facilities. Mil Med. Mar 2007;172(3):237-243.
  3. Bernardo LM, Veenema TG. Pediatric emergency preparedness for mass gatherings and special events. Disaster Manag Response. Oct-Dec 2004;2(4):118-122.
  4. Bostick NA, Subbarao I, Burkle FM, Jr., Hsu EB, Armstrong JH, James JJ. Disaster triage systems for large-scale catastrophic events. Disaster Med Public Health Prep. Sep 2008;2 Suppl 1:S35-39.
  5. Christian MD, Kollek D, Schwartz B. Emergency preparedness: what every health care worker needs to know. CJEM. Sep 2005;7(5):330-337.
  6. Couig MP, Martinelli A, Lavin RP. The National Response Plan: Health and Human Services the lead for Emergency Support Function #8. Disaster Manag Response. Apr-Jun 2005;3(2):34-40.
  7. Hsu EB, Thomas TL, Bass EB, Whyne D, Kelen GD, Green GB. Healthcare worker competencies for disaster training. BMC Med Educ. 2006;6:19.
  8. Adini B, Goldberg A, Laor D, Cohen R, Zadok R, Bar-Dayan Y. Assessing levels of hospital emergency preparedness. Prehosp Disaster Med. Nov-Dec 2006;21(6):451-457.
  9. Challen K, Bentley A, Bright J, Walter D. Clinical review: mass casualty triage--pandemic influenza and critical care. Crit Care. 2007;11(2):212.
  10. Davies K. Disaster preparedness and response: more than major incident initiation. Br J Nurs. Sep 8-21 2005;14(16):868-871.
  11. Lusby LG, Jr. Are you ready to execute your facility's emergency management plans? J Trauma Nurs. Apr-Jun 2006;13(2):74-77.
  12. Rebmann T, Carrico R, English JF. Lessons public health professionals learned from past disasters. Public Health Nurs. Jul-Aug 2008;25(4):344-352.
  13. Barishansky RM, Langan J. Surge capacity. Is your system prepared for the victims of a large-scale incident? EMS Mag. Apr 2009;38(4):36-40.
  14. Rubinson L, Hick JL, Curtis JR, et al. Definitive care for the critically ill during a disaster: medical resources for surge capacity: from a Task Force for Mass Critical Care summit meeting, January 26-27, 2007, Chicago, IL. Chest. May 2008;133(5 Suppl):32S-50S.
  15. Collander B, Green B, Millo Y, Shamloo C, Donnellan J, DeAtley C. Development of an "all-hazards" hospital disaster preparedness training course utilizing multi-modality teaching. Prehosp Disaster Med. Jan-Feb 2008;23(1):63-67; discussion 68-69.
  16. Frykberg ER. Disaster and mass casualty management: a commentary on the American College of Surgeons position statement. J Am Coll Surg. Nov 2003;197(5):857-859.
  17. Chung S, Shannon M. Hospital planning for acts of terrorism and other public health emergencies involving children. Arch Dis Child. Dec 2005;90(12):1300-1307.


Adopted by AANA Board of Directors October 2002.
Revised by AANA Board of Directors August 2011.