By Aine Cryts
When a mass-casualty incident happens, it means that the radiologist working a shift at the hospital may have to read studies outside their comfort zone. That could mean that a non-neuroradiologist must read head CTs—and STAT.

If you’re the only radiologist working in the hospital, you may need to read studies on body parts that you haven’t interpreted for a while, says Ferco Berger, MD, FESER, deputy chief (operations) in the department of medical imaging at Sunnybrook Health Sciences Centre in Toronto; Sunnybrook features Canada’s largest trauma center.

Berger organized and served as moderator for a hot-topic session on imaging and mass casualty at the Radiological Society of North America’s (RSNA’s) annual meeting, which took place in Chicago from December 1 to December 6. He was recently interviewed about radiologists’ role in handling mass-casualty incidents. As a follow-up to that conversation, AXIS Imaging News tapped Berger for insight on ways that radiology departments can help plan ahead for and feed into the hospital’s mass-casualty planning. A lightly edited version of that conversation follows.

AXIS Imaging News: What happens to a radiologist when a mass-casualty incident occurs? Does their day just “blow up?”

Ferco Berger: Depending on the magnitude of the incident, the radiologist will need to change into a ‘war zone’ mentality, where they’re still the best person available to interpret exams after a mass-casualty incident. Thus, there’s a lot of change that comes in the mass-casualty setting, where the paradigm of care shifts. Of course, that depends on how overburdened the system is before the mass-casualty incident occurred. Radiologists can’t just speed up the normal process.

AXIS: What are three things radiologists need to know about mass casualties?

Berger: First, imaging in mass casualty isn’t the same as the normal routine. Radiologists need to provide the best care possible for the largest number of people after mass-casualty incidents. But that’s not the same as what radiologists do every day. Typically, we go ‘all out’ as needed on every patient. Second, radiologists need to be prepared for mass-casualty incidents.

 Third, to be prepared, radiology departments need to have a plan in place; radiologists and other staff members also need to train based on that plan. That means radiologists and other staff members need to do exercises that will bring to light issues in the master plan that don’t work. Take, for example, my team’s experience when we worked with a synoptic report for immediate documentation of life-threatening findings on CT. Before introducing this scenario during our facility’s planning exercises, our team did a table-top exercise to test its functionality, after which edits were proposed. We’re currently in the process of finalizing that process.

AXIS: What do leaders of radiology departments need to do to support the hospital and radiologists in providing high-quality patient care after mass-casualty incidents?

Berger: The three main messages I just discussed are equally important to radiology leadership because they have to initiate training and give radiologists time to participate in the training. The list of issues that can occur is endless. For example, four questions to ask during planning exercises can include:

  1. Where do patients go while they’re waiting for a CT?
  2. Where do patients go after a CT?
  3. How are patients’ needs and results communicated?
  4. How are patients triaged?

Alignment with the hospital is key here. The hospital isn’t prepared for mass-casualty incidents if radiology isn’t incorporated in the scenarios that the hospital tests. That means preparedness needs to be on the agenda of radiology leaders—and radiologists need time to participate in these exercises.

We always think a mass-casualty incident will happen somewhere else and not to us. But as we know, from the Boston Marathon bombing in 2013 to the Bastille Day celebrations in Nice, France, in 2016—when a cargo truck drove into a crowded area resulting in the death of 86 people—it can happen anywhere.

AXIS: Why is it important for radiologic technologists to participate in preparedness exercises for mass-casualty exercises?

Berger: Representation by radiologic technologists in preparedness planning is necessary. They actually know what goes into acquiring a CT. In the hospitals where I’ve worked, luckily it was possible to have radiologic technologists involved. They have valuable insights into how patient flow normally goes for capturing imaging exams—and what’s possible and not. It’s very important to have them at the table.

AXIS: What’s an additional benefit of training for mass-casualty incidents?

Berger: When radiology departments train for one mass-casualty scenario, radiologists and other staff members will get better for other scenarios, even if the radiology team didn’t really specifically address that scenario. Radiology leaders should realize that focusing on mass-casualty preparedness will optimize the entire radiology team’s efficiency and effectiveness.

Aine Cryts is a contributing writer for AXIS Imaging News.