Dynamic on-site treatment strategy for large-scale mass casualty incidents with rescue operation

•The coordination between three tasks of the casualty management is investigated.•A new dynamic resource allocation and casualty prioritization scheme is developed.•The dynamic scheme is compared with static schemes used in practice.•Impacts of resource limitations on the dynamic scheme are studied. The spatial dispersion of casualties and temporal variations of emergency resources are the two critical factors that complicate the casualty management operation in large-scale mass casualty incidents. These factors are studied in this paper to develop an optimal casualty treatment strategy for a medical station that provides first aid assistance for severely injured casualties on the site. This study shows that the optimal treatment strategy to save the highest number of casualties at a medical station with nonstationary arrival and treatment rates is dynamic with time-dependent resource allocation and casualty prioritization strategies. The dynamic treatment strategy is compared with static treatment strategies used in practice. Findings show that the expected performance of the dynamic strategy is always better than the static approaches regardless of the disaster severity level. Also, the overperformance of the dynamic strategy is not affected by the tentative errors that may happen in estimating the parameters of the problem. We show that the shortage of search and rescue resources mitigates the overperformance of the dynamic strategy. In contrast, the medical resource shortage amplifies the importance of implementing the dynamic treatment strategy.