Massive casualty care in a limited health resource setting with no pre-hospital care system: Togo level 2 hospital's “Mascal Plan” experience at Kidal, Northern Mali

Introduction: Massive casualties events are a major challenge for both sub-Saharan and developing world. To manage this challenge, the Togolese hospital level II (HN2-Togo) deployed in Mali as part of the United Nations Multidimensional Integrated Stabilization Mission in Mali, has developed a management plan for massive casualties incidents called Massive Casualties Plan (Mascal). The objective of this work is to present the results of the implementation of this plan. Material and method: Demographic, lesion and evacuation prioritization and medical care data were collected for all victims admitted to HN2-Togo during a Mascal from January 2015 to September 2018. Results: A total of 99 victims were admitted to HN2-Togo during 13 situations of massive casualties events. These victims are mostly military (79.8 %), male (96 %) between 20 and 34 years (78.8 %). The causes of the injuries are diverse as well as the injuries caused. While the number of military casualties is higher than that of civilians, there is no difference between these populations in terms of frequency of death, medical evacuation, or evacuation prioritization. Conclusion: In low resources setting with security and humanitarian health crisis context, the Mascal plan of the Togo Level 2 hospital has shown its interest and its effectiveness to manage exceptional situations which constitute a quantitative rupture and qualitative related to the normal operation of the hospital. The establishment of Mascal plans across the country and the sub-Saharan region coupled with the training of medical personnel could optimize the management of civilian and military casualties.