[MANSCAL(mass casualty incident) hospital alert : "The first 10 minutes"].

Background: In the event of a mass casualty incident (MASCAL) decisions on the spatial, personnel and organizational restructuring of the emergency department have to be made in a very short time from the initial alert to the arrival of the first patient at the hospitals. Due to the rarity of a MASCAL this complex task is a special challenge.

Aim: The aim of the study was to optimize the immediate preparation phase after a MASCAL alarm by means of concise instructions for action and to shorten the time to the automated external alerting.

Material and methods: In a structured dialogue involving the departments of emergency medicine, anesthesia and surgery, the critical issues in the initial organization after a MASCAL activation were identified and a flow chart for the first relevant decision-making processes was developed. The time required for the decisions to be made was compared before and after the implementation of the instructions for action "The first 10 minutes" in practical simulations.

Results: The compiled checklists "The first 10 minutes" contain a clearly structured guide to master the necessary tasks by decision-makers on site in the initial phase. By introducing the concept the duration of the initial decision-making process was reduced by an average of 14.3 min.

Conclusion: The development of instructions for action optimized for the location with a structured checklist leads to a significant acceleration of the initial decision-making processes when a MASCAL is activated.