COORDINATION OF AMBULANCE SERVICES AND EMERGENCY DEPARTMENTS IN MASS CASUALTY INCIDENTS: AN INTEGRATIVE LITERATURE REVIEW

Mass casualty incidents (MCIs) present a profound challenge to emergency medical systems, where effective coordination between ambulance services (EMS) and emergency departments (EDs) is critical for saving lives. This integrative literature review aimed to synthesize evidence on the dynamics, challenges, and facilitators of EMS-ED coordination during MCIs. A systematic search of five databases yielded 22 studies for inclusion. The analysis identified three central themes: (1) Communication and Information Sharing, where breakdowns are a primary barrier, mitigated by real-time data platforms; (2) Command, Control, and Interoperability, requiring clear integrated structures and standardized protocols; and (3) Joint Training and Preparedness, with a noted deficit in multi-agency drills directly linked to poor perceived coordination. Key challenges include communication failures, the uncoordinated "secondary surge" of patients at EDs, and ambiguous authority at the ambulance bay. The review concludes that moving from theoretical plans to operational readiness requires policy mandates for interoperable communication technology, the formalization of EMS liaison roles within hospital command, and the institutionalization of frequent, realistic joint exercises. These steps are essential for building a resilient and coordinated response system. Keywords: mass casualty incident, emergency medical services, emergency department, disaster coordination, pre-hospital communication