In the emergency department response to an implosion with multiple injuries, which action should the charge nurse implement first?

• A. Contact the local blood bank to report the incident.
• B. Call nurses off-duty to come into work.
• C. Notify the house supervisor of the incident.
• D. Instruct staff to check the supplies in the ED.

Answer: (C)

In a mass casualty or major incident in the ED, the first step is to activate the hospital’s incident command system by notifying the house supervisor. This person becomes the incident commander or directs the chain of command, establishing an organized response, assigning roles, and initiating the ED incident action plan. With command in place, triage can begin, resources can be allocated, and communication with other departments and external agencies can be coordinated efficiently. If actions like pulling in off-duty staff, contacting the blood bank, or inventory checks are started before command is established, the response can become chaotic and waste valuable time and resources. The house supervisor’s prompt involvement ensures a structured, hospital-wide response and keeps patient care the priority from the outset.