Management of a Mass Casualty Incident Involving Foreign Workers: Insights From a Single-Center Response to a Microbus Accident in Japan

Abstract

Background: The increasing globalization of workforces presents unique challenges to emergency medical services worldwide. Japan, traditionally a homogeneous society, now faces a growing need to manage multicultural emergency scenarios. This study examines a mass casualty incident (MCI) predominantly involving foreign workers, highlighting the challenges and strategies for effective emergency care amid language and cultural barriers.

Methodology: We conducted a comprehensive analysis of emergency response management for an MCI involving 20 patients (18 foreign nationals and two Japanese nationals) at a secondary emergency medical facility in Japan. Our protocol integrated a two-tier triage system (Simple Triage and Rapid Treatment, followed by Physiological and Anatomical Triage) with a multicultural communication strategy.

Results: Initial triage categorized 17 patients as green (minor) and three as yellow (delayed), with two patients requiring subsequent reclassification from green to yellow. Assessment times for foreign nationals averaged significantly longer than those for Japanese patients (22.3 minutes vs. 12.5 minutes). Implementation of digital translation tools and multilingual medical cards effectively bridged communication gaps. The majority of patients (15/17) were successfully treated and discharged, while two required specialist referral. No fatalities or severe complications were recorded.

Conclusions: This case study emphasizes the significance of three critical components for the effective management of multicultural MCIs. First, dynamic triage protocols must be designed to accommodate language barriers, ensuring equitable and timely care for all patients. Second, the integration of advanced technological solutions for real-time medical translation is essential to bridge communication gaps and support clinical decision-making during emergencies. Finally, culturally competent emergency care systems are vital for addressing the specific needs of diverse patient populations and fostering trust in healthcare delivery. As workforce globalization continues to advance, these findings provide practical insights for emergency medical services adapting to the challenges of increasingly diverse populations. These results have particular relevance for developed nations experiencing demographic transitions through immigration.