🚨 MASS CASUALTY PROTOCOL

🔍 RECOGNIZE

Two+ patients with chills

🛑 DISCONNECT ALL

Do NOT return blood

🚨 CALL FOR HELP

Code Red — Mass Casualty

💉 TREAT UNSTABLE

IV fluids, ICU transfer

The patient is the alarm — NOT the machine

Chills / Rigors

Sudden, violent shaking

Fever

> 38.5°C

Hypotension

BP drop > 20 mmHg

Confusion

Drowsy, disoriented

Unexplained Fatigue

"Not my usual self"

TDS

mg/L

< 10

✅ Safe

10 – 25

⚠️ Monitor

> 25

🔴 Critical

> 5 increase in 1 day = ALERT — investigate immediately

Chlorine / Chloramine

mg/L

0.00

✅ Safe

0.00 – 0.05

⚠️ Alert

> 0.1

🔴 Critical

0.0 is the ONLY acceptable number
> 0.1 = Hemolysis — stop using water immediately

Endotoxin

EU/mL

< 0.25

✅ Safe

0.25 – 0.5

⚠️ Alert

> 1.0

🔴 Critical

Two patients with chills = DISCONNECT ALL
> 1.0 EU/mL = Mass Casualty — call Code Red

Hardness

gpg

< 1

✅ Safe

1 – 2

⚠️ Monitor

> 2

🔴 Critical

> 1 gpg = Softener needs regeneration
High hardness = RO scaling = membrane damage

Check TDS — record & compare to previous day

Test Chlorine — MUST be 0.0

Check Hardness — target < 1 gpg

Check UV Lamp — functional & within lifespan

Check 0.3µ Filter — pressure differential

Review Endotoxin Logs — weekly results

Check Power Supply — UPS/Generator? Power interruptions?

Ask Every Patient — "How do you feel today?"

Check Hemoglobin Trends — sudden drops = RED FLAG

ENDOTOXIN

Two patients with chills = DISCONNECT ALL

CHLORINE

0.0 is the ONLY acceptable number

TDS

> 5 increase in 1 day = ALERT

Water Quality Quick Reference

🚨 MASS CASUALTY PROTOCOL