The Emergency Physician as MCO: Applying Our Unique Skillset in Mass Causality Incident

Introduction – Why This Reflection Matters

In November 2025, I responded to the Tai Po Wang Fuk Court fire as the second Medical Control Officer (MCO). The incident involved over 100 casualties. The first MCO and EMT team were mobilized around 4:00 pm. After a brief handover, I assumed MCO duties for the night shift, working alongside an EMT I had never met before. That evening, I had no time for theory or textbooks. All I had was my emergency physician's training—disaster preparedness, triage, resource management, risk-benefit decisions, communication, and MICC principles. This reflection examines how I applied those skills in real practice, under fire.

Disaster Preparedness – Theory vs. Reality

In disaster medicine textbooks, we often read about chaos, confusion, and role ambiguity. The Tai Po fire certainly had chaos—sirens, smoke, shouting, and anxious residents. But here is where reality differed from my expectations.

First, despite the chaotic environment, everyone knew their role. As I was the second MCO at scene. The MCO, EMT, and AIO fell into position seamlessly after a brief handover. There was no hesitation, no debate about who gives which order. This did not happen by accident—it happened because everyone was well-trained and understood their scope of practice.

Second, the HA MICC provided remarkably well-organized instructions throughout the night. I received regular updates on the evolving situation and, crucially, real-time resource availability across A&E departments. This allowed me to plan rather than react.

Third, victim extraction was not a single massive surge. Instead, firefighters rescued casualties in small, coordinated groups. This made triage and distribution manageable.

Finally, contrary to disaster drills where ambulances are scarce, I had an abundance of ambulances to deploy. The challenge was not quantity—it was directing them to the right receiving hospitals without overwhelming any single A&E.

Resource Management – Understanding A&E Resources in HA

As MCO, triage went beyond clinical severity. I had to match each patient to the right receiving hospital based on ICU bed availability, burn unit capacity, paediatrics services, and ENT coverage. My goal was simple: do not overwhelm any single A&E during the night shift. I diverted casualties across multiple Hong Kong hospitals, balancing the load across the entire system. None of this would have been possible without the EMT at scene, who handled certification of death and immediate resuscitation. That support freed me to focus on resource distribution. Theory teaches capacity. Reality demands distribution.

Risk-Benefit Balance in Real-Time

Three casualties were saved by firefighters that night: an elderly woman, a middle-aged mother, and a three-month-old boy. Each had different needs. The infant required a paediatrics ICU. The elderly man needed general ICU care. The mother had possible airway burns, needing ENT support. But NTEC hospitals had no ICU beds available. My decision: send them to three different hospitals, even if that meant longer transport distances. The risk was extended pre-hospital time. The benefit was appropriate definitive care at centre with capacity. In disaster, the safest hospital is not always the closest—it is the one with the right bed.

Communication and Transfer – The MICC Perspective

Throughout the night, I maintained continuous communication with the HA MICC team. I served as their "eyes" at the scene, providing real-time updates on casualty flow, severity, and extraction progress. In return, the MICC team was my "dashboard"—feeding me live availability of ICU beds, paediatric capacity, and specialist resources across Hong Kong's hospitals. Our most effective communication tool? WhatsApp. It was fast, visual, and allowed simultaneous updates to multiple recipients. But I learned a critical lesson: ensure your phone has sufficient power supply. A dead battery at midnight would have broken that lifeline.

Physical Demand and Challenge – The Hidden Cost

We rarely discuss the physical toll of disaster response. That night, I stood for six continuous hours at the scene—no sitting, no leaning, no break. Strangely, I felt neither thirsty nor hungry during the incident. The adrenaline carried me. But after the surge subsided, exhaustion hit like a wave. My EMT colleague had started from their regular P-shift duty and continued working until 4 am without rest. That is not heroism—that is physiology pushed to its limit.

As doctors and nurses, we all believe this work is deeply meaningful. Saving lives at the scene gives us purpose. But meaning does not erase fatigue. I hope different departments and hospital authorities will recognize this hidden cost and consider proper compensation—whether through overtime recognition, rest provisions, or tangible support for staff who give their physical best during disasters. Our dedication should not come at the expense of our well-being.

Conclusion and Future

Working in a Hospital Authority A&E Department means accepting one reality: disaster can arrive without warning. The Tai Po fire reminded me why emergency physicians possess a unique skill set—disaster preparedness, triage, resource management, real-time risk-benefit decisions, and MICC coordination. These are not theoretical concepts. They are muscles we must exercise before the next emergency strikes.

I am proud that HASDC (Special Duty Cadre) was established after the epidemic precisely to consolidate the experiences we have gained from past incidents.

However, HASDC should not be reserved only for regional or national-scale events. HASDC must have a clear role in local disasters as well—including high-rise residential fires, transport accidents, and community emergencies. The Tai Po incident demonstrated that even a "local" event can overwhelm routine EMS capacity. HASDC can provide surge staffing, incident command support, and structured coordination at the scene.

Moving forward, I hope HASDC expands its mandate to include local disaster activation protocols. Hong Kong must prepare for other major incidents ahead: mega sporting events, large-scale rescue operations, or unforeseen community crises. The next disaster may not make national headlines—but it will still test our system. HASDC's role must begin at the local level, not wait for a catastrophe to escalate.

Dr Wong Kwun Bun

FHKAM(Emergency Medicine)

MBBS (HKU)

Thumbnail of article: Firefighters put the injured person into an ambulance at Wang Fuk Court on Nov 27, 2025. (ADAM LAM / CHINA DAILY)