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The Mass Casualty Incident in Turin, 2017: A Case Study of Disaster Responders’ Mental Health in an Italian Level I Hospital

Published online by Cambridge University Press:  20 June 2019

Valeria Caramello*
Emergency Department, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
Leticia Bertuzzi
Research Center in Emergency and Disaster Medicine, Università del Piemonte Orientale, Novara, Italy Laboratoire Adaptations Travail Individu, Université Paris Descartes, Paris, France
Fulvio Ricceri
Department of Biological and Clinical Sciences, University of Turin, Italy Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco (TO), Italy
Umberto Albert
Rita Levi Montalcini Department of Neuroscience, University of Turin, Italy San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
Giuseppe Maina
Rita Levi Montalcini Department of Neuroscience, University of Turin, Italy San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
Adriana Boccuzzi
Emergency Department, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
Francesco Della Corte
Research Center in Emergency and Disaster Medicine, Università del Piemonte Orientale, Novara, Italy
Merritt C Schreiber
Department of Clinical Pediatrics, Los Angeles Biomedical Research Institute, Harbor University of California at Los Angeles Medical Center, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California
Correspondence and reprint requests to Valeria Caramello, Medicina d’Urgenza AOU San Luigi Gonzaga regione Gonzole 10, 10043 Orbassano (TO), Italy (e-mail:



To assess the psychological impact of a mass casualty incident (MCI) in a subset of personnel in a level I hospital.


Emergency department staff responded to an MCI in June 2017 in Turin, Italy by an unexpected sudden surge of casualties following a stampede (mass escape). Participants completed the Psychological Simple Triage and Rapid Treatment Responder Self-Triage System (PsySTART-R), which classified the potential risk of psychological distress in “no risk” versus “at risk” categorization and identified a range of impacts aggregated for the population of medical responders. Participants were administered a questionnaire on the perceived effectiveness of management of the MCI. Two months later, the participants were evaluated using the Hospital Anxiety and Depression Scale (HADS), the Kessler Psychological Distress Scale (K6), and the Posttraumatic Stress Disorder Checklist (PCL-5).


The majority of the responders were classified as “no risk” by the PsySTART-R; no significant differences on HADS, K6, and PCL-5 were found in the participants grouped by the PsySTART-R categories. The personnel acquainted to work in emergency contexts (emergency department and intensive care unit) scored significantly lower in the HADS than the personnel usually working in other wards. The number of positive PsySTART-R criteria correlated with the HADS depression score.


Most of the adverse psychological implications of the MCI were well handled and averted by the responders. A possible explanation could be related to factors such as the clinical condition of the victims (most were not severely injured, no fatalities), the small number of casualties (87) brought to the hospital, the event not being considered life-threatening, and its brief duration, among others. Responders had mainly to cope with a sudden surge in casualties and with organizational issues.

Original Research
Copyright © 2019 Society for Disaster Medicine and Public Health, Inc. 

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