Abstract
Responding to mass casualty incidents in a tunnel environment is problematic not least from a prehospital emergency medical services (EMS) perspective. The aim of this review was to 1) categorize preconditions for emergency response in tunnel environments based on Haddon’s matrix and 2) identify specific EMS knowledge of providing prehospital care. Twenty eight articles, reports and book chapters were selected for further analysis. Firstly, sorting the data from each included article was done according to Haddon’s matrix. The result covers human factors, technical factors, physical environmental factors and socioeconomic environmental factors all related to preconditions for emergency response. To describe the EMS’s knowledge the data was also sorted according to command and safety, communication, assessment, and triage treatment and transport, also known as CSCATT. Few studies, especially of high quality, actually provide detailed information regarding emergency response to tunnel incidents and those that do, often have a main focus on management by the rescue service. While many incidents studied were caused by fires in tunnels, thus requiring rescue service in action, the subsequent EMS response issues that have taken place appear to have been given limited attention. To optimize the survival rates and health of the injured, as well as to provide a safe and effective work environment for the emergency services, there is a need to explore the event phase.
Highlights
Mass casualty incidents (MCIs) remain an extraordinary challenge for prehospital response
A tunnel fire test has shown that the level of smoke rises very rapidly and that an area can become completely engulfed in smoke in 5 minutes
It is crucial that the tunnel users swiftly evacuate and that emergency services reach the area quickly [24]
Summary
Mass casualty incidents (MCIs) remain an extraordinary challenge for prehospital response. The ramifications of incidents in difficult and confined environments, such as tunnels or other underground sites adds further challenges for emergency response and the outcomes can be devastating, as seen in the Baku Metro fire (289 people killed) [6] and the Daegu underground railway station fire (198 people killed) [7]. Other types of incidents are tunnel collapses, e.g. at a nuclear test site in North Korea (about 200 people killed) [8], which in turn, led to concerns about radiation and safety for personnel as librello half of the deaths occurred during prehospital response. Increasing traffic frequencies, driving speeds, number of hazardous goods transports, and higher loading capacities constitute some risk factors for increased numbers of tunnel incidents [7,9]. Emergency response to tunnel incidents may be impaired, because of limited access routes and possible traffic jams [10,11,12] as well as conditions in the tunnel, for instance impaired vision and extreme heat exposure in the case of a fire [13]
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