Exit wave plan for structured secondary patient distribution : Logistic concept for mass victims of terrorist attacks

Abstract

Following aterrorist attack asecond hit is to be feared. The adequate reaction of the emergency services on site is to clear the scene. Since in such cases no treatment areas are set up at the scene of the incident, the injured are quickly admitted to the nearest hospital, either by themselves or by the emergency services and are largely untreated. Therefore, the hospital has to be ready to take in asignificantly larger number of injured people in avery short period of time than after aconventional mass casualty incident. Due to the conceivably large number of wounded persons the emergency department can ensure primary medical care but nowhere near all casualties admitted to the hospital can be definitively treated. In order to provide injured patients with individual medical care after initial treatment according to the criteria of damage control resuscitation, aconcept should be developed that enables awell-organized secondary transfer to receiving hospitals with appropriate equipment. Within aradius of 100 km from Ulm, all hospitals certified by the German Society for Trauma Surgery were contacted and asked to indicate how many emergency patients of the triage categories T1 (red), T2 (yellow) and T3 (green) could be admitted and treated around the clock (24/7). Special features such as a helicopter landing pad, neurosurgical care and pediatric traumatology care were considered. Of the 32hospitals within a 100 km radius of Ulm 29 (91%) provided information on the admission capacity. In these hospitals 45 T1, 121 T2 and 333 T3 patients could be admitted around the clock (24/7). Ahelicopter landing pad is available at 26 of the 29hospitals (90%), 11 hospitals (38%) can treat patients for emergency neurosurgery and 18hospitals (62%) have the possibility of pediatric traumatological emergency care. Based on this information the structured exit wave plan was developed, which enables asecondary transfer of at least 100 patients to qualified trauma centers. The University Hospital of Ulm has made preparations to admit at least 100 injured patients for initial medical treatment following aterrorist attack. This corresponds to 10% of the hospital beds as required in the literature. Together with the neighboring Military Hospital and the University and Rehabilitation Hospital Ulm up to 300 injured patients can be treated; however, the number of available intensive care unit (ICU) beds and capacities in normal wards for definitive care is much lower, therefore, patients treated according to the principles of damage control resuscitation have to be relocated. By documenting the capacity of the hospitals within a 100 km radius around Ulm and taking their specific features into account, an exit wave plan could be created that enables patient distribution for definitive care without time-consuming procedures.