Hospital organization during multiple casualty incidents

Abstract

Abstract Introduction: The sporadic nature of terror-induced mass casualty incidents (MCIs) makes preparation difficult. Hypothesis-Knowledge regarding utilization of hospital resources during prior MCIs is important for planning the initial 24-hour response to subsequent MCIs. Methods: All data except event times (taken from EMS recordings) were prospectively collected by six Level I Trauma centers. All terror related events (10/1/2000–6/30/2003) were screened. Only data from MCI bombings (Ministry of Health criteria, based on the number/injury severity of admitted patients) were included. Data are presented as % of admitted patients (n = 250). Results: 16 MCIs met inclusion criteria. Average event to arrival time of 1st admitted patient was 22.8±9.2min (range 6–36mins) and to arrival time of 1st admitted patient with ISS > 16 was 30.4±9.8min (range 11–49mins). Patients' severity of injury was: ISS 1-8-40.8±23.1%, ISS 9-14-15.5±12.6%, ISS 16-24-16 ± 12.8%, ISS 25-75-27.7±17.6%. Computed tomography was performed in 42.8±18.3% of admissions. Operative procedures were performed on 151 patients who comprised 67.3±24% of admissions (Table). ICUs were the first admitting department in 40.4±15.4% of cases, the majority of which (64.3±23.7%) arrived there after surgery. TableTemporal distribution of patients entering surgery. Patients often underwent multiple operations by multidisciplinary teams, yielding overall proportions of > 100%. Length of surgery is not described. Data regarding time of entry to surgery were not reported for 6 patients.1–29 min30–59 min1–1.5 hr1.5–2 hr2–2.5 hr2.5–3 hr3–4 hr4–5 hr5–6 hr6–12 hr12–24 hr24+ hrA. Percent of patients entering surgery by time from arrival of first patient4.5 ± 10.911.1 ± 10.717.5 ± 10.39.7 ± 9.34 ± 6.64.5 ± 6.88.5 ± 9.93.1 ± 6.15.7 ± 6.816.2 ± 14.18.9 ± 11.13.7 ± 7.0B. Percent of patients entering surgery by the various surgical specialties and by time from arrival of first patientNeurosurgery01932402014175001200Eye17138200002501200Thoracic833828270142500400Vascular3331247008029000Abdominal100815647202917008617Orthopedic174444674071585057584417 Conclusions: Analysis of resource utilization in response to an MCI reveals the following: 1. Staffing demands for ER, OR and ICU overlap 2. Anesthesiologists, general and thoracic surgeons are in immediate demand. 3. Most ICU admissions follow surgery. 4. Most patients operated within the first 2 hours require multidisciplinary surgery. 5. Demand for orthopedic surgery and anesthesiology services continues for > 24hrs.