Multi-casualty Incident Research Articles

Conducting a conventional multi-casualty incident in COVID-19 personal protective equipment - a semi-structured interview

BackgroundThe risk of COVID-19 transmission to healthcare professionals is likely to continue for the foreseeable future. The wearing of personal protective equipment (PPE) presents a number of potential challenges to responders that may impact upon the management of patients in a multi-casualty incident.This report describes a multi-agency multi-casualty incident. It identifies learning points specifically related to the challenges of conducting a conventional multi-casualty incident in COVID-19 PPE.CaseThe multi casualty incident in Reading, UK on the 20 June 2020 involved six stab injury victims and was attended by four pre-hospital critical care teams. This was the first conventional multi-casualty incident that pre-hospital critical care teams had attended during the COVID-19 era and it was conducted in COVID-19 PPE (1). The scene was an urban park where three patients were confirmed to be in Traumatic Cardiac Arrest (TCA) from stab wounds and another three patients had also suffered stab injuries. By the time the incident had concluded three patients were pronounced dead at the scene. Two patients were transported to the local trauma unit and one patient was transported to the regional Major Trauma Centre depending on the severity of their injuries.ConclusionsWe conducted a semi structured telephone interview with the critical care clinicians who were involved in the incident. The interviews focused specifically on the challenges of responding whilst wearing COVID-19 PPE, rather than the wider challenges of responding to such an incident. The key learning points identified were:Improving the identifiability of clinicians in level 3 PPEwearing identification tabardsusing visible labelling on PPE suitsImproving communication by radiousing a belt to carry the radiousing an earpiece and push to talk system.Training in conducting multi casualty incidents in level 3 PPE.

Multi-casualty incident at a funeral hall that necessitated rapid response car dispatch

Multi-casualty incident at a funeral hall that necessitated rapid response car dispatch

Situation Display for the EMS Dispatch Team during Multi-Casualty Incident Management

Situation Display for the EMS Dispatch Team during Multi-Casualty Incident Management

(P2-77) The Unique Role of Emergency Medical Services (EMS) in an Earthquake – A Community Based Approach

IntroductionTimely actions can facilitate the efficacy of Emergency Medical Services (EMS) response in disaster by understanding the scale of event and shifting of traditional tasks. A simple scaling system of earthquakes/disasters by ABC is proposed: Level A treated by the local EMS. One or more Multi Casualty Incident's (MCI) in a defined geographical area that can easily be Level B hours, by reinforcement of regional and national aid coordinated by automatic autonomic response. An earthquake/disaster where the EMS and medical community can complete their task within 48 Level C - An earthquake/disaster that even joint national forces cannot eliminate within 48 hours.MethodsInformation from medical systems around the world was gathered to help develop strategies to minimize the weaknesses whilst achieving the objectives of the EMS via adapting to shifting conditions.ResultsEMS goal is to provide treatment to those in need of urgent medical care and arrange for timely transfer of the patient to definitive care. EMS are not qualified or equipped to delay victims in the field for hours or days. However, many patients in earthquakes do not require definitive treatment or have an immediate lifethreatening.ConclusionBy scaling the event by the ABC - a timely coordinated autonomic regional / national response can begin immediately. An area defined as level A will automatically back-up a level B/C area, in an event that the standard communication and activation systems collapse. Moreover, a clear shift in EMS roles will take place in a level B or C events. Available-Hours Busy-48-Hours Catastrophe-weeks Types of Levels area for delaying evacuation. Prioritizing, sorting and sending patients that require immediate attention to definitive care whilst considering availability of destination facilities and transportation resources. Patients that do not require immediate attention or cannot be saved shall await evacuation.

Improved Trauma System Multicasualty Incident Response: Comparison of Two Train Crash Disasters

Two train crash multicasualty incidents (MCI) occurred in 2005 and 2008 in Los Angeles. A postcrash analysis of the first MCI determined that most victims went to local community hospitals (CHs) with underutilization of trauma centers (TCs), resulting in changes to our disaster plan. To determine whether our trauma system MCI response improved, we analyzed the distribution of patients from the scene to TCs and CHs in the two MCIs. Data from the emergency medical services and TC records were interrogated to compare patients triage status, type of transport, and the destination in the 2008 MCI to the 2005 MCI. Clinical data from the 2008 MCI were tabulated to evaluate severity of injuries, need for immediate and delayed operation, need for intensive care unit, and need for specialty surgical services, and appropriate distribution of patients. In 2005, 14 (56%) of the 25 severely injured patients and 75 (71%) of the 106 total patients were transported to four CHs. In 2008, 53 (93%) of 57 of the severely injured patients were transported to TCs and only 34 (35%) of 98 of total patients were transported to nine CHs. In 2008, more TCs were used (8 vs. 5) and more patients were transported by air (34 vs. 2). In 2008, the most severely injured victims were transported to four level I TCs (median injury severity score, 16; range, 1-43; 10 emergent operations) and four level II TCs (median injury severity score, 10; range, 1-22; 4 emergent operations). Only 11 patients were admitted to CHs, and no operations were required. A trauma system performance improvement program allowed us to significantly improve our response to MCIs with improved utilization of TCs and improved distribution of victims according to injury severity and needs.

A single, improvised “Kassam” rocket explosion can cause a mass casualty incident: a potential threat for future international terrorism?

Introduction:Over 2000 improvised rockets (called “Kassam” rockets) have been targeted at the south of Israel from the Gaza strip since 2001. Most of them have injured relatively few people. The...

Ability of the Medical Students to Triage Multi-casualty Situations

Objective:Advanced Trauma Life Support (ATLS®) course is routinely taught to the students in medical schools. While the ATLS® training improves the ability of medical students to prioritize and manage individual patients1, data is lacking on the application of ATLS® principles in a multi-casualty incident. The aim of this paper is to analyze the effect of ATLS® training principles on medical students’ ability to effectively triage mass casualty scenarios.Materials and Methods:A total of 103 medical students participated in the study. A pre-ATLS lecture test and a post-ATLS lecture test were designed containing three scenarios of five patients each directly related to different components of ATLS® training. Students were asked to rank patients in order of priority from 1 to 5.Data:Comparison of data showed a significantly higher score in post-lecture test than pre-lecture test (73.3% vs. 37.8%). No correlation was noticed between any completed core rotation and BLS/ALS courses by the students and their triage scores.Conclusion:We found in this paper that teaching ATLS® principles to medical students improved the ability of medical students to effectively triage mass casualty patients. We also found that the students are easily distracted if a child or a pregnant woman is included in the test scenario and core rotations have no significant impact on the triage scores.

A Terrorist Suicide Bombing at a Nightclub in Tel Aviv: Analyzing Response to a Nighttime, Weekend, Multi-Casualty Incident

A Terrorist Suicide Bombing at a Nightclub in Tel Aviv: Analyzing Response to a Nighttime, Weekend, Multi-Casualty Incident

Strategies in Evaluation and Management of Bam Earthquake Victims

On 26 December 2003, an earthquake measuring 6.5 on the Richter scale occurred in the city of Bam in southeastern Iran. Bam was destroyed completely, > 43,000 people were killed, and 30,000 were injured. The national and international responses were quick and considerable. Many field hospitals were created and large numbers of patients were evacuated from their homes and transported to hospitals throughout Iran. Nearly 700 patients were transferred to Chamran hospital in Shiraz within the first 48 hours after the earthquake. This is a retrospective study based on the medical records of earthquake casualties dispatched to Chamran Hospital. A screening tunnel composed of multiple stations was prepared before patients entered to facilitate the large influx of patients. Each of the victims was passed through this screening tunnel and assigned into one of three groups: (1) those needing emergency surgical intervention; (2) those needing less urgent surgery; and (3) those needing elective operations, supportive care, observation, and/or rehabilitation. Among the 708 patients, 392 were male (male/female ratio: 1.24) with a mean value of their ages of 30.5 years. (range: 1.5 months-70 years). Extremity fractures (136, 19%) were more common than were axial skeleton fractures (28, 4%). Out of the total 708 patients, 152 (21.5%) patients needed emergency operations, 26 (4%) needed less urgent surgery, and 530 (74.5%) required wound care or antibiotic therapy and other forms of supportive care. Some complications occurred, such as two patients with compartment syndromes of the leg, three required below-the-knee amputation, eight suffered acute renal failure, two developed fat emboli syndrome, and one had a brain injury that resulted in death. A comprehensive disaster plan is required to ensure a prompt disaster response and coordinated management of a multi-casualty incident. This can influence the outcomes of patients directly. A patient screening tunnel has advantages in rapid and effective evaluation and management of victims in any multi-casualty incident.

The role of the forensic science laboratory

Every incident attended by police in Australia is always initially considered to be a potential crime scene until evidence dictates otherwise. Consequently, forensic science organisational responsibilities typically include: ? The provision of a coordinated multidisciplined scientific field and laboratory response in support of both criminal and non-criminal investigations. ? The effective management of a disaster victim identification (DVI) response to a multi-casualty incident on behalf of the Coroner. In other words, the forensic science mission includes both the crisis (including threat assessment) and consequence of any incident or potential incident.

E MERGENCY M EDICAL P LANNING FOR THE 2000 R EPUBLICAN N ATIONAL C ONVENTION

Planning for emergency medical services (EMS) coverage for the 2000 Republican National Convention in Philadelphia was a complex process that involved the cooperation of municipal, state, and federal agencies as well as local hospitals. The medical needs of the delegates, members of the media, and support personnel at the convention venue had to be met. Contingency plans for the possibility of large, organized political protests and associated injuries had to be developed. Steps had to be taken to ensure the safety of emergency personnel who may have to respond to such incidents. Because of the heightened threat of terrorist attacks on civilian populations in recent years, specialized training and material to respond to such incidents were required. The important role that local hospitals may play in providing care to victims of a large, multicasualty incident, especially one involving weapons of mass destruction, was recognized. Therefore, steps were taken to increase the awareness of hospital staff to patient decontamination and isolation techniques as well as specific therapies for the chemical, biological, and radioactive agents that terrorists might use. Finally, despite the focus placed on the convention, the day-to-day emergency medical needs of the citizens of Philadelphia had to be met. Through careful planning, flexibility, and cooperation, it was possible to successfully address all of these issues.

The Gulf War: The Experience of a Department of Anesthesiology in the Management of Scud Missile Casualties

The pivotal role of anesthesiologists in the implementation of disaster plans is not widely appreciated. To describe the role of anesthesiologists as managers in the operating room (OR) especially during hospital disaster management. On 25 February 1991, King Fahd Hospital of the University in Eastern Saudi Arabia, was alerted, received, triaged, and treated the victims of a Scud missile attack on a United States military barracks which killed 28 and injured more than 100 service personnel. There were 47 males and 15 females admitted to the hospital. Their initial triage categories of injuries were: 1) red, 23; 2) yellow, 27; and 3) green, 7. The flow of patients through the main operating rooms occurred in two peaks: 1) treated within nine hours (60%); and 2) during the next 11 hours (40%). A total 101 units of blood and blood products were consumed. The role of the Chief of Anesthesiology was vital in the dynamics of the situation regarding appropriate deployment of staff and ensuring an orderly throughput of victims in the operating room. He also was required to keep track of resources and supply levels in the operating room, so that he could advise the hospital administration appropriately. The successful management of a large multi-casualty incident, which involved use of the operating rooms, depended upon the efficient coordination of clearly defined functions with the Chief of Anesthesiology Service as the team leader.

Multi-Casualty Incident EMS Response at a Very Remote Location

When a multiple patient incident occurs in a remote location, significant challenges are presented to the Emergency Medical Services (EMS) system. Emergency medical services systems need to have the capability to respond effectively to major incidents anywhere within the service area.On 2 September, 1988, some time after 1400H, a Gray Line of Alaska tour bus overturned at milepost 132 on the Taylor Highway in the interior region of Alaska. The bus rolled from a soft shoulder down a hill as it attempted to pass a large truck going the opposite direction. The accident location was 220 air miles east of Fairbanks, a city of about 60,000 population.

The Role of the Physician at a Medical Disaster: Hospital Emergency Response Teams

The Hospital Emergency Response Team concept, as outlined here and in the Multi-Casualty Incident Operational Procedures of the California Fire Chiefs Association, is the result of a consensus effort by all EMS interest groups in Los Angeles. It is an effective way to utilize the skills of emergency medical personnel at the scene of a disaster. The role of the physician is an important one, and this concept was specifically designed to maximize the benefit to be derived from having a physician at the scene. It is important, however, that physicians recognize their limitations; a medical degree does not automatically confer “mystic abilities”in the area of disaster management. The role of the physician should include pre-disaster planning and at-scene patient management responsibilities as a member or leader of a pre-designated hospital-based emergency medical response team.