Multiple Casualty Research Articles

Study of the preparedness of bystanders with no medical education for first aid provision in multiple casualty incidents

Multiple casualty incidents (MCIs) almost always accompany disasters occurring in our country. Providing first aid is considered a major challenge among the population. An important role is assigned to the potential reserve among eyewitnesses, because often the first specialized medical care is remote in place and time. The adaptation of the basic medical techniques for rendering first aid to the knowledge of potential eyewitnesses among the population with non-medical education has been made, which is among one of the main priorities of the trainers. After the comparative analysis between the first group respondents (FGR) and second group respondents (SGR), we came to several conclusions. There was a group of signs that united the two studied groups: most of the respondents in both groups were earthquake survivors—84.56% of FGR and 42% of SGR; the emergency medical service (EMS) was the most trusted source according to all participants (FGR—68.45%, SGR—50.98%) for providing FA, with the least reliance on the GP; both groups were unsure of their skills (partial and none) in providing FA in MCI—a total of 68.71% of FGR, and 53.59% of SGR; the desire to gain more knowledge in both groups was the same—94% of the total number of respondents answered positively.

Update to U.S. National Response Team's Abandoned Vessels Authorities and Best Practices Guidance

Abstract The U.S. National Response Team promulgated an interagency guidance document entitled “Abandoned Vessel Authorities and Best Practices Guidance” (AVG) in 2014 to address a myriad of questions that the Federal On-Scene Coordinators and broader response community tend to face when mitigating threats caused by abandoned or derelict vessels. This document compiles information surrounding existing laws, policies, and best practices to inform and advise responders without bogging them down in “legalese” or forcing them to search from document to document to find all the relevant information. In the aftermath of the 2017 Atlantic Hurricane Season and associated responses, the National Response Team tasked its Preparedness Committee to reopen the 2014 AVG to ensure the document addressed the challenges that were brought to light amid the responses. The Committee chartered a working group to systematically review and update this document and incorporate the latest pertinent policy changes, including those from Federal Emergency Management Agency to ensure that it most thoroughly addressed the gamut of issues a responder may come up against in the arena of abandoned (or derelict, or displaced) vessel management. The updated AVG was completed and approved by the NRT in 2020 and is posted to the NRT website. Major updates include: Considerations for long-term storage and disposal;Clarification on foreign-flagged vessel nuances;Information for responders to consider regarding contaminants other than those covered under NCP/ESF constructs (e.g. if typical response authorities do not cover a scenario, what options might the responder still leverage);An additional section addressing nuances of managing multiple vessel casualties at once, either due to a natural disaster or an act or omission from a third party; andImportant differences between National Contingency Plan and Stafford Act funded/organized responses. This paper dives into the rationale for making changes, the benefits of additions made, the processes and methodologies for undertaking updates, and major elements of the AVG to provide a snapshot of the guidance it affords the reader.

Physician and nurses' perception of paediatric trauma care in Israeli emergency departments.

Treatment of paediatric trauma requires specialized infrastructure, medical equipment, medical staff and ancillary support personnel that have been specifically trained for such tasks. To examine the perceptions and attitudes of physicians and nurses in general and paediatric emergency departments (PEDs) on training, confidence, and management of paediatric trauma in order to facilitate the establishment of an optimal model for admitting and treating paediatric trauma patients. Drawing on published literature and a previously conducted qualitative study that explored the provision of medical care to paediatric trauma patients, we conducted an attitude survey. A 26-item paper-based questionnaire was distributed by nurse managers to all staff working within general EDs and PEDs of 22 medical centres across Israel. Of 843 physicians and nurses who completed the survey, 61.1% considered PEDs the most appropriate facility for treating both minor and severe paediatric trauma, 88.5% believed that minor paediatric trauma should be treated in designated paediatric trauma centres, and 53.6% deemed that paediatric emergency medicine specialists are the most suitable primary decision makers in paediatric trauma. PED teams expressed greater professional confidence for treating paediatric trauma and multiple casualty incident patients. Greater professional confidence was positively correlated with paediatric trauma training, greater exposure to paediatric trauma cases, and working in larger medical centres. The results of the current study suggest that PEDs are perceived to be more appropriate for dealing with paediatric trauma. Also, treatment of severe trauma may be more appropriate in centres that admit large numbers of paediatric trauma cases. Emergency medicine teams should undergo training for dealing with paediatric trauma. Such training would develop their skills, increase their confidence, and enhance their emotional abilities to cope with paediatric trauma.

Analysis of safety climate and individual factors affecting bus drivers’ crash involvement using a two-level logit model

Although traffic crashes involving buses are less frequent than those involving other vehicle types, the consequences of bus crashes are high due to the potential for multiple injuries and casualties. As driver error is a primary factor affecting bus crashes, driver safety education is one of the main countermeasures used to mitigate crash risk. In China, however, safety education is not as focused as it should be, largely due to the limited research identifying the specific driver behaviors, and potential influences on those behaviors, that are correlated with crashes. The aim of this study is, therefore, to explore the fleet- and driver-level risk factors underlying bus drivers’ self-reported crash involvement, including analyzing the effect of psychological distress on the most influential driver-level factors. A survey was conducted of 725 drivers from a large Shanghai bus company, and a random-effects two-level logit model was developed to integrate fleet and individual variables. Results showed that: 1) the fleet-level safety climate explained about 8.5% of the model’s variance, indicating it was a valid predictor of self-reported crash involvement; 2) the driver-level factors of drivers’ age, seniority, marital status, positive behavior, and driving anger influenced drivers’ self-reported crash involvement, but ordinary violations, lapses, aggressive violations, and insomnia were the most influential variables; 3) psychological distress appeared to associate with the high frequency of risky driving behavior and the high severity of driving anger. This study’s findings will help bus companies to give more attention to their safety climate and implement more targeted improvements to their driver safety education programs.

Demand modelling for emergency medical service system with multiple casualties cases: k-inflated mixture regression model

In most of the literature on emergency medical service (EMS) system design and analysis, arrivals of EMS calls are assumed to follow Poisson process. However, it is not uncommon for real-world EMS systems to experience batch arrivals of EMS requests, where a single call involves more than one patient. Properly capturing such batch arrivals is needed to enhance the quality of analyses, thereby improving the fidelity of a resulting system design. This paper proposes a spatio-temporal demand model that incorporates batch arrivals of EMS calls. Specifically, we construct a spatio-temporal compound Poisson process which consists of a call arrival model and call size model. We build our call arrival model by combining two models available in the existing EMS demand modeling literature—artificial neural network and spatio-temporal Gaussian mixture model. For the call size model, we develop a k-inflated mixture regression model. This model reflects the characteristics of EMS call arrivals that most calls involve one patient while some calls involve multiple patients. The utility of the proposed EMS demand model is illustrated by a probabilistic ambulance location model, where we show ignoring batch arrivals leads to overestimation of ambulance availability.

COVID-19: What we\u2019ve done well and what we could or should have done better\u2014the 4 Ps

The current coronavirus pandemic has impacted heavily on ICUs worldwide. Although many hospitals and healthcare systems had plans in place to manage multiple casualties as a result of major natural disasters or accidents, there was insufficient preparation for the sudden, massive influx of severely ill patients with COVID-19. As a result, systems and staff were placed under immense pressure as everyone tried to optimize patient management. As the pandemic continues, we must apply what we have learned about our response, both good and bad, to improve organization and thus patient care in the future.

Effect of Inorganic Filler Addition on Non-Combustible and Mechanical Properties of Color Coated Steel Sheets

Recent large-scale fires in buildings and logistic warehouses have become a major social issue, involving both property loss and multiple casualties. To make color coated steel sheets non-combustible and/or have anti-fire properties, various ways of optimizing manufacturing parameters have been investigated for outer, inner, roof and ceiling panels. In the present study, the effect of inorganic filler content and size on the non-combustible and mechanical properties of color coated steel sheets has been investigated using samples prepared as pre-painted coating materials. Both salt spray corrosion and chemical resistance tests were also carried out. Filler distribution and size were measured by optical microscopy, scanning electron microscopy and glow discharge spectroscopy, and found to be critical factors affecting non-combustible performance. As the amount of added filler increased, the non-combustible property of the color coated steel sheets improved, while mechanical properties, corrosion resistance by salt spray and chemical resistances deteriorated. During 3t-bending tests, the adhesive strength at the interface between coated layer and hot dip galvanized steel sheets was rather strong, although the filler-added upper coated layer was mostly peeled off. The mechanical properties of 30% filler addition samples were compared to samples with less than 20% filler addition. The main reason for the poorer performance was clarified in terms of filler size and crack propagation in the 3t-bended color coated layer.

An insight into the pharmaceutical sector in Yemen during conflict: challenges and recommendations

ABSTRACT In our world today, we need to understand, measure, and respond to inequality. The conflict and siege in Yemen have caused serious repercussions and consequences for the pharmaceutical sector and health of the people. Hospital, health centres and facilities, medicines warehouses and pharmaceutical factories have been destroyed. Further, the conflict has aggravated the health situation with shortages of medicines, an increase in chronic illnesses, and multiple epidemics and casualties. This article aims to highlight the challenges faced by the pharmaceutical sector in Yemen. It will address the overall state of health of the Yemeni people, as well as focus on the past, current status and future development of the pharmaceutical sector. Further, it will focus on possible remedial actions to solve some of these problems. These problems can be tackled if the responsible parties have the political will to do so. Acknowledging the different classes of problems is undeniably very important to provide clarity on the future of Yemen’s supposedly promising pharmaceutical landscape.

The Multiple Casualty Scenario: Role of the Anesthesiologist.

Purpose of ReviewMass casualty disasters (natural and man-made) present an acute, critical situation that taxes healthcare resources and clinician acumen. This review summarizes the characteristics and management skill sets that anesthesiologists possess that make them valuable clinicians during mass casualty events and why we as anesthesiologists must continually educate ourselves on this important topic.Recent FindingsAnesthesiologists should be involved in all aspects of emergency preparedness—mitigation, planning, response, and recovery. The anesthesia department should have a plan for how it will deal with managing patients during natural and man-made (unintentional or intentional) disasters, one that takes into account a risk hazard analysis and institutional goals. Unfortunately, most practicing anesthesiologists have not had training and ongoing education for such events, and few academic centers train anesthesiology residents and staff to prepare for mass casualty scenarios.SummaryThe everyday clinical practice of anesthesiologists involves the utilization of some of the skills (vascular access, tracheal intubation) commonly required to successfully manage mass casualty scenarios. Anesthesiologists’ knowledge of anti-cholinesterases makes them subject matter experts on nerve agent poisoning, and their experience managing trauma patients will serve them well, depending on the nature of the mass casualty event. Practicing anesthesiologists however need to continually educate themselves on their role during mass casualty events. and current anesthesiology residency programs should develop a curriculum and incorporate simulation training to better prepare future generations of anesthesiologists.

From battlefront to homefront: creation of a civilian walking blood bank

Hemorrhagic shock remains the leading cause of preventable death on the battlefield, despite major advances in trauma care. Early initiation of balanced resuscitation has been shown to decrease mortality in the hemorrhaging patient. To address transfusion limitations in austere environments or in the event of multiple casualties, walking blood banks have been used in the combat setting with great success. Leveraging the success of the region-wide whole blood program in San Antonio, Texas, we report a novel plan that represents a model response to mass casualty incidents.

A multiple casualty incident clinical tracking form for civilian hospitals.

While mass-casualty incidents (MCIs) may have competing absolute definitions, a universally ac-cepted criterion is one that strains locally available resources. In the fall of 2017, a MCI occurred in New York and Bellevue Hospital received multiple injured patients within minutes; lessons learned included the need for a formal-ized, efficient patient and injury tracking system. Our objective was to create an organized MCI clinical tracking form for civilian trauma centers. After the MCI, the notes of the surgeon responsible for directing patient triage were analyzed. A suc-cinct, organized template was created that allows MCI directors to track demographics, injuries, interventions, and other important information for multiple patients in a real-time fashion. This tool was piloted during a subsequent MCI. In late 2018, the hospital received six patients following another MCI. They arrived within a 4-minute window, with 5 patients being critically injured. Two emergent surgeries and angioembolizations were performed. The tool was used by the MCI director to prioritize and expedite care. All physicians agreed that the tool assisted in orga-nizing diagnostic and therapeutic triage. During MCIs, a streamlined patient tracking template assists with information recall and communica-tion between providers and may allow for expedited care.

On triage system

Introduction: Triage is the process of categorizing patients in emergency situation according to the severity of their injuries or sickness. This is done in order to give medical attention to those who need it first, to minimize loss of life from injuries. Aims: This article aims to create an electronic triage system based on the Raspberry Pi computer and Arduino microcontroller. The Raspberry Pi computer wirelessly receives data measured by the Arduino and analyses the data after which it automatically categorizes patients with minimal human intervention. Results: The Raspberry Pi runs a graphical user interface-based system that is used to display results and allow for users to input data into the database. The system contains two functionalities, emergency mode (MODE 1) and emergency department mode (MODE 2). MODE 1 is used for urgent outdoor emergency scenarios such as motor vehicle accident with multiple casualties, to determine the seriously injured victims. MODE 2 can be integrated in a medical center where it is used to determine which patient needs immediate attention in a scenario where there are so many patients waiting. In MODE 2, patient's recent vitals readings can be graphically viewed for further analysis and medical doctors can comment on each patient's progress for future reference. This data is then uploaded to an online server. Conclusion: The article focuses on the design and implementation of triage system which is based on Raspberry Pi.

The challenges of forensic medical expertise in aircraft accidents: A case report

One of the crucial roles that a Forensic Pathologist performs is disaster victim identification. Aircraft accidents are one of the common scenarios that cause mass fatalities. Most of the aircraft crashes happen right after take-off or before landing. Aircraft crashes typically result in multiple casualties due to massive mechanical injuries. We describe a case of identification of 5 deceased passengers of a sports plane that crashed immediately after taking off. One of the passengers managed to jump of the plane before crashing. Visual identification was not possible in the case of four out of the five passengers that remained in the plane as they suffered from superficial charring. The passenger that managed to jump off was found 30 meters away from the wreckage, and identification was possible in his case due to preservation of facial features, dentition, and fingerprints. Autopsy and visual examination were performed on the five cadavers, and blood samples for toxicological analysis and DNA profiling were preserved. Alcohol was not present in the blood of any of the deceased. Full DNA profiles of the cadavers were generated, and the identities of them were established to be members of the Parachute club.

A multiple casualty incident clinical tracking form for civilian hospitals.

While mass-casualty incidents (MCIs) may have competing absolute definitions, a universally accepted criterion is one that strains locally available resources. In the fall of 2017, a MCI occurred in New York and Bellevue Hospi-tal received multiple injured patients within minutes; lessons learned included the need for a formalized, efficient patient and injury tracking system. Our objective was to create an organized MCI clinical tracking form for civilian trauma centers. After the MCI, the notes of the surgeon responsible for directing patient triage were analyzed. A suc-cinct, organized template was created that allows MCI directors to track demographics, injuries, interventions, and other important information for hmultiple patients in a real-time fashion. This tool was piloted during a subsequent MCI. In late 2018, the hospital received six patients following another MCI. They arrived within a 4-minute window, with 5 patients being critically injured. Two emergent surgeries and angioembolizations were performed. The tool was used by the MCI director to prioritize and expedite care. All physicians agreed that the tool assisted in organizing diagnostic and therapeutic triage. During MCIs, a streamlined patient tracking template assists with information recall and communica-tion between providers and may allow for expedited care.

Exploring the impact of resident proximity to wildfires in the northern Rocky Mountains: Perceptions of climate change risks, drought, and policy

Wildfire disaster risks are being heighted globally due to climate change. Here, we present a United States-based wildfire case study of the northern Rocky Mountains to investigate links between wildfire experience, knowledge, and perceived risk due to climate change and potential policy support for two internationally relevant strategies: land management and private/public collaboration. The 2017 fire season was one of the worst on record in the northern Rocky Mountains resulting in billions of dollars in damage and multiple casualties warranting exploration. In order to inform wildfire policy pertaining to forest land management and private/public collaboration, a survey (N = 1154) was conducted in August of 2017 among residents of 34 counties in the northern Rocky Mountains who had either experienced a close proximate large wildfire (n = 611) or had not (n = 543). Consistent with construal level theory, residents who perceived climate change is occurring had a clearer understanding of the link between climate change and local conditions (e.g., drought). Those who experienced a wildfire were more likely to support adaptive policies (i.e., land management changes, increased private/public collaboration). Residents who experienced a wildfire but did not perceive climate change risks (experienced/no risk) were less likely to attribute wildfires to drought conditions and more likely to support land management initiatives. Residents who experienced a wildfire and perceived climate change risks (experienced/risk) were more supportive of collaboration, but not land management initiatives. Theory application and implications are discussed.

Miami Pedestrian Bridge Collapse: Computational Forensic Analysis

AbstractOn March 15, 2018, a pedestrian concrete truss bridge in Miami, Florida, collapsed during construction. The failure of this bridge caused multiple casualties and raised many serious concern...

Virtual Reality Triage Training Can Provide Comparable Simulation Efficacy for Paramedicine Students Compared to Live Simulation-Based Scenarios

Background: Mass-casualty incidents (MCIs) are catastrophic. Whether they arise from natural or man-made disasters, the nature of such incidents and the multiple casualties involved can rapidly overwhelm response personnel. Mass-casualty triage training is traditionally taught via either didactic lectures or table top exercises. This training fails to provide an opportunity for practical application or experiential learning in immersive conditions. Further, large-scale simulations are heavily resource-intensive, logistically challenging, require the coordination and time of multiple personnel, and are costly to replicate. This study compared the simulation efficacy of a bespoke virtual-reality (VR) MCI simulation with an equivalent live simulation scenario designed for undergraduate paramedicine students. Methods: Both simulations involved ten injured patients resulting from a police car chase and shooting. Twenty-nine second-year paramedicine students completed the live and VR simulation in a random order. The training efficacy of the VR and live simulation was evaluated with respect to student immersion and task-difficulty, clinical decision-making (i.e. triage card allocation accuracy and timeliness), learning satisfaction, and cost of delivery. Results: While perceived physical demand was higher in the live simulation compared to VR (p < 0.001), no differences were observed across mental demand, temporal demand, performance, effort or frustration domains. No differences were found for participant satisfaction across the two platforms. No differences were observed in the number of triage cards correctly allocated to patients in each platform. However, participants were able to allocate cards far quicker in VR (p < .001). Cost of running the VR came to AUD $712.04 (staff time), compared to the live simulations which came to AUD $9,413.71 (staff time, moulage, actors, director, prop vehicle), approximately 13 times more expensive. Conclusion: The VR simulation provided near identical simulation efficacy for paramedicine students compared to the live simulation. VR MCI training resources represent an exciting new direction for authentic and cost-effective education and training for medical professionals.

Analysis of the Causes of Multiple Casualties in an Electronics Factory Fire

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Whole blood in disaster and major incident planning

Transfusion emergency preparedness is increasingly becoming an integrated part of major incident planning. The spectrum of planning extends from the sophisticated healthcare system dealing with multiple casualties, to the isolated healthcare facility resuscitating the critically ill patient with massive haemorrhage. Transfusion preparedness should follow risk assessment and be nested within the wider emergency planning system. The response should be designed to deliver both safety and sufficiency of transfusion support and includes diagnostics, donation and distribution. The biggest transfusion risks in emergency situations are those of red cell ABO incompatibility and delayed provision. Sufficiency and supply may be compromised when communities are isolated and cannot access mutual support. Planning may need to consider local collection and testing of blood as a further resilience measure. Considerations include demand planning; inventory management and transfusion triage; a whole blood preparedness model; resilience and resupply and the human factor. We suggest a whole blood programme can simplify the whole vein‐to‐vein process for production, laboratory and clinical staff and can be integrated into a range of healthcare systems.

Riots in Beirut: Description of the Impact of a New Type of Mass Casualty Event on the Emergency System in Lebanon.

In the summer of 2015, Beirut experienced a garbage crisis that led to rioting. Riot control measures resulted in multiple casualties. This study examines injury patterns of riot victims presenting to the emergency department of a tertiary care center in a developing country. A retrospective study was conducted in the emergency department of the American University of Beirut Medical Center between August 22 and August 30, 2015. Patients seen in the emergency department with riot injuries were included. Patient characteristics, injuries, and resources utilized in the emergency department were analyzed. Ninety-five patients were identified. Most patients presented to the emergency department within a short time period. The mean age of the patients was 28.0 ± 8.7 years. Most (90.5%) of the patients were males and 92.6% were protestors. Emergency medical services were utilized by 41.0% of patients. Laceration was the most common presenting complaint (28.5%), and blunt trauma was the most common type of injury (50.5%). The head/face/neck was the most common injured body region (55.8%). Most patients did not require blood tests or procedures (91.6% and 61.0%, respectively), and 91.2% of patients were treated in the emergency department and discharged. One patient required intensive care unit admission and another was dead on arrival. Most patients had mild injuries on presentation. The emergency department experienced a high influx of patients. Complications and deaths can occur from seemingly nonlethal weapons used during riots and warrant effective prehospital and hospital disaster planning.