scholarly journals Regional Variation in Critical Care Evacuation Needs for Children After a Mass Casualty Incident

2012 ◽  
Vol 6 (2) ◽  
pp. 146-149 ◽  
Author(s):  
Robert K. Kanter
Keyword(s):  
Public Health ◽  
New York ◽  
Critical Care ◽  
Metropolitan Area ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Evacuation Time ◽  
Pediatric Critical Care ◽  
Ground Ambulance ◽  
Ground Ambulances

ABSTRACTObjectives: To determine the ability of five New York statewide regions to accommodate 30 children needing critical care after a hypothetical mass casualty incident (MCI) and the duration to complete an evacuation to facilities in other regions if the surge exceeded local capacity.Methods: A quantitative model evaluated pediatric intensive care unit (PICU) vacancies for MCI patients, based on data on existing resources, historical average occupancy, and evidence on early discharges and transfers in a public health emergency. Evacuation of patients exceeding local capacity to the nearest PICU center with vacancies was modeled in discrete event chronological simulations for three scenarios in each region: pediatric critical care transport teams were considered to originate from other PICU hospitals statewide, using (1) ground ambulances or (2) helicopters, and (3) noncritical care teams were considered to originate from the local MCI region using ground ambulances. Chronology of key events was modeled.Results: Across five regions, the number of children needing evacuation would vary from 0 to 23. The New York City (NYC) metropolitan area could accommodate all patients. The region closest to NYC could evacuate all excess patients to PICU hospitals in NYC within 12 hours using statewide critical care teams traveling by ground ambulance. Helicopters and local noncritical care teams would not shorten the evacuation. For other statewide regions, evacuation of excess patients by statewide critical care teams traveling by ground ambulance would require up to nearly 26 hours. Helicopter transport would reduce evacuation time by 40%-44%, while local noncritical care teams traveling by ground would reduce evacuation time by 16%-34%.Conclusions: The present study provides a quantitative, evidence-based approach to estimate regional pediatric critical care evacuation needs after an MCI. Large metropolitan areas with many PICU beds would be better able to accommodate patients in a local MCI, and would serve as a crucial resource if an MCI occurred in a smaller community. Regions near a metropolitan area could be rapidly served by critical care transport teams traveling by ground ambulance. Regions distant from a metropolitan area might benefit from helicopter transport. Using local noncritical care transport teams would involve shorter delays and less expert care during evacuation.(Disaster Med Public Health Preparedness. 2012;6:146–149)

Utilizing a Pediatric Disaster Coalition Model to Increase Pediatric Critical Care Surge Capacity in New York City

2017 ◽  
Vol 11 (4) ◽  
pp. 473-478 ◽  
Author(s):  
Michael Frogel ◽  
Avram Flamm ◽  
Mayer Sagy ◽  
Katharine Uraneck ◽  
Edward Conway ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Critical Care ◽  
York City ◽  
Emergency Preparedness ◽  
Mass Casualty ◽  
Surge Capacity ◽  
Pediatric Critical Care ◽  
Mass Casualty Event ◽  
Care Surgery

AbstractA mass casualty event can result in an overwhelming number of critically injured pediatric victims that exceeds the available capacity of pediatric critical care (PCC) units, both locally and regionally. To address these gaps, the New York City (NYC) Pediatric Disaster Coalition (PDC) was established. The PDC includes experts in emergency preparedness, critical care, surgery, and emergency medicine from 18 of 25 major NYC PCC-capable hospitals. A PCC surge committee created recommendations for making additional PCC beds available with an emphasis on space, staff, stuff (equipment), and systems. The PDC assisted 15 hospitals in creating PCC surge plans by utilizing template plans and site visits. These plans created an additional 153 potential PCC surge beds. Seven hospitals tested their plans through drills. The purpose of this article was to demonstrate the need for planning for disasters involving children and to provide a stepwise, replicable model for establishing a PDC, with one of its primary goals focused on facilitating PCC surge planning. The process we describe for developing a PDC can be replicated to communities of any size, setting, or location. We offer our model as an example for other cities. (Disaster Med Public Health Preparedness. 2017;11:473–478)

scholarly journals (P1-78) Utilizing New York City Pediatric Disaster Coalition Site Visits to Create Hospital Pediatric Critical Care Surge Plans

2011 ◽  
Vol 26 (S1) ◽  
pp. s124-s124
Author(s):  
A. Flamm ◽  
G. Foltin ◽  
K. Uraneck ◽  
A. Cooper ◽  
B.M. Greenwald ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Critical Care ◽  
York City ◽  
Emergency Preparedness ◽  
Capacity Planning ◽  
Mass Casualty ◽  
Federal Grant ◽  
Surge Capacity ◽  
Pediatric Critical Care

PurposeThe New York City (NYC) Department of Health and Mental Hygiene (DOHMH) has supported a federal grant establishing a Pediatric Disaster Coalition (PDC) comprised of pediatric critical care (PCC) and emergency preparedness consultants from major city hospitals and health agencies. One of the PDC's goals was to develop recommendation for hospital-based PCC surge plans.MethodsMembers of the PDC convened bi-weekly and among other projects, developed guidelines for creating PCC surge capacity plans. The PDC members, acting as consultants, conducted scheduled visits to hospitals in NYC and actively assisted in drafting PCC surge plans as annexes to existing hospital disaster plans. The support ranged from facilitating meetings to providing draft language and content, based on each institutions request.ResultsNew York City has 25 hospitals with PCC services with a total of 244 beds. Five major hospitals have completed plans, thereby adding 92 PCC beds to surge capacity. Thirteen additional hospitals are in the process of developing a plan. The PDC consultants participated in meetings at 11 of the planning hospitals, and drafted language for 10 institutions. The PDC continues to reach out to all hospitals with the goal of initiating plans at all 25 PCC hospitals.ConclusionsProviding surge guidelines and the utilization of on-site PDC consultants was a successful model for the development and implementation of citywide PCC surge capacity planning. Visiting hospitals and actively assisting them in creating their plans was an effective, efficient and well received, method to create increased PCC surge capacity. By first planning with major hospitals, a significant increase of surge beds (92 or 38%) was created, from a minimal number of hospitals. Once hospitals complete plans, it is anticipated that there will be the addition of at least 200 PCC surge beds that can be incorporated in to regional city-wide response to pediatric mass-casualty incident.

Mass Casualty Triage: An Evaluation of the Science and Refinement of a National Guideline

2011 ◽  
Vol 5 (2) ◽  
pp. 129-137 ◽  
Author(s):  
E. Brooke Lerner ◽  
David C. Cone ◽  
Eric S. Weinstein ◽  
Richard B. Schwartz ◽  
Phillip L. Coule ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
The United States ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
National Guideline ◽  
Public Health Preparedness ◽  
The Core ◽  
Individual Assessment ◽  
Triage Category

ABSTRACTMass casualty triage is the process of prioritizing multiple victims when resources are not sufficient to treat everyone immediately. No national guideline for mass casualty triage exists in the United States. The lack of a national guideline has resulted in variability in triage processes, tags, and nomenclature. This variability has the potential to inject confusion and miscommunication into the disaster incident, particularly when multiple jurisdictions are involved. The Model Uniform Core Criteria for Mass Casualty Triage were developed to be a national guideline for mass casualty triage to ensure interoperability and standardization when responding to a mass casualty incident. The Core Criteria consist of 4 categories: general considerations, global sorting, lifesaving interventions, and individual assessment of triage category. The criteria within each of these categories were developed by a workgroup of experts representing national stakeholder organizations who used the best available science and, when necessary, consensus opinion. This article describes how the Model Uniform Core Criteria for Mass Casualty Triage were developed.(Disaster Med Public Health Preparedness. 2011;5:129-137)

scholarly journals Prolonged Stabilization During a Mass Casualty Incident at Sea in the Era of Distributed Maritime Operations

2020 ◽  
Vol 185 (11-12) ◽  
pp. 2192-2197
Author(s):  
William G Day ◽  
Elizabeth Cooper ◽  
Khanh Phung ◽  
Benjamin Miller ◽  
Joseph DuBose ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Critical Care ◽  
Whole Blood ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Special Forces ◽  
Care Environment ◽  
Medical Evacuation ◽  
Maritime Operations ◽  
Pulmonary Morbidity

Abstract In August 2017, the USS Bataan received a mass casualty incident (MCI) of 6 foreign special forces operators after a helicopter crash. All 6 patients were medically evacuated successfully to the USS Bataan, and all patients survived and were successfully returned to their allied country. Four of the patients received whole blood with 2 receiving over 10 units of blood or massive transfusions. One patient required 44 units of blood, and at 1 point in his resuscitation, he received 12 units of whole blood every 30 minutes. Due to administrative factors outside of the ship’s control, these 6 patients had prolonged stabilization during the MCI. This factor differentiates this MCI on the USS Bataan from previous cases. Internal medicine trained physicians with their expertise in inpatient care, postsurgical management, and critical care were instrumental in sustaining these casualties in this prolonged stabilization environment. In the era of distributed maritime operations, where casualty-receiving ships will experience more geographic and resource isolation, there is a potential for the need for prolonged stabilization above the 6 to 12-hour window typical of role II platforms. The known increase in cardiac and pulmonary morbidity and mortality with medical evacuation delay highlights the importance of internal medicine physicians in the role II setting. It is critical that we emphasize the inpatient and critical care principles of these patients in the prolonged field care environment.

scholarly journals Using a joint triage model for multi-hospital response to a mass casualty incident in New York city

2009 ◽  
Vol 2 (2) ◽  
pp. 114 ◽  
Author(s):  
Bonnie Arquilla ◽  
Lorenzo Paladino ◽  
Charlotte Reich ◽  
Ethan Brandler ◽  
Michael Lucchesi ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
York City ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Hospital Response

Regional Health System Response to the Virginia Tech Mass Casualty Incident

2007 ◽  
Vol 1 (S1) ◽  
pp. S9-S13 ◽  
Author(s):  
Lisa Kaplowitz ◽  
Morris Reece ◽  
Jody Henry Hershey ◽  
Carol M. Gilbert ◽  
Italo Subbarao
Keyword(s):  
Public Health ◽  
Mortality Rate ◽  
Health System ◽  
Trauma Center ◽  
Virginia Tech ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
System Response ◽  
Regional Health ◽  
Severity Scores

ABSTRACTBackground: On April 16, 2007 a mass shooting occurred on the campus of Virginia Polytechnic Institute and State University (Virginia Tech). Due to both distance and weather, air transport of the injured directly to a level 1 trauma center was not possible. The injured received all of their care or were initially stabilized at 3 primary hospitals that either had a level 3 trauma center designation or no trauma center designation.Methods: This article is a retrospective analysis of the regional health system (prehospital, hospital, regional hospital emergency operations center, and public health local and state) response. Data records from all of the regional responding emergency medical services, hospitals, and coordinating services were reviewed and analyzed. Records for all 26 patients were reviewed and analyzed using triage designations, injury severity scores (ISS), and critical mortality.Results: Twenty-five of the 26 patients were triaged in the field. Excluding 1 patient (asthma), the average ISS for victims presenting was 8.2. Twelve patients had an ISS of ≥9, and 5 had an ISS score of ≥15. Ten of the 26 patients (38%) required urgent intervention and surgery in the first 24 hours. The overall regional health system mortality of victims received was 3.8% (1 death [excluding 1 dead on arrival {DOA}]/ 26 victims from scene). The regional health system critical mortality rate (excluding 1 victim who was DOA) was 20% (1/5).Discussion: The outcomes of the Virginia Tech mass casualty incident, as evidenced by the low overall regional health system mortality of victims received at 3.8% (1/26) and low critical mortality rate (excluding 1 victim who was DOA) of 20%, coupled with a need to treat a significant amount of moderately injured victims 46% (12/26 with ISS ≥9) gives credence to the successful response. The successful response occurred as a consequence of regional collaborative planning, training, and exercising, which resulted not only in increased expertise and improved communications but also in essential relationships and a sense of trust forged among all of the responders. (Disaster Med Public Health Preparedness. 2007;1(Suppl 1):S9–S13)

scholarly journals Plan for Increasing Pediatric Critical Care Surge Capacity in New York City

2010 ◽  
Vol 25 (S1) ◽  
pp. S37-S37
Author(s):  
Sagy Mayer ◽  
Avram Flamm ◽  
George Foltin ◽  
Katherine Uraneck ◽  
Michael Tunik ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Critical Care ◽  
York City ◽  
Surge Capacity ◽  
Pediatric Critical Care

Rural Mass Casualty Preparedness and Response: The Institute of Medicine's Forum on Medical and Public Health Preparedness for Catastrophic Events

2012 ◽  
Vol 6 (3) ◽  
pp. 297-302 ◽  
Author(s):  
Kristin P. Viswanathan ◽  
Robert Bass ◽  
Gamunu Wijetunge ◽  
Bruce M. Altevogt
Keyword(s):  
Public Health ◽  
Best Practices ◽  
Research And Development ◽  
Mass Casualty Incident ◽  
Emerging Technology ◽  
Mass Casualty ◽  
Catastrophic Events ◽  
Public Health Preparedness ◽  
Rural Infrastructure ◽  
Daily Capacity

ABSTRACTThe Institute of Medicine's Forum on Medical and Public Health Preparedness for Catastrophic Events hosted a workshop at the request of the Federal Interagency Committee on Emergency Medical Services (FICEMS) that brought together a range of stakeholders to broadly identify and confront gaps in rural infrastructure that challenge mass casualty incident (MCI) response and potential mechanisms to fill them. This report summarizes the presentations and discussions around 6 major issues specific to rural MCI preparedness and response: (1) improving rural response to MCI through improving daily capacity and capability, (2) leveraging current and emerging technology to overcome infrastructure deficits, (3) sustaining and strengthening relationships, (4) developing and sharing best practices across jurisdictions and sectors, (5) establishing metrics research and development, and (6) fostering the need for federal leadership to expand and integrate EMS into a broader rural response framework.(Disaster Med Public Health Preparedness. 2012;6:297–302)

Model Uniform Core Criteria for Mass Casualty Triage

2011 ◽  
Vol 5 (2) ◽  
pp. 125-128 ◽  
Keyword(s):  
Public Health ◽  
Scientific Evidence ◽  
Geographic Location ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Expert Consensus ◽  
Research Gaps ◽  
Triage System ◽  
Significant Research ◽  
Primary Triage

ABSTRACTThere is a need for model uniform core criteria for mass casualty triage because disasters frequently cross jurisdictional lines and involve responders from multiple agencies who may be using different triage tools. These criteria (Tables 1-4) reflect the available science, but it is acknowledged that there are significant research gaps. When no science was available, decisions were formed by expert consensus derived from the available triage systems. The intent is to ensure that providers at a mass-casualty incident use triage methodologies that incorporate these core principles in an effort to promote interoperability and standardization. At a minimum, each triage system must incorporate the criteria that are listed below. Mass casualty triage systems in use can be modified using these criteria to ensure interoperability. The criteria include general considerations, global sorting, lifesaving interventions, and assignment of triage categories. The criteria apply only to providers who are organizing multiple victims in a discrete geographic location or locations, regardless of the size of the incident. They are classified by whether they were derived through available direct scientific evidence, indirect scientific evidence, expert consensus, and/or are used in multiple existing triage systems. These criteria address only primary triage and do not consider secondary triage. For the purposes of this document the term triage refers to mass-casualty triage and provider refers to any person who assigns primary triage categories to victims of a mass-casualty incident.(Disaster Med Public Health Preparedness. 2011;5:125–128)

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