Mass Casualty Incident (MCI) training in a metropolitan university hospital: short-term experience with MAss Casualty SIMulation system MACSIM®

AbstractAt approximately 12:30 pm on Saturday September 21, 2013, armed assailants attacked the upscale Westgate shopping mall in the Westlands area of Nairobi, Kenya. Using the seven key Major Incident Medical Management and Support (MIMMS) principles, command, safety, communication, assessment, triage, treatment, and transport, the Aga Khan University Hospital, Nairobi (AKUH,N) emergency department (ED) successfully coordinated the reception and care of all the casualties brought to the hospital.This report describes the AKUH,N ED response to the first civilian mass-casualty shooting incident in Kenya, with the hope of informing the development and implementation of mass-casualty emergency preparedness plans by other EDs and hospitals in Kenya, appropriate for the local health care system.WachiraBW, AbdallaRO, WallisLA. Westgate shootings: an emergency department approach to a mass-casualty incident. Prehosp Disaster Med. 2014;29(5):1-4.

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The effect of training and experience on mass casualty incident triage performance: Evidence from emergency personnel in a high complexity university hospital

American Journal of Disaster Medicine ◽

10.5055/ajdm.2019.0322 ◽

2019 ◽

Vol 14 (2) ◽

pp. 113-119 ◽

Cited By ~ 1

Author(s):

Juan P. Vargas, MD, MSc ◽

Ives Hubloue, MD, PhD ◽

Jazmín J. Pinzón, MD ◽

Alejandra Caycedo Duque, MD

Keyword(s):

Emergency Department ◽

Mass Casualty Incident ◽

Mass Casualty ◽

University Hospital ◽

Trauma Patients ◽

Post Intervention ◽

Cross Sectional ◽

Emergency Department Staff ◽

Department Staff ◽

Before And After

Mass casualty incident (MCI) can occur at any time and place and health care institutions must be prepared to deal with these incidents. Emergency department staff rarely learn how to triage MCI patients during their medical or nurse degrees, or through on-the-job training. This study aims to evaluate the effect of training and experience on the MCI triage performance of emergency personnel.Methodology: This was a cross-sectional prospective study that analyzed the performance of 94 emergency department staff on the triage classifications of 50 trauma patients, before and after a short training in MCI triage, while taking into account their academic background and work experience.Results: The participants were assigned initially to one of two groups: low experience if they had less than 5 years of practice, and high experience if they had more than 5 years of practice. In the low experience group, the initial accuracy was 45.76 percent, over triage 45.84 percent, and subtriage 8.38 percent. In the high experience group, the initial accuracy was 53.80 percent, over triage 37.66 percent, and sub triage 8.57 percent.Postintervention Results: In the low experience group, the post intervention accuracy was 63.57 percent, over triage 21.15 percent, and subtriage 15.30 percentage. In the high experience group, the post-intervention accuracy was 67.66 percentage, over triage 15.19 percentage, and subtriage 17.14 percentage. Conclusion: Upon completion of this study, it can be concluded that MCI triage training significantly improved the performance of all those involved in the workshop and that experience plays an important role in MCI triage performance.

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Web-based, rapid and contactless management of ambulatory patients for SARS-CoV-2-testing

10.21203/rs.3.rs-114537/v1 ◽

2020 ◽

Author(s):

Jannik Stemler ◽

Oliver A. Cornely ◽

Torsten Noack-Schönborn ◽

Corinna Forholz ◽

Sofie Schumacher ◽

...

Keyword(s):

Mass Casualty Incident ◽

Mass Casualty ◽

University Hospital ◽

Test Results ◽

Web Based ◽

Duration Of Symptoms ◽

Efficient Management ◽

Ambulatory Patients ◽

The University ◽

Outpatient Appointments

Abstract BackgroundDuring the SARS-CoV-2 pandemic a mass casualty incident of ambulatory patients occurred at the COVID-19 rapid response infrastructure (CRRI) facility at the University Hospital of Cologne (UHC). We report the development of a patient-centred mobile-device solution to support efficient management of the facility, triage of patients and rapid delivery of test results.MethodsThe UHC-Corona Web Tool (CWT) was developed as a web-based application useable on each patient's smartphone. It provides, among others, a self-reported medical history including type and duration of symptoms and potential risk contacts and links all retrieved information to the digital patient chart via a QR code. It provides scheduling of outpatient appointments and automated transmission of SARS-CoV-2 test results.ResultsThe UHC-CWT was launched on April 9th, 2020. It was used by 28652 patients until August 31st,2020. Of those, 15245 (53,2%) consulted the CRRI, representing 43,1% of all CRRI patients during the observed period.There were 8304 (29,0%) specifications concerning travel history and 17145 (59,8%) indications of ≥1 symptom of SARS-CoV-2 infection. The most frequently indicated symptoms were sore throat (60,0%), headache (50,7%), common cold (45,1%) and cough (42,6%) while 11057 (40,2%) patients did not report any symptoms. After implementation of the UHC-CWT, the number of patient contacts per physician rose from 38 to 98,7 per day. The personnel for communication of test results was reduced from four on seven days to one on five days.ConclusionThe UHC-CWT is an effective digital solution for management of large numbers of outpatients for SARS-CoV-2 testing.

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Web-based, rapid and contactless management of ambulatory patients for SARS-CoV-2-testing

BMC Infectious Diseases ◽

10.1186/s12879-021-06249-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jannik Stemler ◽

Oliver A. Cornely ◽

Torsten Noack-Schönborn ◽

Corinna Fohrholz ◽

Sofie Schumacher ◽

...

Keyword(s):

Mass Casualty Incident ◽

Mass Casualty ◽

University Hospital ◽

Test Results ◽

Web Based ◽

Duration Of Symptoms ◽

Efficient Management ◽

Ambulatory Patients ◽

The University ◽

Outpatient Appointments

Abstract Background During the SARS-CoV-2 pandemic a mass casualty incident of ambulatory patients occurred at the COVID-19 rapid response infrastructure (CRRI) facility at the University Hospital of Cologne (UHC). We report the development of a patient-centred mobile-device solution to support efficient management of the facility, triage of patients and rapid delivery of test results. Methods The UHC-Corona Web Tool (CWT) was developed as a web-based software useable on each patient’s smartphone. It provides, among others, a self-reported medical history including type and duration of symptoms and potential risk contacts and links all retrieved information to the digital patient chart via a QR code. It provides scheduling of outpatient appointments and automated transmission of SARS-CoV-2 test results. Results The UHC-CWT was launched on 9 April 2020. It was used by 28,652 patients until 31 August 2020. Of those, 15,245 (53,2%) consulted the CRRI, representing 43,1% of all CRRI patients during the observed period. There were 8304 (29,0%) specifications concerning travel history and 17,145 (59,8%) indications of ≥1 symptom of SARS-CoV-2 infection. The most frequently indicated symptoms were sore throat (60,0%), headache (50,7%), common cold (45,1%) and cough (42,6%) while 11,057 (40,2%) patients did not report any symptoms. After implementation of the UHC-CWT, the amount of patient contacts per physician rose from 38 to 98,7 per day. The personnel for communication of test results were reduced from four on seven days to one on five days. Conclusion The UHC-CWT is an effective digital solution for management of large numbers of outpatients for SARS-CoV-2 testing.

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Effect the Education of Mass Casualty Incident (MCI) on Knowledge, Attitude, Practice and Satisfaction in Red Crescent Rescuers of Hamadan

Scientific Journal of Hamedan Nursing and Midwifery Faculty ◽

10.21859/nmj-25016 ◽

2017 ◽

Vol 25 (1) ◽

pp. 44-51

Author(s):

Arezo Karampourian ◽

Zohreh Ghomian ◽

Katayoun Jahangiri ◽

Behroz Karkhanei

Keyword(s):

Mass Casualty Incident ◽

Mass Casualty

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Validity of neuron-specific enolase as a prognostic tool in acute ischemic stroke in adults at Suez Canal University Hospital

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-021-00268-6 ◽

2021 ◽

Vol 57 (1) ◽

Author(s):

Mohammed H. Shash ◽

Reda Abdelrazek ◽

Nashwa M. Abdelgeleel ◽

Rasha M. Ahmed ◽

Adel H. El-baih

Keyword(s):

Ischemic Stroke ◽

Serum Level ◽

Acute Ischemic Stroke ◽

Cell Damage ◽

Neuron Specific Enolase ◽

Clinical Severity ◽

University Hospital ◽

Short Term ◽

Prediction Of Mortality ◽

Death Group

Abstract Background Biological markers of acute nerve cell damage can assist in the outcome of acute ischemic stroke, such as neuron-specific enolase (NSE) that have been tested for association with initial severity of stroke, extent of infarction, and functional outcome. Objective To determine short-term prognostic value of the biochemical marker neuron-specific enolase (NSE) in acute ischemic stroke. Methods A cohort study carried out on 37 patients with acute ischemic stroke. Data were gathered in a prepared data sheet. Initial serum NSE level was measured to the patients in the Emergency department within 6 h of the onset of stroke and another measurement after 48 h. National Institute of Health Stroke Scale (NIHSS) was held to the patients at presentation and after 28 days of stroke to determine short-term morbidity and mortality. Results Out of the 37 patients, 31 patients survived (no-death group) and 6 patients died (death group). The mean serum level of neuron-specific enolase at presentation and after 48 h was significantly higher in the death group than in the no-death group. There was a statistically significant positive correlation between neuron-specific enolase (NSE) serum level and clinical severity of stroke (NIHSS) among the patients at presentation (r = 0.737, p = 0.000). Conclusion Neuron-specific enolase (NSE) can be applied as single independent marker for prediction of mortality and short-term morbidity in ischemic stroke patients.

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Prehospital Triage by Lay Person First Responders: A Scoping Review and Proposal for a new Prehospital Triage Tool

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2021.19 ◽

2021 ◽

pp. 1-11

Author(s):

Wesley D Jetten ◽

Jeroen Seesink ◽

Markus Klimek

Keyword(s):

Scoping Review ◽

Life Support ◽

First Responders ◽

Mass Casualty Incident ◽

Mass Casualty ◽

Mass Casualty Incidents ◽

Lay People ◽

Online Databases ◽

Healthcare Experience ◽

Prehospital Triage

Abstract Objective: The primary aim of this study is to review the available tools for prehospital triage in case of mass casualty incidents and secondly, to develop a tool which enables lay person first responders (LPFRs) to perform triage and start basic life support in mass casualty incidents. Methods: In July 2019, online databases were consulted. Studies addressing prehospital triage methods for lay people were analyzed. Secondly, a new prehospital triage tool for LPFRs was developed. Therefore, a search for prehospital triage models available in literature was conducted and triage actions were extracted. Results: The search resulted in 6188 articles, and after screening, a scoping review of 4 articles was conducted. All articles stated that there is great potential to provide accurate prehospital triage by people with no healthcare experience. Based on these findings, and combined with the pre-existing prehospital triage tools, we developed a, not-yet validated, prehospital triage tool for lay people, which may improve disaster awareness and preparedness and might positively contribute to community resilience. Conclusion: The prehospital triage tool for lay person first responders may be useful and may help professional medical first responders to determine faster, which casualties most urgently need help in a mass casualty incident.

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A call for a global terrorism-related mass casualty incident response research consortium

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-020-01572-1 ◽

2021 ◽

Author(s):

Amila Ratnayake ◽

◽

Kirthi Abayajeewa ◽

Samiddhi Samarakoon ◽

Tamara Worlton

Keyword(s):

Mass Casualty Incident ◽

Mass Casualty ◽

Incident Response ◽

Global Terrorism ◽

Research Consortium

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The potential benefits of enzymatic debridement in multi-casualty burns incidents

Trauma ◽

10.1177/14604086211002583 ◽

2021 ◽

pp. 146040862110025

Author(s):

John Kiely ◽

Ibrahim Natalwala ◽

Joseph Stallard ◽

Orla Austin ◽

Umair Anwar ◽

...

Keyword(s):

Intensive Care ◽

Mass Casualty Incident ◽

Mass Casualty ◽

Burn Wound ◽

Post Injury ◽

Wound Debridement ◽

Potential Benefits ◽

Goal Directed Fluid Therapy ◽

Male Patients ◽

Enzymatic Debridement

Bromelain-based enzymatic debridement (ED) is a topical treatment that is growing in popularity for the non-surgical management of burn wounds. Although initially used for small injuries, experience has grown in using it for burns >15% Total Burns Surface Area (TBSA). A household explosion resulted in burns to multiple patients, with four requiring burn wound debridement. This case report demonstrates their management using ED. Four adult male patients were treated with ED, mean age 38.4 years. Their injuries ranged from 5–24% TBSA (mean 14.9%), with a high proportion of intermediate-deep dermal injury to their faces and limbs. Our centre has performed enzymatic debridement since 2016 and all senior burns surgeons and burns intensive care specialists in the team are experienced in its use. We perform enzymatic debridement using Nexobrid™ (Mediwound Ltd., Israel). Three patients were managed on a single theatre list, using ED for their burns at 19, 16 and 23 hours post-injury. One patient had ED of his injuries on intensive care at 18 hours. Patients with >15% TBSA were treated in a critical care setting with goal directed fluid therapy. Through the use of enzymatic debridement we were able to achieve burn debridement for four patients in under 24 hours. While not a true mass casualty incident, our experience suggests that for an appropriately resourced service it is likely to have advantages in this scenario. We suggest that burns services regularly using this technique consider inclusion into mass casualty protocols, with training to staff to enable provision in such an incident.

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