scholarly journals War surgery in Afghanistan: a model for mass causalities in terror attacks?

2020 ◽  
Vol 44 (12) ◽  
pp. 2521-2527
Author(s):  
F. Wichlas ◽  
V. Hofmann ◽  
G. Strada ◽  
C. Deininger
Keyword(s):  
Wound Care ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Body Region ◽  
Solution Strategies ◽  
Terror Attacks ◽  
Life Saving ◽  
The Face ◽  
The Difference ◽  
War Victims

Abstract Purpose The aim of the study was to identify solution strategies from a non-governmental (NGO) hospital in a war region for violence-related injuries and to show how high-income countries (HIC) might benefit from this expertise. Methods NGO trauma hospital in Lashkar Gah, Afghanistan. Four hundred eighty-four war victims admitted in a three month period (February 2016–May 2016) were included. Patients´ characteristics were analyzed. Results The mean age was 23.5 years. Four hundred thirty-four (89.9%) were male, and 50 (10.1%) were female. The most common cause of injury was bullet injuries, shell injuries, and mine injuries. The most common injured body region was the lower extremity, upper extremity, and the chest or the face. Apart from surgical wound care and debridements, which were performed on every wound in the operation theatre, laparotomy was the most common surgical procedure, followed by installation of a chest drainage and amputation. Conclusion The surgical expertise and clear pathways outweigh modern infrastructure. In case of a mass casualty incident, fast decision-making with basic diagnostic means in order to take rapid measurements for life-saving therapies could make the difference.

Triage in Complex, Coordinated Terrorist Attacks

2019 ◽  
Vol 34 (04) ◽  
pp. 442-448 ◽  
Author(s):  
Matt Pepper ◽  
Frank Archer ◽  
John Moloney
Keyword(s):  
Physiological Stress ◽  
Mass Casualty ◽  
Terrorist Attacks ◽  
Mass Violence ◽  
Patient Movement ◽  
Terror Attacks ◽  
Physiological Variables ◽  
Large Numbers ◽  
Life Saving ◽  
San Bernardino

AbstractIntroduction:Terror attacks have increased in frequency, and tactics utilized have evolved. This creates significant challenges for first responders providing life-saving medical care in their immediate aftermath. The use of coordinated and multi-site attack modalities exacerbates these challenges. The use of triage is not well-validated in mass-casualty settings, and in the setting of intentional mass violence, new and innovative approaches are needed.Methods:Literature sourced from gray and peer-reviewed sources was used to perform a comparative analysis on the application of triage during the 2011 Oslo/Utoya Island (Norway), 2015 Paris (France), and 2015 San Bernardino (California USA) terrorist attacks. A thematic narrative identifies strengths and weaknesses of current triage systems in the setting of complex, coordinated terrorist attacks (CCTAs).Discussion:Triage systems were either not utilized, not available, or adapted and improvised to the tactical setting. The complexity of working with large numbers of patients, sensory deprived environments, high physiological stress, and dynamic threat profiles created significant barriers to the implementation of triage systems designed around flow charts, physiological variables, and the use of tags. Issues were identified around patient movement and “tactical triage.”Conclusion:Current triage tools are inadequate for use in insecure environments, such as the response to CCTAs. Further research and validation are required for novel approaches that simplify tactical triage and support its effective application. Simple solutions exist in tactical triage, patient movement, and tag use, and should be considered as part of an overall triage system.

Tabletop Application of SALT Triage to 10, 100, and 1000 Pediatric Victims

2020 ◽  
Vol 35 (2) ◽  
pp. 165-169
Author(s):  
Nicholas McGlynn ◽  
Ilene Claudius ◽  
Amy H. Kaji ◽  
Emilia H. Fisher ◽  
Alaa Shaban ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Pediatric Trauma ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Trauma Patients ◽  
Kappa Test ◽  
Life Saving ◽  
Number Of Patients ◽  
Level 1 ◽  
Level 1 Trauma Center

AbstractIntroduction:The Sort, Access, Life-saving interventions, Treatment and/or Triage (SALT) mass-casualty incident (MCI) algorithm is unique in that it includes two subjective questions during the triage process: “Is the victim likely to survive given the resources?” and “Is the injury minor?”Hypothesis/Problem:Given this subjectivity, it was hypothesized that as casualties increase, the inter-rater reliability (IRR) of the tool would decline, due to an increase in the number of patients triaged as Minor and Expectant.Methods:A pre-collected dataset of pediatric trauma patients age <14 years from a single Level 1 trauma center was used to generate “patients.” Three trained raters triaged each patient using SALT as if they were in each of the following scenarios: 10, 100, and 1,000 victim MCIs. Cohen’s kappa test was used to evaluate IRR between the raters in each of the scenarios.Results:A total of 247 patients were available for triage. The kappas were consistently “poor” to “fair:” 0.37 to 0.59 in the 10-victim scenario; 0.13 to 0.36 in the 100-victim scenario; and 0.05 to 0.36 in the 1,000-victim scenario. There was an increasing percentage of subjects triaged Minor as the number of estimated victims increased: 27.8% increase from 10- to 100-victim scenario and 7.0% increase from 100- to 1,000-victim scenario. Expectant triage categorization of patients remained stable as victim numbers increased.Conclusion:Overall, SALT demonstrated poor IRR in this study of increasing casualty counts while triaging pediatric patients. Increased casualty counts in the scenarios did lead to increased Minor but not Expectant categorizations.

Impact of a Two-step Emergency Department Triage Model with START, then CTAS, on Patient Flow During a Simulated Mass-casualty Incident

2015 ◽  
Vol 30 (4) ◽  
pp. 390-396 ◽  
Author(s):  
James S. Lee ◽  
Jeffrey M. Franc
Keyword(s):  
Emergency Department ◽  
Patient Flow ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Mean Difference ◽  
Time Intervals ◽  
Simulation Exercise ◽  
Physician Assessment ◽  
Emergency Department Triage ◽  
The Difference

AbstractIntroductionA high influx of patients during a mass-casualty incident (MCI) may disrupt patient flow in an already overcrowded emergency department (ED) that is functioning beyond its operating capacity. This pilot study examined the impact of a two-step ED triage model using Simple Triage and Rapid Treatment (START) for pre-triage, followed by triage with the Canadian Triage and Acuity Scale (CTAS), on patient flow during a MCI simulation exercise.Hypothesis/ProblemIt was hypothesized that there would be no difference in time intervals nor patient volumes at each patient-flow milestone.MethodsPhysicians and nurses participated in a computer-based tabletop disaster simulation exercise. Physicians were randomized into the intervention group using START, then CTAS, or the control group using START alone. Patient-flow milestones including time intervals and patient volumes from ED arrival to triage, ED arrival to bed assignment, ED arrival to physician assessment, and ED arrival to disposition decision were compared. Triage accuracy was compared for secondary purposes.ResultsThere were no significant differences in the time interval from ED arrival to triage (mean difference 108 seconds; 95% CI, -353 to 596 seconds; P=1.0), ED arrival to bed assignment (mean difference 362 seconds; 95% CI, -1,269 to 545 seconds; P=1.0), ED arrival to physician assessment (mean difference 31 seconds; 95% CI, -1,104 to 348 seconds; P=0.92), and ED arrival to disposition decision (mean difference 175 seconds; 95% CI, -1,650 to 1,300 seconds; P=1.0) between the two groups. There were no significant differences in the volume of patients to be triaged (32% vs 34%; 95% CI for the difference -16% to 21%; P=1.0), assigned a bed (16% vs 21%; 95% CI for the difference -11% to 20%; P=1.0), assessed by a physician (20% vs 22%; 95% CI for the difference -14% to 19%; P=1.0), and with a disposition decision (20% vs 9%; 95% CI for the difference -25% to 4%; P=.34) between the two groups. The accuracy of triage was similar in both groups (57% vs 70%; 95% CI for the difference -15% to 41%; P=.46).ConclusionExperienced triage nurses were able to apply CTAS effectively during a MCI simulation exercise. A two-step ED triage model using START, then CTAS, had similar patient flow and triage accuracy when compared to START alone.LeeJS, FrancJM. Impact of a two-step emergency department triage model with START, then CTAS, on patient flow during a simulated mass-casualty incident. Prehosp Disaster Med. 2015;30(4):1–7.

scholarly journals Augmented Reality for Guideline Presentation in Medicine: A Crossover Simulation Trial for Technically Assisted Decision-making (Preprint)

2019 ◽  
Author(s):  
Andreas Follmann ◽  
Alexander Ruhl ◽  
Michael Gösch ◽  
Marc Felzen ◽  
Rolf Rossaint ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Mass Casualty Incident ◽  
Modern Medicine ◽  
Mass Casualty ◽  
Tablet Pc ◽  
Additional Time ◽  
Smart Glasses ◽  
Significant Difference ◽  
The Difference ◽  
Time Critical

BACKGROUND Guidelines provide instructions for diagnostics and therapy in modern medicine. Various mobile devices are used to represent the potential complex decision trees. An example of time-critical decisions is triage in case of a mass casualty incident. OBJECTIVE In this randomized controlled cross-over study, the potential of augmented reality for guideline presentation was evaluated and compared with a tablet PC as a conventional device. METHODS A specific Android app was designed for use with Smart Glasses as well as with a tablet PC for presentation of a triage algorithm as an example for a complex guideline. 40 volunteers simulated a triage based on 30 fictional patient descriptions each, with technical support from data glasses and a tablet PC in cross-over trial design. The time to come to a decision and the accuracy were recorded and compared between the different devices. RESULTS A total of 2400 assessments were performed. A significantly faster triage time has been achieved with the tablet PC (12.8 sec) compared to the smart glasses (17.5 sec; P = .001) in total. Considering the difference in triage duration between both devices, the additional time needed with the smart glasses could be reduced significantly in the course (P = .001). In accuracy of guideline decisions, there was no significant difference comparing both devices. CONCLUSIONS The presentation of a guideline on a tablet computer, as well as in the form of augmented reality, achieved good results. The implementation using smart glasses took more time due to a more complex operating concept but could be accelerated in the course of the study after adaptation. Especially in a non-time-critical working area where hands-free interfaces are meaningful, a guideline presentation with augmented reality can already be implemented.

scholarly journals Immediate response to major incidents: defining an immediate responder!

2019 ◽  
Vol 46 (6) ◽  
pp. 1309-1320 ◽  
Author(s):  
Amir Khorram-Manesh ◽  
Patricia Plegas ◽  
Åsa Högstedt ◽  
Mahmoudreza Peyravi ◽  
Eric Carlström
Keyword(s):  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Extensive Literature ◽  
Expert Group ◽  
The Public ◽  
Know How ◽  
Life Saving ◽  
Before And After ◽  
Major Incidents ◽  
Appropriate Education

Abstract Purpose There is a gap in time between the occurrence of a mass casualty incident (MCI) and the arrival of the first responders to the scene, which offers an opportunity for the public (immediate responders) to perform life-saving measures. The purpose of this study was to identify these measures and the public’s willingness to conduct them. Method An extensive literature review was performed to identify the possible measures that can be undertaken by the public. A group of experts were asked to prioritize and rank the feasibility of performing the measures by the public. Finally, the public was asked whether they were willing to do the chosen measures before and after an appropriate education. Results Twenty different measures were identified and presented in a questionnaire as statements, which were prioritized and ranked by the expert group into four categories: what (1) should be done, (2) is good to know how, (3) is not necessary to know, and (4) should not be done. All statements were converted into understandable statements and were sent to the public. There were some differences and some agreements between the experts and the public regarding what an immediate responder should do. However, the willingness of the public to perform most of the measures was high and increased after being offered an appropriate education. Conclusion The use of immediate responders is a life-saving approach in MCIs and in situations when every minute counts and every human resource is an invaluable asset. Multiple steps, such as education, empowerment, and access, should be taken into consideration to enable bystanders to effectively help struggling survivors.

Difference in First Aid Activity During Mass Casualty Training Based on Having Taken an Educational Course

2017 ◽  
Vol 12 (4) ◽  
pp. 437-440
Author(s):  
Youichi Yanagawa ◽  
Kazuhiko Omori ◽  
Kouhei Ishikawa ◽  
Ikuto Takeuchi ◽  
Kei Jitsuiki ◽  
...  
Keyword(s):  
Life Support ◽  
Initial Period ◽  
Fire Department ◽  
First Aid ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Disaster Medicine ◽  
Ambulance Service ◽  
Medical Practitioners ◽  
The Difference

ABSTRACTBackgroundThe Japanese Association for Disaster Medicine developed a mass casualty life support (MCLS) course to improve cooperation among medical practitioners during a disaster, which is essential for reducing the rates of preventable disaster death. We investigated whether there was difference in first aid activity among members of the ambulance service during mass casualty training based on having taken the MCLS course.MethodsMass casualty training was held at the fire department of Numazu City. Twenty-one ambulance service parties participated in this training. They first evaluated the mass casualty situation, performed the appropriate services at the scene during the initial period, and then provided START triage for mock wounded patients. Throughout the training, 5 examiners evaluated their performance.ResultsRegarding the difference in first aid activity based on MCLS course attendance among the ambulance service members, the cooperative management (scored on a scale of 1 to 5) among the members who had taken the MCLS course was significantly better than that among those who had not taken the course (median [interquartile range]: 5 [0.5] vs. 4 [1.75], P<0.05).ConclusionAttending an MCLS course may help to improve outcomes in the face of an actual mass casualty incident. (Disaster Med Public Health Preparedness. 2018;12:437–440)

scholarly journals Volunteer First Responders for Optimizing Management of Mass Casualty Incidents

2018 ◽  
Vol 13 (02) ◽  
pp. 287-294 ◽  
Author(s):  
Eli Yafe ◽  
Blake Byron Walker ◽  
Ofer Amram ◽  
Nadine Schuurman ◽  
Ellen Randall ◽  
...  
Keyword(s):  
Population Distribution ◽  
Response Times ◽  
First Responders ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Rapid Response ◽  
First Response ◽  
Life Saving ◽  
Rural Settings ◽  
Trauma Mortality

ABSTRACTObjectiveRapid response to a trauma incident is vital for saving lives. However, in a mass casualty incident (MCI), there may not be enough resources (first responders and equipment) to adequately triage, prepare, and evacuate every injured person. To address this deficit, a Volunteer First Responder (VFR) program was established.MethodsThis paper describes the organizational structure and roles of the VFR program, outlines the geographical distribution of volunteers, and evaluates response times to 3 MCIs for both ambulance services and VFRs in 2000 and 2016.ResultsWhen mapped, the spatial distribution of VFRs and ambulance stations closely and deliberately reflects the population distribution of Israel. We found that VFRs were consistently first to arrive at the scene of an MCI and greatly increased the number of personnel available to assist with MCI management in urban, suburban, and rural settings.ConclusionsThe VFR program provides an important and effective life-saving resource to supplement emergency first response. Given the known importance of rapid response to trauma, VFRs likely contribute to reduced trauma mortality, although further research is needed in order to examine this question specifically. (Disaster Med Public Health Preparedness. 2019;13:287–294)

New Drugs of 2012: A Concise Overview of the NMEs and Trends for Innovative Brand Market in the United States

2013 ◽  
Vol 6 (2) ◽  
pp. 2009-2013
Author(s):  
D Samba Reddy
Keyword(s):  
Drug Approval ◽  
The United States ◽  
New Drugs ◽  
New Combination ◽  
Drug Status ◽  
Combination Drug ◽  
Human Cord Blood ◽  
Life Saving ◽  
Genomics And Proteomics ◽  
The Face

Thirty-nine (39) new drugs have been approved by the U.S. FDA in 2012, a record highest number of approvals since 1996. The record is a sign that pharma companies are poised to tap recent advances from genomics and proteomics. This list includes novel new drugs, known as new molecular entities (NMEs), biologics and new products. Many life-saving drugs are approved for marketing. The list includes a total of 10 drugs for cancer treatment, and nearly a quarter of those approved in 2012 had orphan drug status.  Among the breakthrough drugs approved in 2012 were ivacaftor (cystic fibrosis), vasmodegib (skin cancer), HPC-C (human cord blood product), ruxolitinib (myelofibrosis) and a new combination drug to treat HIV. In addition,  several unique products were approved for the treatment of macular degeneration, chronic weight management, overactive bladder, actinic keratosis, erectile dysfunction, glaucoma, respiratory distress syndrome, and COPD. The approval of 39 drugs in 2012 underscores a robust success rate and confirms that innovation is once again beginning to pay off. In the existing climate of reduced revenues in the face of generic competitions, the future and survival of big companies rests heavily on their unique niche products. It is apparent that big Pharma and a growing number of emerging Biotechs alike have focused their attention on developing new NMEs for rare diseases. In 2012, the length of the FDA’s review is shorter than agencies in other countries. Innovative models adopted for R&D strategies, communications, and new regulatory changes appear to shorten development timelines. Despite record drug approvals, there is bleak scope for blockbusters because most of these drugs have a limited market. The pipeline for blockbusters appears very low. However, there is unmet medical need for new drugs in autism, Alzheimer’s disease and epilepsy. Overall, the new drug approval list unveils unique and reemerging trends indicating that the pharma companies are poised for big growth from new brands approved for marketing for narrow-spectrum indications.    

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