Medical consequences of suicide bombing mass casualty incidents: The impact of explosion setting on injury patterns

First responders are exposed to various types of disasters throughout their career. Because of their roles, they are often regarded as stronger people than individuals from other occupations. A systematic review of literature was conducted to determine if distinct characteristics exist that make first responders more susceptible to psychological trauma. Five categories of traits were found to put first responders at risk for psychological problems: personal, predisposing, peridisposing, postdisposing, and protective. To counteract the impact of psychological trauma, first responders need additional preincident psychological and resiliency training. Preparedness and awareness will help combat psychological impact from disasters and compassion fatigue.

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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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Impact of the first COVID-19 shutdown on patient volumes and surgical procedures of a Level I trauma center

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-021-01654-8 ◽

2021 ◽

Author(s):

Carolin A. Kreis ◽

Birte Ortmann ◽

Moritz Freistuehler ◽

René Hartensuer ◽

Hugo Van Aken ◽

...

Keyword(s):

Surgical Procedures ◽

Trauma Center ◽

Control Period ◽

Open Fractures ◽

Injury Patterns ◽

Emergency Patient ◽

Emergency Operations ◽

Incidence Proportion ◽

Level I ◽

The Impact

Abstract Purpose In Dec 2019, COVID-19 was first recognized and led to a worldwide pandemic. The German government implemented a shutdown in Mar 2020, affecting outpatient and hospital care. The aim of the present article was to evaluate the impact of the COVID-19 shutdown on patient volumes and surgical procedures of a Level I trauma center in Germany. Methods All emergency patients were recorded retrospectively during the shutdown and compared to a calendar-matched control period (CTRL). Total emergency patient contacts including trauma mechanisms, injury patterns and operation numbers were recorded including absolute numbers, incidence proportions and risk ratios. Results During the shutdown period, we observed a decrease of emergency patient cases (417) compared to CTRL (575), a decrease of elective cases (42 vs. 13) and of the total number of operations (397 vs. 325). Incidence proportions of emergency operations increased from 8.2 to 12.2% (shutdown) and elective surgical cases decreased (11.1 vs. 4.3%). As we observed a decrease for most trauma mechanisms and injury patterns, we found an increasing incidence proportion for severe open fractures. Household-related injuries were reported with an increasing incidence proportion from 26.8 to 47.5% (shutdown). We found an increasing tendency of trauma and injuries related to psychological disorders. Conclusion This analysis shows a decrease of total patient numbers in an emergency department of a Level I trauma center and a decrease of the total number of operations during the shutdown period. Concurrently, we observed an increase of severe open fractures and emergency operations. Furthermore, trauma mechanism changed with less traffic, work and sports-related accidents.

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A call for collective learning from mass casualty incidents

Injury ◽

10.1016/j.injury.2021.02.068 ◽

2021 ◽

Author(s):

Amila Ratnayake ◽

Sanjeewa Garusinghe ◽

Miklosh Bala ◽

Tamara J. Worlton

Keyword(s):

Mass Casualty ◽

Collective Learning ◽

Mass Casualty Incidents

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Does Self-reporting Facilitate History Taking in Food Poisoning Mass-casualty Incidents?

Prehospital and Disaster Medicine ◽

10.1017/s1049023x14000764 ◽

2014 ◽

Vol 29 (4) ◽

pp. 417-420 ◽

Cited By ~ 1

Author(s):

Ya-I Hsu ◽

Ying C. Huang

Keyword(s):

Health Care ◽

Medical History ◽

Food Poisoning ◽

Mass Casualty ◽

Mass Casualty Incidents ◽

Control Group ◽

History Taking ◽

Care Providers ◽

Time Required ◽

Experimental Group

AbstractIntroductionMedical history is an important contributor to diagnosis and patient management. In mass-casualty incidents (MCIs), health care providers are often overwhelmed by large numbers of casualties. An efficient, reliable, and affordable method of information collection is essential for effective health care response.Hypothesis/ProblemIn some MCIs, self-reporting of symptoms can decrease the time required for history taking, without sacrificing the completeness of triage information.MethodsTwo resident doctors and a number of seventh graders who had previous experience of abdominal discomfort were invited to join this study. A questionnaire was developed to collect information on common symptoms in food poisoning. Each question was scored, and enrolled students were randomly divided into two groups. The experimental group students answered the questionnaire first and then were interviewed to complete the medical history. The control group students were interviewed in the traditional way to collect medical history. Time of all interviews was measured and recorded. The time needed to complete the history taking and completeness of obtained information were compared with students’ t tests, or Mann-Whitney U tests, based on the normality of data. Comprehensibility of each question, scored by enrolled students, was reported by descriptive statistics.ResultsThere were 41 students enrolled: 22 in the experimental group and 19 in the control group. Time to complete history taking in the experimental group (163.0 seconds, SD=52.3) was shorter than that in the control group (198.7 seconds, SD=40.9) (P=.010). There was no difference in the completeness of history obtained between the experimental group and the control group (94.8%, SD=5.0 vs 94.2%, SD=6.1; P=.747). Between the two doctors, no significant difference was found in the time required for history taking (185.2 seconds, SD=42.2 vs 173.1 seconds, SD=58.6; P=.449), or the completeness of information (94.1%, SD=5.9 vs 95.0%, SD=5.0; P=.601). Most of the questions were scored “good” in comprehensibility.ConclusionSelf-reporting of symptoms can shorten the time of history taking during a food poisoning mass-casualty event without sacrificing the completeness of information.HsuY, HuangYC. Does self-reporting facilitate history taking in food poisoning mass-casualty incidents?Prehosp Disaster Med. 2014;29(4):1-4.

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An internet-based bar code tracking system: coordination of confusion at mass casualty incidents

Disaster Management & Response ◽

10.1016/s1540-2487(03)70007-8 ◽

2003 ◽

Vol 1 (1) ◽

pp. 25-28 ◽

Cited By ~ 11

Author(s):

Jeff Hamilton

Keyword(s):

Tracking System ◽

Mass Casualty ◽

Mass Casualty Incidents ◽

Bar Code ◽

Code Tracking

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Editorial

Acute Medicine Journal ◽

10.52964/amja.0532 ◽

2012 ◽

Vol 11 (1) ◽

Author(s):

Chris Roseveare ◽

Keyword(s):

Patient Safety ◽

Young Male ◽

Final Diagnosis ◽

Mass Casualty ◽

Major Incident ◽

Spare Capacity ◽

Acute Medical Unit ◽

Infected Urine ◽

Temporary Closure ◽

The Impact

The snow and freezing temperatures will hopefully have passed by the time this edition reaches you; the sight of daffodils may be asignal that the relief of spring is not far off. Winter frequently stretches AMU resources to the limit – in recent years we have had epidemics of seasonal and swine f lu, but this year Norovirus seems to have been the bigger challenge. Ward closures from diarrhoea outbreaks have traditionally been more of a ‘downstream’ problem (no pun intended), but the impact of closure of the AMU would be substantial.At the time of writing this has still, thankfully, been avoided in my own hospital; however it remains a circumstance for which we have to be prepared. This edition’s ‘Viewpoint’ article describes how temporary closure of the AMU was managed in a London hospital. The use of an empty ‘winter pressures ward’ eased the burden in this case, enabling the AMU service to be maintained. Even with the luxury of this spare capacity, there was clearly significant disruption, requiring close collaboration between a variety of departments, which is well described by the authors. Many hospitals have become highly dependent on a functioning AMU to provide timely, safe and effective care for medical emergencies. Major incident plans are in place to deal with mass casualty incidents; we need to consider similar contingencies to deal with AMU closure if patient safety is going to be maintained. This article is a timely reminder of the need for forward planning. Maintaining patient safety is a mantra which will be familiar to acute physicians, particularly those who attended any of the recent SAM meetings, where this theme has been well rehearsed. An acute medical unit can provide significant safety benefits by concentrating resources in a single area. However, for the 60% who cannot go directly home from the AMU, this model creates the need for care to be transferred at some point. It is well recognised that transfer is a time at which patient safety can become compromised; so if safety is our mantra, acute physicians and nurses have a responsibility to manage this process effectively. The article by David Hindmash and Liz Lees provides an important addition to the limited literature in this area. Structured checklists are becoming an increasing part of medical practice; this paper highlights how a checklist can be used to improve the quality of handover from AMU. The authors emphasise the need to keep the form simple, and the importance of regular reinforcement to ensure that it is used. What skills and attributes does an acute physician require? With interview season approaching it’s a question that many prospective trainees will be contemplating – remaining calm under pressure, communication skills and teamworking are some of the standard responses; but what about a good sense of smell? Most of us recognise the characteristic odour of melaena , or the whiff of infected urine. But the absence of body odour might be equally revealing. Luther and Yap noted their patient to be ‘remarkably clean’ – unusual, perhaps, for a young male patient on the AMU; along with his persistent demands to use the showering facilities, this was a clue to the final diagnosis of Cannabis Hyperemesis Syndrome.It’s a case worth reading and highlights the importance of lateral thinking, particularly when patients repeatedly attend – as well as having a ‘good nose’ to sniff out something unusual!

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Evaluating the impact of decontamination interventions performed in sequence for mass casualty chemical incidents

10.21203/rs.3.rs-373547/v1 ◽

2021 ◽

Author(s):

Samuel Collins ◽

Natalie Williams ◽

Felicity Southworth ◽

Thomas James ◽

Louise Davidson ◽

...

Keyword(s):

Vegetable Oil ◽

Methyl Salicylate ◽

Emergency Services ◽

Mass Casualty ◽

Human Volunteer ◽

Additional Contribution ◽

Uv Photography ◽

Chemical Incidents ◽

The Impact ◽

Control Skin

Abstract The Initial Operational Response (IOR) to chemical incidents is a suite of rapid strategies including evacuation, disrobe and improvised and interim decontamination. IOR and Specialist Operational Response (SOR) decontamination protocols involving mass decontamination units would be conducted in sequence by UK emergency services following a chemical incident, to allow for safe onward transfer of casualties. As part of a series of human volunteer studies, we examined the effectiveness of IOR and SOR decontamination procedures alone and in sequence. Specifically, we evaluated the additional contribution of SOR, when following improvised and interim decontamination. Two simulants, methyl salicylate (MeS) with vegetable oil and benzyl salicylate (BeS), were applied to participants’ skin. Participants underwent improvised dry, improvised wet, interim wet, specialist decontamination and a no decontamination control. Skin analysis and UV photography indicated significantly lower levels of both simulants remaining following decontamination compared to controls. There were no significant differences in MeS levels recovered between decontamination conditions. Analysis of BeS, a more persistent simulant than MeS, showed that recovery from skin was significantly reduced following combined IOR with SOR than IOR alone. These results show modest additional benefits of decontamination interventions conducted in sequence, particularly for persistent chemicals, supporting current UK operational procedures.

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