Prehospital triage and communication performance in small mass casualty incidents: A gauge for disaster preparedness

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 translational triage research development tool: standardizing prehospital triage decision-making systems in mass casualty incidents

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-021-00932-z ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Amir Khorram-Manesh ◽

Johan Nordling ◽

Eric Carlström ◽

Krzysztof Goniewicz ◽

Roberto Faccincani ◽

...

Keyword(s):

Decision Making ◽

Mass Casualty ◽

Mass Casualty Incidents ◽

Future Research ◽

Triage System ◽

Universal System ◽

Global Consensus ◽

Development Tool ◽

Prehospital Triage ◽

Evidence Review

Abstract Background There is no global consensus on the use of prehospital triage system in mass casualty incidents. The purpose of this study was to evaluate the most commonly used pre-existing prehospital triage systems for the possibility of creating one universal translational triage tool. Methods The Rapid Evidence Review consisted of (1) a systematic literature review (2) merging and content analysis of the studies focusing on similarities and differences between systems and (3) development of a universal system. Results There were 17 triage systems described in 31 eligible articles out of 797 identified initially. Seven of the systems met the predesignated criteria and were selected for further analysis. The criteria from the final seven systems were compiled, translated and counted for in means of 1/7’s. As a product, a universal system was created of the majority criteria. Conclusions This study does not create a new triage system itself but rather identifies the possibility to convert various prehospital triage systems into one by using a triage translational tool. Future research should examine the tool and its different decision-making steps either by using simulations or by experts’ evaluation to ensure its feasibility in terms of speed, continuity, simplicity, sensitivity and specificity, before final evaluation at prehospital level.

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A need for prehospital triage standardizing tool in mass casualty incidents

Health Problems of Civilization ◽

10.5114/hpc.2021.107782 ◽

2021 ◽

Author(s):

Amir Khorram-Manesh ◽

Johan Nordling ◽

Eric Carlström ◽

Krzysztof Goniewicz ◽

Roberto Faccincani ◽

...

Keyword(s):

Mass Casualty ◽

Mass Casualty Incidents ◽

Prehospital Triage

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Real-Time Monitoring Electronic Triage Tag System for Improving Survival Rate in Disaster-Induced Mass Casualty Incidents

Healthcare ◽

10.3390/healthcare9070877 ◽

2021 ◽

Vol 9 (7) ◽

pp. 877

Author(s):

Ju Young Park

Keyword(s):

Survival Rate ◽

Vital Sign ◽

Disaster Response ◽

Electricity Consumption ◽

Mass Casualty ◽

Ease Of Use ◽

Mass Casualty Incidents ◽

Design Development ◽

Prehospital Triage ◽

Rapid Prototyping Model

This study was conducted to contribute to active disaster response by developing internet of things (IoT)-based vital sign monitoring e-triage tag system to improve the survival rate at disaster mass casualty incidents fields. The model used in this study for developing the e-triage tag system is the rapid prototyping model (RAD). The process comprised six steps: analysis, design, development, evaluation, implementation, and simulation. As a result of detailed assessment of the system design and development by an expert group, areas with the highest score in the triage sensor evaluation were rated “very good”, with 5 points for continuous vital sign data delivery, portability, and robustness. In addition, ease of use, wearability, and electricity consumption were rated 4.8, 4.7, and 4.6 points, respectively. In the triage application evaluation, the speed and utility scored a perfect 5 points, and the reliability and expressiveness were rated 4.9 points and 4.8 points, respectively. This study will contribute significantly to increasing the survival rate via the development of a conceptual prehospital triage for field applications and e-triage tag system implementation.

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Improving Pediatric Administrative Disaster Preparedness Through Simulated Disaster Huddles

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2020.10 ◽

2020 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Isabel T. Gross ◽

Scott A. Goldberg ◽

Travis Whitfill ◽

Storm Liebling ◽

Angelica Garcia ◽

...

Keyword(s):

Emergency Department ◽

Patient Outcomes ◽

Disaster Preparedness ◽

Mass Casualty ◽

Mass Casualty Incidents ◽

Time Commitment ◽

Potential Impact

ABSTRACT Members of an emergency department (ED) staff need to be prepared for mass casualty incidents (MCIs) at all times. Didactic sessions, drills, and functional exercises have shown to be effective, but it is challenging to find time and resources for appropriate training. We conducted brief, task-specific drills (deemed “disaster huddles”) in a pediatric ED (PED) to examine if such an approach could be an alternative or supplement to traditional MCI training paradigms. Over the course of the study, we observed an improving trend in the overall score for administrative disaster preparedness. Disaster huddles may be an effective way to improve administrative disaster preparedness in the PED. Low-effort, low-time commitment education could be an attractive way for further disaster preparedness efforts. Further studies are indicated to show a potential impact on lasting behavior and patient outcomes.

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Developing a Hospital Disaster Preparedness Plan for Mass Casualty Incidents: Lessons Learned From the Downtown Beirut Bombing

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2017.83 ◽

2017 ◽

Vol 12 (3) ◽

pp. 379-385 ◽

Cited By ~ 8

Author(s):

Mazen El Sayed ◽

Ali F. Chami ◽

Eveline Hitti

Keyword(s):

Disaster Preparedness ◽

Disaster Response ◽

Hospital Staff ◽

Mass Casualty ◽

Lessons Learned ◽

Mass Casualty Incidents ◽

Preparedness Plan ◽

Security Issues ◽

Response System ◽

General Response

AbstractMass casualty incidents (MCIs) are becoming more frequent worldwide, especially in the Middle East where violence in Syria has spilled over to many neighboring countries. Lebanon lacks a coordinated prehospital response system to deal with MCIs; therefore, hospital preparedness plans are essential to deal with the surge of casualties. This report describes our experience in dealing with an MCI involving a car bomb in an urban area of downtown Beirut, Lebanon. It uses general response principles to propose a simplified response model for hospitals to use during MCIs. A summary of the debriefings following the event was developed and an analysis was performed with the aim of modifying our hospital’s existing disaster preparedness plan. Casualties’ arrival to our emergency department (ED), the performance of our hospital staff during the event, communication, and the coordination of resources, in addition to the response of the different departments, were examined. In dealing with MCIs, hospital plans should focus on triage area, patient registration and tracking, communication, resource coordination, essential staff functions, as well as on security issues and crowd control. Hospitals in other countries that lack a coordinated prehospital disaster response system can use the principles described here to improve their hospital’s resilience and response to MCIs. (Disaster Med Public Health Preparedness. 2018; 12: 379–385)

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Erratum. Evaluation of disaster preparedness for mass casualty incidents in private hospitals in Central Saudi Arabia.

Saudi Medical Journal ◽

10.15537/smj.2018.11.23713 ◽

2018 ◽

Vol 39 (11) ◽

pp. 1165-1165

Author(s):

Abdullah Bin Shalhoub ◽

Anas Khan ◽

Yaser Alaska

Keyword(s):

Saudi Arabia ◽

Disaster Preparedness ◽

Mass Casualty ◽

Mass Casualty Incidents ◽

Private Hospitals

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Planning for the Use of Imaging in Mass Casualty Incidents

Prehospital and Disaster Medicine ◽

10.1017/s1049023x19003595 ◽

2019 ◽

Vol 34 (s1) ◽

pp. s159-s159

Author(s):

Deborah Starkey ◽

Denise Elliott

Keyword(s):

Disaster Preparedness ◽

Disaster Planning ◽

Mass Casualty Incident ◽

Mass Casualty ◽

Lessons Learned ◽

Mass Casualty Incidents ◽

Challenging Situation ◽

Mass Fatality Incidents ◽

Forensic Radiography ◽

Mass Fatality

Introduction:A mass casualty incident presents a challenging situation in any health care setting. The value of preparation and planning for mass casualty incidents has been widely reported in the literature. The benefit of imaging, in particular, forensic radiography, in these situations is also reported. Despite this, the inclusion of detailed planning on the use of forensic radiography is an observed gap in disaster preparedness documentation.Aim:To identify the role of forensic radiography in mass casualty incidents and to explore the degree of inclusion of forensic radiography in publicly available disaster planning documents.Methods:An extended literature review was undertaken to identify examples of forensic radiography in mass casualty incidents, and to determine the degree of inclusion of forensic radiography in publicly available disaster planning documents. Where included, the activity undertaken by forensic radiography was reviewed in relation to the detail of the planning information.Results:Limited results were identified of disaster planning documents containing detail of the role or planned activity for forensic radiography.Discussion:While published accounts of situation debriefing and lessons learned from past mass casualty incidents provide evidence for integration into future planning activities, limited reports were identified with the inclusion of forensic radiography. This presentation provides an overview of the roles of forensic radiography in mass casualty incidents. The specific inclusion of planning for the use of imaging in mass fatality incidents is recommended.

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Preparedness for the evaluation and management of mass casualty incidents involving anticholinesterase compounds: A survey of emergency department directors in the 12 largest cities in the United States

American Journal of Disaster Medicine ◽

10.5055/ajdm.2010.0040 ◽

2010 ◽

Vol 5 (6) ◽

pp. 333-351 ◽

Cited By ~ 9

Author(s):

James M. Madsen, MD, MPH, FCAP, FACOEM, COL, MC-FS, USA ◽

Michael I. Greenberg, MD, MPH

Keyword(s):

Disaster Preparedness ◽

Online Survey ◽

The United States ◽

Mass Casualty ◽

National Institutes Of Health ◽

Mass Casualty Incidents ◽

Medical Toxicologist ◽

Large Numbers ◽

Department Directors ◽

E Mail

Objectives: Anticholinesterases include carbamate and organophosphorus (OP) insecticides and nerve agents. Release of these compounds can flood emergency departments (EDs) with large numbers of poisoned victims and worried individuals. It was hypothesized that despite the focus of disaster preparedness on large metropolitan areas, EDs in these cities would still report self-perceptions of deficiencies in preparedness for mass casualty incidents (MCIs) involving these chemicals.Design and setting: A secure and anonymous online survey was prepared and piloted, and E-mail invitations were sent to the physician directors of the 220 continuously staffed EDs in the 12 most populous incorporated cities in the United States.Results: Forty-six ED directors could not be contacted despite repeated attempts. Of the remaining 174 directors, eight declined and 89 took the survey, for a response rate of 51.1 percent. Fewer than 20 percent were very confident in the effectiveness of their training, and only 4.9 percent were very confident that drills had given them the preparation that they needed. Only 45.7 percent of reporting hospitals had a board-certified medical toxicologist to help in such an emergency. Almost two-thirds (73.6 percent) of those familiar with the online Radiation Event Medical Management (REMM) module from the National Library of Medicine and the National Institutes of Health thought that a chemical counterpart to REMM would be either moderately or very helpful for MCIs involving anticholinesterases.Conclusions: This study demonstrates that physician ED directors perceived marked deficiencies in their abilities to respond to this kind of toxicological emergency and suggests critical directions for remediation of these deficiencies.

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