scholarly journals P135: TriagED: A serious game for mass casualty triage and field disaster management

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S113
Author(s):  
C. Wallner ◽  
P. Sneath ◽  
K. Morgan ◽  
T. Chan
Keyword(s):  
Patient Flow ◽  
Prehospital Care ◽  
Mass Casualty ◽  
Leadership Role ◽  
Card Game ◽  
Care Providers ◽  
Incident Command ◽  
Scene Management ◽  
Multiple Injured ◽  
Injured Patients

Innovation Concept: Mass Casualty Incidents (MCI) are complex events that most paramedics encounter only a few times in their careers. Triaging and managing multiple patients during an incident requires different skills than typically practiced by prehospital providers. Simulation and drills can provide an opportunity to practice those skills, but are costly and resource intensive while only allowing a few providers to be in a triage or leadership role. It is important to find engaging and less expensive methods for teaching MCI triage and initial scene management. Methods: The authors have developed and are testing a card game based on the previously published GridlockED board game. The game was developed utilizing an iterative process previously described. This game was tested with paramedics as well as other emergency medicine learners to determine usability, engagement, fidelity, as well as usefulness in teaching MCI triage and patient-flow concepts. Curriculum, Tool or Material: The card game provides a focused learning experience to allow providers to practice initial triage of multiple injured patients as well as manage patient flow from the scene to area hospitals when faced with limited prehospital resources and capabilities. Players work together in various simulated scenarios to correctly triage injured patients and send them to the correct healthcare facility. Conclusion: Serious gaming has gained momentum in medical education. Developing novel curriculae around low frequency, high stakes situations using a game like TriagED may hold the key to ensure prehospital care providers are trained for these incidents. In the future, games which integrate an element of Incident Command or receiving hosptials (e.g. full integration with GridlockED game) may help to further explore the relationship between scene management and patient flow within receiving hospitals.

scholarly journals MP01: Use of an unmanned aerial vehicle to provide situational awareness in a simulated mass casualty incident

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S40-S40
Author(s):  
A. K. Sibley ◽  
T. Jain ◽  
B. Nicholson ◽  
M. Butler ◽  
S. David ◽  
...  
Keyword(s):  
Situational Awareness ◽  
Optimal Strategies ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Treatment Area ◽  
Incident Command ◽  
Emergency Responders ◽  
Video Footage ◽  
Scene Management ◽  
Patient Localization

Introduction: Situational awareness (SA) is essential for maintenance of scene safety and effective resource allocation in mass casualty incidents (MCI). Unmanned aerial vehicles (UAV) can potentially enhance SA with real-time visual feedback during chaotic and evolving or inaccessible events. The purpose of this study was to test the ability of paramedics to use UAV video from a simulated MCI to identify scene hazards, initiate patient triage, and designate key operational locations. Methods: A simulated MCI, including fifteen patients of varying acuity (blast type injuries), plus four hazards, was created on a college campus. The scene was surveyed by UAV capturing video of all patients, hazards, surrounding buildings and streets. Attendees of a provincial paramedic meeting were invited to participate. Participants received a lecture on SALT Triage and the principles of MCI scene management. Next, they watched the UAV video footage. Participants were directed to sort patients according to SALT Triage step one, identify injuries, and localize the patients within the campus. Additionally, they were asked to select a start point for SALT Triage step two, identify and locate hazards, and designate locations for an Incident Command Post, Treatment Area, Transport Area and Access/Egress routes. Summary statistics were performed and a linear regression model was used to assess relationships between demographic variables and both patient triage and localization. Results: Ninety-six individuals participated. Mean age was 35 years (SD 11), 46% (44) were female, and 49% (47) were Primary Care Paramedics. Most participants (80 (84%)) correctly sorted at least 12 of 15 patients. Increased age was associated with decreased triage accuracy [-0.04(-0.07,-0.01);p=0.031]. Fifty-two (54%) were able to localize 12 or more of the 15 patients to a 27x 20m grid area. Advanced paramedic certification, and local residency were associated with improved patient localization [2.47(0.23,4.72);p=0.031], [-3.36(-5.61,-1.1);p=0.004]. The majority of participants (78 (81%)) chose an acceptable location to start SALT triage step two and 84% (80) identified at least three of four hazards. Approximately half (53 (55%)) of participants designated four or more of five key operational areas in appropriate locations. Conclusion: This study demonstrates the potential of UAV technology to remotely provide emergency responders with SA in a MCI. Additional research is required to further investigate optimal strategies to deploy UAVs in this context.

A multiple casualty incident clinical tracking form for civilian hospitals

2020 ◽  
Vol 15 (1) ◽  
pp. 43-48
Author(s):  
Spiros G. Frangos, MD, MPH ◽  
Marko Bukur, MD ◽  
Cherisse Berry, MD ◽  
Manish Tandon, MD, MBA ◽  
Leandra Krowsoski, MD ◽  
...  
Keyword(s):  
New York ◽  
Tracking System ◽  
Mass Casualty ◽  
Lessons Learned ◽  
Bellevue Hospital ◽  
Information Recall ◽  
Civilian Trauma ◽  
Multiple Injured ◽  
Injured Patients ◽  
Multiple Injured Patients

Background: While mass-casualty incidents (MCIs) may have competing absolute definitions, a universally accepted criterion is one that strains locally available resources. In the fall of 2017, a MCI occurred in New York and Bellevue Hospital received multiple injured patients within minutes; lessons learned included the need for a formalized, efficient patient and injury tracking system. Our objective was to create an organized MCI clinical tracking form for civilian trauma centers.Methods: After the MCI, the notes of the surgeon responsible for directing patient triage were analyzed. A succinct, organized template was created that allows MCI directors to track demographics, injuries, interventions, and other important information for hmultiple patients in a real-time fashion. This tool was piloted during a subsequent MCI.Results: In late 2018, the hospital received six patients following another MCI. They arrived within a 4-minute window, with 5 patients being critically injured. Two emergent surgeries and angioembolizations were performed. The tool was used by the MCI director to prioritize and expedite care. All physicians agreed that the tool assisted in organizing diagnostic and therapeutic triage. Conclusions: During MCIs, a streamlined patient tracking template assists with information recall and communication between providers and may allow for expedited care.

scholarly journals Training Emergency Department Charge Nurses Through Tabletop Exercises

2019 ◽  
Vol 34 (s1) ◽  
pp. s19-s19
Author(s):  
Beth Weeks
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Training Program ◽  
Disaster Response ◽  
Mass Casualty ◽  
Full Scale ◽  
Leadership Role ◽  
Mass Casualty Incidents ◽  
Charge Nurses ◽  
Incident Command

Introduction:In a disaster or mass casualty incident, the Emergency Department (ED) charge nurse is thrust into an expanded leadership role, expected to not only manage the department but also organize a disaster response. Hospital emergency preparedness training programs typically focus on high-level leadership, while frontline decision-making staff get experience only through online training and infrequent full-scale exercises. Financial and time limitations of full-scale exercises have been identified as major barriers to frontline training.Aim:To discuss a cost-effective approach to training ED charge nurses and informal leaders in disaster response.Methods:A formal training program was implemented in the ED. All permanent and relief charge nurses are required to attend one four-hour Hospital ICS course within their first year in their position, as well as participate in a minimum of one two-hour ED-based tabletop exercise per year. The tabletop exercises are offered bimonthly, covering various mass casualty scenarios such as apartment complex fires, riots, and a tornado strike. Full-scale exercises involving the ED occur annually.Results:ED permanent and relief charge nurses expressed increased skills and knowledge in areas such as initiation of disaster processes, implementation of hospital incident command, and familiarization with protocols and available resources. Furthermore, ED charge nurses have demonstrated strong leadership, decision-making, and improved response to actual mass casualty incidents since implementing ICS training and tabletop exercises.Discussion:Limitations of relying on full-scale disaster exercises to provide experience to frontline leaders can be overcome by the inclusion of ICS training and tabletop exercises for ED charge nurses in a hospital training and exercise plan. Implementing a structured training program for ED charge nurses focusing on leadership in mass casualty incidents is one step to building a more resilient and prepared ED, hospital, and community.

Prehospital Care Algorithm for Blast Injuries due to Bombing Incidents

2010 ◽  
Vol 25 (6) ◽  
pp. 595-600 ◽  
Author(s):  
G. Bobby Kapur ◽  
M. Tyson Pillow ◽  
Ira Nemeth
Keyword(s):  
Interpersonal Violence ◽  
Large Scale ◽  
Prehospital Care ◽  
The United States ◽  
Mass Casualty ◽  
Prehospital Setting ◽  
Blast Injuries ◽  
Care Providers ◽  
Universal Algorithm ◽  
Emergency Medical Services Personnel

AbstractTerrorist bombings continue to remain a risk for local jurisdictions, and retrospective data from the United States show that bombings occur in residential and business areas due to interpersonal violence without political motives. In the event of a mass-casualty bombing incident, prehospital care providers will have the responsibility for identifying and managing blast injuries unique to bombing victims. In a large-scale event, emergency medical services personnel should be required to provide prolonged medical care in the prehospital setting, and they will be able to deliver improved care with a better understanding of blast injuries and a concise algorithm for managing them. Blast injuries are categorized as primary, secondary, tertiary, and quaternary, and these injuries are related to the mechanism of injury from the blast event. After an initial evaluation, the emergency healthcare provider should consider following a universal algorithm to identify and treat blast injuries within these categories to prevent further morbidity or mortality in the prehospital setting.

Analgesia in the Field

1989 ◽  
Vol 4 (1) ◽  
pp. 31-34 ◽  
Author(s):  
Ronald D. Stewart
Keyword(s):  
United States ◽  
Life Support ◽  
Prehospital Care ◽  
Advanced Life Support ◽  
The United States ◽  
Mass Casualty ◽  
Transport Systems ◽  
Medical Problems ◽  
Interhospital Transport ◽  
Injured Patients

Emergency Medical Services and the care of patients in the field have taken giant steps forward over the past decade. Born of the desire of physicians to influence the mortality rates of sudden cardiac death in the community, systems of advanced life support have taken root in the urban centers in the United Kingdom, Australia, the United States, and other countries (1-3). Although originally largely designed around the concept of “mobile coronary care,” these systems soon were deluged with calls for help from all sectors of the community, and faced a variety of medical problems. As trauma gradually became recognized for the killer and maimer of young lives that it is, regional programs of trauma care were developed in the United States and led gradually to the expansion of prehospital and interhospital transport systems in which critically injured patients were being moved about, often over long distances. The growth of emergency medicine as a specialty in its own right has encouraged the study and improvement of systems of disaster and mass casualty management.Although the focus of these efforts has been largely the overall reduction of death and disability in critically ill or injured patients, controversy continues around not only the extent of field intervention but also the influence of our efforts on the outcome of these patients (4, 5). The importance of particular interventions such as intravenous line placement, administration of certain medications, the use of the pneumatic anti-shock garment, and other sacred cows of prehospital care, all have been questioned of late (6, 7).

A multiple casualty incident clinical tracking form for civilian hospitals

2020 ◽  
Vol 18 (3) ◽  
pp. 261-266
Author(s):  
Spiros G. Frangos, MD, MPH ◽  
Marko Bukur, MD ◽  
Cherisse Berry, MD ◽  
Manish Tandon, MD, MBA ◽  
Leandra Krowsoski, MD ◽  
...  
Keyword(s):  
New York ◽  
Tracking System ◽  
Mass Casualty ◽  
Lessons Learned ◽  
Information Recall ◽  
Civilian Trauma ◽  
Multiple Injured ◽  
Injured Patients ◽  
Multiple Patients ◽  
Multiple Injured Patients

Background: While mass-casualty incidents (MCIs) may have competing absolute definitions, a universally accepted criterion is one that strains locally available resources. In the fall of 2017, a MCI occurred in New York and Bellevue Hospital received multiple injured patients within minutes; lessons learned included the need for a formalized, efficient patient and injury tracking system. Our objective was to create an organized MCI clinical tracking form for civilian trauma centers.Methods: After the MCI, the notes of the surgeon responsible for directing patient triage were analyzed. A succinct, organized template was created that allows MCI directors to track demographics, injuries, interventions, and other important information for multiple patients in a real-time fashion. This tool was piloted during a subsequent MCI.Results: In late 2018, the hospital received six patients following another MCI. They arrived within a 4-minute window, with 5 patients being critically injured. Two emergent surgeries and angioembolizations were performed. The tool was used by the MCI director to prioritize and expedite care. All physicians agreed that the tool assisted in organizing diagnostic and therapeutic triage.Conclusions: During MCIs, a streamlined patient tracking template assists with information recall and communication between providers and may allow for expedited care.

Vehicle Crash Rescue Skills and Residency Training in Emergency Medicine

1985 ◽  
Vol 1 (S1) ◽  
pp. 103-104
Author(s):  
Robert R. Harrison ◽  
Kimball I. Maull ◽  
C. Paul Boyan
Keyword(s):  
Life Support ◽  
Prehospital Care ◽  
Advanced Life Support ◽  
Hospital Environment ◽  
Prehospital Emergency Care ◽  
Care Providers ◽  
Accident Victim ◽  
Prehospital Emergency ◽  
Time Required ◽  
Injured Patients

Recent advances in the resuscitation and stabilization skills of prehospital emergency care providers have done much to improve the quality of immediate care provided to suddenly ill or injured patients. Although much of the innovation and leadership in this area has been provided by emergency department physicians, most of them still lack an adequate appreciation of the circumstances under which these skills are executed. While many physicians participate in prehospital care teaching and evaluation of the system, most have not gained personal experience in those aspects of care foreign to hospital environment. They are particularly unacquainted with the intricacies of rescuing patients from automobile accidents and similar entrapments. It is not unusual, however, for an accident victim to spend half of the time required for the prehospital phase of emergency medical care undergoing extrication, and in many cases this must be done before full advanced life support measures may be initiated.

scholarly journals Disaster Day: A Simulation-Based Disaster Medicine Curriculum for Novice Learners

2021 ◽  
Vol 8 ◽  
pp. 238212052110207
Author(s):  
Brad D Gable ◽  
Asit Misra ◽  
Devin M Doos ◽  
Patrick G Hughes ◽  
Lisa M Clayton ◽  
...  
Keyword(s):  
Medical Students ◽  
Disaster Management ◽  
Disaster Preparedness ◽  
Real Life ◽  
Mass Casualty ◽  
Disaster Medicine ◽  
Incident Command ◽  
Management Concepts ◽  
Simulation Based ◽  
Second Year

Background: Mass casualty and multi-victim incidents have increased in recent years due to a number of factors including natural disasters and terrorism. The Association of American Medical Colleges (AAMC) recommends that medical students be trained in disaster preparedness and response. However, a majority of United States medical students are not provided such education. Objective: The goal of this study was to evaluate the effectiveness of a 1 day, immersive, simulation-based Disaster Day curriculum. Settings and Design: Learners were first and second year medical students from a single institution. Materials and Methods: Our education provided learners with information on disaster management, allowed for application of this knowledge with hands-on skill stations, and culminated in near full-scale simulation where learners could evaluate the knowledge and skills they had acquired. Statistical analysis used: To study the effectiveness of our Disaster Day curriculum, we conducted a single-group pretest-posttest and paired analysis of self-reported confidence data. Results: A total of 40 first and second year medical students participated in Disaster Day as learners. Learners strongly agreed that this course provided new information or provided clarity on previous training, and they intended to use what they learned, 97.6% and 88.4%, respectively. Conclusions: Medical students’ self-reported confidence of key disaster management concepts including victim triage, tourniquet application, and incident command improved after a simulation-based disaster curriculum. This Disaster Day curriculum provides students the ability to apply concepts learned in the classroom and better understand the real-life difficulties experienced in a resource limited environment.

Patient Flow or the Patient’s Journey? Exploring Health Care Providers’ Experiences and Understandings of Implementing a Care Pathway to Improve the Quality of Transitional Care for Older People

2021 ◽  
pp. 104973232110038
Author(s):  
Cecilie Fromholt Olsen ◽  
Astrid Bergland ◽  
Jonas Debesay ◽  
Asta Bye ◽  
Anne Gudrun Langaas
Keyword(s):  
Health Care ◽  
Older People ◽  
Health Care Providers ◽  
Transitional Care ◽  
Care Pathway ◽  
Patient Flow ◽  
Care Pathways ◽  
Care Providers ◽  
Patient Centered ◽  
Care For Older People

Internationally, the implementation of care pathways is a common strategy for making transitional care for older people more effective and patient-centered. Previous research highlights inherent tensions in care pathways, particularly in relation to their patient-centered aspects, which may cause dilemmas for health care providers. Health care providers’ understandings and experiences of this, however, remain unclear. Our aim was to explore health care providers’ experiences and understandings of implementing a care pathway to improve transitional care for older people. We conducted semistructured interviews with 20 health care providers and three key persons, along with participant observations of 22 meetings, in a Norwegian quality improvement collaborative. Through a thematic analysis, we identified an understanding of the care pathway as both patient flow and the patient’s journey and a dilemma between the two, and we discuss how the negotiation of conflicting institutional logics is a central part of care pathway implementation.

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