Identification of the Incapacitated Patient in Mass Casualty Events: An Exploration of Challenges, Solutions, and Barriers

2018 ◽  
Vol 13 (02) ◽  
pp. 338-344 ◽  
Author(s):  
Danielle Osborn ◽  
Lucy Easthope
Keyword(s):  
Public Health ◽  
Pediatric Patients ◽  
Mass Casualty ◽  
Scientific Methods ◽  
Identification Methods ◽  
Emergency Responders ◽  
Visual Identification ◽  
Mass Casualty Events ◽  
Incapacitated Patients ◽  
Mistaken Identification

AbstractIncreasing scrutiny of the role and actions of emergency responders in the aftermath of mass casualty events has led to improvements and advances in terms of treatment and care. However, despite these improvements, the authors have identified a growing concern relating to the identification of incapacitated patients and those unable to provide any identifying details, such as pediatric patients. The use of visual identification and the reliance on personal effects within the vicinity of a victim, either living or deceased, has resulted in mistaken identification in a number of major international incidents. The purpose of this article is to consider whether commonly used scientific methods for identification of the deceased could and should be broadened to include victims who are incapacitated and unable to confirm their own identity. The medicolegal questions that may arise when applying identification methods established for deceased patients to the living casualty will also be examined. (Disaster Med Public Health Preparedness. 2019;13:338–344)

Altered Standards of Care During an Influenza Pandemic: Identifying Ethical, Legal, and Practical Principles to Guide Decision Making

2009 ◽  
Vol 3 (S2) ◽  
pp. S132-S140 ◽  
Author(s):  
Donna Levin ◽  
Rebecca Orfaly Cadigan ◽  
Paul D. Biddinger ◽  
Suzanne Condon ◽  
Howard K. Koh ◽  
...  
Keyword(s):  
Public Health ◽  
Planning Process ◽  
Influenza Pandemic ◽  
State Level ◽  
Mass Casualty ◽  
Standards Of Care ◽  
Public Health Preparedness ◽  
Community Stakeholders ◽  
Mass Casualty Events ◽  
Public Health Officials

ABSTRACTAlthough widespread support favors prospective planning for altered standards of care during mass casualty events, the literature includes few, if any, accounts of groups that have formally addressed the overarching policy considerations at the state level. We describe the planning process undertaken by public health officials in the Commonwealth of Massachusetts, along with community and academic partners, to explore the issues surrounding altered standards of care in the event of pandemic influenza. Throughout 2006, the Massachusetts Department of Public Health and the Harvard School of Public Health Center for Public Health Preparedness jointly convened a working group comprising ethicists, lawyers, clinicians, and local and state public health officials to consider issues such as allocation of antiviral medications, prioritization of critical care, and state seizure of private assets. Community stakeholders were also engaged in the process through facilitated discussion of case scenarios focused on these and other issues. The objective of this initiative was to establish a framework and some fundamental principles that would subsequently guide the process of establishing specific altered standards of care protocols. The group collectively identified 4 goals and 7 principles to guide the equitable allocation of limited resources and establishment of altered standards of care protocols. Reviewing and analyzing this process to date may serve as a resource for other states. (Disaster Med Public Health Preparedness. 2009;3(Suppl 2):S132–S140)

Die a Hero or Live Long Enough to Become the Villain: Mass Casualty Preparedness in Hospitals and Protecting Doctors from Liability during Mass Casualty Events

2015 ◽  
Vol 6 (1) ◽  
Author(s):  
Ashley Tseung
Keyword(s):  
Public Health ◽  
United States ◽  
Emergency Preparedness ◽  
Preventive Measures ◽  
The United States ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Public Health Emergency ◽  
Terrorist Attacks ◽  
Mass Casualty Events

AbstractSince 9/11, the United States and the international community have emphasized the need to protect people from terrorist attacks. The Boston Bombing that took place on April 15, 2013, showed that even with all of the preventive measures in place, the United States is not immune from terrorist attacks. If there had been a bioterrorist attack in Boston instead of a homemade bomb, the amount of casualties would likely have been a lot higher. Many hospitals lack effective emergency preparedness plans that address bioterrorist attacks. One area that will help prepare nations during a mass casualty incident or public health emergency involves implementing effective mass casualty preparedness plans for hospitals. This paper analyzes mass casualty preparedness in hospitals and demonstrates the need to have legislation in place to protect doctors who treat patients during mass casualty events.

Society for the Advancement of Disaster Nursing: Exploring the Path to Excellence

2017 ◽  
Vol 11 (6) ◽  
pp. 641-646 ◽  
Author(s):  
Roberta Proffitt Lavin ◽  
Deborah S. Adelman ◽  
Tener Goodwin Veenema
Keyword(s):  
Public Health ◽  
Disaster Response ◽  
Mass Casualty ◽  
Professional Organization ◽  
Scope Of Practice ◽  
Service Needs ◽  
Health Security ◽  
Public Health Emergencies ◽  
Mass Casualty Events ◽  
Professional Credibility

AbstractObjectiveMajor disasters occurring within the Unites States require nursing participation as a component of a successful response. Disaster nursing includes the care of populations affected by disasters, public health emergencies, and mass casualty events, both natural and man-made. A unique knowledge base, abilities, and skills are needed to respond appropriately to health care and human service needs resulting from these events.MethodsDespite prior efforts to advance disaster nursing as a specialty, none were sustainable and a professional framework for establishing standards and guidelines remains lacking.ResultsDisaster nursing is a complex arena where the intersection of competence, scope of practice, regulation, and clinical guidelines continues to evolve. Professional credibility and our contribution to disaster response lie in our ability to articulate and advance professionalism. Disaster nursing as a specialty practice requires a similar foundational framework to nursing specialties recognized by the American Nurses Association within a model of professional practice in order to ensure population outcomes that are reflective of safe, quality, evidence-based practice.ConclusionsIt is time to define a disaster nursing scope of practice, establish standards for care, identify best practices, and pursue the establishment of an independent professional organization within the field of disaster nursing. This will establish the necessary foundation for optimizing nursing’s contribution to and support of the National Health Security Strategy. (Disaster Med Public Health Preparedness. 2017;11:641–646)

scholarly journals Evaluation of a Scalable Information Analytics System for Enhanced Situational Awareness in Mass Casualty Events

2016 ◽  
Vol 2016 ◽  
pp. 1-10
Author(s):  
Aura Ganz ◽  
James M. Schafer ◽  
Zhuorui Yang ◽  
Jun Yi ◽  
Graydon Lord ◽  
...  
Keyword(s):  
Visual Analytics ◽  
Situational Awareness ◽  
Mass Casualty ◽  
Transport Time ◽  
Emergency Responders ◽  
Left Behind ◽  
Lighting Conditions ◽  
Mass Casualty Events ◽  
Time Reduction ◽  
Triage Time

We investigate the utility of DIORAMA-II system which provides enhanced situational awareness within a disaster scene by using real-time visual analytics tools and a collaboration platform between the incident commander and the emergency responders. Our trials were conducted in different geographical areas (feature-rich and featureless regions) and in different lighting conditions (daytime and nighttime). DIORAMA-II obtained considerable time gain in efficiency compared to conventional paper based systems. DIORAMA-II time gain was reflected in reduction of both average triage time per patient (up to 34.3% average triage time reduction per patient) and average transport time per patient (up to 76.3% average transport time reduction per red patient and up to 66.3% average transport time reduction per yellow patient). In addition, DIORAMA-II ensured that no patients were left behind or transported in the incorrect order compared to the conventional method which resulted in patients being left behind and transported in the incorrect order.

Early Diagnosis and Intervention in Mass Casualty Events

2008 ◽  
Author(s):  
Ilan Kutz ◽  
Rachel Dekel ◽  
Shaul Schreiber ◽  
Victor Resnick ◽  
Ornah T. Dolberg ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Mass Casualty ◽  
Mass Casualty Events

Non-Pediatric Nurses’ Willingness to Provide Care to Pediatric Patients during a Disaster: An Assessment of Pediatric Surge Capacity in Four Midwestern Hospitals

2021 ◽  
pp. 1-6
Author(s):  
Terri Rebmann ◽  
Rachel L. Charney ◽  
Rebecca L. Eschmann ◽  
M. Colleen Fitzpatrick
Keyword(s):  
Pediatric Patients ◽  
Response Rate ◽  
Mass Casualty ◽  
Pediatric Care ◽  
Pediatric Nurses ◽  
Surge Capacity ◽  
Factors Associated ◽  
Pediatric Hospitals ◽  
Survey Response Rate ◽  
Mass Casualty Event

Abstract Objective: To assess non-pediatric nurses’ willingness to provide care to pediatric patients during a mass casualty event (MCE). Methods: Nurses from 4 non-pediatric hospitals in a major metropolitan Midwestern region were surveyed in the fall of 2018. Participants were asked about their willingness to provide MCE pediatric care. Hierarchical logistical regression was used to describe factors associated with nurses’ willingness to provide MCE pediatric care. Results: In total, 313 nurses were approached and 289 completed a survey (response rate = 92%). A quarter (25.3%, n = 73) would be willing to provide MCE care to a child of any age; 12% (n = 35) would provide care only to newborns in the labor and delivery area, and 16.6% (n = 48) would only provide care to adults. Predictors of willingness to provide care to a patient of any age during an MCE included providing care to the youngest-age children during routine duties, reporting confidence in calculating doses and administering pediatric medications, working in the emergency department, being currently or previously certified in PALS, and having access to pediatric-sized equipment in the unit or hospital. Conclusion: Pediatric surge capacity is lacking among nurses. Increasing nurses’ pediatric care self-efficacy could improve pediatric surge capacity and minimize morbidity and mortality during MCEs.

Postexposure Interventions to Prevent Infection With HBV, HCV, or HIV, and Tetanus in People Wounded During Bombings and Other Mass Casualty Events—United States, 2008: Recommendations of the Centers for Disease Control and Prevention and Disaster Medicine and Public Health Preparedness

2008 ◽  
Vol 2 (3) ◽  
pp. 150-165 ◽  
Author(s):  
Louisa E. Chapman ◽  
Ernest E. Sullivent ◽  
Lisa A. Grohskopf ◽  
Elise M. Beltrami ◽  
Joseph F. Perz ◽  
...  
Keyword(s):  
Public Health ◽  
Disease Control ◽  
Emergency Response ◽  
Mass Casualty ◽  
Acute Injury ◽  
Mass Casualties ◽  
Public Health Preparedness ◽  
Mass Casualty Event ◽  
Public Health Officials ◽  
Centers For Disease Control

ABSTRACTPeople wounded during bombings or other events resulting in mass casualties or in conjunction with the resulting emergency response may be exposed to blood, body fluids, or tissue from other injured people and thus be at risk for bloodborne infections such as hepatitis B virus, hepatitis C virus, human immunodeficiency virus, or tetanus. This report adapts existing general recommendations on the use of immunization and postexposure prophylaxis for tetanus and for occupational and nonoccupational exposures to bloodborne pathogens to the specific situation of a mass casualty event. Decisions regarding the implementation of prophylaxis are complex, and drawing parallels from existing guidelines is difficult. For any prophylactic intervention to be implemented effectively, guidance must be simple, straightforward, and logistically undemanding. Critical review during development of this guidance was provided by representatives of the National Association of County and City Health Officials, the Council of State and Territorial Epidemiologists, and representatives of the acute injury care, trauma, and emergency response medical communities participating in the Centers for Disease Control and Prevention’s Terrorism Injuries: Information, Dissemination and Exchange project. The recommendations contained in this report represent the consensus of US federal public health officials and reflect the experience and input of public health officials at all levels of government and the acute injury response community. (Disaster Med Public Health Preparedness. 2008;2:150–165)

COVID-19: lessons learnt and priorities in trauma and orthopaedic surgery

2021 ◽  
Author(s):  
S Madanipour ◽  
F Iranpour ◽  
T Goetz ◽  
S Khan
Keyword(s):  
Elective Surgery ◽  
Risk Mitigation ◽  
Mass Casualty ◽  
Health Crisis ◽  
Lessons Learnt ◽  
Mass Casualty Events ◽  
Trauma Networks ◽  
Major Incidents ◽  
Bed Capacity ◽  
Orthopaedic Community

The COVID-19 pandemic is the most serious health crisis of our time. Global public measures have been enacted to try to prevent healthcare systems from being overwhelmed. The trauma and orthopaedic (T&O) community has overcome challenges in order to continue to deliver acute trauma care to patients and plan for challenges ahead. This review explores the lessons learnt, the priorities and the controversies that the T&O community has faced during the crisis. Historically, the experience of major incidents in T&O has focused on mass casualty events. The current pandemic requires a different approach to resource management in order to create a long-term, system-sustaining model of care alongside a move towards resource balancing and facilitation. Significant limitations in theatre access, anaesthetists and bed capacity have necessitated adaptation. Strategic changes to trauma networks and risk mitigation allowed for ongoing surgical treatment of trauma. Outpatient care was reformed with the uptake of technology. The return to elective surgery requires careful planning, restructuring of elective pathways and risk management. Despite the hope that mass vaccination will lift the pressure on bed capacity and on bleak economic forecasts, the orthopaedic community must readjust its focus to meet the challenge of huge backlogs in elective caseloads before looking to the future with a robust strategy of integrated resilient pathways. The pandemic will provide the impetus for research that defines essential interventions and facilitates the implementation of strategies to overcome current barriers and to prepare for future crises.

scholarly journals (P1-99) Comparative Descriptive Analysis of Post-Disaster Psychological Interventions

2011 ◽  
Vol 26 (S1) ◽  
pp. s131-s131
Author(s):  
E.Y.L. Cheung ◽  
E.Y.Y. Chan ◽  
S.H. Lee
Keyword(s):  
Public Health ◽  
Empirical Evidence ◽  
Descriptive Analysis ◽  
First Aid ◽  
Psychological Interventions ◽  
Current Crisis ◽  
Instructor Training ◽  
Emergency Responders ◽  
Public Health Practitioners ◽  
Post Disaster

IntroductionDisaster could greatly affect physical, psychological and social health of people affected. However, current crisis intervention protocols after natural or man-made disasters often overlook the psychosocial impact of crisis on victims. In its executive board meeting in 2005, WHO has called for action in implementing programs that can repair the psychological damage of war, conflict and natural disasters. Currently there are three main post-disaster psychological interventions available in the field: Critical Incidence Stress Management developed by Mitchell and Everly in 1980's; Psychological First Aid developed by the National Child Traumatic Stress Network and National Center for PTSD after millennium; and Mental Health First Aid developed by the Kitchener and Jorm after millennium.MethodsA comparative descriptive analysis among the three different interventions was performed. Specific objectives, target populations, content, training duration, empirical evidence, instructor training and various adaptations were compared. Public health implications for implementation in disaster settings are discussed.ResultsThe study is among the first that provided a detail comparison among the different protocols available in the field. More importantly it discussed the empirical evidence that support the use of the specific protocols at different scenarios. Implication the results of the study could be used as a guidance for choosing psychological interventions immediately post-disasters by emergency responders, public health practitioners and academic researchers.

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