Field Triage and Patient Maldistribution in a Mass-Casualty Incident

2007 ◽  
Vol 22 (3) ◽  
pp. 224-229 ◽  
Author(s):  
Richard M. Zoraster ◽  
Cathy Chidester ◽  
William Koenig
Keyword(s):  
Los Angeles ◽  
Prehospital Care ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Trauma Centers ◽  
Community Hospitals ◽  
Center Staff ◽  
Field Triage ◽  
Number Of Patients ◽  
To Receive

AbstractIntroduction:Management of mass-casualty incidents should optimize outcomes by appropriate prehospital care, and patient triage to the most capably facilities. The number of patients, the nature of injuries, transportation needs, distances, and hospital capabilities and availabilities are all factors to be considered. Patient maldistributions such as overwhelming individual facilities, or transport to facilities incapable of providing appropriate care should be avoided. This report is a critical view of the application of the START triage nomenclature in the prehospital arena following a train crash in Los Angeles County on 26 January 2005.Methods:A scheduled debriefing was held with the major fire and emergency medical services responders, Medical Alert Center staff, and hospitals to assess and review the response to the incident. Site visits were made to all of the hospitals involved. Follow-up questions were directed to emergency department staff that were on duty during the day of the incident.Results:The five Level-I Trauma Centers responded to the poll with the capacity to receive a total of 12 “Immediate” patients, 2.4 patients per center, the eight Level-II Trauma Centers responded with capacity to receive 17 “Immediate” patients, two patients per center, while the 25 closest community hospitals offered to accept 75 “Immediate” patients, three patients per hospital. These community hospitals were typically about one-half of the size of the trauma centers (average 287 beds versus 548, average 8.7 operating rooms versus 16.6). Twenty-six patients were transported to a community hospital >15 miles from the scene, while eight closer community hospitals did not receive any patients.Conclusions:The debriefing summary of this incident concluded that there were no consistently used criteria to decide ultimate destination for “Immediates”, and that they were distributed about equally between community hospitals and trauma centers.

scholarly journals (P2-7) Patient Distribution during a Mass-Casualty Incident: The 25 February 2009 Turkish Airlines Crash in Amsterdam

2011 ◽  
Vol 26 (S1) ◽  
pp. s137-s137 ◽  
Author(s):  
I.L.E. Postma ◽  
H. Weel ◽  
M. Heetveld ◽  
F. Bloemers ◽  
T. Bijlsma ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Major Trauma ◽  
Injury Severity ◽  
Emergency Services ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Trauma Centers ◽  
Risk Area ◽  
High Risk Area ◽  
Number Of Patients

BackgroundDifficulties have been reported in patient distribution during mass-casualty incidents (MCIs). In this retrospective, descriptive study, the regional Patient Distribution Protocol (PDP) and the management of the patient distribution after the Turkish Airlines airplane crash on 25 February 2009 near Schiphol Airport in Amsterdam were analyzed.MethodsAnalysis of the of PDP involving the 126 surviving victims of the crash, by collecting data on Medical Treatment Capacity (MTC), number of patients received per hospital, triage classification, Injury Severity Scale (ISS) score, secondary transfers, distance from the crash site, and critical mortality rate.ResultsThe PDP holds two inconsistent definitions of MTC. The PDP was not followed. Four hospitals received 133–213% of their MTC, and five hospitals received one patient. There were 14 receiving hospitals (distance from crash: 5.8–53.5 km); thre hospitals within 20 km of the crash did not receive any patients. Major trauma centers received 89% of the “critical” casualties and 92% of the casualties with ISS score ≥ 16. They also received 10% of “minor” casualties and 29% of casualties with ISS score < 8. Only three patients were secondarily transferred, and no casualties died in, or on the way to, the hospital (critical mortality rate = 0%).ConclusionsPatient distribution was effective, as secondary transfers were low, and the critical mortality rate was zero. The regional PDP could not be followed during this MCI. Uneven casualty distribution was seen in the hospitals. The regional PDP is inconsistent, and should be updated in a new cooperation between Emergency Services, surrounding hospitals and vSchiphol Airport, a high risk area, for which area-specific PDPs must be designed.

Disaster Response to a Mass Casualty Incident in a Hospital Fire by Regional Disaster Medical Assistance Team: Characteristics of Hospital Fire

2020 ◽  
pp. 1-4
Author(s):  
Jae Ho Jang ◽  
Jin-Seong Cho ◽  
Youg Su Lim ◽  
Sung Youl Hyun ◽  
Jae-Hyug Woo ◽  
...  
Keyword(s):  
Medical Records ◽  
Medical Staff ◽  
Disaster Response ◽  
Fire Department ◽  
Treatment Method ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Medical Assistance ◽  
Fire Disaster ◽  
Field Triage

ABSTRACT Objective: A disaster in the hospital is particularly serious and quite different from other ordinary disasters. This study aimed at analyzing the activity outcomes of a disaster medical assistance team (DMAT) for a fire disaster at the hospital. Methods: The data which was documented by a DMAT and emergent medical technicians of a fire department contained information about the patient’s characteristics, medical records, triage results, and the hospital which the patient was transferred from. Patients were categorized into four groups according to results of field triage using the simple triage and rapid treatment method. Results: DMAT arrived on the scene in 37 minutes. One hundred and thirty eight (138) patients were evacuated from the disaster scene. There were 25 patients (18.1%) in the Red group, 96 patients (69.6%) in the Yellow group, and 1 patient (0.7%) in the Green group. One patient died. There were 16 (11.6%) medical staff and hospital employees. The injury of the caregiver or the medical staff was more severe compared to the family protector. Conclusions: For an effective disaster-response system in hospital disasters, it is important to secure the safety of medical staff, to utilize available medical resources, to secure patients’ medical records, and to reorganize the DMAT dispatch system.

Are there Field Triage Criteria that Can Predict Low-Yield Air Medical Transports?

2019 ◽  
Vol 34 (6) ◽  
pp. 596-603
Author(s):  
Hiroko Miyagi ◽  
David C. Evans ◽  
Howard A. Werman
Keyword(s):  
Trauma Center ◽  
Early Discharge ◽  
Hospital Death ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Predictive Values ◽  
Field Triage ◽  
Number Of Patients ◽  
Medical Transport ◽  
The Impact

AbstractIntroduction:Air medical transport of trauma patients from the scene of injury plays a critical role in the delivery of severely injured patients to trauma centers. Over-triage of patients to trauma centers reduces the system efficiency and jeopardizes safety of air medical crews.Hypothesis:The objective of this study was to determine which triage factors utilized by Emergency Medical Services (EMS) providers are strong predictors of early discharge for trauma patients transported by helicopter to a trauma center.Methods:A retrospective chart review over a two-year period was performed for trauma patients flown from the injury site into a Level I trauma center by an air medical transport program. Demographic and clinical data were collected on each patient. Prehospital factors such as Glasgow Coma Score (GCS), Revised Trauma Score (RTS), intubation status, mechanism of injury, anatomic injuries, physiologic parameters, and any combinations of these factors were investigated to determine which triage criteria accurately predicted early discharge. Hospital factors such as Injury Severity Score (ISS), length-of-stay (LOS), survival, and emergency department disposition were also collected. Early discharge was defined as a hospital stay of less than 24 hours in a patient who survives their injuries. A more stringent definition of appropriate triage was defined as a patient with in-hospital death, an ISS >15, those taken to the operating room (OR) or intensive care unit (ICU), or those receiving blood products. Those patients who failed to meet these criteria were also used to determine over-triage rates.Results:An overall early discharge rate of 35% was found among the study population. Furthermore, when the more stringent definition was applied, over-triage rates were as high as 85%. Positive predictive values indicated that patients who met at least one anatomic and physiologic criteria were appropriately transported by helicopter as 94% of these patients had stays longer than 24 hours. No other criteria or combination of criteria had a high predictive value for early discharge.Conclusions:No individual triage criteria or combination of criteria examined demonstrated the ability to uniformly predict an early discharge. Although helicopter transport and subsequent hospital care is costly and resource consuming, it appears that a significant number of patients will be discharged within 24 hours of their transport to a trauma center. Future studies must determine the impact of eliminating “low-yield” triage criteria on under-triage of scene trauma patients.

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.

scholarly journals Disaster and Mass Casualty Incident Responses by Doctor Car

2019 ◽  
Vol 34 (s1) ◽  
pp. s121-s121
Author(s):  
Masamune Kuno ◽  
Kensuke Suzuki ◽  
Kyoko Unemoto ◽  
Takashi Tagami ◽  
Fumihiko Nakayama ◽  
...  
Keyword(s):  
Medical Care ◽  
Prehospital Care ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Medical Team ◽  
First Case ◽  
The Disabled ◽  
Care Systems ◽  
Prehospital Medical Care ◽  
Under Construction

Introduction:Ambulances with physicians, known as Doctor Car, and Tokyo DMAT are the two prehospital care systems responsible for medical team dispatch in the Tokyo area. While there are 25 designated hospitals for DMAT, Doctor Car is only available at four hospitals. Our hospital incorporates both systems. While the prehospital care system must be utilized at the time of disaster, Doctor Car was dispatched 418 times in 2017, and the use of DMAT is less than ten times per year.Aim:To review the past disaster responses of our hospital.Methods:The study reviews three cases where our hospital responded to mass casualty incidents and disasters with either Doctor Car or DMAT. The first case was the treatment of crush syndrome caused by a collapsed parking slope. It took more than 24 hours for the rescue, in which the team treated patients during transport and at the hospital. The second case was our response to a mass stabbing incident committed at a facility for the disabled. In collaboration with the onsite rescue team, we conducted triage, hemostasis, transfusion, etc. The third case was caused by a fire in a building under construction. We provided treatments like triage and tracheal intubation on the spot.Results:Because paramedics are allowed to conduct only a limited amount of treatments, dispatch of the medical team to the site is effective.Discussion:For a medical team to be effective at the dispatched site, the team must be accustomed not only to the specific need of medical care during disasters but also prehospital medical care, which may include the abilities to ensure safety during transport and on-site and adapt to the prehospital environment. Doctor Car is a useful way to realize such abilities.

scholarly journals Confusion, Chaos, and Bridging the Gap: A Prospective Study Gauging Disaster Triage Methodologies and Usage Across First Responder Professions

2019 ◽  
Vol 34 (s1) ◽  
pp. s111-s111
Author(s):  
Brenna Adelman
Keyword(s):  
National Policy ◽  
First Responders ◽  
The United States ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Future Research ◽  
Field Triage ◽  
Mass Casualty Event ◽  
A Prospective Study ◽  
National Trends

Introduction:Disasters are unique in that they impact all socioeconomic, class, and social divides. They are complex, hard to conceptualize and operationally define, and occur sporadically without warning. However, regardless of each disasters innate unpredictability, there is one common need that directly impacts patient morbidity and mortality: effective triage.Aim:Currently the United States has no uniform triage mandate. The purpose of this study is to gather descriptive data on the type of mass-casualty triage currently being utilized by first responders (Emergency Medical Services/Fire/Nurses) and improve our understanding regarding the prevalence of mass casualty triage.Methods:A descriptive mixed methods survey is being distributed to first responders/nurses in the Appalachian region. This survey collects respondents demographics, profession, and MCI triage data. Data will be analyzed and descriptive statistics will be generated. GIS will be utilized to graph findings and visualize local and national trends.Results:Results of this study are pending.Discussion:Organizations have addressed the need for a standard triage protocol, even going so far as to create uniform criteria which each triage system should meet. However, the literature does not describe how individual professions train their members in disaster triage, or what triage is currently being utilized in each profession. Nurses and first-responders serve as linchpins in many communities. They remain in a community, both before, during, and after a mass casualty event, but they do not perform in a vacuum. During an MCI (mass-casualty incident) their scope of practice may vary, but they have common foci: the affected community. A better understanding of the type of MCI triage that each profession is using is vital in understanding how triage is being applied, and vital in identifying gaps in application that may impact the effectiveness of field triage, and affect local and national policy, practice, and future research.

Mass Casualty Incident Management Preparedness: A Survey of the American College of Surgeons Committee on Trauma

2016 ◽  
Vol 82 (12) ◽  
pp. 1227-1231 ◽  
Author(s):  
Aaron M. Lewis ◽  
Salvador Sordo ◽  
Leonard J. Weireter ◽  
Michelle A. Price ◽  
Leopoldo Cancio ◽  
...  
Keyword(s):  
Public Transportation ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Incident Management ◽  
Trauma Centers ◽  
Select Group ◽  
Level Ii ◽  
American College Of Surgeons ◽  
Level I ◽  
Trauma Surgeons

Mass casualty incidents (MCIs) are events resulting in more injured patients than hospital systems can handle with standard protocols. Several studies have assessed hospital preparedness during MCIs. However, physicians and trauma surgeons need to be familiar with their hospital's MCI Plan. The purpose of this survey was to assess hospitals’ and trauma surgeon's preparedness for MCIs. Online surveys were e-mailed to members of the American College of Surgeons committee on Trauma Ad Hoc Committee on Disaster and Mass Casualty Management before the March 2012 meeting. Eighty surveys were analyzed (of 258). About 76 per cent were American College of Surgeons Level I trauma centers, 18 per cent were Level II trauma centers. Fifty-seven per cent of Level I and 21 per cent of Level II trauma centers had experienced an MCI. A total of 98 per cent of respondents thought it was likely their hospital would see a future MCI. Severe weather storm was the most likely event (95%), followed by public transportation incident (86%), then explosion (85%). About 83 per cent of hospitals had mechanisms to request additional physician/surgeons, and 80 per cent reported plans for operative triage. The majority of trauma surgeons felt prepared for an MCI and believed an event was likely to occur in the future. The survey was limited by the highly select group of respondents and future surveys will be necessary.

Distribution of Casualties in a Mass-Casualty Incident with Three Local Hospitals in the Periphery of a Densely Populated Area: Lessons Learned from the Medical Management of a Terrorist Attack

2007 ◽  
Vol 22 (3) ◽  
pp. 186-192 ◽  
Author(s):  
Yuval H. Bloch ◽  
Dagan Schwartz ◽  
Moshe Pinkert ◽  
Amir Blumenfeld ◽  
Shkolnick Avinoam ◽  
...  
Keyword(s):  
Medical Management ◽  
Terrorist Attack ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Lessons Learned ◽  
Suicide Bombing ◽  
Populated Area ◽  
Medical Response ◽  
Ambulance Dispatch ◽  
To Receive

AbstractIntroduction:A mass-casualty incident (MCI) can occur in the periphery of a densely populated area, away from a metropolitan area. In such circumstances, the medical management of the casualties is expected to be difficult because the nearest hospital and the emergency medical services (EMS), only can offer limited resources.When coping with these types of events (i.e., limited medical capability in the nearby medical facilities), a quick response time and rational triage can have a great impact on the outcome of the victims. The objective of this study was to identify the lessons learned from the medical response to a terrorist attack that occurred on 05 December 2005, in Netanya, a small Israeli city.Methods:Data were collected during and after the event from formal debriefings and from patient files. The data were processed using descriptive statistics and compared to those from previous events. The event is described according to Disastrous Incidents Systematic Analysis Through Components, Interactions, Results (DISAST-CIR) methodology.Results:Four victims and the terrorist died as a result of this suicide bombing. A total of 131 patients were evacuated (by EMS or self-evacuation) to three nearby hospitals. Due to the proximity of the event to the ambulance dispatch station, the EMS response was quick.The first evacuation took place only three minutes after the explosion. Non-urgent patients were diverted to two close-circle hospitals, allowing the nearest hospital to treat urgent patients and to receive the majority of self-evacuated patients. The nearest hospital continued to receive patients for >6 hours after the explosion, 57 of them (78%) were self-evacuated.Conclusion:The distribution of casualties from the scene plays a vital role in the management of a MCI that occurs in the outskirts of a densely populated area.Non-urgent patients should be referred to a hospital close to the scene of the event, but not the closest hospital.The nearest hospital should be prepared to treat urgent casualties, as well as a large number of self-evacuated patients.

The Tsukui (Japan) Yamayuri-en Facility Stabbing Mass-Casualty Incident

2019 ◽  
Vol 34 (02) ◽  
pp. 203-208
Author(s):  
Takaaki Maruhashi ◽  
Ichiro Takeuchi ◽  
Jun Hattori ◽  
Yuichi Kataoka ◽  
Yasushi Asari
Keyword(s):  
Emergency Surgery ◽  
Fire Department ◽  
Disabled Persons ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Fire Departments ◽  
Stab Wounds ◽  
Medical Institutions ◽  
Field Triage ◽  
Study Hospital

Introduction:In July 2016, a mass-casualty stabbing attack took place at a facility for disabled persons located in Sagamihara City (Kanagawa Prefecture, Japan). The attack resulted in 45 casualties, including 19 deaths. The study hospital dispatched physicians to the field and admitted multiple casualties. This report aimed to review the physicians’ experiences and to provide insights for the formulation of response measures for similar incidents in the future.Report:This incident involved 30 emergency teams and 12 fire department teams, including those from neighboring fire departments. Five physicians from three medical institutions, including the study hospital, entered the field. The Simple Triage and Rapid Treatment (START) method was used on the field. The final field triage category count was: 20 red, four yellow, two green, and 19 black tags. All the casualties (n = 26) except for the 19 black tag casualties were transported to one of six neighboring medical institutions.The median age of the transported casualties was 41 years (interquartile range [IQR] = 35.5 – 42.0). Three casualties (21.4%) were in hemorrhagic shock on arrival at the hospital. Twelve patients had multiple cervical stab wounds (median four wounds; IQR = 3.75 – 6.0). A total of 91.7% of these stab wounds were in mid-neck Zone II region. Of the 12 patients with cervical stab wounds, four (33.3%) required emergency surgery, and the rest were sutured on an out-patient basis. One patient had already been sutured on the field. All patients requiring emergency surgery had deep wounds, including those of the carotid vein, thyroid gland, nerves, and the trachea. Eight of the casualties were hospitalized at the study institution. Five of them were admitted to the intensive care unit. There were no deaths among the casualties transported to the hospitals.Conclusion:Regional core disaster medical hospitals must take on a central role, particularly in the case of local disasters. Horizontal communication and interactions should be reinforced by devising protocols and conducting joint training for effective inter-department collaborations on the field.Maruhashi, T, Takeuchi, I, Hattori, J, Kataoka, Y, Asari, Y. The Tsukui (Japan) Yamayuri-en facility stabbing mass-casualty incident. Prehosp Disaster Med. 2019;34(2):203–208

Triage During Mass Gatherings

2012 ◽  
Vol 27 (6) ◽  
pp. 531-535 ◽  
Author(s):  
Sheila A. Turris ◽  
Adam Lund
Keyword(s):  
Large Scale ◽  
Scoring Systems ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Mass Casualty Incidents ◽  
Limited Resources ◽  
Mass Gathering ◽  
Publication Type ◽  
Mass Gatherings ◽  
Field Triage

AbstractTriage is a complex process and is one means for determining which patients most need access to limited resources. Triage has been studied extensively, particularly in relation to triage in overcrowded emergency departments, where individuals presenting for treatment often are competing for the available stretchers. Research also has been done in relation to the use of prehospital and field triage during mass-casualty incidents and disasters.In contrast, scant research has been done to develop and test an effective triage approach for use in mass-gathering and mass-participation events, although there is a growing body of knowledge regarding the health needs of persons attending large events. Existing triage and acuity scoring systems are suboptimal for this unique population, as these events can involve high patient presentation rates (PPR) and, occasionally, critically ill patients. Mass-gathering events are dangerous; a higher incidence of injury occurs than would be expected from general population statistics.The need for an effective triage and acuity scoring system for use during mass gatherings is clear, as these events not only create multiple patient encounters, but also have the potential to become mass-casualty incidents. Furthermore, triage during a large-scale disaster or mass-casualty incident requires that multiple, local agencies work together, necessitating a common language for triage and acuity scoring.In reviewing existing literature with regard to triage systems that might be employed for this population, it is noted that existing systems are biased toward traumatic injuries, usually ignoring mitigating factors such as alcohol and drug use and environmental exposures. Moreover, there is a substantial amount of over-triage that occurs with existing prehospital triage systems, which may lead to misallocation of limited resources. This manuscript presents a review of the available literature and proposes a triage system for use during mass gatherings that also may be used in the setting of mass-casualty incidents or disaster responses.TurrisSA, LundA. Triage during mass gatherings. Prehosp Disaster Med. 2012;27(6):1-5.

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