Defining the Problem, Main Objective, and Strategies of Medical Management in Mass-Casualty Incidents Caused by Terrorist Events

2008 ◽  
Vol 23 (1) ◽  
pp. 82-89 ◽  
Author(s):  
Itamar Ashkenazi ◽  
Boris Kessel ◽  
Oded Olsha ◽  
Tawfik Khashan ◽  
Meir Oren ◽  
...  
Keyword(s):  
Medical Management ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Mass Casualty Incidents ◽  
Traditional Management ◽  
Treat Ment ◽  
Impact On Survival ◽  
Life Threatening ◽  
Management Roles ◽  
Terrorist Events

AbstractBased on the experience of managing >20 such events during the last decade, the authors' understanding of a mass-casualty incident is that it is an event in which there may be many victims, but only a few that actually suffer from life-threatening injuries. To make an impact on survival, one must identify those who are severely wounded as quickly as possible and offer those patients opti-mal care. Experienced trauma physicians are the most important resource available to achieve this objective, and they should be allocated to the treat-ment of seriously injured victims instead of more traditional management roles such as triage and incident manager.

scholarly journals Prehospital Triage by Lay Person First Responders: A Scoping Review and Proposal for a new Prehospital Triage Tool

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.

scholarly journals Modeling Uncertain and Dynamic Casualty Health in Optimization-Based Decision Support for Mass Casualty Incident Response

2015 ◽  
pp. 411-423
Author(s):  
Duncan T. Wilson ◽  
Glenn I. Hawe ◽  
Graham Coates ◽  
Roger S. Crouch
Keyword(s):  
Decision Support ◽  
Real Time ◽  
Health Assessment ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Mass Casualty Incidents ◽  
Support Program ◽  
Dynamic Nature ◽  
Significant Challenge ◽  
Health Model

When designing a decision support program for use in coordinating the response to Mass Casualty Incidents, the modelling of the health of casualties presents a significant challenge. In this paper we propose one such health model, capable of acknowledging both the uncertain and dynamic nature of casualty health. Incorporating this into a larger optimisation model capable of use in real-time and in an online manner, computational experiments examining the effect of errors in health assessment, regular updates of health and delays in communication are reported. Results demonstrate the often significant impact of these factors.

Evaluation of Medical Management During a Mass Casualty Incident Exercise: An Objective Assessment Tool to Enhance Direct Observation

2010 ◽  
Vol 39 (5) ◽  
pp. 629-636 ◽  
Author(s):  
Pier Luigi Ingrassia ◽  
Federico Prato ◽  
Alessandro Geddo ◽  
Davide Colombo ◽  
Marco Tengattini ◽  
...  
Keyword(s):  
Direct Observation ◽  
Medical Management ◽  
Assessment Tool ◽  
Objective Assessment ◽  
Mass Casualty Incident ◽  
Mass Casualty

scholarly journals (A213) Review of the Mass Casualty Incident after a Bomb Explosion in a Crowded Restaurant

2011 ◽  
Vol 26 (S1) ◽  
pp. s59-s59
Author(s):  
S.S. Shettar ◽  
K.V. Kelkar ◽  
A.V. Jamkar ◽  
Y.V. Gawali ◽  
V. Kapil ◽  
...  
Keyword(s):  
Fatal Outcome ◽  
Blast Injury ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Blast Injuries ◽  
Injury Patterns ◽  
Medical Facilities ◽  
Life Threatening ◽  
Enclosed Space ◽  
Type Of Injury

Terror struck Pune on 13 Feb. 2010 as a powerful bomb ripped apart a popular restaurant, killing nine people and injuring more than 45. A retrospective analysis of the injury patterns was done.Materials and MethodsThe CDC template, viz. “Bomb Surveillance Form” was used for the data collection, that was analyzed by SPSS version 15 software.ResultsOf the 50 survivors transferred to the four nearby hospitals, 11 (22%) of them had severe life threatening injuries, with 19 patients (38%) having primary blast injuries, Secondary type of injury was seen in, and 22% had tertiary injuries. Orthopedic (24%) and burn injuries (36%) were prominent. The mortality rate was 16%.DiscussionThe occurrence of MCI in an unexpected scenario overwhelms the medical resources and challenges the emergency medical facilities. Analysis of the injuries revealed that fatal outcome was related to presence of shock, severe lung, bowel injury, presence of more than four types of injury and greater than 50% burns.StrengthsHighlights the importance of being able to recognize the blast injury patterns and their management.LimitationsInability to compare with other blast injuries due to several missing data.ConclusionBlast injury sustained in a small, enclosed space is one of the most serious and complicated forms of multiple trauma. Hospitals and civic authorities must be prepared to counter this menace of modem times. Not everything that is faced can be changed, but nothing can be changed until it is faced.

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.

scholarly journals SIMEDIS 2.0 : ON THE ROAD TOWARD A COMPREHENSIVE MASS CASUALTY INCIDENT MEDICAL MANAGEMENT SIMULATOR

2018 ◽  
Author(s):  
Ruben De Rouck ◽  
Michel Debacker ◽  
Ives Hubloue ◽  
Selma Koghee ◽  
Filip Van Utterbeeck ◽  
...  
Keyword(s):  
Medical Management ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
The Road ◽  
On The Road

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.

Emergency radiology and mass casualty incidents—report of a mass casualty incident at a level 1 trauma center

2016 ◽  
Vol 24 (1) ◽  
pp. 47-53 ◽  
Author(s):  
Ferdia Bolster ◽  
Ken Linnau ◽  
Steve Mitchell ◽  
Eric Roberge ◽  
Quynh Nguyen ◽  
...  
Keyword(s):  
Trauma Center ◽  
Emergency Radiology ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Mass Casualty Incidents ◽  
Level 1 ◽  
Level 1 Trauma Center

scholarly journals Planning for the Use of Imaging in Mass Casualty Incidents

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.

Pediatric disaster triage education and skills assessment: A coalition approach

2014 ◽  
Vol 12 (2) ◽  
pp. 141 ◽  
Author(s):  
Katherine Kenningham, MD ◽  
Kathryn Koelemay, MD, MPH ◽  
Mary A. King, MD, MPH
Keyword(s):  
Disaster Preparedness ◽  
Life Support ◽  
De Novo ◽  
Advanced Life Support ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Washington State ◽  
King County ◽  
Cross Sectional ◽  
Life Threatening

Objective: This study aims to 1) demonstrate one method of pediatric disaster preparedness education using a regional disaster coalition organized workshop and 2) evaluate factors reflecting the greatest shortfall in pediatric mass casualty incident (MCI) triage skills in a varied population of medical providers in King County,WA.Design: Educational intervention and cross-sectional survey.Setting: Pediatric disaster preparedness conference created de novo and offered by the King County Healthcare Coalition, with didactic sessions and workshops including a scored mock pediatric MCI triage. Participants: Ninety-eight providers from throughout the King County, WA, region selected by their own institutions following invitation to participate, with 88 completing exit surveys.Interventions: Didactic lectures regarding pediatric MCI triage followed by scored exercises.Main outcome measures: Mock triage scores were analyzed and compared according to participant characteristics and workplace environment.Results: A half-day regional pediatric disaster preparedness educational conference convened in September 2011 by the King County Healthcare Coalition in partnership with regional pediatric experts was so effective and well-received that it has been rescheduled yearly (2012 and 2013) and has expanded to three Washington State venues sponsored by the Washington State Department of Health. Emergency department (ED) or intensive care unit (ICU) employment and regular exposure to pediatric patients best predicted higher mock pediatric MCI triage scores (ED/ICU 80 percent vs non-ED/ICU 73 percent, p = 0.026; regular pediatric exposure 80 percent vs less exposure 77 percent, p = 0.038, respectively). Pediatric Advanced Life Support training was not found to be associated with improved triage performance, and mock patients whose injuries were not immediately life threatening tended to be over-triaged (observed trend).Conclusions: A regional coalition can effectively organize member hospitals and provide education for focused populations using specialty experts such as pediatricians. Providers working in higher acuity environments and those with regular pediatric patient exposure perform better mock pediatric MCI triage than their counterparts after just-in-time training. Pediatric MCI patients with less than life-threatening injuries tended to be over-triaged.

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