scholarly journals (A152) Is There a Need to Reconsider the Policy of Evacuating All Casualties from Remote Mass Casualty Incident (MCI) to the Closest Hospital? Lessons Learned from a Rural MCI

2011 ◽  
Vol 26 (S1) ◽  
pp. s53-s53
Author(s):  
B. Adini ◽  
R. Cohen ◽  
E. Glassberg ◽  
B. Azaria ◽  
D. Simon ◽  
...  
Keyword(s):  
Rural Areas ◽  
Life Support ◽  
Tertiary Care ◽  
Mass Casualty ◽  
Lessons Learned ◽  
Local Hospital ◽  
Minimal Trauma ◽  
Primary Hospital ◽  
Trauma Surgeons ◽  
The Impact

BackgroundInappropriate distribution of casualties in mass casualty incidents (MCIs) may result in patient overload in primary medical facilities.ObjectiveThe aim of this study was to review the consequences of evacuating casualties from a bus accident to a single rural hospital and lessons learned regarding policy of casualty evacuation.MethodsHospital medical records of all casualties from primary and tertiary hospitals were independently reviewed by two senior trauma surgeons. In addition four senior trauma surgeons reviewed the impact of treatment provided in the primary hospital on patient outcomes.Results31 survivors from the accident were transferred to the closest local hospital; 4 died en route to the hospital or within 30 minutes of arrival. 27 casualties were air evacuated from the local hospital within 2.5 to 6.15 hours to level I and II hospitals. Under-triage of 15% and over-triage of 7% were noted. 4 casualties did not receive treatment at the local hospital that might have improved their condition.DiscussionOver and under-triage might have been due to minimal trauma related experience of primary hospital personnel. Evacuation of casualties from an MCI to a limited capacity hospital may overwhelm the facility and affect its ability to provide appropriate medical care.ConclusionsIn MCIs occurring in rural areas, only immediate unstable casualties should be transferred to the closest primary hospital. On-site Advanced Life Support (ALS) should be administered to non-severe casualties until they can be evacuated directly to tertiary care hospitals. First responders must be trained to provide ALS to non-severe casualties until evacuation resources are available.

Reconsidering Policy of Casualty Evacuation in a Remote Mass-Casualty Incident

2013 ◽  
Vol 29 (1) ◽  
pp. 91-95 ◽  
Author(s):  
Bruria Adini ◽  
Robert Cohen ◽  
Elon Glassberg ◽  
Bella Azaria ◽  
Daniel Simon ◽  
...  
Keyword(s):  
Injury Severity ◽  
Life Support ◽  
Tertiary Care ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Lessons Learned ◽  
Care Hospital ◽  
Publication Type ◽  
Local Hospital ◽  
Trauma Surgeons

AbstractObjectivesInappropriate distribution of casualties in mass-casualty incidents (MCIs) may overwhelm hospitals. This study aimed to review the consequences of evacuating casualties from a bus accident to a single peripheral hospital and lessons learned regarding policy of casualty evacuation.MethodsMedical records of all casualties relating to evacuation times, injury severity, diagnoses, treatments, resources utilized and outcomes were independently reviewed by two senior trauma surgeons. In addition, four senior trauma surgeons reviewed impact of treatment provided on patient outcomes. They reviewed the times for the primary and secondary evacuation, injury severity, diagnoses, surgical treatments, resources utilized, and the final outcomes of the patients at the point of discharge from the tertiary care hospital.ResultsThirty-one survivors were transferred to the closest local hospital; four died en route to hospital or within 30 minutes of arrival. Twenty-seven casualties were evacuated by air from the local hospital within 2.5 to 6.15 hours to Level I and II hospitals. Undertriage of 15% and overtriage of seven percent were noted. Four casualties did not receive treatment that might have improved their condition at the local hospital.ConclusionsIn MCIs occurring in remote areas, policy makers should consider revising the current evacuation plan so that only immediate unstable casualties should be transferred to the closest primary hospital. On site Advanced Life Support (ALS) should be administered to non-severe casualties until they can be evacuated directly to tertiary care hospitals. First responders must be trained to provide ALS to non-severe casualties until evacuation resources are available.AdiniB, CohenR, GlassbergE, AzariaB, SimonD, SteinM, KleinY, PelegK. Reconsidering policy of casualty evacuation in a remote mass-casualty incident. Prehosp Disaster Med. 2013;28(6):1-5.

Abstract P164: The Impact of the Expanded EVT Window on Acute Stroke Services: A Large Northwest Telestroke Network Experience

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Theodore Lowenkopf ◽  
Leslie Corless ◽  
Elizabeth Baraban
Keyword(s):  
Acute Stroke ◽  
Rural Areas ◽  
Treatment Time ◽  
Time Window ◽  
Tertiary Care ◽  
The United States ◽  
Geographic Region ◽  
Anterior Circulation ◽  
Stroke Subtypes ◽  
The Impact

Background: Telestroke has led the technological revolution in providing acute medical services to rural areas in the United States since the beginning of this century. In January 2018 the American Stroke Association made a level IA recommendation to expand the treatment time window for endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) from 6 to 24 hours for anterior circulation stroke based on perfusion imaging. Our study is the first to our knowledge to report the effect of the expanded time window on acute stroke consult and treatment volumes in a large rural supporting telestroke network. Methods: Stroke registry data from two tertiary care facilities from a 22 hospital telestroke network supporting a large (> 78,000 mi 2 ) primarily rural Northwest geographic region were used. Data included stroke patients arriving within 24 hours of last known well (LKW) between January 2017 and March 2019. Patients arriving January 2017 to December 2017 were grouped into the PRE-expanded time window and those arriving April 2018 to March 2019 into the POST-expanded time window. Stroke subtypes, transfers, telestroke consults (via phone or video), and EVT treatments were compared across time periods. Analyses were performed using Pearson’s chi square test, corrected for multiple comparisons. Results: A total of 1117 patients arrived with stroke symptoms within 24 hours of LKW, 567 (50.8%) in PRE and 550 (49.2%) in POST-window. The percentage of all stroke subtypes were not significantly different in the PRE and POST patient groups (p=.720). However, the percent of telestroke consults increased by 12.1% from 62.3% to 74.4% (p<.001) but the percent of video consults remained similar (25.9% vs 25.8%). The total number of transfers (142 vs 141) and percentage of transfers among AIS patients (25.0% vs 25.6%) from partner to hub did not change. The percentage of thrombectomies among transfers rose by 8.7% with the expanded time window, but was not statistically significant [p=0.118]. Conclusions: In a large Northwest telestroke rural network the expanded EVT treatment time window led to a marked increase in all telestroke consults but did not impact video consults, transfer, or percentage of patients treated.

First Responder Psychological Recovery Following a Mass Casualty Event

2017 ◽  
pp. 143-157
Author(s):  
Sara Garrido ◽  
John Nicoletti
Keyword(s):  
Psychological Impact ◽  
Crisis Response ◽  
Mass Casualty ◽  
Lessons Learned ◽  
Trauma Recovery ◽  
Community Members ◽  
Mass Casualty Events ◽  
Columbine High School ◽  
Crime Scene Investigators ◽  
The Impact

Mass Casualty Events (MCE) have an extraordinary impact on an entire community. The impact on victims' families, survivors, and community members is often the subject of significant attention; however, rarely does the impact on first responders (law enforcement officers, firefighters, dispatchers, crime scene investigators/photographers, etc.) garner the same coverage. Additionally, agencies can quickly become overwhelmed by the magnitude of the response causing them to overlook the psychological impact of these incidents on their personnel. Serving as specialists in police and public safety psychology, crisis intervention, and trauma recovery, the authors reflect on lessons learned from their response to multiple MCEs, including the 1999 Columbine High School shooting and the 2012 Aurora Century 16 Theater shooting, and offer recommendations to agencies regarding crisis response and trauma recovery.

New Perspectives for Modern Trauma Management – Lessons Learned from 25 Years FAST and 15 Years E-FAST

2019 ◽  
Vol 40 (05) ◽  
pp. 560-583 ◽  
Author(s):  
Joseph Osterwalder ◽  
Gebhard Mathis ◽  
Beatrice Hoffmann
Keyword(s):  
Life Support ◽  
Point Of Care ◽  
Clinical Situation ◽  
Lessons Learned ◽  
Advanced Trauma Life Support ◽  
Point Of Care Ultrasound ◽  
Trauma Management ◽  
Abdominal Image ◽  
Trauma Surgeons ◽  
Ultrasound Applications

AbstractE-FAST (Extended-Focused Assessment with Sonography for Trauma) is now a widely utilized and internationally recognized standard exam in trauma care. It is highly accepted by emergency physicians and trauma surgeons alike. Thanks to the popularity of PoCUS (point-of-care ultrasound), it has continued to evolve over the last years and can now improve trauma diagnosis at all stages of the primary ABCDE. This review article summarizes key observations made over recent years and also highlights the extension of FAST into E-FAST in the context of PoCUS and CT developments for modern trauma management. Time has come to learn the lessons from 25 years of FAST and 15 years of E-FAST. We should redefine and position ultrasound in the primary ATLS survey (Advanced Trauma Life Support) on two levels: 1. Basic ATLS with new clinical questions, six additional abdominal image sections and one or more follow-up examinations depending on the clinical situation, and 2. Advanced ATLS with ultrasound applications for the entire trauma ABCDE.

The Impact of Terrorism on Children: A Two-Year Experience

2003 ◽  
Vol 18 (3) ◽  
pp. 242-248 ◽  
Author(s):  
Yehezkel Waisman ◽  
Limor Aharonson-Daniel ◽  
Meirav Mor ◽  
Lisa Amir ◽  
Kobi Peleg
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Pediatric Population ◽  
Mass Casualty ◽  
Phase 2 ◽  
Surgical Interventions ◽  
Prehospital Phase ◽  
Hospital Resources ◽  
Triage Algorithm ◽  
The Impact

AbstractObjectives:To review and analyze the cumulative two-year, Israeli experience with medical care for children victims of terrorism during the prehospital and hospital phases.Methods:Data were collected from the: (1) Magen David Adom National Emergency Medical System Registry (prehospital phase); (2) medical records from the authors’ institutions (pediatric triage); and (3) Israel Tr auma Registry (injury characteristics and utilization of in-hospital resources). Statistical analyses were performed as appropriate.Introduction:During the recent wave of violence in Israel and the surrounding region, hundreds of children have been exposed to and injured by terrorist attacks. There is a paucity of data on the epidemiology and management of terror-related trauma in the pediatric population and its effects on the healthcare system. This study focuses on four aspects of terrorism-related injuries: (1) tending to victims in the prehospital phase; (2) triage, with a description of a modified, pediatric triage algorithm; (3) characteristics of trauma-related injuries in children; and (4) utilization of in-hospital resources.Results:During the study period, 41 mass-casualty events (MCEs) were managed by Magen David Adom. Each event involved on average, 32 regular and nine mobile intensive care unit ambulances with 93 medics, 19 paramedics, and four physicians. Evacuation time was 5–10 minutes in urban areas and 15–20 minutes in rural areas. In most cases, victims were evacuated to multiple facilities. To improve efficiency and speed, the Magen David Adom introduced the use of well-trained “first-responders” and volunteer, off-duty professionals, in addition to “scoop and run” on-the-scene management. Because of differences in physiology and response between children and adults, a pediatric triage algorithm was developed using four categories instead of the usual three. Analysis of the injuries sustained by the 160 children hospitalized after these events indicates that most were caused by blasts and penetration by foreign objects. Sixty-five percent of the children had multiple injuries, and the proportion of critical to fatal injuries was high (18%). Compared to children with non-terrorism-related injuries, the terrorism-related group had a higher rate of surgical interventions, longer hospital stays, and greater needs for rehabilitation services.Conclusion:Terrorism-related injuries in children are severe and increase the demand for acute care. The modifications in the management of pedi-atric casualties from terrorism in Israel may contribute to the level of preparedness of medical and paramedical personnel to cope with future events. Further studies of other aspects of traumatic injuries, such as its short- and long-term psychological consequences, will provide a more comprehensive picture of the damage inflicted on children by acts of terrorism.

scholarly journals Riots in Beirut: Description of the Impact of a New Type of Mass Casualty Event on the Emergency System in Lebanon

2019 ◽  
Vol 13 (5-6) ◽  
pp. 849-852
Author(s):  
Mohamad El Warea ◽  
Roula Sasso ◽  
Rana Bachir ◽  
Mazen El Sayed
Keyword(s):  
Emergency Department ◽  
Medical Center ◽  
Care Center ◽  
Tertiary Care ◽  
Patient Characteristics ◽  
Mass Casualty ◽  
Control Measures ◽  
Body Region ◽  
Mass Casualty Event ◽  
The Impact

ABSTRACTIntroduction:In the summer of 2015, Beirut experienced a garbage crisis that led to rioting. Riot control measures resulted in multiple casualties. This study examines injury patterns of riot victims presenting to the emergency department of a tertiary care center in a developing country.Methods:A retrospective study was conducted in the emergency department of the American University of Beirut Medical Center between August 22 and August 30, 2015. Patients seen in the emergency department with riot injuries were included. Patient characteristics, injuries, and resources utilized in the emergency department were analyzed.Results:Ninety-five patients were identified. Most patients presented to the emergency department within a short time period. The mean age of the patients was 28.0 ± 8.7 years. Most (90.5%) of the patients were males and 92.6% were protestors. Emergency medical services were utilized by 41.0% of patients. Laceration was the most common presenting complaint (28.5%), and blunt trauma was the most common type of injury (50.5%). The head/face/neck was the most common injured body region (55.8%). Most patients did not require blood tests or procedures (91.6% and 61.0%, respectively), and 91.2% of patients were treated in the emergency department and discharged. One patient required intensive care unit admission and another was dead on arrival.Conclusions:Most patients had mild injuries on presentation. The emergency department experienced a high influx of patients. Complications and deaths can occur from seemingly nonlethal weapons used during riots and warrant effective prehospital and hospital disaster planning.

scholarly journals The Impact of Policy and Technology Parameters on the Economics of Microgrids for Rural Electrification: A Case Study of Remote Communities in Bolivia

Energies ◽  
2020 ◽  
Vol 13 (4) ◽  
pp. 877 ◽  
Author(s):  
Munir Husein ◽  
Hyung-Ju Kim ◽  
Il-Yop Chung
Keyword(s):  
Rural Areas ◽  
Lessons Learned ◽  
Pollutant Emissions ◽  
Sensitivity Analyses ◽  
Rural Electrification ◽  
Remote Communities ◽  
Modeling Framework ◽  
Cost Of Energy ◽  
Operating Strategies ◽  
The Impact

Throughout the developing world, most remote and isolated communities are still without reliable electricity in the twenty-first century, and this is primarily due to the high cost of grid extensions. In communities that do have electricity, they usually rely on diesel generators, though these have high operating and maintenance costs, while also polluting the environment. A more sustainable approach is to deploy microgrids, however, microgrids have a high upfront cost, which is a major obstacle, especially in rural areas of developing countries. This study aims to investigate the parameters that can be influenced to make microgrids more economical for rural electrification. Through sensitivity analyses, five key policy and technology parameters were identified. They include real discount rates, diesel prices, grants, battery chemistry, and operating strategies. The system was then redesigned using scenarios formulated by varying these parameters. Results show that the parameters affect the configuration, levelized cost of energy (LCOE), renewable energy penetration (REP), and pollutant emissions. The study uses three remote communities in the Beni Department of Bolivia as case studies. MDSTool was used as a modeling framework to design the microgrids. The unique insights and lessons learned during the design process are discussed at length because these may be valuable for future microgrid designs for remote communities.

Terrorism in France

2003 ◽  
Vol 18 (2) ◽  
pp. 92-99 ◽  
Author(s):  
Pierre Carli ◽  
Caroline Telion ◽  
David Baker
Keyword(s):  
Emergency Response ◽  
Life Support ◽  
Mass Casualty ◽  
Lessons Learned ◽  
National Plan ◽  
Medical Response ◽  
Emergency Medical ◽  
Mass Casualty Events ◽  
Psychological Assistance ◽  
Key Aspects

AbstractFrance has experienced two waves of major terrorist bombings since 1980. In the first wave (1985–1986), eight bombings occurred in Paris, killing 13 and injuring 281. In the second wave (1995–1996), six bombings occurred in Paris and Lyon, killing 10 and injuring 262. Based on lessons learned during these events, France has developed and improved a sophisticated national system for prehospital emergency response to conventional terrorist attacks based on its national emergency medical services (EMS) system, Service d' Aide Medicale Urgente (SAMU). According to the national plan for the emergency medical response to mass-casualty events (White Plan), the major phases of EMS response are: (1) alert; (2) search and rescue; (3) triage of victims and provision of critical care to first priority victims; (4) regulated dispatch of victims to hospitals; and (5) psychological assistance.Following the 1995 Tokyo subway sarin attack, a national plan for the emergency response to chemical and biological events (PIRATOX) was implemented. In 2002, the Ministries of Health and the Interior collaborated to produce a comprehensive national plan (BIOTOX) for the emergency response to chemical, biological, radiological, and nuclear events. Key aspects of BIOTOX are the prehospital provision of specialized advance life support for toxic injuries and the protection of responders in contaminated environments. BIOTOX was successfully used during the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak in France.

scholarly journals Dealing with the impact of the COVID-19 pandemic on a rapid response team operation in Brazil: Quality in practice

2020 ◽  
Author(s):  
Hermano Alexandre Lima Rocha ◽  
Antonia Célia de Castro Alcântara ◽  
Fernanda Colares de Borba Netto ◽  
Flavio Lucio Pontes Ibiapina ◽  
Livia Amaral Lopes ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Rapid Response Team ◽  
Lessons Learned ◽  
Rapid Response ◽  
Initial Assessment ◽  
Care Hospital ◽  
Large Tertiary Care ◽  
Response Team ◽  
Hospital Wards ◽  
The Impact

Abstract Quality problem or issue Up to 13 July 2020, &gt;12 million laboratory-confirmed cases of coronavirus disease of 2019 (COVID-19) infection have been reported worldwide, 1 864 681 in Brazil. We aimed to assess an intervention to deal with the impact of the COVID-19 pandemic on the operations of a rapid response team (RRT). Initial assessment An observational study with medical record review was carried out at a large tertiary care hospital in Fortaleza, a 400-bed quaternary hospital, 96 of which are intensive care unit beds. All adult patients admitted to hospital wards, treated by the RRTs during the study period, were included, and a total of 15 461 RRT calls were analyzed. Choice of solution Adequacy of workforce sizing. Implementation The hospital adjusted the size of its RRTs during the period, going from two to four simultaneous on-duty medical professionals. Evaluation After the beginning of the pandemic, the number of treated cases in general went from an average of 30.6 daily calls to 79.2, whereas the extremely critical cases went from 3.5 to 22 on average. In percentages, the extremely critical care cases went from 10.47 to 20%, with P &lt; 0.001. Patient mortality remained unchanged. The number of critically ill cases and the number of treated patients increased 2-fold in relation to the prepandemic period, but the effectiveness of the RRT in relation to mortality was not affected. Lessons learned The observation of these data is important for hospital managers to adjust the size of their RRTs according to the new scenario, aiming to maintain the intervention effectiveness.

scholarly journals Outcomes from the Medication Assisted Treatment Pilot Program for Adults With Opioid Use Disorders in Rural Colorado

2021 ◽  
Author(s):  
Claudia R. Amura ◽  
Tanya R. Sorrell ◽  
Mary Weber ◽  
Andrea Alvarez ◽  
Nancy Beste ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Rural Areas ◽  
Addiction Severity Index ◽  
Lessons Learned ◽  
Opioid Overdose ◽  
Pilot Program ◽  
Care Providers ◽  
Physical And Mental Health ◽  
Opioid Use ◽  
The Impact

Abstract Background. As Colorado ranked among the top nationally in non-medical use of opioids, a pilot medication for opioid use disorder (MOUD) program was developed to increase the number of NPs and PAs providing MOUD in order to bring this evidence based treatment 2 counties showing disproportionally high opioid overdose deaths. Over the first 18 months, the MOUD Pilot Program led to 15 new health care providers receiving MOUD waiver training and 1,005 patients receiving MOUD from the 3 participating organizations. Here we evaluate the impact of the pilot MOUD program implemented in 2 rural counties severely affected by the opioid crisis on patient centered clinical and functional outcomes. Methods. Under state-funded law, three rural agencies submitted patient-level data at baseline (N = 1005) and after 6 months of treatment (N = 190, 25%) between December 2017 and January 2020. The Addiction Severity Index with McNemar-Bowker and t tests were used to measure program impact. Results. Patients in treatment reported using less heroin (13.0 vs. 3.7 days), opioids (3.7 vs. 1.9 days), and alcohol (3.2 vs 0.7 days, all P < 0.01). Patients reported improved health (53.4% vs. 68.2%, P = 0.04), less days of disability (8.69 vs. 6.51, P = 0.02), symptoms (29.8% vs 21.3%), pain (67.5 % to 53.6), worry (45.3% vs 62.3%), anxiety (49.7% vs 23.2%), depression (54.1% vs 23.3%, all P < 0.02) after treatment. Conclusions. This study shows decreased substance use, improved physical and mental health, and reduced symptoms after 6 months of MOUD. Although more research on retention and long-term effects is needed, data shows improved health outcomes after 6 months of MOUD. Lessons learned from implementing this pilot program informed program expansion into other rural areas in need to address some of Colorado’ major public health crises.

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