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.

scholarly journals Maintaining Preparedness to Severe Though Infrequent Threats—Can It Be Done?

2020 ◽  
Vol 17 (7) ◽  
pp. 2385
Author(s):  
Maya Siman-Tov ◽  
Benny Davidson ◽  
Bruria Adini
Keyword(s):  
Emergency Preparedness ◽  
Geographical Location ◽  
Evaluation Process ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Medical Facilities ◽  
Potential Risks ◽  
The Impact ◽  
And Training ◽  
Secondary Contamination

Background: A mass casualty incident (MCI) caused by toxicological/chemical materials constitutes a potential though uncommon risk that may cause great devastation. Presentation of casualties exposed to such materials in hospitals, if not immediately identified, may cause secondary contamination resulting in dysfunction of the emergency department. The study examined the impact of a longitudinal evaluation process on the ongoing emergency preparedness of hospitals for toxicological MCIs, over a decade. Methods: Emergency preparedness for toxicological incidents of all Israeli hospitals were periodically evaluated, over ten years. The evaluation was based on a structured tool developed to encourage ongoing preparedness of Standard Operating Procedures (SOPs), equipment and infrastructure, knowledge of personnel, and training and exercises. The benchmarks were distributed to all hospitals, to be used as a foundation to build and improve emergency preparedness. Scores were compared within and between hospitals. Results: Overall mean scores of emergency preparedness increased over the five measurements from 88 to 95. A significant increase between T1 (first evaluation) and T5 (last evaluation) occurred in SOPs (p = 0.006), training and exercises (p = 0.003), and in the overall score (p = 0.004). No significant changes were found concerning equipment and infrastructure and knowledge; their scores were consistently very high throughout the decade. An interaction effect was found between the cycles of evaluation and the hospitals’ geographical location (F (1,20) = 3.0, p = 0.056), proximity to other medical facilities (F (1,20) = 10.0 p = 0.005), and type of area (Urban vs. Periphery) (F (1,20) = 13.1, p = 0.002). At T5, all hospitals achieved similar high scores of emergency preparedness. Conclusions: Use of accessible benchmarks, which clearly delineate what needs to be continually implemented, facilitates an ongoing sustenance of effective levels of emergency preparedness. As this was demonstrated for a risk that does not frequently occur, it may be assumed that it is possible and practical to achieve and maintain emergency preparedness for other potential risks.

scholarly journals Treating Blast and Explosion Victims: An Overview

2016 ◽  
Vol 4 (1) ◽  
Author(s):  
Chandrasekhar Krishnamurti
Keyword(s):  
Health Care ◽  
Health Care Provider ◽  
Care Provider ◽  
Environmental Hazards ◽  
Blast Injuries ◽  
Injury Patterns ◽  
Delivery Method ◽  
Surrounding Environment ◽  
Present Complex ◽  
Life Threatening

<p><em>Blast injuries result from explosions that have the capability to cause multisystem, life-threatening injuries in single or multiple victims simultaneously. The injury patterns following such events are a product of the composition and amount of the materials involved, the surrounding environment, delivery method (if a bomb), the distance between the victim and the blast, and any intervening protective barriers or environmental hazards.  These types of events present complex triage, diagnostic, and management challenges for the health care provider.</em></p>

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.

Mass-Casualty Terrorist Bombings In Istanbul, Turkey, November 2003: Report of the Events and the Prehospital Emergency Response

2004 ◽  
Vol 19 (2) ◽  
pp. 133-145 ◽  
Author(s):  
Ülkümen Rodoplu ◽  
Jeffrey L. Arnold ◽  
Rifat Tokyay ◽  
Gurkan Ersoy ◽  
Serkan Cetiner ◽  
...  
Keyword(s):  
Emergency Response ◽  
Mass Casualty ◽  
Terrorist Attacks ◽  
Blast Injuries ◽  
American Hospital ◽  
Direct Measurements ◽  
Medical Facilities ◽  
Prehospital Emergency ◽  
Improvised Explosive ◽  
Explosive Devices

AbstractBackground:This paper describes the two mass-casualty, terrorist attacks that occurred in Istanbul, Turkey in November 2003, and the resulting prehospital emergency response.Methods:A complex, retrospective, descriptive study was performed, using open source reports, interviews, direct measurements of street distances, and hospital records from the American Hospital (AH) and Taksim Education and Research State Hospital (TERSH) in Istanbul.Results:On 15 November, improvised explosive devices (IEDs) in trucks were detonated outside the Neve Shalom and Beth Israel Synagogues, killing 30 persons and injuring an estimated additional 300. Victims were maldistributed to 16 medical facilities. For example, AH, a private hospital located six km from both synagogues, received 69 injured survivors, of which 86% had secondary blast injuries and 13% were admitted to the hospital. The TERSH, a government hospital located 1 km from both synagogues, received 48 injured survivors. On 20 November, IEDs in trucks were detonated outside the Hong Kong Shanghai Banking Corporation (HSBC) headquarters and the British Consulate (BC), killing 33 and injuring an estimated additional 450. Victims were maldistributed to 16 medical facilities. For example, TERSH, located 18 km from the HSBC site and 2 km from the the BC received 184 injured survivors, of which 93% had secondary blast injuries and 15% were hospitalized. The AH, located 9 km from the HSBC site and 6 km from the BC, received 16 victims.Conclusion:The twin suicide truck bombings on 15 and 20 November 2003 were the two largest terrorist attacks in modern Turkish history, collectively killing 63 persons and injuring an estimated 750 others. The vast majority of victims had secondary blast injuries, which did not require hospitalization. Factors associated with the maldistribution of casualties to medical facilities appeared to include the distance from each bombing site, the type of medical facility, and the personal preference of injured survivors.

scholarly journals Blast injuries in children: a mixed-methods narrative review

2019 ◽  
Vol 3 (1) ◽  
pp. e000452 ◽  
Author(s):  
John Milwood Hargrave ◽  
Phillip Pearce ◽  
Emily Rose Mayhew ◽  
Anthony Bull ◽  
Sebastian Taylor
Keyword(s):  
Mixed Methods ◽  
Paediatric Population ◽  
Blast Injury ◽  
Morbidity And Mortality ◽  
Blast Injuries ◽  
Older Children ◽  
Injury Patterns ◽  
Provision Of Services ◽  
Explosive Remnants Of War ◽  
Unexploded Ordinance

Background and significanceBlast injuries arising from high explosive weaponry is common in conflict areas. While blast injury characteristics are well recognised in the adults, there is a lack of consensus as to whether these characteristics translate to the paediatric population. Understanding blast injury patterns in this cohort is essential for providing appropriate provision of services and care for this vulnerable cohort.MethodsIn this mixed-methods review, original papers were screened for data pertaining to paediatric injuries following blasts. Information on demographics, morbidity and mortality, and service requirements were evaluated. The papers were written and published in English from a range of international specialists in the field.ResultsChildren affected by blast injuries are predominantly male and their injuries arise from explosive remnants of war, particularly unexploded ordinance. Blasts show increased morbidity and mortality in younger children, while older children have injury patterns similar to adults. Head and burn injuries represent a significant cause of mortality in young children, while lower limb morbidity is reduced compared with adults. Children have a disproportionate requirement for both operative and non-operative service resources, and provisions for this burden are essential.ConclusionsCertain characteristics of paediatric injuries arising from blasts are distinct from that of the adult cohort, while the intensive demands on services highlight the importance of understanding the diverse injury patterns in order to optimise future service provisions in caring for this child blast survivor.

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.

Tympanic Membrane Rupture in the Survivors of the July 7, 2005, London Bombings

2011 ◽  
Vol 145 (5) ◽  
pp. 806-812 ◽  
Author(s):  
Peter Radford ◽  
Hasu D. L. Patel ◽  
Nicholas Hamilton ◽  
Mark Collins ◽  
Steven Dryden
Keyword(s):  
Tympanic Membrane ◽  
Blast Injury ◽  
Mass Casualty ◽  
Blast Injuries ◽  
Cross Sectional ◽  
Primary Blast ◽  
Membrane Rupture ◽  
Mass Casualty Event ◽  
Short Period ◽  
London Bombings

Objective. The goal of this study was to analyze the prevalence of tympanic membrane rupture in the survivors of the London bombings of July 2005 and to assess whether tympanic membrane rupture provides a useful biomarker for underlying primary blast injuries. Study Design. Cross-sectional study. Subjects and Methods. Survivors of the 4 blasts of London bombings on July 7, 2005. Data were gathered from medical records and the London’s Metropolitan Police evidence documenting the injuries sustained by 143 survivors of the blasts. All patients with tympanic membrane rupture or primary blast injury were indentified. Analysis was made of distance against prevalence of tympanic membrane rupture. Correlation between tympanic membrane rupture and other forms of primary blast injury was then assessed. Results. Results from the 143 survivors showed a 48% prevalence of tympanic membrane rupture across all 4 sites. Fifty-one patients had isolated tympanic membrane rupture with no other primary blast injuries. Eleven patients had tympanic membrane rupture and other primary blast injuries, but only one of these was an initially concealed injury (blast lung). Conclusions. Tympanic membrane rupture in survivors of the London bombings on July 7, 2005, had a high prevalence affecting half of patients across a range of distances from the blasts. Tympanic membrane did not act as an effective biomarker of underlying blast lung. In a mass casualty event, patients with isolated tympanic membrane rupture with normal observations and chest radiography can be monitored for a short period and safely discharged with arrangement for ear, nose, and throat follow-up.

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.

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