(A285) Hospital Preparation for Mass Casualty Events

2011 ◽  
Vol 26 (S1) ◽  
pp. s79-s79
Author(s):  
G. Margalit
Keyword(s):  
National Level ◽  
Task Assignment ◽  
Emergency Situation ◽  
Hospital Staff ◽  
Mass Casualty ◽  
Mass Casualties ◽  
Trauma Patients ◽  
Industrial Accidents ◽  
Car Accidents ◽  
Mass Casualty Events

BackgroundHospitals handle numerous tasks whose fundamental purpose is to provide medical treatment. Amongst these, the hospital prepares for the treatment of trauma patients who have been involved in car accidents, injuries at work and industrial accidents. These preparations, although part of the operative conventions of the hospital, do not guarantee the ability to handle Mass Casualty Events which require unique and dedicated preparation and a different operational approach. This paper presents the hospital approach of handling Emergency Mass Casualty Events.The ApproachThe preparations require involvement of a national level that must participate in the definition of the activities, task assignment and preparation of an annual plan. The peak of the preparations is a multidisciplinary drill, implemented as part of the annual activity of the hospital.The ImplementationIn an emergency situation, the aim is for the hospital staff to be capable of providing its patients (and family members) the best professional care in any given scenario. To achieve the above, the hospital is required to perform the following tasks: Defining procedures, personnel training, logistics infrastructure, control, drills and lesson learned implementation. The tasks should be performed under a multi-annual plan that covers various Mass Casualties Events scenarios including: a train accident, an event involving dangerous industrial materials (e.g. ammonia spill), biological scenarios (e.g. bird-flu) and radiation events (e.g. nuclear reaction).ConclusionsOnly precise preparations, disconnected completely from the on-going hospital routine can answer the need to handle Mass Casualties Events.

Terrorist Attacks: Transfusion Specialists’ Point of View.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 4103-4103
Author(s):  
Eldad J. Dann ◽  
Lilach Bonstein ◽  
Abraham Kornberg ◽  
Naomi Rahimi-Levene
Keyword(s):  
Blood Sample ◽  
Blood Supply ◽  
Mass Casualty ◽  
Blood Bank ◽  
Near Miss ◽  
Terrorist Attacks ◽  
Mass Casualties ◽  
Blood Transfusions ◽  
Trauma Patients ◽  
Total Blood

Abstract The issue of mass casualties in civilian population has lately become globally relevant and prevalent. Explosions of loaded busses by suicide bombers as well as explosions in crowded public places create a great number of casualties, many of them being children and several members of same families, who are evacuated by scoop and run method to nearby hospitals. We report on potential hazards of massive blood transfusions to multi-trauma patients, simultaneously admitted to hospital. Upon admission to the emergency room (ER) ID and personal details of patients are recorded and a temporary ID badge is issued for unidentified patients. Then, a blood sample for typing and screening is taken and required blood is ordered. Primary blood supply for patients with unstable condition, who need immediate blood transfusion, is O Rh positive packed cells (for fertile females O Rh negative) until the ABO and Rh blood groups are established. In order to avoid misidentification our routine includes presence of a blood bank representative in the ER for confirming identification of patients and correct labeling of blood samples. 2 individuals must identify patients from whom samples are taken. In the operating rooms (OR) another blood bank representative (either a transfusion medicine specialist or a hematologist) matches blood types and identification numbers, maintains contact with the blood bank, conveys information to anesthesiology team and advises them on replacement therapy. 7 terrorist attacks resulted in a total of 55 patients, evacuated to 2 hospitals in Israel. 285 packed cells units were typed and cross-matched for these patients. The amount of packed cells supplied during the first 2 hours was 47% of the total blood supplied during the first 24 hours. The cross-matched/transfused ratio varied from 1.3 to 2.19 reflecting overestimation of blood requirement during mass casualty episodes. One “near-miss” was prevented in OR when two members of the same family were operated on in adjacent rooms. Units for one of these patients were misplaced. ABO incompatibility is one of the major causes of morbidity and mortality resulting from blood transfusions. Signs and symptoms are masked in an anesthesized patient. The fact that units of blood accumulate at patient’s bedside upon being deleted from the blood bank inventory may be misinterpreted as a shortage of blood supply in the blood bank. There is also a potential for errors in matching units of blood to patients both in ER and OR. In the setup of mass casualties influx the blood bank personnel should be on alert for the following potential Achilles’ heels: misidentification of the patient when taking a blood sample for typing and screening or misidentification of the patient who needs to receive the blood product. Reasons for these may be either one digit difference in serial temporary number of unidentified patients, being operated on simultaneously in nearby rooms, or several family members undergoing simultaneous surgery in adjacent OR. Such errors can be minimized by using a 3-digit bold number in addition to the running temporary ID and thus providing 2 identification parameters. Our data suggest that the amount of blood products ordered for such patients is excessive. Surgical teams should be aware of the possibility to have blood components kept on hold in the blood bank instead of accumulating them in ER and OR and risking misidentification and suboptimal storage conditions.

Two teams, one mission: A study using EMS units in hospital triage during active-shooter and other mass-casualty events

2020 ◽  
Vol 15 (1) ◽  
pp. 33-41
Author(s):  
Thomas Simons, MA ◽  
Anke Richter, PhD ◽  
Lauren Wollman, PhD
Keyword(s):  
Hospital Staff ◽  
Mass Casualty ◽  
Proof Of Concept ◽  
Active Shooter ◽  
Incident Command ◽  
Mass Casualty Events ◽  
Level Ii ◽  
Field Triage ◽  
Mass Casualty Event ◽  
Urban Level

Background: Recent mass-casualty events have exposed errors with common assumptions about response processes, notably triage and transport of patients. Response planners generally assume that the majority of patients from a mass-casualty event will have received some level of field triage and transport from the scene to the hospital will have been coordinated through on-scene incident command. When this is not the case, emergency response at the hospital is hampered as staff must be pulled to handle the influx of untriaged patients.Objective: Determine whether the use of emergency medical service (EMS) field resources in hospital triage could enhance the overall response to active-shooter and other mass-casualty events.Design: A proof of concept study was planned in conjunction with a regularly scheduled mass-casualty hospital exercise conducted by an urban level II trauma center in Utah. This was a cross-over study with triage initially performed by hospital staff, and at the midpoint of the exercise, triage was transferred to EMS field units. General performance was judged by exercise planners with limited additional data collection.Results: EMS crews at the hospital significantly enhanced the efficiency and efficacy of the triage operation in both qualitative and quantitative assessment.Conclusions: Hospital planners deemed the proof of concept exercise a success and are now experimenting with implementation of this alternate approach to triage. However, much additional work remains to fully implement this change in processes.

US Army split forward surgical team management of mass casualty events in Afghanistan: Surgeon performed triage results in excellent outcomes

2009 ◽  
Vol 4 (6) ◽  
pp. 321-329 ◽  
Author(s):  
Shawn C. Nessen, DO, FACS ◽  
Daniel R. Cronk, MD ◽  
Jason Edens, MD ◽  
Brian J. Eastridge, MD, FACS ◽  
Lorne H. Blackbourne, MD, FACS
Keyword(s):  
Injury Severity ◽  
Surgical Care ◽  
Injured Patient ◽  
Mass Casualty ◽  
Trauma Patients ◽  
Us Army ◽  
Institutional Review ◽  
Mass Casualty Events ◽  
Admission Data ◽  
Surgical Teams

Objective: US Army “split” forward surgical teams (FST) currently provide most of the resuscitative surgical care for combat patients in Afghanistan. These small units typically comprised 10 personnel and two surgeons each, who frequently encounter mass casualty (MASCAL) situations in geographically isolated regions. This article evaluates the effectiveness of one split FST managing 43 MASCAL situations in two separate locations for more than a 14-month period in Afghanistan.Design: An Institutional Review Board-approved review of all admission data of the 541st FST was conducted. Comparison was made between patients treated in MASCAL situations to those of patients treated in non-MASCAL events.Setting: Split-based US Army forward surgical elements in a combat environment in Afghanistan.Patients: Two hundred eighty-two patients were treated during MASCAL events and 479 in non- MASCAL situations.Main Outcome Measures: The primary endpoint was survival outcomes among trauma patients when 5 or more patients arrived simultaneously or if 3 or more patients required immediate surgery.Results: Four patients (1.70 percent) died in the MASCAL group compared with 12 (3.30 percent) in the non-MASCAL group.The mortality of patients receiving surgery at the FST was 2.73 percent and the mortality was 0.93 percent in those transferred without surgery. In the MASCAL group, 41 patients (14.5 percent) were critically injured and the critical mortality rate was 6.25 percent. In MASCAL events, 39 percent of patients required surgery compared with 44.9 percent in the non- MASCAL group. The average Injury Severity Score (ISS) of the most severely injured patient was 21.19 and ISS rapidly decreased to scores consistent with mild injury suggesting over triage at the scene.Conclusions: Despite very limited resources, the split FST can achieve, with appropriate triage, acceptable mortality outcomes in MASCAL situations. Over triage at the wounding scene is common and surgical intervention is frequently required.

scholarly journals Healthcare under siege: a qualitative study of health-worker responses to targeting and besiegement in Syria

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e029651 ◽  
Author(s):  
Nasser Fardousi ◽  
Yazan Douedari ◽  
Natasha Howard
Keyword(s):  
Qualitative Study ◽  
Health Worker ◽  
Resource Constraints ◽  
Health Workers ◽  
Resource Conservation ◽  
Mass Casualty ◽  
Health Facilities ◽  
Mass Casualties ◽  
Emotional Resilience ◽  
Mass Casualty Events

ObjectivesTo explore health-worker perspectives on security, improving safety, managing constrained resources and handling mass casualties during besiegement in Syria.DesignA qualitative study using semi-structured key informant interviews, conducted remotely over WhatsApp and Skype, and analysed thematically using inductive coding.SettingSecondary and tertiary health facilities affected by besiegement in Aleppo (from July to December 2016) and Rural Damascus (from August 2013 to February 2018).ParticipantsTwenty-one male Syrian health-workers and service-users who had experienced besiegement and targeting of their health facilities.ResultsParticipants described four related challenges of: (i) conflict-related responses, particularly responding to mass casualties; (ii) targeted attack responses, particularly preventing/surviving facility bombings; (iii) besiegement responses, particularly mitigating severe resource constraints; and (iv) chronic risk responses, particularly maintaining emotional resilience. Mass casualty response involved triage and training to prioritise mortality reduction and available resources, for example those with greatest need and likelihood of survival. Targeting response was largely physical, including fortification, working underground, reducing visibility and services dispersal. Besiegement response required resource conservation, for example, controlling consumption, reusing consumables, low-technology equipment, finding alternative supply routes, stockpiling and strengthening available human resources through online trainings and establishing a medical school in Ghouta. Risk responses included managing safety worries, finding value in work and maintaining hope.ConclusionBesieged health-workers were most affected by severe resource constraints and safety concerns while responding to overwhelming mass casualty events. Lessons for targeting/besiegement planning include training staff and preparing for: (i) mass casualties, through local/online health-worker training in triage, emergency response and resource conservation; allowing task-shifting; and providing access to low-technology equipment; (ii) attacks, through strengthened facility security, for example, protection and deterrence through fortification, working underground and reducing visibility; and (iii) besiegement, through ensuring access to internet, electricity and low-technology/reusable equipment; securely stockpiling fuel, medicines and supplies; and establishing alternative supply routes.

The Importance of Preparedness for Emergency Response to Railway Incidents

2017 ◽  
Author(s):  
John Cockle ◽  
Larry Day
Keyword(s):  
Public Transportation ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Mass Casualties ◽  
Shared Resources ◽  
Use Of Time ◽  
Mass Casualty Events ◽  
Large Numbers ◽  
Time And Energy ◽  
Large Groups

Public transportation provides opportunities for people to share a common platform or mode of transportation as they move from place to place, often amassing persons in large groups or quantities. Rail transportation in particular has the benefit of accommodating very large numbers of people in one movement, often upwards of 1000 persons. The benefits to society are considerable: shared resources, lower impacts on the environment, and more efficient use of time and energy. The consequence when something goes wrong, however, can also be considerable: mass casualties (fatalities and/or injuries) from a single event, disrupted supply chains, and environmental damages to name a few. Even if persons are not physically harmed, the effects of an incident can be felt by a far greater number of persons. Adequate preparation can play a key role in minimizing the effects of mass casualty events such as railway collisions or derailments. Indeed, lives can be saved or lost depending on the resources, training, and organization that are employed when responding to a mass casualty incident.

Transplant Team in Mass Casualties

1985 ◽  
Vol 1 (3) ◽  
pp. 287-288
Author(s):  
S. Agnes ◽  
S.C. Magalini ◽  
M. Castagneto
Keyword(s):  
Brain Death ◽  
Head Trauma ◽  
Southern Italy ◽  
Mass Casualty ◽  
Mass Casualties ◽  
Trauma Patients ◽  
Practical Issue ◽  
Direct Trauma ◽  
Transplant Center ◽  
Transplant Team

The topic of this paper is not only of concern to people interested in transplantation. The organization described stemmed from the experience of the earthquake in southern Italy in 1980, in which physicians of our transplant center participated only as surgeons. We feel that a tranaplant team could be useful in a mass casualty situation with the intent to help in the triage of the seriously injured, select patients with brain death, and transport selected donors to transplant centers.The problem of triage in mass casualties is by itself a difficult and complex ethical and practical issue (1). The first hours after any disaster has occurred are crucial in dividing patients into different categories and in putting them into the care of specialized physicians, according to their primary lesions. Often severely traumatized people are discovered late and do not get the primary intensive assistance which will allow them to stabilize their clinical condition (2).According to the type of disaster, the percentage of head trauma patients varies greatly, reaching its peak in case of earthquakes (approximately 4% of victims died of head trauma), air crashes and building destructions (3). It is reasonable to think that often head trauma is associated with multiple traumas and that in some cases (direct trauma of the most important organs, crush lesions, etc.) this may represent a contraindication to considering the patient as a donor. Generally, however, head trauma with brain death, even associated with different lesions but without metabolic, septic or cardiovascular alterations, must at least be considered for organ donation (4).

scholarly journals The Trifecta of Tele-Critical Care: Intrahospital, Operational, and Mass Casualty Applications

2021 ◽  
Vol 186 (Supplement_1) ◽  
pp. 253-260
Author(s):  
Kristina M Ieronimakis ◽  
Christopher J Colombo ◽  
Justin Valovich ◽  
Mark Griffith ◽  
Konrad L Davis ◽  
...  
Keyword(s):  
Critical Care ◽  
Health Agency ◽  
Mass Casualty ◽  
Lessons Learned ◽  
Mass Casualties ◽  
Field Hospital ◽  
Care Services ◽  
Mass Casualty Events ◽  
Simulation Scenario ◽  
Field Exercise

ABSTRACT Introduction Tele-critical care (TCC) has improved outcomes in civilian hospitals and military treatment facilities (MTFs). Tele-critical care has the potential to concurrently support MTFs and operational environments and could increase capacity and capability during mass casualty events. TCC services distributed across multiple hub sites may flexibly adapt to rapid changes in patient volume and complexity to fully optimize resources. Given the highly variable census in MTF intensive care units (ICU), the proposed TCC solution offers system resiliency and redundancy for garrison, operational, and mass casualty needs, while also maximizing return on investment for the Defense Health Agency. Materials and Methods The investigators piloted simultaneous TCC support to the MTF during three field exercises: (1) TCC concurrently monitored the ICU during a remote mass casualty exercise: the TCC physician monitored a high-risk ICU patient while the nurse monitored 24 simulated field casualties; (2) TCC concurrently monitored the garrison ICU and a remote military medical field exercise: the physician provided tele-mentoring during prolonged field care for a simulated casualty, and the nurse provided hospital ICU TCC; (3) the TCC nurse simultaneously monitored the ICU while providing reach-back support to field hospital nurses training in a simulation scenario. Results TCC proved feasible during multiple exercises with concurrent tele-mentoring to different care environments including physician and nurse alternating operational and hospital support roles, and an ICU nurse managing both simultaneously. ICU staff noted enhanced quality and safety of bedside care. Field exercise participants indicated TCC expanded multipatient monitoring during mass casualties and enhanced novice caregiver procedural capability and scope of patient complexity. Conclusions Tele-critical care can extend critical care services to anywhere at any time in support of garrison medicine, operational medicine, and mass casualty settings. An interoperable, flexibly staffed, and rapidly expandable TCC network must be further developed given the potential for large casualty volumes to overwhelm a single TCC provider with multiple duties. Lessons learned from development of this capability should have applicability for managing military and civilian mass casualty events.

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

Austerity and fragmentation: Dynamics of Europeanization of media discourses in Greece and Italy

2020 ◽  
Vol 45 (s1) ◽  
pp. 864-892
Author(s):  
Cristiano Bee ◽  
Stavroula Chrona
Keyword(s):  
Financial Crisis ◽  
Qualitative Analysis ◽  
National Level ◽  
Emergency Situation ◽  
Media Representations ◽  
Euro Crisis ◽  
Public Spheres ◽  
Fragmentation Dynamics ◽  
Communication Practices ◽  
Media Discourses

AbstractThis article investigates media representations of the European financial crisis in Greece and Italy. We study the Euro crisis as an ‘emergency situation’ with domino effects, where media played a central role in shaping communication practices at the national level as well as between the two countries. Drawing upon vertical and horizontal dynamics of Europeanization, we map the convergences and divergences in media discourses that surround the period 2011–2015. In doing so, we elaborate a qualitative analysis of newspaper articles focusing, in particular, on the themes of austerity and the fragmentation of Europe. Our argument suggests that national public spheres in times of transnational crisis become increasingly nationalized; yet under certain circumstances such as when the supranational infrastructure is the target of blame, they converge, opening the path toward a transnational discursive dialogue.

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)

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