scholarly journals (P2-82) Developing and Implementing an Emergency Preparedness and Trauma Research Program in a New Level One Trauma Center

2011 ◽  
Vol 26 (S1) ◽  
pp. s163-s163
Author(s):  
T.E. Rives ◽  
C. Hecht ◽  
A. Wallace ◽  
R. Gandhi
Keyword(s):  
Emergency Preparedness ◽  
Trauma Center ◽  
Emergency Services ◽  
Mass Casualty ◽  
Senior Executives ◽  
Research Administration ◽  
Trauma Research ◽  
Uninsured Patient ◽  
Research Relationship ◽  
Trauma Surgeons

Our level one trauma center with a service area covering a population of approximately four-million people treats approximately 80,000 patients per year. In 2010, we anticipate more than 23,000 patients admitted, and to experience more than 850,000 patient encounters within the network. Trauma research is an important component to any level one trauma center, as well as a requirement of the American College of Surgeons/Committee on Trauma (ACS/COT). Our trauma center has recently gained level one designation and began an emergency preparedness research and trauma research (EPR/TR) program in earnest. We are fortunate to have support from executive administrators. Stewardship is a necessary element of our planning, in part because we are a county hospital serving a large uninsured patient population. The following are a few of the necessary steps we took to build an (EPR/TR) department from the beginning, to the point of submitting abstracts, manuscripts, funding grants, and presentations to regional, national, and international conferences, journals, and agencies. Structure the Emergency Preparedness Office to be a component of Trauma Services, allowing a unique opportunity for real-time disaster and mass casualty research. Secure a commitment from senior executives. Secure an experienced researcher, capable of research administration. Ensure the (EPR/TR) director, trauma medical director, trauma services director, and emergency preparedness coordinator can be a cohesive team with complimentary skills. Encourage trauma surgeons to perform research with assistance from the (EPR/TR) Office. Seek federal and foundation funding. Seek alliances with appropriate consortiums and associations. Develop a research relationship with pre-hospital emergency services. The above steps represent only some of the components used to build our (EPR/TR) department. We anticipate the planned expansion of the above steps will take our EPR/TR to the next level and increase extramural funding.

scholarly journals (A164) Emergency Preparedness Model for a Level-One Trauma Center

2011 ◽  
Vol 26 (S1) ◽  
pp. s47-s47
Author(s):  
T.E. Rives ◽  
C. Hecht ◽  
A. Wallace ◽  
R. Gandhi
Keyword(s):  
Emergency Preparedness ◽  
Trauma Center ◽  
Emergency Operation ◽  
Daily Basis ◽  
Standards Of Care ◽  
Disaster Plan ◽  
Preparedness Plan ◽  
Trauma Research ◽  
Emergency Situations ◽  
Daily Experiences

This Level-1 Trauma Center, with a service area covering a population of approximately four million people, treats approximately 80,000 patients per year. In 2010 it is anticipated that > 23,000 patients will be admitted, and > 850,000 patient encounters will occur within the network. This year was especially fruitful with the World Series, Dallas Cowboys, and other large crowd events simultaneously. The disaster plan prepares the hospital for the Super Bowl in February 2011, and its anticipated 250,000 extra people. The emergency preparedness program is a unique hybrid model integrating hospital accreditation guidelines, governmental guidelines, and regulations with the daily experiences at the trauma center. Emergency Preparedness is a program of the Trauma Department; this relationship provides a direct connection between the emergency preparedness program and direct execution of the plan. The emergency preparedness coordinator is responsible for directing the hospital command center at the time of a disaster requiring activation of the plan. The four phases of emergency planning: (1) Mitigation; (2) Preparedness; (3) Response; and (4) Recovery comprise the core of the plan. However, memoranda of understanding with local, regional, and state emergency operation professionals and organizations are enacted so depleted resources can be replenished. This integration provides for a flexible web that allows sharing of expertise and resources. Trauma Research is available for conducting measurable assessments of emergency preparedness drills and exercises, as well as actual disasters and emergencies where a paucity of research exists. Compliance with all relative agencies is important. A successful emergency preparedness plan directly incorporates daily experiences. This model allows for the continued provision of standards of care and continuity of service during disasters and emergency situations on a daily basis.

scholarly journals (A108) Hospital Disaster Planning: The Structured Approach

2011 ◽  
Vol 26 (S1) ◽  
pp. s30-s30
Author(s):  
G.E.A. Khalifa
Keyword(s):  
Emergency Preparedness ◽  
Disaster Preparedness ◽  
Disaster Response ◽  
Emergency Services ◽  
Disaster Planning ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Disaster Plan ◽  
Preparedness Plan ◽  
Hospital Disaster Preparedness

BackgroundDisasters and incidents with hundreds, thousands, or tens of thousands of casualties are not generally addressed in hospital disaster plans. Nevertheless, they may occur, and recent disasters around the globe suggest that it would be prudent for hospitals to improve their preparedness for a mass casualty incident. Disaster, large or small, natural or man-made can strike in many ways and can put the hospital services in danger. Hospitals, because of their emergency services and 24 hour a day operation, will be seen by the public as a vital resource for diagnosis, treatment, and follow up for both physical and psychological care.ObjectivesDevelop a hospital-based disaster and emergency preparedness plan. Consider how a disaster may pose various challenges to hospital disaster response. Formulate a disaster plan for different medical facility response. Assess the need for further changes in existing plans.MethodsThe author uses literature review and his own experience to develop step-by-step logistic approach to hospital disaster planning. The author presents a model for hospital disaster preparedness that produces a living document that contains guidelines for review, testing, education, training and update. The model provides the method to develop the base plan, functional annexes and hazard specific annexes.

scholarly journals Ensuring Emergency Preparedness through Systematic Evaluations

2019 ◽  
Vol 34 (s1) ◽  
pp. s76-s76
Author(s):  
Gila Margalit ◽  
Orna Rachaminov ◽  
Yuval Levy ◽  
Bruria Adini ◽  
Amir Grinberg
Keyword(s):  
Emergency Preparedness ◽  
Trauma Center ◽  
Mass Casualty ◽  
Home Front ◽  
Administrative Professionals ◽  
Emergency Scenarios ◽  
High Level ◽  
Relative Change ◽  
Chemical Incidents ◽  
The Impact

Introduction:Hospitals are required to maintain emergency preparedness 24/7. In order to maintain readiness, Israeli hospitals operate Emergency Committees comprised of medical, nursing, and administrative professionals who are responsible for capacity building including the development of plans, infrastructure, equipment, training, crisis management, and learning lessons. The Ministry of Health (MOH) and Home Front Command (HFC) conduct a comprehensive, structured evaluation of emergency preparedness in every hospital every two to three years.Aim:To assess the impact of a periodical evaluation on levels of emergency preparedness over time in a level one trauma center.Methods:Evaluation of emergency preparedness is conducted by approximately 12 evaluators from the MOH and HFC, encompassing mass casualty incidents (MCIs), mass toxicological/chemical incidents (MTEs), radiological and biological events, earthquakes and conflicts. Evaluations are based on objective parameters, relayed to hospitals prior to the evaluation. The hospital’s level of emergency preparedness is graded and improvements that must be implemented are delineated. The grades of four evaluations conducted from 2011 to 2018 were compared to identify trends in preparedness.Results:Mean levels of emergency preparedness in the 2018 versus 2011 evaluations presented an increase concerning all threats, including MCIs (92 vs. 90), MTEs (99 vs. 77, respectively), biological events (96 vs. 73, respectively), radiological events (91 vs. 79), earthquakes (87 vs. 60, respectively), and conflicts (95 vs. 74). The relative change in levels of preparedness was more noted concerning biological events and earthquakes.Discussion:A periodical evaluation by governing authorities seems to motivate the hospital’s administrations to invest efforts in building and maintain a high level of emergency preparedness. Systematic evaluations conducted bi-annually contributed to improved readiness for diverse emergency scenarios, including for threats that less frequently materialize.

Mass Casualty following Unprecedented Tornadic Events in the Southeast: Natural Disaster Outcomes at a Level I Trauma Center

2012 ◽  
Vol 78 (7) ◽  
pp. 770-773 ◽  
Author(s):  
Elizabeth H. Hartmann ◽  
Nathan Creel ◽  
Jacob Lepard ◽  
Robert A. Maxwell
Keyword(s):  
Soft Tissue ◽  
Length Of Stay ◽  
Emergency Preparedness ◽  
Trauma Center ◽  
Average Length ◽  
Mass Casualty ◽  
Incident Command ◽  
Trauma Service ◽  
Large Patient ◽  
Level I

On April 27, 2011, an EF4 (enhanced Fujita scale) tornado struck a 48-mile path across northwest Georgia and southeast Tennessee. Traumatic injuries sustained during this tornado and others in one of the largest tornado outbreaks in history presented to the regional Level I trauma center, Erlanger Health System, in Chattanooga, TN. Patients were triaged per mass casualty protocols through an incident command center and triage officer. Medical staffing was increased to anticipate a large patient load. Records of patients admitted as a result of tornado-related injury were retrospectively reviewed and characterized by the injury patterns, demographics, procedures performed, length of stay, and complications. One hundred four adult patients were treated in the emergency department; of these, 28 (27%) patients required admission to the trauma service. Of those admitted, 16 (57%) were male with an age range of 21 to 87 years old and an average length of stay of 10.9 ± 11.8 days. Eleven (39%) patients required intensive care unit admissions. The most common injuries seen were those of soft tissue, bony fractures, and the chest. Interventions included tube thoracostomies, exploratory laparotomies, orthopedic fixations, soft tissue reconstructions, and craniotomy. All 28 patients admitted survived to discharge. Nineteen (68%) patients were discharged home, six (21%) went to a rehabilitation hospital, and three (11%) were transferred to skilled nursing facilities. Emergency preparedness and organization are key elements in effectively treating victims of natural disasters. Those victims who survive the initial tornadic event and present to a Level I trauma center have low mortality. Like in our experience, triage protocols need to be implemented to quickly and effectively manage mass injuries.

Evaluating the impact of decontamination interventions performed in sequence for mass casualty chemical incidents

2021 ◽  
Author(s):  
Samuel Collins ◽  
Natalie Williams ◽  
Felicity Southworth ◽  
Thomas James ◽  
Louise Davidson ◽  
...  
Keyword(s):  
Vegetable Oil ◽  
Methyl Salicylate ◽  
Emergency Services ◽  
Mass Casualty ◽  
Human Volunteer ◽  
Additional Contribution ◽  
Uv Photography ◽  
Chemical Incidents ◽  
The Impact ◽  
Control Skin

Abstract The Initial Operational Response (IOR) to chemical incidents is a suite of rapid strategies including evacuation, disrobe and improvised and interim decontamination. IOR and Specialist Operational Response (SOR) decontamination protocols involving mass decontamination units would be conducted in sequence by UK emergency services following a chemical incident, to allow for safe onward transfer of casualties. As part of a series of human volunteer studies, we examined the effectiveness of IOR and SOR decontamination procedures alone and in sequence. Specifically, we evaluated the additional contribution of SOR, when following improvised and interim decontamination. Two simulants, methyl salicylate (MeS) with vegetable oil and benzyl salicylate (BeS), were applied to participants’ skin. Participants underwent improvised dry, improvised wet, interim wet, specialist decontamination and a no decontamination control. Skin analysis and UV photography indicated significantly lower levels of both simulants remaining following decontamination compared to controls. There were no significant differences in MeS levels recovered between decontamination conditions. Analysis of BeS, a more persistent simulant than MeS, showed that recovery from skin was significantly reduced following combined IOR with SOR than IOR alone. These results show modest additional benefits of decontamination interventions conducted in sequence, particularly for persistent chemicals, supporting current UK operational procedures.

scholarly journals Simple Emergency Triage (SET) – the new perspective on mass casualty incident triage

2020 ◽  
Vol 7 (2) ◽  
pp. 120-123
Author(s):  
Jerzy Jaskuła ◽  
Marek Siuta
Keyword(s):  
Personal Experience ◽  
Emergency Services ◽  
Statistical Data ◽  
First Aid ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Starting Point ◽  
Analysis And Synthesis ◽  
The Subject ◽  
New Perspective

The aim: Incidents with large number of casualties present a major challenge for the emergency services. Incident witnesses are always the first on scene. Authors aim at giving them an algorithm arranging the widely known first aid rules in such way, that the number of potential fatalities before the services’ arrival may be decreased. Material and methods: The authors’ main aim was creating an algorithm for mass casualty incident action, comprising elements not exceeding first aid skill level. Proceedings have been systematized, which led to creation of mass casualty incident algorithm. The analysis was based on the subject matter literature, legal acts and regulations, statistical data and author’s personal experience. Results: The analysis and synthesis of data from various sources allowed for the creation of Simple Emergency Triage (SET) algorithm. It has been proven – on theoretical level – that introducing an organized way of proceeding in mass casualty incident on the first aid level is justified. Conclusions: The SET algorithm presented in the article is of an implemental character. It may be a supplement to basic first aid skills. Algorithm may also be the starting point for further empirical research aimed at verifying its effectiveness.

Preparedness for Mass Casualty Incidents: The Effectiveness of Current Training Model

2021 ◽  
pp. 1-9
Author(s):  
Seema Biswas ◽  
Hany Bahouth ◽  
Evgeny Solomonov ◽  
Igor Waksman ◽  
Michael Halberthal ◽  
...  
Keyword(s):  
Disaster Management ◽  
Emergency Services ◽  
Traumatic Event ◽  
Management Training ◽  
Training Model ◽  
Mass Casualty ◽  
The Public ◽  
Physical Injuries ◽  
Nation States ◽  
State Infrastructure

Abstract The importance of MCI organization and training was highlighted by the events of September 11, 2001. Training focuses on the management of physical injuries caused by a single traumatic event over a well-defined, relatively short timeframe. MCI management is integrated into surgical and trauma training, with disaster management training involving the emergency services, law enforcement, and state infrastructure agencies. The COVID-19 pandemic revealed gaps in the preparedness of nation states and global partners in disaster management. The questions that arose include ‘has training really prepared us for an actual emergency,’ ‘what changes need to be made to training to make it more effective,’ and ‘who else should training be extended to?’ This article focuses on the importance of involving multiple sectors in mass casualty training and asks whether greater involvement of non-medical agencies and the public, in operational drills might improve preparedness for global events such as the COVID-19 pandemic.

scholarly journals A Case of an Advanced Chain of Survival in Penetrating Cardiac Injury

2019 ◽  
Vol 2019 ◽  
pp. 1-2
Author(s):  
Mads Jønsson Andersen ◽  
Frank V. De Paoli ◽  
Rikke Mærkedahl ◽  
Søren Vad Jepsen ◽  
Karoline Skov Dalgaard ◽  
...  
Keyword(s):  
Trauma Center ◽  
Emergency Services ◽  
Cardiac Injury ◽  
Tension Pneumothorax ◽  
Transport Systems ◽  
Spontaneous Respiration ◽  
Long Distance ◽  
Cardiac Trauma ◽  
Continuous Drainage ◽  
Penetrating Cardiac Injury

The survival rate of penetrating cardiac trauma is dismal, with only a few patients reaching the hospital with any signs of life. Short transport time and close proximity to the trauma center are positive factors for survival. We report the successful case of a 21-year-old male with penetrating cardiac injury and tension-pneumothorax with long distance to a trauma facility. The patient was stabbed twice in the anterior left side of the thorax. The emergency services found the patient with suspicion of left tension-pneumothorax. Urgent left mini-thoracotomy was established resulting in spontaneous respiration and clinical improvement. Due to rapid clinical deterioration and clinical suspicion of pericardial tamponade, patient was transported to the local regional hospital only minutes away. Echocardiography confirmed tamponade, and urgent ultrasound-guided pericardiocentesis was performed. During the transport blood was intermittently drained from the pericardial sack until arrival at the trauma center where a penetrating injury to the left ventricle was repaired during urgent cardiac surgery. The patient was discharged 8 days after the incident. Conclusion. Well organized emergency medical transport systems increase the chance of survival in penetrating cardiac injuries. Urgent pericardiocentesis with continuous drainage can help stabilize a patient until arrival at trauma facility.

scholarly journals Nerve agents: emergency preparedness

2020 ◽  
Vol 166 (1) ◽  
pp. 42-46
Author(s):  
Alan George Andrew Weir ◽  
S Makin ◽  
J Breeze
Keyword(s):  
Emergency Preparedness ◽  
Emergency Services ◽  
Chemical Properties ◽  
Chemical Warfare Agents ◽  
Nerve Agents ◽  
Clinical Effects ◽  
Individual Agent ◽  
Warfare Agents ◽  
The Individual ◽  
The Uk

Nerve agents (NAs) are a highly toxic group of chemical warfare agents. NAs are organophosphorus esters with varying physical and chemical properties depending on the individual agent. The most recently developed class of NA is ‘Novichok’, the existence of which was first revealed in the early 1990s, just before Russia signed the Chemical Weapons Convention. In 1984, Iraq became the first nation to deploy NA on the battlefield when they used tabun against Iranian military forces in Majnoon Island near Basra. The first terrorist use of an NA is believed to be the attack in Matsumoto, Japan, on 27 June 1994 by the Aum Shinrikyo doomsday cult. Symptoms and ultimate toxicity from NA poisoning are related to the agent involved, the form and degree of exposure, and rapidity of medical treatment. The classic toxidrome of significant exposure to NA comprises bronchorrhoea, bronchospasm, bradycardia and convulsions, with an onset period of as early as a few seconds depending on the mode and extent of exposure. If medical management is not instituted rapidly, death may occur in minutes by asphyxiation and cardiac arrest. In the UK, emergency preparedness for NA poisoning includes an initial operational response programme across all blue light emergency services and key first responders. This paper describes the development, pathophysiology, clinical effects and current guidance for management of suspected NA poisoning. It also summarises the known events in which NA poisoning has been confirmed.

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