Principles of Emergency Department Facility Design for Optimal Management of Mass-Casualty Incidents

2012 ◽  
Vol 27 (2) ◽  
pp. 204-212 ◽  
Author(s):  
Pinchas Halpern ◽  
Scott A. Goldberg ◽  
Jimmy G. Keng ◽  
Kristi L. Koenig
Keyword(s):  
Emergency Department ◽  
Medical Center ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Mass Casualty Incidents ◽  
Optimal Management ◽  
Facility Design ◽  
Surge Capacity ◽  
Efficient Management ◽  
Structural Principles

AbstractIntroductionThe Emergency Department (ED) is the triage, stabilization and disposition unit of the hospital during a mass-casualty incident (MCI). With most EDs already functioning at or over capacity, efficient management of an MCI requires optimization of all ED components. While the operational aspects of MCI management have been well described, the architectural/structural principles have not. Further, there are limited reports of the testing of ED design components in actual MCI events. The objective of this study is to outline the important infrastructural design components for optimization of ED response to an MCI, as developed, implemented, and repeatedly tested in one urban medical center.ReportIn the authors’ experience, the most important aspects of ED design for MCI have included external infrastructure and promoting rapid lockdown of the facility for security purposes; an ambulance bay permitting efficient vehicle flow and casualty discharge; strategic placement of the triage location; patient tracking techniques; planning adequate surge capacity for both patients and staff; sufficient command, control, communications, computers, and information; well-positioned and functional decontamination facilities; adequate, well-located and easily distributed medical supplies; and appropriately built and functioning essential services.DiscussionDesigning the ED to cope well with a large casualty surge during a disaster is not easy, and it may not be feasible for all EDs to implement all the necessary components. However, many of the components of an appropriate infrastructural design add minimal cost to the normal expenditures of building an ED.ConclusionThis study highlights the role of design and infrastructure in MCI preparedness in order to assist planners in improving their ED capabilities. Structural optimization calls for a paradigm shift in the concept of structural and operational ED design, but may be necessary in order to maximize surge capacity, department resilience, and patient and staff safety.Halpern P, Goldberg SA, Keng JG, Koenig KL. Principles of Emergency Department facility design for optimal management of mass-casualty incidents.Prehosp Disaster Med.2012;27(2):1-9.

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 A Surprise Mass Casualty Incident Simulation: Does It Improve Knowledge or Is It Just a Bit of Fun?

2019 ◽  
Vol 34 (s1) ◽  
pp. s18-s19
Author(s):  
Brad Mitchell ◽  
Karen Hammad ◽  
Dana Aldwin
Keyword(s):  
Emergency Department ◽  
Low Cost ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Major Incident ◽  
Likert Scales ◽  
The Past ◽  
Emergency Department Nurses ◽  
Major Incidents ◽  
Simulation Scenario

Introduction:We opened a national conference in Australia with a surprise mass casualty simulation scenario of a van versus multiple persons outside the conference venue. The purpose of this exercise was to increase awareness of, and preparation for, mass casualty incident (MCI) events for the conference delegates who were paramedics, emergency department nurses, and doctors.Aim:The aim of the research is to understand whether a surprise MCI simulation is a useful way to increase knowledge and motivate preparedness.Methods:A survey hosted on Qualtrics was circulated to delegates via email. The survey was designed by the research team and had 38 questions about demographics and respondents’ experience with MCIs, as well as their perceptions of the simulation exercise. The questions were a mixture of 5-point Likert scales, multiple choice, and short answers.Results:The majority of respondents were clinicians (n = 66, 76%) and those who worked in emergency departments or the prehospital setting (n = 75, 86%). While the majority had not responded to an MCI in the past 5 years (n = 67, 77%), more than half (n = 50, 57%) had undertaken MCI training during this time. Overall, a vast majority of respondents found the simulation to be a worthwhile exercise that increased knowledge and preparedness. An overwhelming majority also reported that the simulation was relevant to practice, of high quality, and a useful way to teach about major incidents.Discussion:Our surprise major incident simulation was a fun and effective way to raise awareness and increase knowledge in prehospital and emergency department clinicians about MCI response. This approach to simulation can be easily replicated at relatively low cost and is, therefore, a useful solution to training a group of multidisciplinary health professionals outside of the workplace.

scholarly journals Westgate Shootings: An Emergency Department Approach to a Mass-casualty Incident

2014 ◽  
Vol 29 (5) ◽  
pp. 538-541 ◽  
Author(s):  
Benjamin W. Wachira ◽  
Ramadhani O. Abdalla ◽  
Lee A. Wallis
Keyword(s):  
Emergency Department ◽  
Emergency Preparedness ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
University Hospital ◽  
Shopping Mall ◽  
Major Incident ◽  
Local Health ◽  
Publication Type ◽  
Communication Assessment

AbstractAt approximately 12:30 pm on Saturday September 21, 2013, armed assailants attacked the upscale Westgate shopping mall in the Westlands area of Nairobi, Kenya. Using the seven key Major Incident Medical Management and Support (MIMMS) principles, command, safety, communication, assessment, triage, treatment, and transport, the Aga Khan University Hospital, Nairobi (AKUH,N) emergency department (ED) successfully coordinated the reception and care of all the casualties brought to the hospital.This report describes the AKUH,N ED response to the first civilian mass-casualty shooting incident in Kenya, with the hope of informing the development and implementation of mass-casualty emergency preparedness plans by other EDs and hospitals in Kenya, appropriate for the local health care system.WachiraBW, AbdallaRO, WallisLA. Westgate shootings: an emergency department approach to a mass-casualty incident. Prehosp Disaster Med. 2014;29(5):1-4.

A unique hospital physician disaster response system for a nonemployed medical staff

2009 ◽  
Vol 4 (2) ◽  
pp. 95-100
Author(s):  
James D. Leo, MD, FCCP ◽  
Desiree Thomas, RN, MSN, CCRN ◽  
Ginger Alhadeff, BA, RN, MA
Keyword(s):  
Medical Staff ◽  
Disaster Response ◽  
Medical Center ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Care Needs ◽  
For Profit ◽  
Major Disaster ◽  
Physician Care ◽  
Special Challenge

Private hospitals with nonemployed, volunteer medical staffs face a special challenge in meeting the patient-care needs posed by a mass casualty incident (MCI). Although most disaster response systems focus on emergency department and trauma management, such systems often do not provide for the need to triage existing inpatients to create room for incoming casualties, for continuity of physician care for those patients, as well as for MCI victims in case of major disaster. Such systems must also provide a mechanism for ethical and appropriate rationing of limited resources during a MCI. Community hospitals without 24/7 in-house physicians must provide a mechanism for physician care for patients in situations in which access to the hospital may be limited by the disaster (eg, major earthquake or flood). This article describes a system established at Long Beach Memorial Medical Center, a 740-bed not-for-profit hospital with a volunteer medical staff, to ensure continuity of physician care in a major disaster. To our knowledge, this is the first published report of such a system.

The effect of training and experience on mass casualty incident triage performance: Evidence from emergency personnel in a high complexity university hospital

2019 ◽  
Vol 14 (2) ◽  
pp. 113-119 ◽  
Author(s):  
Juan P. Vargas, MD, MSc ◽  
Ives Hubloue, MD, PhD ◽  
Jazmín J. Pinzón, MD ◽  
Alejandra Caycedo Duque, MD
Keyword(s):  
Emergency Department ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
University Hospital ◽  
Trauma Patients ◽  
Post Intervention ◽  
Cross Sectional ◽  
Emergency Department Staff ◽  
Department Staff ◽  
Before And After

Mass casualty incident (MCI) can occur at any time and place and health care institutions must be prepared to deal with these incidents. Emergency department staff rarely learn how to triage MCI patients during their medical or nurse degrees, or through on-the-job training. This study aims to evaluate the effect of training and experience on the MCI triage performance of emergency personnel.Methodology: This was a cross-sectional prospective study that analyzed the performance of 94 emergency department staff on the triage classifications of 50 trauma patients, before and after a short training in MCI triage, while taking into account their academic background and work experience.Results: The participants were assigned initially to one of two groups: low experience if they had less than 5 years of practice, and high experience if they had more than 5 years of practice. In the low experience group, the initial accuracy was 45.76 percent, over triage 45.84 percent, and subtriage 8.38 percent. In the high experience group, the initial accuracy was 53.80 percent, over triage 37.66 percent, and sub triage 8.57 percent.Postintervention Results: In the low experience group, the post intervention accuracy was 63.57 percent, over triage 21.15 percent, and subtriage 15.30 percentage. In the high experience group, the post-intervention accuracy was 67.66 percentage, over triage 15.19 percentage, and subtriage 17.14 percentage.  Conclusion: Upon completion of this study, it can be concluded that MCI triage training significantly improved the performance of all those involved in the workshop and that experience plays an important role in MCI triage performance.

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