Triage During Mass Gatherings

2012 ◽  
Vol 27 (6) ◽  
pp. 531-535 ◽  
Author(s):  
Sheila A. Turris ◽  
Adam Lund
Keyword(s):  
Large Scale ◽  
Scoring Systems ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Mass Casualty Incidents ◽  
Limited Resources ◽  
Mass Gathering ◽  
Publication Type ◽  
Mass Gatherings ◽  
Field Triage

AbstractTriage is a complex process and is one means for determining which patients most need access to limited resources. Triage has been studied extensively, particularly in relation to triage in overcrowded emergency departments, where individuals presenting for treatment often are competing for the available stretchers. Research also has been done in relation to the use of prehospital and field triage during mass-casualty incidents and disasters.In contrast, scant research has been done to develop and test an effective triage approach for use in mass-gathering and mass-participation events, although there is a growing body of knowledge regarding the health needs of persons attending large events. Existing triage and acuity scoring systems are suboptimal for this unique population, as these events can involve high patient presentation rates (PPR) and, occasionally, critically ill patients. Mass-gathering events are dangerous; a higher incidence of injury occurs than would be expected from general population statistics.The need for an effective triage and acuity scoring system for use during mass gatherings is clear, as these events not only create multiple patient encounters, but also have the potential to become mass-casualty incidents. Furthermore, triage during a large-scale disaster or mass-casualty incident requires that multiple, local agencies work together, necessitating a common language for triage and acuity scoring.In reviewing existing literature with regard to triage systems that might be employed for this population, it is noted that existing systems are biased toward traumatic injuries, usually ignoring mitigating factors such as alcohol and drug use and environmental exposures. Moreover, there is a substantial amount of over-triage that occurs with existing prehospital triage systems, which may lead to misallocation of limited resources. This manuscript presents a review of the available literature and proposes a triage system for use during mass gatherings that also may be used in the setting of mass-casualty incidents or disaster responses.TurrisSA, LundA. Triage during mass gatherings. Prehosp Disaster Med. 2012;27(6):1-5.

Mass-Gathering Medicine: Creation of an Online Event and Patient Registry

2012 ◽  
Vol 27 (6) ◽  
pp. 601-611 ◽  
Author(s):  
Adam Lund ◽  
Sheila A. Turris ◽  
Neda Amiri ◽  
Kerrie Lewis ◽  
Michael Carson
Keyword(s):  
Data Collection ◽  
Large Scale ◽  
Patient Characteristics ◽  
Patient Registry ◽  
Mass Gathering ◽  
Publication Type ◽  
Pilot Testing ◽  
Mass Gatherings ◽  
Mass Gathering Medicine ◽  
Early Implementation

AbstractIntroduction/ProblemA review of the mass-gathering medicine literature confirms that the research community currently lacks a standardized approach to data collection and reporting in relation to large-scale community events. This lack of consistency, particularly with regard to event characteristics, patient characteristics, acuity determination, and reporting of illness and injury rates makes comparisons between and across events difficult. In addition, a lack of access to good data across events makes planning medical support on-site, for transport, and at receiving hospitals, challenging. This report describes the development of an Internet-hosted, secure registry for event and patient data in relation to mass gatherings.MethodsDescriptive; development and pilot testing of a Web-based event and patient registry.ResultsSeveral iterations of the registry have resulted in a cross-event platform for standardized data collection at a variety of events. Registry and reporting field descriptions, successes, and challenges are discussed based on pilot testing and early implementation over two years of event enrollment.ConclusionThe Mass-Gathering Medicine Event and Patient Registry provides an effective tool for recording and reporting both event and patient-related variables in the context of mass-gathering events. Standardizing data collection will serve researchers and policy makers well. The structure of the database permits numerous queries to be written to generate standardized reports of similar and dissimilar events, which supports hypothesis generation and the development of theoretical foundations in mass-gathering medicine.LundA,TurrisSA,AmiriN,LewisK,CarsonM.Mass-gathering medicine: creation of an online event and patient registry.Prehosp Disaster Med.2012;27(6):1-11.

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.

Disaster Response to a Mass Casualty Incident in a Hospital Fire by Regional Disaster Medical Assistance Team: Characteristics of Hospital Fire

2020 ◽  
pp. 1-4
Author(s):  
Jae Ho Jang ◽  
Jin-Seong Cho ◽  
Youg Su Lim ◽  
Sung Youl Hyun ◽  
Jae-Hyug Woo ◽  
...  
Keyword(s):  
Medical Records ◽  
Medical Staff ◽  
Disaster Response ◽  
Fire Department ◽  
Treatment Method ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Medical Assistance ◽  
Fire Disaster ◽  
Field Triage

ABSTRACT Objective: A disaster in the hospital is particularly serious and quite different from other ordinary disasters. This study aimed at analyzing the activity outcomes of a disaster medical assistance team (DMAT) for a fire disaster at the hospital. Methods: The data which was documented by a DMAT and emergent medical technicians of a fire department contained information about the patient’s characteristics, medical records, triage results, and the hospital which the patient was transferred from. Patients were categorized into four groups according to results of field triage using the simple triage and rapid treatment method. Results: DMAT arrived on the scene in 37 minutes. One hundred and thirty eight (138) patients were evacuated from the disaster scene. There were 25 patients (18.1%) in the Red group, 96 patients (69.6%) in the Yellow group, and 1 patient (0.7%) in the Green group. One patient died. There were 16 (11.6%) medical staff and hospital employees. The injury of the caregiver or the medical staff was more severe compared to the family protector. Conclusions: For an effective disaster-response system in hospital disasters, it is important to secure the safety of medical staff, to utilize available medical resources, to secure patients’ medical records, and to reorganize the DMAT dispatch system.

scholarly journals (P1-103) Utilization of a Pediatric Disaster Coalition as a Model for Regional Pediatric Disaster Planning

2011 ◽  
Vol 26 (S1) ◽  
pp. s132-s132
Author(s):  
G. Foltin ◽  
A. Flamm ◽  
A. Cooper ◽  
M. Sagy ◽  
B.M. Greenwald ◽  
...  
Keyword(s):  
Critical Care ◽  
Emergency Preparedness ◽  
Large Scale ◽  
Pediatric Emergency ◽  
Mass Casualty ◽  
Metropolitan Region ◽  
Pediatric Care ◽  
Preparedness Planning ◽  
Field Triage ◽  
Care Surgery

PurposeThere remains a lack of comprehensive pediatric emergency preparedness planning worldwide. A disaster or mass-casualty incident (MCI) involving pediatric patients could overwhelm existing pediatric resources within the New York City (NYC) metropolitan region. The NYC Department of Health and Mental Hygiene (DOHMH) recognizing the importance to plan for a MCI with a large number of pediatric victims, implemented a project (the Pediatric Disaster Coalition; PDC), to address gaps in the healthcare system to provide effective and timely pediatric care during a MCI.MethodsThe PDC includes experts in emergency preparedness, critical care, surgery, and emergency medicine from the NYC pediatric/children's hospitals, DOHMH, Office of Emergency Management, and Fire Department (FDNY). Two committees addressed pediatric prehospital triage, transport, and pediatric critical care (PCC) surge capacities. They developed guidelines and recommendations for pediatric field triage and transport, matching patients' needs to resources, and increasing PCC Surge Capacities.ResultsSurge recommendations were formulated. The algorithm developed provides specific pediatric triage criteria that identify severity of illness using the traditional Red, Yellow, and Green categories plus an Orange designation for continual reassessments that has been adopted by FDNY that has trained > 3,000 FDNY EMS personnel in its use. Triaged patients can be transported to appropriate resources based on a tiered system that defines pediatric hospital capabilities. The Surge Committee has created PCC Surge Capacity Guideline that can be used by hospitals to create their individual PCC surge plans. 15 of 25 NYC hospitals with PCC capabilities are participating with PDC planning; 5 have completed surge plans, 3 are nea completion, and 7 are in development. The completed plans add 92 surge beds to 244 regularly available PICU beds. The goal is to increase the PCC surge bed capacity by 200 + beds.ConclusionsThe project is an effective, multidisciplinary group approach to planning for a regional, large-scale pediatric MCI. Regional lead agencies must emphasize pediatric emergency preparedness in their disaster plans.

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.

scholarly journals (P2-39) Public Health Safety for Traditional Mass Gatherings in India: A 10-Year Analysis

2011 ◽  
Vol 26 (S1) ◽  
pp. s148-s148 ◽  
Author(s):  
S. Sanyal ◽  
A. Madan
Keyword(s):  
Violent Behavior ◽  
Healthcare Services ◽  
Mass Casualty ◽  
Sporting Events ◽  
Mass Gathering ◽  
Health Safety ◽  
Crowd Management ◽  
Mass Gatherings ◽  
Indian Context ◽  
The Times

IntroductionIn the past decade, India has witnessed many lapses in crowd safety during mass gatherings. The high casualty rate in stampedes during traditional mass gatherings has prompted the study of these events. Wide variations exist in casualty rates for similar events, and key issues in healthcare services in these special situations were addressed in the Indian context.MethodsFrom 2001–2010, Mass gathering data were collected from news items reported in the archives of newspapers, “The Times of India”, “The Hindu” and “The Indian Express”. The keywords used were: “stampede”, “mass gathering”, “mass-gathering events”, “mass-gathering incidents”, “crowd”, and “crowd management”. The study included triggers for the incident and the number of casualties (dead and injured) in each incident.ResultsIn 27 separate mass gatherings in India, there were 936 dead and 540 injured casualties. The unique characteristics of mass gatherings in India included a predominance of old and vulnerable people in traditional mass gatherings, in contrast to the young and middle-aged groups who gather for music and sporting events elsewhere. Further, alcohol/substance abuse, brawls, and violent behavior were absent at traditional Indian mass gatherings. Non-traditional mass gatherings accounted for a lesser number of incidents in India, and were located in movie theatres and railway stations.ConclusionsIn a populous country like India, traditional mass gatherings predominate, and ensuring the health, safety, and security of the public at such events will require an understanding of crowd behavior, critical crowd densities, and crowd capacities in the Indian context. However, planning for mass gatherings can be developed using the existing body of knowledge of mass-casualty preparedness, food safety, and health promotion.

Mass-gathering Health Research Foundational Theory: Part 2 - Event Modeling for Mass Gatherings

2014 ◽  
Vol 29 (6) ◽  
pp. 655-663 ◽  
Author(s):  
Sheila A. Turris ◽  
Adam Lund ◽  
Alison Hutton ◽  
Ron Bowles ◽  
Elizabeth Ellerson ◽  
...  
Keyword(s):  
Health Research ◽  
Current Knowledge ◽  
Meta Analysis ◽  
Theory Development ◽  
Mass Gathering ◽  
Publication Type ◽  
Conceptual Approach ◽  
Mass Gatherings ◽  
Event Modeling ◽  
Event Model

AbstractBackgroundCurrent knowledge about mass-gathering health (MGH) fails to adequately inform the understanding of mass gatherings (MGs) because of a relative lack of theory development and adequate conceptual analysis. This report describes the development of a series of event lenses that serve as a beginning “MG event model,” complimenting the “MG population model” reported elsewhere.MethodsExisting descriptions of “MGs” were considered. Analyzing gaps in current knowledge, the authors sought to delineate the population of events being reported. Employing a consensus approach, the authors strove to capture the diversity, range, and scope of MG events, identifying common variables that might assist researchers in determining when events are similar and might be compared. Through face-to-face group meetings, structured breakout sessions, asynchronous collaboration, and virtual international meetings, a conceptual approach to classifying and describing events evolved in an iterative fashion.FindingsEmbedded within existing literature are a variety of approaches to event classification and description. Arising from these approaches, the authors discuss the interplay between event demographics, event dynamics, and event design. Specifically, the report details current understandings about event types, geography, scale, temporality, crowd dynamics, medical support, protective factors, and special hazards. A series of tables are presented to model the different analytic lenses that might be employed in understanding the context of MG events.InterpretationThe development of an event model addresses a gap in the current body of knowledge vis a vis understanding and reporting the full scope of the health effects related to MGs. Consistent use of a consensus-based event model will support more rigorous data collection. This in turn will support meta-analysis, create a foundation for risk assessment, allow for the pooling of data for illness and injury prediction, and support methodology for evaluating health promotion, harm reduction, and clinical response interventions at MGs.TurrisSA, LundA, HuttonA, BowlesR, EllersonE, SteenkampM, RanseJ, ArbonP. Mass-gathering health research foundational theory: part 2 - event modeling for mass gatherings. Prehosp Disaster Med. 2014;29(6):1-9.

scholarly journals Modeling Uncertain and Dynamic Casualty Health in Optimization-Based Decision Support for Mass Casualty Incident Response

2015 ◽  
pp. 411-423
Author(s):  
Duncan T. Wilson ◽  
Glenn I. Hawe ◽  
Graham Coates ◽  
Roger S. Crouch
Keyword(s):  
Decision Support ◽  
Real Time ◽  
Health Assessment ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Mass Casualty Incidents ◽  
Support Program ◽  
Dynamic Nature ◽  
Significant Challenge ◽  
Health Model

When designing a decision support program for use in coordinating the response to Mass Casualty Incidents, the modelling of the health of casualties presents a significant challenge. In this paper we propose one such health model, capable of acknowledging both the uncertain and dynamic nature of casualty health. Incorporating this into a larger optimisation model capable of use in real-time and in an online manner, computational experiments examining the effect of errors in health assessment, regular updates of health and delays in communication are reported. Results demonstrate the often significant impact of these factors.

scholarly journals MP26: Development and evaluation of a novel emergency physician fan-out mechanism at an urban centre for use in mass casualty incidents

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S51
Author(s):  
J. Melegrito ◽  
B. Granberg ◽  
K. Hanrahan
Keyword(s):  
Emergency Department ◽  
Emergency Physician ◽  
Large Scale ◽  
Response Rate ◽  
Text Message ◽  
Mass Casualty ◽  
Mass Casualty Incidents ◽  
Process Mapping ◽  
Emergency Physicians ◽  
Physician Response

Background: Understaffing in mass casualty incidents limits flow in the overwhelmed emergency department, which is further compounded by inefficient use of those same human resources. Process mapping analysis of a “Code Orange” exercise at a tertiary academic hospital exposed the failures of telephone-based emergency physician fan-out protocols to address these issues. As such, a quality improvement and patient safety initiative was undertaken to design, implement, and evaluate a new mass casualty incident fan-out mechanism. Aim Statement: By February 2019, emergency physician fan-out will be accomplished within 1 hour of Code Orange declaration, with a response rate greater than 20%. Measures & Design: Process mapping of a Code Orange simulation highlighted telephone fan-out to be ineffective in mobilizing emergency physicians to provide care in mass casualty incidents: available staff were pulled from their usual duties to help unit clerks unsuccessfully reach off-duty physicians by telephone for hours. Stakeholders subsequently identified automation and computerization as a compelling change idea. A de-novo automated bidirectional text-messaging system was thus developed. Early trials were analyzed for process measures including fan-out speed, unit clerk involvement, and physician response rate, with further large-scale tests planned for early 2019. Evaluation/Results: Only 50% of telephone fan-out was completed after a 2-hour exercise despite 3 staff supplementing the 2 on-shift unit clerks, with a 4% physician response rate. In contrast, data from initial trials of the automated system suggest that full fan-out can be performed within 1 hour of Code Orange declaration and require only 1 unit clerk, with text-messages projected to yield higher physician response rates than telephone calls. Early findings have thus far affirmed stakeholder sentiments that automating fan-out can improve speed, unit clerk efficiency, and physician response rate. Discussion/Impact: Automated text-message systems can expedite fan-out protocol in mass casualty incidents, relieve allied health staff strain, and more reliably recruit emergency physicians. Large-scale trials of the novel system are therefore planned for early 2019, with future expansion of the protocol to other medical personnel under consideration. Thus, automated text-message systems can be implemented in urban centres to improve fan-out efficiency and aid overall emergency department flow in mass casualty incidents.

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