Comparison of Computerized Patients versus Live Moulaged Actors for a Mass-casualty Drill

2015 ◽  
Vol 30 (5) ◽  
pp. 438-442 ◽  
Author(s):  
Ilene Claudius ◽  
Amy Kaji ◽  
Genevieve Santillanes ◽  
Mark Cicero ◽  
J. Joelle Donofrio ◽  
...  
Keyword(s):  
Student Performance ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Simulated Patients ◽  
Publication Type ◽  
Multiple Modalities ◽  
Computer Based ◽  
Level 1 ◽  
Computerized Simulation ◽  
Level 1 Trauma Center

AbstractIntroductionMultiple modalities for simulating mass-casualty scenarios exist; however, the ideal modality for education and drilling of mass-casualty incident (MCI) triage is not established.Hypothesis/ProblemMedical student triage accuracy and time to triage for computer-based simulated victims and live moulaged actors using the pediatric version of the Simple Triage and Rapid Treatment (JumpSTART) mass-casualty triage tool were compared, anticipating that student performance and experience would be equivalent.MethodsThe victim scenarios were created from actual trauma records from pediatric high-mechanism trauma presenting to a participating Level 1 trauma center. The student-reported fidelity of the two modalities was also measured. Comparisons were done using nonparametric statistics and regression analysis using generalized estimating equations.ResultsThirty-three students triaged four live patients and seven computerized patients representing a spectrum of minor, immediate, delayed, and expectant victims. Of the live simulated patients, 92.4% were given accurate triage designations versus 81.8% for the computerized scenarios (P=.005). The median time to triage of live actors was 57 seconds (IQR=45-66) versus 80 seconds (IQR=58-106) for the computerized patients (P<.0001). The moulaged actors were felt to offer a more realistic encounter by 88% of the participants, with a higher associated stress level.ConclusionWhile potentially easier and more convenient to accomplish, computerized scenarios offered less fidelity than live moulaged actors for the purposes of MCI drilling. Medical students triaged live actors more accurately and more quickly than victims shown in a computerized simulation.ClaudiusI, KajiA, SantillanesG, CiceroM, DonofrioJJ, Gausche-HillM, SrinivasanS, ChangTP. Comparison of computerized patients versus live moulaged actors for a mass-casualty drill. Prehosp Disaster Med.2015; 30(5): 438–442.

Accuracy, Efficiency, and Inappropriate Actions Using JumpSTART Triage in MCI Simulations

2015 ◽  
Vol 30 (5) ◽  
pp. 457-460 ◽  
Author(s):  
Ilene Claudius ◽  
Amy H. Kaji ◽  
Genevieve Santillanes ◽  
Mark X. Cicero ◽  
J. Joelle Donofrio ◽  
...  
Keyword(s):  
A Priori ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Simulated Patients ◽  
Publication Type ◽  
Computer Based ◽  
Time Required ◽  
Triage Algorithm ◽  
Mean Time ◽  
Level Performance

AbstractIntroductionUsing the pediatric version of the Simple Triage and Rapid Treatment (JumpSTART) algorithm for the triage of pediatric patients in a mass-casualty incident (MCI) requires assessing the results of each step and determining whether to move to the next appropriate action. Inappropriate application can lead to performance of unnecessary actions or failure to perform necessary actions.Hypothesis/ProblemTo report overall accuracy and time required for triage, and to assess if the performance of unnecessary steps, or failure to perform required steps, in the triage algorithm was associated with inaccuracy of triage designation or increased time to reach a triage decision.MethodsMedical students participated in an MCI drill in which they triaged both live actors portraying patients and computer-based simulated patients to the four triage levels: minor, delayed, immediate, and expectant. Their performance was timed and compared to intended triage designations and a priori determined critical actions.ResultsThirty-three students completed 363 scenarios. The overall accuracy was 85.7% and overall mean time to assign a triage designation was 70.4 seconds, with decreasing times as triage acuity level decreased. In over one-half of cases, the student omitted at least one action and/or performed at least one action that was not required. Each unnecessary action increased time to triage by a mean of 8.4 seconds and each omitted action increased time to triage by a mean of 5.5 seconds.DiscussionIncreasing triage level, performance of inappropriate actions, and omission of recommended actions were all associated with increasing time to perform triage.ClaudiusI, KajiAH, SantillanesG, CiceroMX, DonofrioJJ, Gausche-HillM, SrinivasanS, ChangTP. Accuracy, efficiency, and inappropriate actions using JumpSTART triage in MCI simulations. Prehosp Disaster Med. 2015;30(5):457–460.

Tabletop Application of SALT Triage to 10, 100, and 1000 Pediatric Victims

2020 ◽  
Vol 35 (2) ◽  
pp. 165-169
Author(s):  
Nicholas McGlynn ◽  
Ilene Claudius ◽  
Amy H. Kaji ◽  
Emilia H. Fisher ◽  
Alaa Shaban ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Pediatric Trauma ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Trauma Patients ◽  
Kappa Test ◽  
Life Saving ◽  
Number Of Patients ◽  
Level 1 ◽  
Level 1 Trauma Center

AbstractIntroduction:The Sort, Access, Life-saving interventions, Treatment and/or Triage (SALT) mass-casualty incident (MCI) algorithm is unique in that it includes two subjective questions during the triage process: “Is the victim likely to survive given the resources?” and “Is the injury minor?”Hypothesis/Problem:Given this subjectivity, it was hypothesized that as casualties increase, the inter-rater reliability (IRR) of the tool would decline, due to an increase in the number of patients triaged as Minor and Expectant.Methods:A pre-collected dataset of pediatric trauma patients age <14 years from a single Level 1 trauma center was used to generate “patients.” Three trained raters triaged each patient using SALT as if they were in each of the following scenarios: 10, 100, and 1,000 victim MCIs. Cohen’s kappa test was used to evaluate IRR between the raters in each of the scenarios.Results:A total of 247 patients were available for triage. The kappas were consistently “poor” to “fair:” 0.37 to 0.59 in the 10-victim scenario; 0.13 to 0.36 in the 100-victim scenario; and 0.05 to 0.36 in the 1,000-victim scenario. There was an increasing percentage of subjects triaged Minor as the number of estimated victims increased: 27.8% increase from 10- to 100-victim scenario and 7.0% increase from 100- to 1,000-victim scenario. Expectant triage categorization of patients remained stable as victim numbers increased.Conclusion:Overall, SALT demonstrated poor IRR in this study of increasing casualty counts while triaging pediatric patients. Increased casualty counts in the scenarios did lead to increased Minor but not Expectant categorizations.

Primary Triage, Evacuation Priorities, and Rapid Primary Distribution between Adjacent Hospitals—Lessons Learned from a Suicide Bomber Attack in Downtown Tel-Aviv

2008 ◽  
Vol 23 (4) ◽  
pp. 337-341 ◽  
Author(s):  
Moshe Pinkert ◽  
Ofer Lehavi ◽  
Odeda Benin Goren ◽  
Yaron Raiter ◽  
Ari Shamis ◽  
...  
Keyword(s):  
Trauma Center ◽  
Medical Center ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Severely Injured ◽  
Tel Aviv ◽  
Medical Response ◽  
Level 1 ◽  
Level 1 Trauma Center ◽  
Primary Triage

AbstractIntroduction:Terrorist attacks have occurred in Tel-Aviv that have caused mass-casualties.The objective of this study was to draw lessons from the medical response to an event that occurred on 19 January 2006, near the central bus station, Tel-Aviv, Israel. The lessons pertain to the management of primary triage, evacuation priorities, and rapid primary distribution between adjacent hospitals and the operational mode of the participating hospitals during the event.Methods:Data were collected in formal debriefings both during and after the event. Data were analyzed to learn about medical response components, interactions, and main outcomes. The event is described according to Disastrous Incidents Systematic AnalysiS Through—Components, Interactions and Results (DISAST-CIR) methodology.Results:A total of 38 wounded were evacuated from the scene, including one severely injured, two moderately injured, and 35 mildly injured. The severe casualty was the first to be evacuated 14 minutes after the explosion. All of the casualties were evacuated from the scene within 29 minutes. Patients were distributed between three adjacent hospitals including one non-Level-1 Trauma Center that received mild casualties. Twenty were evacuated to the nearby, Level-1 Sourasky Medical Center, including the only severely injured patient. Nine mildly injured patients were evacuated to the Sheba Medical Center and nine to Wolfson Hospital, a non-Level-1 Trauma Center hospital. All the receiving hospitals were operated according to the mass-casualty incident doctrine.Conclusions:When a mass-casualty incident occurs in the vicinity of more than one hospital, primary triage, evacuation priority decision-making, and rapid distribution of casualties between all of the adjacent hospitals enables efficient and effective containment of the event.

Emergency radiology and mass casualty incidents—report of a mass casualty incident at a level 1 trauma center

2016 ◽  
Vol 24 (1) ◽  
pp. 47-53 ◽  
Author(s):  
Ferdia Bolster ◽  
Ken Linnau ◽  
Steve Mitchell ◽  
Eric Roberge ◽  
Quynh Nguyen ◽  
...  
Keyword(s):  
Trauma Center ◽  
Emergency Radiology ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Mass Casualty Incidents ◽  
Level 1 ◽  
Level 1 Trauma Center

Comparison of Electronic Versus Manual Mass-Casualty Incident Triage

2018 ◽  
Vol 33 (3) ◽  
pp. 273-278 ◽  
Author(s):  
Claudie Bolduc ◽  
Nisreen Maghraby ◽  
Patrick Fok ◽  
The Minh Luong ◽  
Valerie Homier
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Simulated Patients ◽  
Mass Casualties ◽  
Care Providers ◽  
Manual Method ◽  
Computer Based ◽  
Triage Time

AbstractIntroductionMass-casualty incidents (MCIs) easily overwhelm a health care facility’s human and material resources through the extraordinary influx of casualties. Efficient and accurate triage of incoming casualties is a critical step in the hospital disaster response.Hypothesis/ProblemTraditionally, triage during MCIs has been manually performed using paper cards. This study investigated the use of electronic Simple Triage and Rapid Treatment (START) triage as compared to the manual method.MethodsThis observational, crossover study was performed during a live MCI simulation at an urban, Canadian, Level 1 trauma center on May 26, 2016. Health care providers (two medical doctors [MDs], two paramedics [PMs], and two registered nurses [RNs]) each triaged a total of 30 simulated patients - 15 by manual (paper-based) and 15 by electronic (computer-based) START triage. Accuracy of triage categories and time of triage were analyzed. Post-simulation, patients and participating health care providers also completed a feedback form.ResultsThere was no difference in accuracy of triage between the electronic and manual methods overall, 83% and 80% (P=1.0), between providers or between triage categories. On average, triage time using the manual method was estimated to be 8.4 seconds faster (P<.001) for PMs; and while small differences in triage times were observed for MDs and RNs, they were not significant. Data from the participant feedback survey showed that the electronic method was preferred by most health care providers. Patients had no preference for either method. However, patients perceived the computer-based method as “less personal” than the manual triage method, but they also perceived the former as “better organized.”ConclusionHospital-based electronic START triage had the same accuracy as hospital-based manual START triage, regardless of triage provider type or acuity of patient presentations. Time of triage results suggest that speed may be related to provider familiarity with a modality rather than the modality itself. Finally, according to patient and provider perceptions, electronic triage is a feasible modality for hospital triage of mass casualties. Further studies are required to assess the performance of electronic hospital triage, in the context of a rapid surge of patients, and should consider additional efficiencies built in to electronic triage systems. This study presents a framework for assessing the accuracy, triage time, and feasibility of digital technologies in live simulation training or actual MCIs.BolducC, MaghrabyN, FokP, LuongTM, HomierV. Comparison of electronic versus manual mass-casualty incident triage. Prehosp Disaster Med. 2018;33(3):273–278.

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 Practicing Mass Casualty Scenarios: Experience From a Developing Level 1 Trauma Center in the Himalayan Foothills

2020 ◽  
pp. 1-6
Author(s):  
Md Quamar Azam ◽  
Mahesh Devasthale ◽  
Chandu Raj B ◽  
Ajay Kumar ◽  
Bhaskar Sarkar ◽  
...  
Keyword(s):  
Trauma Center ◽  
Trauma Surgery ◽  
Mass Casualty ◽  
Low Resource Settings ◽  
Low Resource ◽  
Natural Beauty ◽  
Increased Risk ◽  
Himalayan Foothills ◽  
Level 1 ◽  
Level 1 Trauma Center

ABSTRACT Objective: Uttarakhand is an Indian state in the Himalayan foothills, a favored adventure destination in the country due to abundant natural beauty. However, the terrain has also conferred an increased risk of earthquakes, flash floods, and major road tragedies, resulting in as many as 8 major natural disasters in the state in the preceding 20 years. AIIMS Rishikesh, an autonomous central institute, has been entrusted to build a Level 1 Trauma Center in Uttarakhand, which would help improve the response, coordination, and hence outcome in mass casualty scenarios (MCSs). Methods: As a step toward the achievement of this larger goal, a workshop on MCS and management was conducted by the Department of Trauma Surgery in collaboration with Rambam Hospital, Haifa. We hereby present our template for conducting MCS drills in low resource settings like ours and the lessons learnt. Results: Process, logistics, limitations, workforce, scheduling, overview, and report of the MCS drill conducted are discussed hereafter. Conclusion: This template may be replicated by hospitals that intend to conduct similar MCS drills in low resource settings, realizing the real threat of MCS occurrence in our country at anytime.

First Responder Accuracy Using SALT during Mass-casualty Incident Simulation

2016 ◽  
Vol 31 (2) ◽  
pp. 150-154 ◽  
Author(s):  
Christopher W.C. Lee ◽  
Shelley L. McLeod ◽  
Kristine Van Aarsen ◽  
Michelle Klingel ◽  
Jeffrey M. Franc ◽  
...  
Keyword(s):  
Primary Care ◽  
Motor Vehicle ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Medical Attention ◽  
First Responder ◽  
Publication Type ◽  
Fire Science ◽  
Significant Difference ◽  
Second Year

AbstractIntroductionDuring mass-casualty incidents (MCIs), patient volume often overwhelms available Emergency Medical Services (EMS) personnel. First responders are expected to triage, treat, and transport patients in a timely fashion. If other responders could triage accurately, prehospital EMS resources could be focused more directly on patients that require immediate medical attention and transport.HypothesisTriage accuracy, error patterns, and time to triage completion are similar between second-year primary care paramedic (PCP) and fire science (FS) students participating in a simulated MCI using the Sort, Assess, Life-saving interventions, Treatment/Transport (SALT) triage algorithm.MethodsAll students in the second-year PCP program and FS program at two separate community colleges were invited to participate in this study. Immediately following a 30-minute didactic session on SALT, participants were given a standardized briefing and asked to triage an eight-victim, mock MCI using SALT. The scenario consisted of a four-car motor vehicle collision with each victim portrayed by volunteer actors given appropriate moulage and symptom coaching for their pattern of injury. The total number and acuity of victims were unknown to participants prior to arrival to the mock scenario.ResultsThirty-eight PCP and 29 FS students completed the simulation. Overall triage accuracy was 79.9% for PCP and 72.0% for FS (∆ 7.9%; 95% CI, 1.2-14.7) students. No significant difference was found between the groups regarding types of triage errors. Over-triage, under-triage, and critical errors occurred in 10.2%, 7.6%, and 2.3% of PCP triage assignments, respectively. Fire science students had a similar pattern with 15.2% over-triaged, 8.7% under-triaged, and 4.3% critical errors. The median [IQR] time to triage completion for PCPs and FSs were 142.1 [52.6] seconds and 159.0 [40.5] seconds, respectively (P=.19; Mann-Whitney Test).ConclusionsPrimary care paramedics performed MCI triage more accurately than FS students after brief SALT training, but no difference was found regarding types of error or time to triage completion. The clinical importance of this difference in triage accuracy likely is minimal, suggesting that fire services personnel could be considered for MCI triage depending on the availability of prehospital medical resources and appropriate training.LeeCWC, McLeodSL, Van AarsenK, KlingelM, FrancJM, PeddleMB. First responder accuracy using SALT during mass-casualty incident simulation. Prehosp Disaster Med. 2016;31(2):150–154.

Wound patterns in survivors of modern firearm related civilian Mass Casualty Incidents

2019 ◽  
Vol 14 (3) ◽  
pp. 175-180
Author(s):  
Chase Knickerbocker, MS ◽  
Mario F. Gomez, DO ◽  
Jose Lozada, MD ◽  
Jonathan Zadeh, MD ◽  
Eugene Costantini, MD ◽  
...  
Keyword(s):  
Trauma Center ◽  
Multidisciplinary Approach ◽  
Mass Casualty ◽  
Medical Examiner ◽  
Fatality Rate ◽  
Mass Shootings ◽  
Fort Lauderdale ◽  
Mass Shooting ◽  
Level 1 ◽  
Level 1 Trauma Center

Background: Civilian mass shooting events (CMSE) are occurring with increased frequency. Unfortunately, our knowledge of how to respond to these events is largely based on military experience and medical examiner data. While this translational knowledge has improved our basic response to such events, it is critical that we have a better understanding of the wound patterns observed and the resources utilized in civilian mass shootings. This will allow us to better prepare our systems for future events.Methods: Patients from two consecutive CMSEs presented to the same level 1 trauma center in Fort Lauderdale, Florida. The patients received by this center were studied for their wound patterns as well as the care they received while in the hospital. This included wound patterns and severity, subspecialty interventions, and hospitalization requirements.Results: Both events produced a total of 19 victims who were brought to the center as trauma activations. The events had a combined fatality rate of 55 percent. Fifty-five percent of patients also had at least one wound to an extremity, two with major vascular injuries who had field tourniquets applied. Sixty-three percent required an orthopedic intervention and 32 percent required intensive care unit (ICU) admission, half of these with prolonged ventilator support.Conclusions: Given the number of extremity wounds in these events, we should continue the efforts championed by the stop the bleed campaign. The variety and quantity of specialties involved in the care of these patients also highlights the importance of a multidisciplinary approach to preparation and implementation of care in mass shooting events.

Introduction of Pediatric Physiological and Anatomical Triage Score in Mass-Casualty Incident

2018 ◽  
Vol 33 (2) ◽  
pp. 147-152 ◽  
Author(s):  
Chiaki Toida ◽  
Takashi Muguruma ◽  
Takeru Abe ◽  
Mafumi Shinohara ◽  
Masayasu Gakumazawa ◽  
...  
Keyword(s):  
Predictive Value ◽  
Characteristic Curve ◽  
Retrospective Chart Review ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Publication Type ◽  
Revised Trauma Score ◽  
Sensitivity Specificity ◽  
Trauma Score ◽  
Accuracy Of Prediction

AbstractBackgroundTriage has an important role in providing suitable care to the largest number of casualties in a disaster setting, but there are no secondary triage methods suitable for children. This study developed a new secondary triage method named the Pediatric Physiological and Anatomical Triage Score (PPATS) and compared its accuracy with current triage methods.MethodsA retrospective chart review of pediatric patients under 16 years old transferred to an emergency center from 2014 to 2016 was performed. The PPATS categorized the patients, defined the intensive care unit (ICU)-indicated patients if the category was highest, and compared the accuracy of prediction of ICU-indicated patients among PPATS, Physiological and Anatomical Triage (PAT), and Triage Revised Trauma Score (TRTS).ResultsAmong 137 patients, 24 (17.5%) were admitted to ICU. The median PPATS score of these patients was significantly higher than that of patients not admitted to ICU (11 [IQR: 9-13] versus three [IQR: 2-4]; P<.001). The optimal cut-off value of the PPTAS was six, yielding a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 95.8%, 86.7%, 60.5%, and 99.0%. The area under the receiver-operating characteristic curve (AUC) was larger for PPTAS than for PAT or TRTS (0.95 [95% CI, 0.87-1.00] versus 0.65 [95% CI, 0.58-0.72]; P<.001 and 0.79 [95% CI, 0.69-0.89]; P=.003, respectively). Regression analysis showed a significant association between the PPATS and the predicted mortality rate (r2=0.139; P<.001), ventilation time (r2=0.320; P<.001), ICU stay (r2=0.362; P<.001), and hospital stay (r2=0.308; P<.001).ConclusionsThe accuracy of PPATS was superior to other methods for secondary triage of children.ToidaC, MugurumaT, AbeT, ShinoharaM, GakumazawaM, YogoN, ShirasawaA, MorimuraN. Introduction of pediatric physiological and anatomical triage score in mass-casualty incident. Prehosp Disaster Med. 2018;33(2):147–152.

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