Emergency Preparedness amongst Health Professionals for a Mass Casualty Incident (MCI) in the State of Assam, India

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.

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An armed assailant in our hospital: Are we prepared?

Annals of the Academy of Medicine, Singapore ◽

10.47102/annals-acadmedsg.2021225 ◽

2021 ◽

Vol 50 (9) ◽

pp. 712-716

Author(s):

Sohil Pothiawala ◽

Rabind Charles ◽

Wai Kein Chow ◽

Kheng Wee Ang ◽

Karen Hsien Ling Tan ◽

...

Keyword(s):

Emergency Preparedness ◽

Hospital Setting ◽

Mass Casualty Incident ◽

Mass Casualty ◽

Incident Response ◽

Potential Threat ◽

Healthcare Facilities ◽

Response Strategies ◽

Hospital Preparedness ◽

Response Plan

ABSTRACT While armed assailant attacks are rare in the hospital setting, they pose a potential risk to healthcare staff, patients, visitors and the infrastructure. Singapore hospitals have well-developed disaster plans to respond to a mass casualty incident occurring outside the hospital. However, lack of an armed assailant incident response plan can significantly reduce the hospital’s ability to appropriately respond to such an incident. The authors describe various strategies that can be adopted in the development of an armed assailant incident response plan. Regular staff training will increase staff resilience and capability to respond to a potential threat in the future. The aim of this article is to highlight the need for the emergency preparedness units of all hospitals to work together with various stakeholders to develop an armed assailant incident response plan. This will be of great benefit for keeping healthcare facilities safe, both for staff as well as for the community. Keywords: Armed assailant, hospital, preparedness, response, strategies

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Maintaining Preparedness to Severe Though Infrequent Threats—Can It Be Done?

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17072385 ◽

2020 ◽

Vol 17 (7) ◽

pp. 2385

Author(s):

Maya Siman-Tov ◽

Benny Davidson ◽

Bruria Adini

Keyword(s):

Emergency Preparedness ◽

Geographical Location ◽

Evaluation Process ◽

Mass Casualty Incident ◽

Mass Casualty ◽

Medical Facilities ◽

Potential Risks ◽

The Impact ◽

And Training ◽

Secondary Contamination

Background: A mass casualty incident (MCI) caused by toxicological/chemical materials constitutes a potential though uncommon risk that may cause great devastation. Presentation of casualties exposed to such materials in hospitals, if not immediately identified, may cause secondary contamination resulting in dysfunction of the emergency department. The study examined the impact of a longitudinal evaluation process on the ongoing emergency preparedness of hospitals for toxicological MCIs, over a decade. Methods: Emergency preparedness for toxicological incidents of all Israeli hospitals were periodically evaluated, over ten years. The evaluation was based on a structured tool developed to encourage ongoing preparedness of Standard Operating Procedures (SOPs), equipment and infrastructure, knowledge of personnel, and training and exercises. The benchmarks were distributed to all hospitals, to be used as a foundation to build and improve emergency preparedness. Scores were compared within and between hospitals. Results: Overall mean scores of emergency preparedness increased over the five measurements from 88 to 95. A significant increase between T1 (first evaluation) and T5 (last evaluation) occurred in SOPs (p = 0.006), training and exercises (p = 0.003), and in the overall score (p = 0.004). No significant changes were found concerning equipment and infrastructure and knowledge; their scores were consistently very high throughout the decade. An interaction effect was found between the cycles of evaluation and the hospitals’ geographical location (F (1,20) = 3.0, p = 0.056), proximity to other medical facilities (F (1,20) = 10.0 p = 0.005), and type of area (Urban vs. Periphery) (F (1,20) = 13.1, p = 0.002). At T5, all hospitals achieved similar high scores of emergency preparedness. Conclusions: Use of accessible benchmarks, which clearly delineate what needs to be continually implemented, facilitates an ongoing sustenance of effective levels of emergency preparedness. As this was demonstrated for a risk that does not frequently occur, it may be assumed that it is possible and practical to achieve and maintain emergency preparedness for other potential risks.

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(A108) Hospital Disaster Planning: The Structured Approach

Prehospital and Disaster Medicine ◽

10.1017/s1049023x11001105 ◽

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.

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Die a Hero or Live Long Enough to Become the Villain: Mass Casualty Preparedness in Hospitals and Protecting Doctors from Liability during Mass Casualty Events

Journal of Biosecurity Biosafety and Biodefense Law ◽

10.1515/jbbbl-2015-0010 ◽

2015 ◽

Vol 6 (1) ◽

Author(s):

Ashley Tseung

Keyword(s):

Public Health ◽

United States ◽

Emergency Preparedness ◽

Preventive Measures ◽

The United States ◽

Mass Casualty Incident ◽

Mass Casualty ◽

Public Health Emergency ◽

Terrorist Attacks ◽

Mass Casualty Events

AbstractSince 9/11, the United States and the international community have emphasized the need to protect people from terrorist attacks. The Boston Bombing that took place on April 15, 2013, showed that even with all of the preventive measures in place, the United States is not immune from terrorist attacks. If there had been a bioterrorist attack in Boston instead of a homemade bomb, the amount of casualties would likely have been a lot higher. Many hospitals lack effective emergency preparedness plans that address bioterrorist attacks. One area that will help prepare nations during a mass casualty incident or public health emergency involves implementing effective mass casualty preparedness plans for hospitals. This paper analyzes mass casualty preparedness in hospitals and demonstrates the need to have legislation in place to protect doctors who treat patients during mass casualty events.

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Mass-casualty Response to the Kiss Nightclub in Santa Maria, Brazil

Prehospital and Disaster Medicine ◽

10.1017/s1049023x14001368 ◽

2014 ◽

Vol 30 (1) ◽

pp. 93-96 ◽

Cited By ~ 9

Author(s):

Silvana T. Dal Ponte ◽

Carlos F. D. Dornelles ◽

Bonnie Arquilla ◽

Christina Bloem ◽

Patricia Roblin

Keyword(s):

Disaster Preparedness ◽

Disaster Response ◽

Mass Casualty Incident ◽

Mass Casualty ◽

The State ◽

Capital City ◽

Smoke Inhalation ◽

Publication Type ◽

Incident Command ◽

Santa Maria

AbstractOn January 27, 2013, a fire at the Kiss Nightclub in Santa Maria, Brazil led to a mass-casualty incident affecting hundreds of college students. A total of 234 people died on scene, 145 were hospitalized, and another 623 people received treatment throughout the first week following the incident.1 Eight of the hospitalized people later died.1 The Military Police were the first on scene, followed by the state fire department, and then the municipal Mobile Prehospital Assistance (SAMU) ambulances. The number of victims was not communicated clearly to the various units arriving on scene, leading to insufficient rescue personnel and equipment. Incident command was established on scene, but the rescuers and police were still unable to control the chaos of multiple bystanders attempting to assist in the rescue efforts. The Municipal Sports Center (CDM) was designated as the location for dead bodies, where victim identification and communication with families occurred, as well as forensic evaluation, which determined the primary cause of death to be asphyxia. A command center was established at the Hospital de Caridade Astrogildo de Azevedo (HCAA) in Santa Maria to direct where patients should be admitted, recruit staff, and procure additional supplies, as needed. The victims suffered primarily from smoke inhalation and many required endotracheal intubation and mechanical ventilation. There was a shortage of ventilators; therefore, some had to be borrowed from local hospitals, neighboring cities, and distant areas in the state. A total of 54 patients1 were transferred to hospitals in the capital city of Porto Alegre (Brazil). The main issues with the response to the fire were scene control and communication. Areas for improvement were identified, namely the establishment of a disaster-response plan, as well as regularly scheduled training in disaster preparedness/response. These activities are the first steps to improving mass-casualty responses.Dal PonteST, DornellesCFD, ArquillaB, BloemC, RoblinP. Mass-casualty response to the Kiss Nightclub in Santa Maria, Brazil. Prehosp Disaster Med. 2015;30(1):1-4.

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747 Developing a Burn Mass Casualty Incident (BMCI) Plan for a State (first Steps)

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.329 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S206-S206

Author(s):

Randy D Kearns ◽

Kathryn Mai ◽

Paige B Hargrove ◽

Tracee Short ◽

Chris W Hector ◽

...

Keyword(s):

Planning Process ◽

Burn Injury ◽

Trigger Point ◽

Extended Period ◽

Mass Casualty Incident ◽

Mass Casualty ◽

The State ◽

Disaster Plan ◽

Burn Centers ◽

Burn Center

Abstract Introduction A burn mass casualty incident (BMCI) occurs when a disaster involves many injured patients who have specific burn injuries. For this particular state, there are four burn centers. They range in size from 4–20 beds. The area hazards include: Methods A meeting was arranged for the burn center directors. Burn surgeons, along with burn center nursing staff, evaluated a series of “predefined patients” distributed over a compressed timeline during the hourlong exercise. The participants had not previously seen the “patients” nor were they aware of their injuries until the exercise controller released the information. The exercise controller was provided by a state emergency response coordination agency. The exercise followed a meeting that discussed efforts to standardize emergency medical services (EMS) care in the state, and route burn patients through the state call center to the most appropriate burn center. The final hour of the morning focused on the tabletop exercise, followed by a “hot-wash” (debriefing). Results The scenario included 20 patients staggered over the morning with each surgeon considering capacity and capability to manage the theoretical patients who ranged in age from 1 month to 81 years old (Median 24, Mean 28.2) with a TBSA range of 0 to 73 (Median 6, Mean 12.85). There were 4/20 patients intubated on arrival, and an additional 7/16 had “soot tinged sputum.” 16/20 arrived by EMS. Assuming this was a Type III Burn Disaster (meaning burn event only), all four burn center directors reported under ideal circumstances; they could absorb these patients into their respective hospital systems. However, it was also clear that while all could admit, sustaining all of these patients over an extended period may be problematic and potentially require a transfer. It was also discussed that had the severity of burn injury changed for two or more patients, it could have led to exceeding the capability/capacity for most of the burn centers. Conclusions The key to this event was to identify a trigger point for each facility. Every disaster plan requires a trigger or triggers meaning an activation point to begin treating an event based on their BMCI (or burn surge) plan. The next logical step in this process is to analyze further the capabilities and capacities that will inform the planning process as it evolves. Applicability of Research to Practice A working BMCI plan could improve resource utilization during disasters.

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Triage and resource allocation during crisis medical surge conditions (pandemics and mass casualty situations)

Christian Journal for Global Health ◽

10.15566/cjgh.v7i1.387 ◽

2020 ◽

Vol 7 (1) ◽

pp. 45-55

Author(s):

Paul Hoehner ◽

David H. Beyda ◽

William P. Cheshire ◽

Robert E. Cranston ◽

John T. Dunlop ◽

...

Keyword(s):

Resource Allocation ◽

Medical Association ◽

Health Professionals ◽

Task Force ◽

Position Statement ◽

Mass Casualty ◽

Medical Conditions ◽

Direct Response ◽

Allied Health Professionals ◽

A Current

The Christian Medical and Dental Associations (CMDA) was founded in 1931 and is made up of the Christian Medical Association (CMA) and the Christian Dental Association (CDA). CMDA has a current membership of over 19,000 physicians, dentists, and other allied health professionals. During and in direct response to the pressing urgencies of the COVID-19 universal pandemic of 2020 the President of CMDA commissioned a special task force to provide current and future Christian reflection and guidance on triage and resource allocation policies during pandemics and other forms of crisis surge medical conditions (e.g., mass casualty situations). This is a condensed version of the CMDA special task force position statement.

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