scholarly journals Confusion, Chaos, and Bridging the Gap: A Prospective Study Gauging Disaster Triage Methodologies and Usage Across First Responder Professions

2019 ◽  
Vol 34 (s1) ◽  
pp. s111-s111
Author(s):  
Brenna Adelman
Keyword(s):  
National Policy ◽  
First Responders ◽  
The United States ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Future Research ◽  
Field Triage ◽  
Mass Casualty Event ◽  
A Prospective Study ◽  
National Trends

Introduction:Disasters are unique in that they impact all socioeconomic, class, and social divides. They are complex, hard to conceptualize and operationally define, and occur sporadically without warning. However, regardless of each disasters innate unpredictability, there is one common need that directly impacts patient morbidity and mortality: effective triage.Aim:Currently the United States has no uniform triage mandate. The purpose of this study is to gather descriptive data on the type of mass-casualty triage currently being utilized by first responders (Emergency Medical Services/Fire/Nurses) and improve our understanding regarding the prevalence of mass casualty triage.Methods:A descriptive mixed methods survey is being distributed to first responders/nurses in the Appalachian region. This survey collects respondents demographics, profession, and MCI triage data. Data will be analyzed and descriptive statistics will be generated. GIS will be utilized to graph findings and visualize local and national trends.Results:Results of this study are pending.Discussion:Organizations have addressed the need for a standard triage protocol, even going so far as to create uniform criteria which each triage system should meet. However, the literature does not describe how individual professions train their members in disaster triage, or what triage is currently being utilized in each profession. Nurses and first-responders serve as linchpins in many communities. They remain in a community, both before, during, and after a mass casualty event, but they do not perform in a vacuum. During an MCI (mass-casualty incident) their scope of practice may vary, but they have common foci: the affected community. A better understanding of the type of MCI triage that each profession is using is vital in understanding how triage is being applied, and vital in identifying gaps in application that may impact the effectiveness of field triage, and affect local and national policy, practice, and future research.

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.

Mass Casualty Triage: An Evaluation of the Science and Refinement of a National Guideline

2011 ◽  
Vol 5 (2) ◽  
pp. 129-137 ◽  
Author(s):  
E. Brooke Lerner ◽  
David C. Cone ◽  
Eric S. Weinstein ◽  
Richard B. Schwartz ◽  
Phillip L. Coule ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
The United States ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
National Guideline ◽  
Public Health Preparedness ◽  
The Core ◽  
Individual Assessment ◽  
Triage Category

ABSTRACTMass casualty triage is the process of prioritizing multiple victims when resources are not sufficient to treat everyone immediately. No national guideline for mass casualty triage exists in the United States. The lack of a national guideline has resulted in variability in triage processes, tags, and nomenclature. This variability has the potential to inject confusion and miscommunication into the disaster incident, particularly when multiple jurisdictions are involved. The Model Uniform Core Criteria for Mass Casualty Triage were developed to be a national guideline for mass casualty triage to ensure interoperability and standardization when responding to a mass casualty incident. The Core Criteria consist of 4 categories: general considerations, global sorting, lifesaving interventions, and individual assessment of triage category. The criteria within each of these categories were developed by a workgroup of experts representing national stakeholder organizations who used the best available science and, when necessary, consensus opinion. This article describes how the Model Uniform Core Criteria for Mass Casualty Triage were developed.(Disaster Med Public Health Preparedness. 2011;5:129-137)

Local Disasters, Government Actors, and National Policy

2020 ◽  
pp. 1-11
Author(s):  
Timothy W. Kneeland
Keyword(s):  
New York ◽  
Emergency Management ◽  
Federal Government ◽  
National Policy ◽  
The United States ◽  
Local Leadership ◽  
Disaster Policy ◽  
National Trends ◽  
Disaster Aid

This introductory chapter provides an overview of Hurricane Agnes, which swept through New York and Pennsylvania in late June of 1972. National trends influenced the federal and local response to the disaster. Hurricane Agnes struck the United States less than five months before the 1972 presidential election, and Richard Nixon's response to Hurricane Agnes was one variable in that election, which charted the course of American politics for the next three decades. In order to win reelection in 1972, President Nixon enacted the most substantial disaster aid package in history to that time, termed the Agnes Recovery Act, which he was convinced was the key to winning New York and Pennsylvania. The chapter then explains that local leaders played a crucial role in responding to the crisis in their communities and in flood recovery operations and rebuilding. Often neglected in studies of natural disaster policy is the way in which local leadership from government and the private sector interacted with representatives of the federal government to restore order and implement change. The chapter also introduces the Federal Office of Emergency Management (FEMA).

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 Methodologies Utilized and Lessons Learned in High Threat Environments and Mass Casualty Environments.

2019 ◽  
pp. 1-7
Author(s):  
Andrew Bennett
Keyword(s):  
First Responders ◽  
The United States ◽  
Mass Casualty ◽  
Lessons Learned ◽  
Great Opportunity ◽  
Special Operations ◽  
Innovative Products ◽  
High Threat ◽  
Austere Environments ◽  
Learn Network

In May 2019, the author was awarded the Australian Tactical Medical Association (ATMA) study grant to attend the Special Operations Medicine Scientific Assembly (SOMSA) 2019 in Charlotte, North Carolina in the United States of America. Whilst in the U.S. the author had the opportunity to hear many talks, attend labs and talk to many first responders in high threat and austere environments to learn about how they operate, and the lessons learned from their experiences. This report highlights the two objectives of the study grant: Record the key content and lessons learned by attendance at SOMSA 2019. Discuss techniques utilized and lessons learned by first responders operating in high threat environments and mass casualty incidents. The SOMSA brings together many like-minded pre-hospital, tactical, wilderness, austere, disaster and deployed medicine operators from all around the world to share their learnings with a primary goal to advance the art and science of special operations medical care. It is a great opportunity for military and civilian providers to learn, network and engage with industry partners showcasing innovative products and technology.

Abstract 248: National Trends in Utilization and Economic Outcomes of Catheter Ablation for Atrial Fibrillation in the United States 2003-2008

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Anant Mandawat ◽  
Aditya Mandawat ◽  
Rama Mandawat ◽  
Mahendra Mandawat
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Clinical Outcomes ◽  
The United States ◽  
Economic Outcomes ◽  
Future Research ◽  
The Us ◽  
Comorbidity Index ◽  
The Mean ◽  
National Trends

Introduction: Data on the utilization and economic outcomes of catheter ablation in atrial fibrillation (AF) is scarce, limiting the ability to make informed policy decisions. Hypothesis: We hypothesized that the number of catheter ablations for AF increased while length of stay and charges decreased. Methods: Patients > 18 years undergoing catheter ablation for AF were selected in the 2003-2008 HCUP-Nationwide Inpatient Sample, the largest all-payor inpatient database in the US. Patient demographic and clinical variables, including a Charlson comorbidity index, as well as hospital characteristics were analyzed. We calculated trends in rates of utilization, economic (mean LOS and total inflation-adjusted charges) and clinical (in-hospital mortality and in-hospital complications, defined using ICD-9 codes) outcomes using χ 2 , Mantel-Haenszel tests, and analysis of variance (ANOVA). Results: There were 40,145 admissions for catheter ablation for AF (mean age 60.01 years (SD 11.74; Range 18-98). The number of ablations increased by nearly 300% between 2003 and 2008 (Table). A comparison of use rates between 2003-2005 (early) vs 2006-2008 (late) showed a higher utilization among patients aged 65-79 (27.3% vs 34.0%), those with moderate comorbidities (30.3% vs 46.3%), and medium-sized hospitals (9.8% vs 19.7%), all p<0.001. During the study period, the mean LOS decreased by 30% while inflation-adjusted charges increased by 25% (Table). There was no significant change in clinical outcomes (Table). Conclusions: The number of catheter ablations for AF has increased rapidly. Although the procedure is being applied to a broader patient population and being performed in smaller-sized hospitals, LOS has decreased and clinical outcomes are stable. Factors contributing to and strategies to limit rising charges for this expanding procedure are important areas of future research.

Field Triage and Patient Maldistribution in a Mass-Casualty Incident

2007 ◽  
Vol 22 (3) ◽  
pp. 224-229 ◽  
Author(s):  
Richard M. Zoraster ◽  
Cathy Chidester ◽  
William Koenig
Keyword(s):  
Los Angeles ◽  
Prehospital Care ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Trauma Centers ◽  
Community Hospitals ◽  
Center Staff ◽  
Field Triage ◽  
Number Of Patients ◽  
To Receive

AbstractIntroduction:Management of mass-casualty incidents should optimize outcomes by appropriate prehospital care, and patient triage to the most capably facilities. The number of patients, the nature of injuries, transportation needs, distances, and hospital capabilities and availabilities are all factors to be considered. Patient maldistributions such as overwhelming individual facilities, or transport to facilities incapable of providing appropriate care should be avoided. This report is a critical view of the application of the START triage nomenclature in the prehospital arena following a train crash in Los Angeles County on 26 January 2005.Methods:A scheduled debriefing was held with the major fire and emergency medical services responders, Medical Alert Center staff, and hospitals to assess and review the response to the incident. Site visits were made to all of the hospitals involved. Follow-up questions were directed to emergency department staff that were on duty during the day of the incident.Results:The five Level-I Trauma Centers responded to the poll with the capacity to receive a total of 12 “Immediate” patients, 2.4 patients per center, the eight Level-II Trauma Centers responded with capacity to receive 17 “Immediate” patients, two patients per center, while the 25 closest community hospitals offered to accept 75 “Immediate” patients, three patients per hospital. These community hospitals were typically about one-half of the size of the trauma centers (average 287 beds versus 548, average 8.7 operating rooms versus 16.6). Twenty-six patients were transported to a community hospital >15 miles from the scene, while eight closer community hospitals did not receive any patients.Conclusions:The debriefing summary of this incident concluded that there were no consistently used criteria to decide ultimate destination for “Immediates”, and that they were distributed about equally between community hospitals and trauma centers.

Mechanical ventilation in disaster situations: A new paradigm using the AGILITIES Score System

2010 ◽  
Vol 5 (6) ◽  
pp. 369-384 ◽  
Author(s):  
Eric P. Wilkens, MD, MPH ◽  
Gary M. Klein, MD, MPH, MBA
Keyword(s):  
Mechanical Ventilation ◽  
Hurricane Katrina ◽  
The United States ◽  
Mass Casualty ◽  
Government Agencies ◽  
Critical Systems ◽  
New Paradigm ◽  
Mechanical Ventilators ◽  
Use Of Resources ◽  
Mass Casualty Event

Background: The failure of life-critical systems such as mechanical ventilators in the wake of a pandemic or a disaster may result in death, and therefore, state and federal government agencies must have precautions in place to ensure availability, reliability, and predictability through comprehensive preparedness and response plans.Methods: All 50 state emergency preparedness response plans were extensively examined for the attention given to the critically injured and ill patient population during a pandemic or mass casualty event. Public health authorities of each state were contacted as well.Results: Nine of 51 state plans (17.6 percent) included a plan or committee for mechanical ventilation triage and management in a pandemic influenza event. All 51 state plans relied on the Centers for Disease Control and Prevention Flu Surge 2.0 spreadsheet to provide estimates for their influenza planning. In the absence of more specific guidance, the authors have developed and provided guidelines recommended for ventilator triage and the implementation of the AGILITIES Score in the event of a pandemic, mass casualty event, or other catastrophic disaster.Conclusions: The authors present and describe the AGILITIES Score Ventilator Triage System and provide related guidelines to be adopted uniformly by government agencies and hospitals.This scoring system and the set of guidelines are to be used in disaster settings, such as Hurricane Katrina, and are based on three key factors: relative health, duration of time on mechanical ventilation, and patients’ use of resources during a disaster. For any event requiring large numbers of ventilators for patients, the United States is woefully unprepared. The deficiencies in this aspect of preparedness include (1) lack of accountability for physical ventilators, (2) lack of understanding with which healthcare professionals can safely operate these ventilators, (3) lack of understanding from where additional ventilator resources exist, and (4) a triage strategy to provide ventilator support to those patients with the greatest chances of survival.

Mechanical ventilation in disaster situations: A new paradigm using the AGILITIES Score System

2019 ◽  
Vol 14 (4) ◽  
pp. 311-326
Author(s):  
Eric P. Wilkens, MD, MPH ◽  
Gary M. Klein, MD, MPH, MBA
Keyword(s):  
Mechanical Ventilation ◽  
Hurricane Katrina ◽  
The United States ◽  
Mass Casualty ◽  
Government Agencies ◽  
Critical Systems ◽  
New Paradigm ◽  
Mechanical Ventilators ◽  
Use Of Resources ◽  
Mass Casualty Event

Background: The failure of life-critical systems such as mechanical ventilators in the wake of a pandemic or a disaster may result in death, and therefore, state and federal government agencies must have precautions in place to ensure availability, reliability, and predictability through comprehensive preparedness and response plans.Methods: All 50 state emergency preparedness response plans were extensively examined for the attention given to the critically injured and ill patient population during a pandemic or mass casualty event. Public health authorities of each state were contacted as well.Results: Nine of 51 state plans (17.6 percent) included a plan or committee for mechanical ventilation triage and management in a pandemic influenza event. All 51 state plans relied on the Centers for Disease Control and Prevention Flu Surge 2.0 spreadsheet to provide estimates for their influenza planning. In the absence of more specific guidance, the authors have developed and provided guidelines recommended for ventilator triage and the implementation of the AGILITIES Score in the event of a pandemic, mass casualty event, or other catastrophic disaster.Conclusions: The authors present and describe the AGILITIES Score Ventilator Triage System and provide related guidelines to be adopted uniformly by government agencies and hospitals. This scoring system and the set of guidelines are to be used in disaster settings, such as Hurricane Katrina, and are based on three key factors: relative health, duration of time on mechanical ventilation, and patients’ use of resources during a disaster. For any event requiring large numbers of ventilators for patients, the United States is woefully unprepared. The deficiencies in this aspect of preparedness include (1) lack of accountability for physical ventilators, (2) lack of understanding with which healthcare professionals can safely operate these ventilators, (3) lack of understanding from where additional ventilator resources exist, and (4) a triage strategy to provide ventilator support to those patients with the greatest chances of survival.

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