scholarly journals Disaster and Mass Casualty Incident Responses by Doctor Car

2019 ◽  
Vol 34 (s1) ◽  
pp. s121-s121
Author(s):  
Masamune Kuno ◽  
Kensuke Suzuki ◽  
Kyoko Unemoto ◽  
Takashi Tagami ◽  
Fumihiko Nakayama ◽  
...  
Keyword(s):  
Medical Care ◽  
Prehospital Care ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Medical Team ◽  
First Case ◽  
The Disabled ◽  
Care Systems ◽  
Prehospital Medical Care ◽  
Under Construction

Introduction:Ambulances with physicians, known as Doctor Car, and Tokyo DMAT are the two prehospital care systems responsible for medical team dispatch in the Tokyo area. While there are 25 designated hospitals for DMAT, Doctor Car is only available at four hospitals. Our hospital incorporates both systems. While the prehospital care system must be utilized at the time of disaster, Doctor Car was dispatched 418 times in 2017, and the use of DMAT is less than ten times per year.Aim:To review the past disaster responses of our hospital.Methods:The study reviews three cases where our hospital responded to mass casualty incidents and disasters with either Doctor Car or DMAT. The first case was the treatment of crush syndrome caused by a collapsed parking slope. It took more than 24 hours for the rescue, in which the team treated patients during transport and at the hospital. The second case was our response to a mass stabbing incident committed at a facility for the disabled. In collaboration with the onsite rescue team, we conducted triage, hemostasis, transfusion, etc. The third case was caused by a fire in a building under construction. We provided treatments like triage and tracheal intubation on the spot.Results:Because paramedics are allowed to conduct only a limited amount of treatments, dispatch of the medical team to the site is effective.Discussion:For a medical team to be effective at the dispatched site, the team must be accustomed not only to the specific need of medical care during disasters but also prehospital medical care, which may include the abilities to ensure safety during transport and on-site and adapt to the prehospital environment. Doctor Car is a useful way to realize such abilities.

Managing a Mass CO Poisoning: Critical Issues and Solutions From the Field to the Hyperbaric Chamber

2016 ◽  
Vol 11 (2) ◽  
pp. 251-255 ◽  
Author(s):  
Adriano Valerio ◽  
Matteo Verzè ◽  
Francesco Marchiori ◽  
Igor Rucci ◽  
Lucia De Santis ◽  
...  
Keyword(s):  
Emergency Department ◽  
Carbon Monoxide ◽  
Emergency Services ◽  
Carbon Monoxide Poisoning ◽  
Heating System ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Accidental Poisoning ◽  
Complex Situation ◽  
First Case

AbstractCarbon monoxide acute intoxication is a common cause of accidental poisoning in industrialized countries and sometimes it produces a real mass casualty incident. The incident described here occurred in a church in the province of Verona, when a group of people was exposed to carbon monoxide due to a heating system malfunction. Fifty-seven people went to the Emergency Department. The mean carboxyhemoglobin (COHb) level was 10.1±5.7% (range: 3-25%). The clinicians, after medical examination, decided to move 37 patients to hyperbaric chambers for hyperbaric oxygen (HBO) therapy. This is the first case report that highlights and analyses the logistic difficulties of managing a mass carbon monoxide poisoning in different health care settings, with a high influx of patients in an Emergency Department and a complex liaison between emergency services. This article shows how it is possible to manage a complex situation with good outcome. (Disaster Med Public Health Preparedness. 2017;11:251–255)

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.

Refining Surge Capacity: Conventional, Contingency, and Crisis Capacity

2009 ◽  
Vol 3 (S1) ◽  
pp. S59-S67 ◽  
Author(s):  
John L. Hick ◽  
Joseph A. Barbera ◽  
Gabor D. Kelen
Keyword(s):  
Health Care ◽  
Medical Care ◽  
Care Facility ◽  
Health Care Facility ◽  
Standard Of Care ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Health Care Facilities ◽  
Surge Capacity ◽  
Care Facilities

ABSTRACTHealth care facility surge capacity has received significant planning attention recently, but there is no commonly accepted framework for detailed, phased surge capacity categorization and implementation. This article proposes a taxonomy within surge capacity of conventional capacity (implemented in major mass casualty incidents and representing care as usually provided at the institution), contingency capacity (using adaptations to medical care spaces, staffing constraints, and supply shortages without significant impact on delivered medical care), and crisis capacity (implemented in catastrophic situations with a significant impact on standard of care). Suggested measurements used to gauge a quantifiable component of surge capacity and adaptive strategies for staff and supply challenges are proposed. The use of refined definitions of surge capacity as it relates to space, staffing, and supply concerns during a mass casualty incident may aid phased implementation of surge capacity plans at health care facilities and enhance the consistency of terminology and data collection between facilities and regions. (Disaster Med Public Health Preparedness. 2009;3(Suppl 1):S59–S67)

scholarly journals A systematic review of ePCR systems on reducing the response time of prehospital medical care

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 1209
Author(s):  
ALI JASBI ◽  
Saravanan Muthaiyah ◽  
Thein Oak Kyaw Zaw
Keyword(s):  
Systematic Review ◽  
Response Time ◽  
Medical Care ◽  
Prehospital Care ◽  
Considerable Proportion ◽  
Healthcare Organisation ◽  
Care Services ◽  
Prehospital Medical Care ◽  
Actual Response ◽  
The Impact

Background Poor communication at the time of patient handover is recognized as a root cause of a considerable proportion of preventable deaths. Despite several advantages, the Patient Care Report (PCR) implementation may include insufficient details for demonstrating the functional status of the patients during the actual response which can further prolong the response time. Healthcare entities have been emphasizing the need to implement e-PCR systems. This systematic review aimed to examine the impact of e-PCR systems on reducing response time of prehospital care. Methods Literature search was carried out using the relevant search terms and keywords with inclusion and exclusion criteria. N=6 researchers that focused on the impact of e-PCR systems on reducing response time of prehospital medical care were included within this review. Results The findings indicated that ePCR implementation led to prominent improvements in the quality of the care services provided by the healthcare organisation. Additionally, ePCR reduces the response rate by data standardization. Conclusion The implementation of e-PCR systems ensures the availability of records and automates reporting on given quality metrics. Moreover, the implementation of e-PCR systems also improved response time and increased the out of hospital rates of survival. However, fear of increasing the ambulance run time, compromise on the availability of ambulance, and challenges in integration with the existing information systems implemented within the hospitals, were some of the most common challenging situations associated with implementing e-PCR systems.

Infectious safety of patients in the provision of prehospital care for burns

2020 ◽  
pp. 71-75
Author(s):  
Marina Dmitryeva
Keyword(s):  
Medical Care ◽  
Prehospital Care ◽  
Medical Professionals ◽  
Emergency Medical Care ◽  
Emergency Medical

The article describes the measures taken by medical professionals of emergency medical care to observe infectious safety of patients in the provision of pre-medical care in case of burns.

scholarly journals Prehospital identification of Covid-19: an observational study

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Douglas Spangler ◽  
Hans Blomberg ◽  
David Smekal
Keyword(s):  
Predictive Value ◽  
Prehospital Care ◽  
The Novel ◽  
Test Results ◽  
Care Providers ◽  
Care Systems ◽  
Primary Hospital ◽  
Novel Coronavirus ◽  
Rule Out ◽  
Descriptive Statistical Analysis

Abstract Background The novel coronavirus disease 2019 (Covid-19) pandemic has affected prehospital care systems across the world, but the prehospital presentation of affected patients and the extent to which prehospital care providers are able to identify them is not well characterized. In this study, we describe the presentation of Covid-19 patients in a Swedish prehospital care system, and asses the predictive value of Covid-19 suspicion as documented by dispatch and ambulance nurses. Methods Data for all patients with dispatch, ambulance, and hospital records between January 1–August 31, 2020 were extracted. A descriptive statistical analysis of patients with and without hospital-confirmed Covid-19 was performed. In a subset of records beginning from April 14, we assessed the sensitivity and specificity of documented Covid-19 suspicion in dispatch and ambulance patient care records. Results A total of 11,894 prehospital records were included, of which 481 had a primary hospital diagnosis code related to-, or positive test results for Covid-19. Covid-19-positive patients had considerably worse outcomes than patients with negative test results, with 30-day mortality rates of 24% vs 11%, but lower levels of prehospital acuity (e.g. emergent transport rates of 14% vs 22%). About half (46%) of Covid-19-positive patients presented to dispatchers with primary complaints typically associated with Covid-19. Six thousand seven hundred seventy-six records were included in the assessment of predictive value. Sensitivity was 76% (95% CI 71–80) and 82% (78–86) for dispatch and ambulance suspicion respectively, while specificities were 86% (85–87) and 78% (77–79). Conclusions While prehospital suspicion was strongly indicative of hospital-confirmed Covid-19, based on the sensitivity identified in this study, prehospital suspicion should not be relied upon as a single factor to rule out the need for isolation precautions. The data provided may be used to develop improved guidelines for identifying Covid-19 patients in the prehospital setting.

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.

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