scholarly journals From intensive care to step-down units: Managing patients throughput in response to COVID-19

2020 ◽  
Author(s):  
Vanni AGNOLETTI ◽  
Emanuele RUSSO ◽  
Alessandro CIRCELLI ◽  
Marco BENNI ◽  
Giuliano BOLONDI ◽  
...  
Keyword(s):  
Intensive Care ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Lessons Learned ◽  
Initial Assessment ◽  
Admission Rates ◽  
Hospitalization Rates ◽  
System Collapse ◽  
Step Down ◽  
Critical Patients

Abstract Quality problem or issue The on-going COVID-19 pandemic may cause the collapse of healthcare systems because of unprecedented hospitalization rates. Initial assessment A total of 8.2 individuals per 1000 inhabitants have been diagnosed with COVID-19 in our province. The hospital predisposed 110 beds for COVID-19 patients: on the day of the local peak, 90% of them were occupied and intensive care unit (ICU) faced unprecedented admission rates, fearing system collapse. Choice of solution Instead of increasing the number of ICU beds, the creation of a step-down unit (SDU) close to the ICU was preferred: the aim was to safely improve the transfer of patients and to relieve ICU from the risk of overload. Implementation A nine-bed SDU was created next to the ICU, led by intensivists and ICU nurses, with adequate personal protective equipment, monitoring systems and ventilators for respiratory support when needed. A second six-bed SDU was also created. Evaluation Patients were clinically comparable to those of most reports from Western Countries now available in the literature. ICU never needed supernumerary beds, no patient died in the SDU, and there was no waiting time for ICU admission of critical patients. SDU has been affordable from human resources, safety and economic points of view. Lessons learned COVID-19 is like an enduring mass casualty incident. Solutions tailored on local epidemiology and available resources should be implemented to preserve the efficiency and adaptability of our institutions and provide the adequate sanitary response.

The potential benefits of enzymatic debridement in multi-casualty burns incidents

Trauma ◽  
2021 ◽  
pp. 146040862110025
Author(s):  
John Kiely ◽  
Ibrahim Natalwala ◽  
Joseph Stallard ◽  
Orla Austin ◽  
Umair Anwar ◽  
...  
Keyword(s):  
Intensive Care ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Burn Wound ◽  
Post Injury ◽  
Wound Debridement ◽  
Potential Benefits ◽  
Goal Directed Fluid Therapy ◽  
Male Patients ◽  
Enzymatic Debridement

Bromelain-based enzymatic debridement (ED) is a topical treatment that is growing in popularity for the non-surgical management of burn wounds. Although initially used for small injuries, experience has grown in using it for burns >15% Total Burns Surface Area (TBSA). A household explosion resulted in burns to multiple patients, with four requiring burn wound debridement. This case report demonstrates their management using ED. Four adult male patients were treated with ED, mean age 38.4 years. Their injuries ranged from 5–24% TBSA (mean 14.9%), with a high proportion of intermediate-deep dermal injury to their faces and limbs. Our centre has performed enzymatic debridement since 2016 and all senior burns surgeons and burns intensive care specialists in the team are experienced in its use. We perform enzymatic debridement using Nexobrid™ (Mediwound Ltd., Israel). Three patients were managed on a single theatre list, using ED for their burns at 19, 16 and 23 hours post-injury. One patient had ED of his injuries on intensive care at 18 hours. Patients with >15% TBSA were treated in a critical care setting with goal directed fluid therapy. Through the use of enzymatic debridement we were able to achieve burn debridement for four patients in under 24 hours. While not a true mass casualty incident, our experience suggests that for an appropriately resourced service it is likely to have advantages in this scenario. We suggest that burns services regularly using this technique consider inclusion into mass casualty protocols, with training to staff to enable provision in such an incident.

scholarly journals Kuala Lumpur train collision during the COVID-19 pandemic

2022 ◽  
Vol 17 (1) ◽  
Author(s):  
Alzamani M. Idrose ◽  
Fikri M. Abu-Zidan ◽  
Nurul Liana Roslan ◽  
Khairul Izwan M. Hashim ◽  
Saiyidi Mohd Azizi Mohd Adibi ◽  
...  
Keyword(s):  
Hospital Management ◽  
Standard Operating Procedure ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Base Station ◽  
Lessons Learned ◽  
Kuala Lumpur ◽  
Disaster Plan ◽  
Incident Command ◽  
Green Zone

Abstract Background Two city trains collided in an underground tunnel on 24 May 2021 at the height of COVID-19 pandemic near the Petronas Towers, Kuala Lumpur, Malaysia, immediately after the evening rush hours. We aim to evaluate the management of this mass casualty incident highlighting the lessons learned to be used in preparedness for similar incidents that may occur in other major cities worldwide. Methods Information regarding incident site and hospital management response were analysed. Data on demography, triaging, injuries and hospital management of patients were collected according to a designed protocol. Challenges, difficulties and their solutions were reported. Results The train's emergency response team (ERT) has shut down train movements towards the incident site. Red zone (in the tunnel), yellow zone (the station platform) and green zone (outside the station entrance) were established. The fire and rescue team arrived and assisted the ERT in the red zone. Incident command system was established at the site. Medical base station was established at the yellow zone. Two hundred and fourteen passengers were in the trains. Sixty-four of them were injured. They had a median (range) ISS of 2 (1–43), and all were sent to Hospital Kuala Lumpur (HKL). Six (9.4%) patients were clinically triaged as red (critical), 19 (29.7%) as yellow (semi-critical) and 39 (60.9%) as green (non-critical). HKL's disaster plan was activated. All patients underwent temperature and epidemiology link assessment. Seven (10.9%) patients were admitted to the hospital (3 to the ICU, 3 to the ward and 1 to a private hospital as requested by the patient), while the rest 56 (87.5%) were discharged home. Six (9.4%) needed surgery. The COVID-19 tests were conducted on seven patients (10.9%) and were negative. There were no deaths. Conclusions The mass casualty incident was handled properly because of a clear standard operating procedure, smooth coordination between multi-agencies and the hospitals, presence of a 'binary' system for 'COVID-risk' and 'non-COVID-risk' areas, and the modifications of the existing disaster plan. Preparedness for MCIs is essential during pandemics.

Leadership as a Component of Crowd Control in a Hospital Dealing with a Mass-Casualty Incident: Lessons Learned from the October 2000 Riots in Nazareth

2007 ◽  
Vol 22 (6) ◽  
pp. 522-526 ◽  
Author(s):  
Moshe Pinkert ◽  
Yuval Bloch ◽  
Dagan Schwartz ◽  
Isaac Ashkenazi ◽  
Bishara Nakhleh ◽  
...  
Keyword(s):  
Emergency Services ◽  
Hospital Management ◽  
Hospital Staff ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Management Control ◽  
Lessons Learned ◽  
Great Effort ◽  
Public Health Agencies ◽  
Crowd Control

AbstractIntroduction:Crowd control is essential to the handling of mass-casualty incidents (MCIs).This is the task of the police at the site of the incident. For a hospital, responsibility falls on its security forces, with the police assuming an auxiliary role. Crowd control is difficult, especially when the casualties are due to riots involving clashes between rioters and police. This study uses data regarding the October 2000 riots in Nazareth to draw lessons about the determinants of crowd control on the scene and in hospitals.Methods:Data collected from formal debriefings were processed to identify the specifics of a MCI due to massive riots. The transport of patients to the hospital and the behavior of their families were considered.The actions taken by the Hospital Manager to control crowds on the hospital premises also were analyzed.Results:During 10 days of riots (01–10 October 2000), 160 casualties, including 10 severely wounded, were evacuated to the Nazareth Italian Hospital. The Nazareth English Hospital received 132 injured patients, including one critically wounded, nine severely wounded, 26 moderately injured, and 96 mildly injured. All victims were evacuated from the scene by private vehicles and were accompanied by numerous family members. This obstructed access to hospitals and hampered the care of the casualties in the emergency department. The hospital staff was unable to perform triage at the emergency department's entrance and to assign the wounded to immediate treatment areas or waiting areas. All of the wounded were taken by their families directly into the “immediate care” location where a great effort was made to prioritize the severely injured. In order to control the events, the hospital's managers enlisted prominent individuals within the crowds to aid with control. At one point, the mayor was enlisted to successfully achieve crowd control.Conclusions:During riots, city, community, and even makeshift leaders within a crowd can play a pivotal role in helping hospital management control crowds. It may be advisable to train medical teams and hospital management to recognize potential leaders, and gain their cooperation in such an event. To optimize such cooperation, community leaders also should be acquainted with the roles of public health agencies and emergency services systems.

scholarly journals The pan-London intensive care burden of a mass casualty incident (7 July 2005)

Injury Extra ◽  
2007 ◽  
Vol 38 (4) ◽  
pp. 117-118
Author(s):  
K. Fong ◽  
J. Lohn ◽  
P. Ward ◽  
P. Shirley ◽  
M. Healey ◽  
...  
Keyword(s):  
Intensive Care ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Care Burden

scholarly journals Association of Intravenous Bamlanivimab Use with Reduced Hospitalization, Intensive Care Unit Admission, and Mortality in Patients with Mild to Moderate COVID-19

2021 ◽  
Author(s):  
Ravindra Ganesh ◽  
Colin Pawlowski ◽  
John C O'Horo ◽  
Lori L Arndt ◽  
Richard Arndt ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
High Risk ◽  
Intensive Care Unit Admission ◽  
Mayo Clinic ◽  
Admission Rates ◽  
Hospitalization Rates ◽  
Risk Characteristics ◽  
All Cause Mortality ◽  
Risk Patients

Background: Clinical data to support the use of bamlanivimab for the treatment of outpatients with mild to moderate coronavirus disease-19 (COVID-19) is needed. Methods: 2,335 patients who received single-dose bamlanivimab infusion between November 12, 2020 to February 17, 2021 were compared with a propensity-matched control of 2,335 untreated patients with mild to moderate COVID-19 at Mayo Clinic facilities across 4 states. The primary outcome was the rate of hospitalization at days 14, 21 and 28. Results: The median age of the population was 63; 47.3% of the bamlanivimab-treated cohort were ≥65 years; 49.3% were female. High-risk characteristics included hypertension (54.2%), body mass index ≥35 (32.4%), diabetes mellitus (26.5%), chronic lung disease (25.1%), malignancy (16.6%), and renal disease (14.5%). Patients who received bamlanivimab had lower all-cause hospitalization rates at days 14 (1.5% vs 3.5%; Odds Ratio [OR], 0.38), 21 (1.9% vs 3.9%; OR, 0.46), and 28 (2.5% vs 3.9%; OR, 0.61). Secondary exploratory outcomes included lower intensive care unit admission rates at days 14 (0.14% vs 1%; OR, 0.12), 21 (0.25% vs 1%; OR: 0.24) and 28 (0.56% vs 1.1%; OR: 0.52), and lower all-cause mortality at days 14 (0% vs 0.33%), 21 (0.05% vs 0.4%; OR,0.08) and 28 (0.11% vs 0.44%; OR, 0.01). Adverse events were uncommon with bamlanivimab, occurring in 19/2355, most commonly fever (n=6), nausea (n=5), and lightheadedness (n=3). Conclusions: Among high-risk patients with mild to moderate COVID-19, treatment with bamlanivimab was associated with a statistically significant lower rate of hospitalization compared with usual care. Funding: Mayo Clinic. 

Distribution of Casualties in a Mass-Casualty Incident with Three Local Hospitals in the Periphery of a Densely Populated Area: Lessons Learned from the Medical Management of a Terrorist Attack

2007 ◽  
Vol 22 (3) ◽  
pp. 186-192 ◽  
Author(s):  
Yuval H. Bloch ◽  
Dagan Schwartz ◽  
Moshe Pinkert ◽  
Amir Blumenfeld ◽  
Shkolnick Avinoam ◽  
...  
Keyword(s):  
Medical Management ◽  
Terrorist Attack ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Lessons Learned ◽  
Suicide Bombing ◽  
Populated Area ◽  
Medical Response ◽  
Ambulance Dispatch ◽  
To Receive

AbstractIntroduction:A mass-casualty incident (MCI) can occur in the periphery of a densely populated area, away from a metropolitan area. In such circumstances, the medical management of the casualties is expected to be difficult because the nearest hospital and the emergency medical services (EMS), only can offer limited resources.When coping with these types of events (i.e., limited medical capability in the nearby medical facilities), a quick response time and rational triage can have a great impact on the outcome of the victims. The objective of this study was to identify the lessons learned from the medical response to a terrorist attack that occurred on 05 December 2005, in Netanya, a small Israeli city.Methods:Data were collected during and after the event from formal debriefings and from patient files. The data were processed using descriptive statistics and compared to those from previous events. The event is described according to Disastrous Incidents Systematic Analysis Through Components, Interactions, Results (DISAST-CIR) methodology.Results:Four victims and the terrorist died as a result of this suicide bombing. A total of 131 patients were evacuated (by EMS or self-evacuation) to three nearby hospitals. Due to the proximity of the event to the ambulance dispatch station, the EMS response was quick.The first evacuation took place only three minutes after the explosion. Non-urgent patients were diverted to two close-circle hospitals, allowing the nearest hospital to treat urgent patients and to receive the majority of self-evacuated patients. The nearest hospital continued to receive patients for >6 hours after the explosion, 57 of them (78%) were self-evacuated.Conclusion:The distribution of casualties from the scene plays a vital role in the management of a MCI that occurs in the outskirts of a densely populated area.Non-urgent patients should be referred to a hospital close to the scene of the event, but not the closest hospital.The nearest hospital should be prepared to treat urgent casualties, as well as a large number of self-evacuated patients.

Postextubation Dysphagia in Critical Patients: A First Report From the Largest Step-Down Intensive Care Unit in Greece

2016 ◽  
Vol 25 (2) ◽  
pp. 150-156 ◽  
Author(s):  
Georgia A. Malandraki ◽  
Vasiliki Markaki ◽  
Voula C. Georgopoulos ◽  
Loukia Psychogios ◽  
Serafim Nanas
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
First Report ◽  
Step Down ◽  
Critical Patients

Securing the Emergency Department During Terrorism Incidents: Lessons Learned From the Boston Marathon Bombings

2019 ◽  
Vol 13 (4) ◽  
pp. 791-798 ◽  
Author(s):  
Horacio Hojman ◽  
Rishi Rattan ◽  
Rob Osgood ◽  
Mengdi Yao ◽  
Nikolay Bugaev
Keyword(s):  
Emergency Department ◽  
The United States ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Lessons Learned ◽  
Morbidity And Mortality ◽  
Policy Changes ◽  
Near Misses ◽  
Boston Marathon ◽  
Health Care Law

ABSTRACTTerrorist incidents that target hospitals magnify morbidity and mortality. Before a real or perceived terrorist mass casualty incident threatens a hospital and its providers, it is essential to have protocols in place to minimize damage to the infrastructure, morbidity, and mortality. In the years following the Boston Marathon bombings, much has been written about the heroic efforts of survivors and responders. Far less has been published about near misses due to lack of experience responding to a mass casualty incident resulting from terrorism. After an extensive review of the medical literature and published media in English, Spanish, and Hebrew, we were unable to identify a similar event. To the best of our knowledge, this is the first reported experience of a bomb threat caused evacuation of an emergency department in the United States while actively responding to multiple casualty terrorist incidents. We summarized the chronology of the events that led to a bomb threat being identified and the subsequent evacuation of the emergency department. We then reviewed the problematic nature of our response and described evidence-based policy changes based on data from health care, law enforcement, and counterterrorism. (Disaster Med Public Health Preparedness. 2019;13:791–798)

Reconsidering Policy of Casualty Evacuation in a Remote Mass-Casualty Incident

2013 ◽  
Vol 29 (1) ◽  
pp. 91-95 ◽  
Author(s):  
Bruria Adini ◽  
Robert Cohen ◽  
Elon Glassberg ◽  
Bella Azaria ◽  
Daniel Simon ◽  
...  
Keyword(s):  
Injury Severity ◽  
Life Support ◽  
Tertiary Care ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Lessons Learned ◽  
Care Hospital ◽  
Publication Type ◽  
Local Hospital ◽  
Trauma Surgeons

AbstractObjectivesInappropriate distribution of casualties in mass-casualty incidents (MCIs) may overwhelm hospitals. This study aimed to review the consequences of evacuating casualties from a bus accident to a single peripheral hospital and lessons learned regarding policy of casualty evacuation.MethodsMedical records of all casualties relating to evacuation times, injury severity, diagnoses, treatments, resources utilized and outcomes were independently reviewed by two senior trauma surgeons. In addition, four senior trauma surgeons reviewed impact of treatment provided on patient outcomes. They reviewed the times for the primary and secondary evacuation, injury severity, diagnoses, surgical treatments, resources utilized, and the final outcomes of the patients at the point of discharge from the tertiary care hospital.ResultsThirty-one survivors were transferred to the closest local hospital; four died en route to hospital or within 30 minutes of arrival. Twenty-seven casualties were evacuated by air from the local hospital within 2.5 to 6.15 hours to Level I and II hospitals. Undertriage of 15% and overtriage of seven percent were noted. Four casualties did not receive treatment that might have improved their condition at the local hospital.ConclusionsIn MCIs occurring in remote areas, policy makers should consider revising the current evacuation plan so that only immediate unstable casualties should be transferred to the closest primary hospital. On site Advanced Life Support (ALS) should be administered to non-severe casualties until they can be evacuated directly to tertiary care hospitals. First responders must be trained to provide ALS to non-severe casualties until evacuation resources are available.AdiniB, CohenR, GlassbergE, AzariaB, SimonD, SteinM, KleinY, PelegK. Reconsidering policy of casualty evacuation in a remote mass-casualty incident. Prehosp Disaster Med. 2013;28(6):1-5.

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