scholarly journals The Trifecta of Tele-Critical Care: Intrahospital, Operational, and Mass Casualty Applications

2021 ◽  
Vol 186 (Supplement_1) ◽  
pp. 253-260
Author(s):  
Kristina M Ieronimakis ◽  
Christopher J Colombo ◽  
Justin Valovich ◽  
Mark Griffith ◽  
Konrad L Davis ◽  
...  
Keyword(s):  
Critical Care ◽  
Health Agency ◽  
Mass Casualty ◽  
Lessons Learned ◽  
Mass Casualties ◽  
Field Hospital ◽  
Care Services ◽  
Mass Casualty Events ◽  
Simulation Scenario ◽  
Field Exercise

ABSTRACT Introduction Tele-critical care (TCC) has improved outcomes in civilian hospitals and military treatment facilities (MTFs). Tele-critical care has the potential to concurrently support MTFs and operational environments and could increase capacity and capability during mass casualty events. TCC services distributed across multiple hub sites may flexibly adapt to rapid changes in patient volume and complexity to fully optimize resources. Given the highly variable census in MTF intensive care units (ICU), the proposed TCC solution offers system resiliency and redundancy for garrison, operational, and mass casualty needs, while also maximizing return on investment for the Defense Health Agency. Materials and Methods The investigators piloted simultaneous TCC support to the MTF during three field exercises: (1) TCC concurrently monitored the ICU during a remote mass casualty exercise: the TCC physician monitored a high-risk ICU patient while the nurse monitored 24 simulated field casualties; (2) TCC concurrently monitored the garrison ICU and a remote military medical field exercise: the physician provided tele-mentoring during prolonged field care for a simulated casualty, and the nurse provided hospital ICU TCC; (3) the TCC nurse simultaneously monitored the ICU while providing reach-back support to field hospital nurses training in a simulation scenario. Results TCC proved feasible during multiple exercises with concurrent tele-mentoring to different care environments including physician and nurse alternating operational and hospital support roles, and an ICU nurse managing both simultaneously. ICU staff noted enhanced quality and safety of bedside care. Field exercise participants indicated TCC expanded multipatient monitoring during mass casualties and enhanced novice caregiver procedural capability and scope of patient complexity. Conclusions Tele-critical care can extend critical care services to anywhere at any time in support of garrison medicine, operational medicine, and mass casualty settings. An interoperable, flexibly staffed, and rapidly expandable TCC network must be further developed given the potential for large casualty volumes to overwhelm a single TCC provider with multiple duties. Lessons learned from development of this capability should have applicability for managing military and civilian mass casualty events.

First Responder Psychological Recovery Following a Mass Casualty Event

2017 ◽  
pp. 143-157
Author(s):  
Sara Garrido ◽  
John Nicoletti
Keyword(s):  
Psychological Impact ◽  
Crisis Response ◽  
Mass Casualty ◽  
Lessons Learned ◽  
Trauma Recovery ◽  
Community Members ◽  
Mass Casualty Events ◽  
Columbine High School ◽  
Crime Scene Investigators ◽  
The Impact

Mass Casualty Events (MCE) have an extraordinary impact on an entire community. The impact on victims' families, survivors, and community members is often the subject of significant attention; however, rarely does the impact on first responders (law enforcement officers, firefighters, dispatchers, crime scene investigators/photographers, etc.) garner the same coverage. Additionally, agencies can quickly become overwhelmed by the magnitude of the response causing them to overlook the psychological impact of these incidents on their personnel. Serving as specialists in police and public safety psychology, crisis intervention, and trauma recovery, the authors reflect on lessons learned from their response to multiple MCEs, including the 1999 Columbine High School shooting and the 2012 Aurora Century 16 Theater shooting, and offer recommendations to agencies regarding crisis response and trauma recovery.

Global responsibility in mass casualty events: The Israeli experience in Japan

2012 ◽  
Vol 7 (1) ◽  
pp. 61-64 ◽  
Author(s):  
Ofer Merin, MD ◽  
Nehemia Blumberg, MD ◽  
David Raveh, MD ◽  
Ariel Bar, MD ◽  
Masafumi Nishizawa, MD ◽  
...  
Keyword(s):  
Humanitarian Aid ◽  
Mass Casualty ◽  
Minimal Access ◽  
Field Hospital ◽  
Referral Center ◽  
Global Responsibility ◽  
Mass Casualty Events ◽  
Regional Referral Center ◽  
Israeli Experience

Objective: To describe humanitarian aid following the 2011 earthquake and tsunami in Japan.Setting: A field hospital deployed in a small Japanese coastal village devastated by a major tsunami.Patients: Thousands of Japanese refugees with minimal access to medical care.Results: After well-coordinated diplomatic efforts, our medical delegation was the first foreign team to deploy in Japan. Our facility served as a regional referral center for specialized medical treatment.Conclusions: Following major disasters, even highly modernized countries will face an urgent surge in the need of medical resources.These situations emphasize the need for global responsibility to provide assistance.

(A285) Hospital Preparation for Mass Casualty Events

2011 ◽  
Vol 26 (S1) ◽  
pp. s79-s79
Author(s):  
G. Margalit
Keyword(s):  
National Level ◽  
Task Assignment ◽  
Emergency Situation ◽  
Hospital Staff ◽  
Mass Casualty ◽  
Mass Casualties ◽  
Trauma Patients ◽  
Industrial Accidents ◽  
Car Accidents ◽  
Mass Casualty Events

BackgroundHospitals handle numerous tasks whose fundamental purpose is to provide medical treatment. Amongst these, the hospital prepares for the treatment of trauma patients who have been involved in car accidents, injuries at work and industrial accidents. These preparations, although part of the operative conventions of the hospital, do not guarantee the ability to handle Mass Casualty Events which require unique and dedicated preparation and a different operational approach. This paper presents the hospital approach of handling Emergency Mass Casualty Events.The ApproachThe preparations require involvement of a national level that must participate in the definition of the activities, task assignment and preparation of an annual plan. The peak of the preparations is a multidisciplinary drill, implemented as part of the annual activity of the hospital.The ImplementationIn an emergency situation, the aim is for the hospital staff to be capable of providing its patients (and family members) the best professional care in any given scenario. To achieve the above, the hospital is required to perform the following tasks: Defining procedures, personnel training, logistics infrastructure, control, drills and lesson learned implementation. The tasks should be performed under a multi-annual plan that covers various Mass Casualties Events scenarios including: a train accident, an event involving dangerous industrial materials (e.g. ammonia spill), biological scenarios (e.g. bird-flu) and radiation events (e.g. nuclear reaction).ConclusionsOnly precise preparations, disconnected completely from the on-going hospital routine can answer the need to handle Mass Casualties Events.

scholarly journals Mass casualty events: what to do as the dust settles?

2018 ◽  
Vol 3 (1) ◽  
pp. e000210 ◽  
Author(s):  
Rachel M Russo ◽  
Joseph M Galante ◽  
John B Holcomb ◽  
Warren Dorlac ◽  
Jason Brocker ◽  
...  
Keyword(s):  
Panel Discussion ◽  
Trauma Team ◽  
Mass Casualty ◽  
Lessons Learned ◽  
Detention Center ◽  
Plane Crash ◽  
Mass Casualty Events ◽  
Boston Marathon Bombing ◽  
Mass Casualty Event ◽  
Boston Marathon

Care during mass casualty events (MCE) has improved during the last 15 years. Military and civilian collaboration has led to partnerships which augment the response to MCE. Much has been written about strategies to deliver care during an MCE, but there is little about how to transition back to normal operations after an event. A panel discussion entitled The Day(s) After: Lessons Learned from Trauma Team Management in the Aftermath of an Unexpected Mass Casualty Event at the 76th Annual American Association for the Surgery of Trauma meeting on September 13, 2017 brought together a cadre of military and civilian surgeons with experience in MCEs. The events described were the First Battle of Mogadishu (1993), the Second Battle of Fallujah (2004), the Bagram Detention Center Rocket Attack (2014), the Boston Marathon Bombing (2013), the Asiana Flight 214 Plane Crash (2013), the Baltimore Riots (2015), and the Orlando Pulse Night Club Shooting (2016). This article focuses on the lessons learned from military and civilian surgeons in the days after MCEs.

Terrorism in France

2003 ◽  
Vol 18 (2) ◽  
pp. 92-99 ◽  
Author(s):  
Pierre Carli ◽  
Caroline Telion ◽  
David Baker
Keyword(s):  
Emergency Response ◽  
Life Support ◽  
Mass Casualty ◽  
Lessons Learned ◽  
National Plan ◽  
Medical Response ◽  
Emergency Medical ◽  
Mass Casualty Events ◽  
Psychological Assistance ◽  
Key Aspects

AbstractFrance has experienced two waves of major terrorist bombings since 1980. In the first wave (1985–1986), eight bombings occurred in Paris, killing 13 and injuring 281. In the second wave (1995–1996), six bombings occurred in Paris and Lyon, killing 10 and injuring 262. Based on lessons learned during these events, France has developed and improved a sophisticated national system for prehospital emergency response to conventional terrorist attacks based on its national emergency medical services (EMS) system, Service d' Aide Medicale Urgente (SAMU). According to the national plan for the emergency medical response to mass-casualty events (White Plan), the major phases of EMS response are: (1) alert; (2) search and rescue; (3) triage of victims and provision of critical care to first priority victims; (4) regulated dispatch of victims to hospitals; and (5) psychological assistance.Following the 1995 Tokyo subway sarin attack, a national plan for the emergency response to chemical and biological events (PIRATOX) was implemented. In 2002, the Ministries of Health and the Interior collaborated to produce a comprehensive national plan (BIOTOX) for the emergency response to chemical, biological, radiological, and nuclear events. Key aspects of BIOTOX are the prehospital provision of specialized advance life support for toxic injuries and the protection of responders in contaminated environments. BIOTOX was successfully used during the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak in France.

Specialized retrieval systems

2016 ◽  
Keyword(s):  
Critical Care ◽  
Medical Care ◽  
Emergency Response ◽  
Disaster Response ◽  
Country Of Origin ◽  
Mass Casualty ◽  
Medical Emergency ◽  
Retrieval Systems ◽  
Mass Casualty Events ◽  
Care Response

Civilian and military retrieval services commonly respond to mass casualty events and international disasters. It is necessary to adapt usual practices to achieve the most for many. The structures, systems, language, and discipline take on a military flavour in civilian disaster response. This brings some order to the chaos and facilitates multiagency cooperation. Triage, treatment, and transport must occur in unfavourable environments. This is exemplified in military scenarios where there is ongoing risk to casualties and retrieval teams. Medical care provided by retrieval teams will depend on risk and resources. Staged retrieval may be required. This is also the case with civilian international retrieval where the patient may be transferred to an intermediate destination facility for immediate care, before being repatriated to their country of origin. Also included, is a section on medical emergency response teams which provide a critical care response to deteriorating patients in a hospital ward setting.

scholarly journals Healthcare under siege: a qualitative study of health-worker responses to targeting and besiegement in Syria

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e029651 ◽  
Author(s):  
Nasser Fardousi ◽  
Yazan Douedari ◽  
Natasha Howard
Keyword(s):  
Qualitative Study ◽  
Health Worker ◽  
Resource Constraints ◽  
Health Workers ◽  
Resource Conservation ◽  
Mass Casualty ◽  
Health Facilities ◽  
Mass Casualties ◽  
Emotional Resilience ◽  
Mass Casualty Events

ObjectivesTo explore health-worker perspectives on security, improving safety, managing constrained resources and handling mass casualties during besiegement in Syria.DesignA qualitative study using semi-structured key informant interviews, conducted remotely over WhatsApp and Skype, and analysed thematically using inductive coding.SettingSecondary and tertiary health facilities affected by besiegement in Aleppo (from July to December 2016) and Rural Damascus (from August 2013 to February 2018).ParticipantsTwenty-one male Syrian health-workers and service-users who had experienced besiegement and targeting of their health facilities.ResultsParticipants described four related challenges of: (i) conflict-related responses, particularly responding to mass casualties; (ii) targeted attack responses, particularly preventing/surviving facility bombings; (iii) besiegement responses, particularly mitigating severe resource constraints; and (iv) chronic risk responses, particularly maintaining emotional resilience. Mass casualty response involved triage and training to prioritise mortality reduction and available resources, for example those with greatest need and likelihood of survival. Targeting response was largely physical, including fortification, working underground, reducing visibility and services dispersal. Besiegement response required resource conservation, for example, controlling consumption, reusing consumables, low-technology equipment, finding alternative supply routes, stockpiling and strengthening available human resources through online trainings and establishing a medical school in Ghouta. Risk responses included managing safety worries, finding value in work and maintaining hope.ConclusionBesieged health-workers were most affected by severe resource constraints and safety concerns while responding to overwhelming mass casualty events. Lessons for targeting/besiegement planning include training staff and preparing for: (i) mass casualties, through local/online health-worker training in triage, emergency response and resource conservation; allowing task-shifting; and providing access to low-technology equipment; (ii) attacks, through strengthened facility security, for example, protection and deterrence through fortification, working underground and reducing visibility; and (iii) besiegement, through ensuring access to internet, electricity and low-technology/reusable equipment; securely stockpiling fuel, medicines and supplies; and establishing alternative supply routes.

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