Trauma, Teams, and Telemedicine: Evaluating Telemedicine and Teamwork in a Mass Casualty Simulation

2021 ◽  
Vol 186 (7-8) ◽  
pp. e811-e818
Author(s):  
Ashley M Hughes ◽  
Shirley C Sonesh ◽  
Rachel E Mason ◽  
Megan E Gregory ◽  
Antonio Marttos ◽  
...  
Keyword(s):  
Psychological Safety ◽  
Mass Casualty ◽  
High Stakes ◽  
Care Plans ◽  
Mass Casualty Events ◽  
Training Event ◽  
Potential Benefits ◽  
Negative Impacts ◽  
Trauma Teams ◽  
Surgical Teams

Abstract Introduction Mass casualty events (MASCAL) are on the rise globally. Although natural disasters are often unavoidable, the preparation to respond to unique patient demands in MASCAL can be improved. Utilizing telemedicine can allow for a better response to such disasters by providing access to a virtual team member with necessary specialized expertise. The purpose of this study was to examine the positive and/or negative impacts of telemedicine on teamwork in teams responding to MASCAL events. Methods We introduced a telemedical device (DiMobile Care) to Forward Surgical Teams during a MASCAL simulated training event. We assessed teamwork-related attitudes, behaviors, and cognitions during the MASCAL scenario through pre-post surveys and observations of use. Analyses compare users and nonusers of telemedicine and pre-post training differences in teamwork. Results We received 50 complete responses to our surveys. Overall, clinicians have positive reactions toward the potential benefits of telemedicine; further, participants report a significant decrease in psychological safety after training, with users rating psychological safety as significantly higher than non-telemedicine users. Neither training nor telemedicine use produced significant changes in cognitive and behavioral-based teamwork. Nonetheless, participants reported perceiving that telemedicine improved leadership and adaptive care plans. Conclusions Telemedicine shows promise in connecting Forward Surgical Teams with nuanced surgical expertise without harming quality of care metrics (i.e., teamwork). However, we advise future iterations of DiMobile Care and other telemedical devices to consider contextual features of information flow to ensure favorable use by teams in time-intensive, high-stakes environments, such as MASCAL.

scholarly journals Team trust and performance in pediatric trauma

2020 ◽  
Vol 9 (1) ◽  
pp. 93-97
Author(s):  
Sarah Coppola ◽  
Kristen Webster ◽  
Ayse Gurses
Keyword(s):  
Team Learning ◽  
Pediatric Trauma ◽  
Psychological Safety ◽  
Pediatric Intensive Care ◽  
Child Life ◽  
High Stakes ◽  
Targeted Interventions ◽  
And Performance ◽  
Trauma Teams ◽  
Team Trust

Pediatric trauma cases involve multiple healthcare workers and a complicated coordination of care. The differing roles and changing hospital schedules means that trauma teams are constantly changing and each trauma case may involve a new team. Trust in these dynamic, high stakes environment is important for team performance. A survey on team trust, psychological safety, and team learning behavior was circulated by email to all roles that respond to the highest level trauma at a large, Midatlantic, level 1 pediatric trauma center. Seventy-seven participants responded and represented the emergency department, pediatric intensive care unit, surgery, respiratory therapy, pharmacy, technician, child life, social work, and spiritual care. The respondents generally scored high on measures of psychological safety; however, the majority (69%) did not agree that it was safe to take a risk on the team. Similarly, the respondents scored high on measures of team trust. Measures of team learning varied with the majority responding neither agree nor disagree on “In this team, someone always makes sure that we stop to reflect on the team's work process,” “People in this team often speak up to test assumptions about issues under discussion,” and “We invite people from outside the team to present information or have discussions with us”. The results show that these responses also vary by role and home department, but these differences were not statistically significant. Understanding current perceptions of team trust and learning will allow for targeted interventions to improve team communication and performance in pediatric trauma.

US Army split forward surgical team management of mass casualty events in Afghanistan: Surgeon performed triage results in excellent outcomes

2009 ◽  
Vol 4 (6) ◽  
pp. 321-329 ◽  
Author(s):  
Shawn C. Nessen, DO, FACS ◽  
Daniel R. Cronk, MD ◽  
Jason Edens, MD ◽  
Brian J. Eastridge, MD, FACS ◽  
Lorne H. Blackbourne, MD, FACS
Keyword(s):  
Injury Severity ◽  
Surgical Care ◽  
Injured Patient ◽  
Mass Casualty ◽  
Trauma Patients ◽  
Us Army ◽  
Institutional Review ◽  
Mass Casualty Events ◽  
Admission Data ◽  
Surgical Teams

Objective: US Army “split” forward surgical teams (FST) currently provide most of the resuscitative surgical care for combat patients in Afghanistan. These small units typically comprised 10 personnel and two surgeons each, who frequently encounter mass casualty (MASCAL) situations in geographically isolated regions. This article evaluates the effectiveness of one split FST managing 43 MASCAL situations in two separate locations for more than a 14-month period in Afghanistan.Design: An Institutional Review Board-approved review of all admission data of the 541st FST was conducted. Comparison was made between patients treated in MASCAL situations to those of patients treated in non-MASCAL events.Setting: Split-based US Army forward surgical elements in a combat environment in Afghanistan.Patients: Two hundred eighty-two patients were treated during MASCAL events and 479 in non- MASCAL situations.Main Outcome Measures: The primary endpoint was survival outcomes among trauma patients when 5 or more patients arrived simultaneously or if 3 or more patients required immediate surgery.Results: Four patients (1.70 percent) died in the MASCAL group compared with 12 (3.30 percent) in the non-MASCAL group.The mortality of patients receiving surgery at the FST was 2.73 percent and the mortality was 0.93 percent in those transferred without surgery. In the MASCAL group, 41 patients (14.5 percent) were critically injured and the critical mortality rate was 6.25 percent. In MASCAL events, 39 percent of patients required surgery compared with 44.9 percent in the non- MASCAL group. The average Injury Severity Score (ISS) of the most severely injured patient was 21.19 and ISS rapidly decreased to scores consistent with mild injury suggesting over triage at the scene.Conclusions: Despite very limited resources, the split FST can achieve, with appropriate triage, acceptable mortality outcomes in MASCAL situations. Over triage at the wounding scene is common and surgical intervention is frequently required.

Early Diagnosis and Intervention in Mass Casualty Events

2008 ◽  
Author(s):  
Ilan Kutz ◽  
Rachel Dekel ◽  
Shaul Schreiber ◽  
Victor Resnick ◽  
Ornah T. Dolberg ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Mass Casualty ◽  
Mass Casualty Events

scholarly journals Didymo and Its Polysaccharide Stalks: Beneficial to the Environment or Not?

2021 ◽  
Vol 2 (1) ◽  
pp. 69-79
Author(s):  
Hurmat Ejaz ◽  
Esther Somanader ◽  
Uday Dave ◽  
Hermann Ehrlich ◽  
M. Azizur Rahman
Keyword(s):  
Invasive Species ◽  
Structural Component ◽  
Negative Effects ◽  
Adhesive Properties ◽  
The Past ◽  
Positive Side ◽  
Potential Benefits ◽  
Negative Impacts ◽  
Bodies Of Water ◽  
Agricultural Setting

Didymosphenia geminata diatoms, or Didymo, was first found to be an invasive species that could have negative impacts on the environment due to the aggressive growth of its polysaccharide-based stalks. The stalks’ adhesive properties have prompted park officials to alert the general public to limit further spread and contamination of this algae to other bodies of water. Although the negative effects of Didymo have been studied in the past, recent studies have demonstrated a potential positive side to this alga. One of the potential benefits includes the structural component of the polysaccharide stalks. The origin of the polysaccharides within stalks remains unknown; however, they can be useful in a waste management and agricultural setting. The primary purpose of this study was to describe both the harmful and beneficial nature of Didymo. Important outcomes include findings related to its application in various fields such as medicine and technology. These polysaccharides can be isolated and studied closely to produce efficient solar power cells and batteries. Though they may be harmful while uncontained in nature, they appear to be very useful in the technological and medical advancement of our society.

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.

COVID-19: lessons learnt and priorities in trauma and orthopaedic surgery

2021 ◽  
Author(s):  
S Madanipour ◽  
F Iranpour ◽  
T Goetz ◽  
S Khan
Keyword(s):  
Elective Surgery ◽  
Risk Mitigation ◽  
Mass Casualty ◽  
Health Crisis ◽  
Lessons Learnt ◽  
Mass Casualty Events ◽  
Trauma Networks ◽  
Major Incidents ◽  
Bed Capacity ◽  
Orthopaedic Community

The COVID-19 pandemic is the most serious health crisis of our time. Global public measures have been enacted to try to prevent healthcare systems from being overwhelmed. The trauma and orthopaedic (T&O) community has overcome challenges in order to continue to deliver acute trauma care to patients and plan for challenges ahead. This review explores the lessons learnt, the priorities and the controversies that the T&O community has faced during the crisis. Historically, the experience of major incidents in T&O has focused on mass casualty events. The current pandemic requires a different approach to resource management in order to create a long-term, system-sustaining model of care alongside a move towards resource balancing and facilitation. Significant limitations in theatre access, anaesthetists and bed capacity have necessitated adaptation. Strategic changes to trauma networks and risk mitigation allowed for ongoing surgical treatment of trauma. Outpatient care was reformed with the uptake of technology. The return to elective surgery requires careful planning, restructuring of elective pathways and risk management. Despite the hope that mass vaccination will lift the pressure on bed capacity and on bleak economic forecasts, the orthopaedic community must readjust its focus to meet the challenge of huge backlogs in elective caseloads before looking to the future with a robust strategy of integrated resilient pathways. The pandemic will provide the impetus for research that defines essential interventions and facilitates the implementation of strategies to overcome current barriers and to prepare for future crises.

Preventing Pediatric Mass Casualty Events

2007 ◽  
Vol 5 (2) ◽  
pp. 25-26 ◽  
Author(s):  
Margaret M. McMahon
Keyword(s):  
Mass Casualty ◽  
Mass Casualty Events

Altered Standards of Care During an Influenza Pandemic: Identifying Ethical, Legal, and Practical Principles to Guide Decision Making

2009 ◽  
Vol 3 (S2) ◽  
pp. S132-S140 ◽  
Author(s):  
Donna Levin ◽  
Rebecca Orfaly Cadigan ◽  
Paul D. Biddinger ◽  
Suzanne Condon ◽  
Howard K. Koh ◽  
...  
Keyword(s):  
Public Health ◽  
Planning Process ◽  
Influenza Pandemic ◽  
State Level ◽  
Mass Casualty ◽  
Standards Of Care ◽  
Public Health Preparedness ◽  
Community Stakeholders ◽  
Mass Casualty Events ◽  
Public Health Officials

ABSTRACTAlthough widespread support favors prospective planning for altered standards of care during mass casualty events, the literature includes few, if any, accounts of groups that have formally addressed the overarching policy considerations at the state level. We describe the planning process undertaken by public health officials in the Commonwealth of Massachusetts, along with community and academic partners, to explore the issues surrounding altered standards of care in the event of pandemic influenza. Throughout 2006, the Massachusetts Department of Public Health and the Harvard School of Public Health Center for Public Health Preparedness jointly convened a working group comprising ethicists, lawyers, clinicians, and local and state public health officials to consider issues such as allocation of antiviral medications, prioritization of critical care, and state seizure of private assets. Community stakeholders were also engaged in the process through facilitated discussion of case scenarios focused on these and other issues. The objective of this initiative was to establish a framework and some fundamental principles that would subsequently guide the process of establishing specific altered standards of care protocols. The group collectively identified 4 goals and 7 principles to guide the equitable allocation of limited resources and establishment of altered standards of care protocols. Reviewing and analyzing this process to date may serve as a resource for other states. (Disaster Med Public Health Preparedness. 2009;3(Suppl 2):S132–S140)

scholarly journals When Direct Pressure Is Not Enough: An Educational Technique for Teaching Wound Packing in Athletic Training Education

2021 ◽  
Vol 16 (4) ◽  
pp. 278-286
Author(s):  
Ashley B. Thrasher ◽  
Edward J. Strapp
Keyword(s):  
Athletic Training ◽  
Clinical Education ◽  
Wound Care ◽  
Athletic Trainers ◽  
Mass Casualty ◽  
Laboratory Activity ◽  
Civilian Casualty ◽  
Mass Casualty Events ◽  
Direct Pressure ◽  
Educational Technique

Context Uncontrolled hemorrhage is a major cause of preventable death. Wound care and managing external hemorrhage are important skills for athletic trainers. Objective Describe a laboratory activity used to allow students to practice managing uncontrolled external hemorrhage and wound packing. Background The prevalence of active shooter and other mass casualty events has grown, and a trend to move military-based emergency skills into civilian casualty care has emerged. Athletic trainers are uniquely positioned to respond to catastrophic events at the time of injury. Controlling hemorrhage and rapidly applying a tourniquet or administering wound packing have a great effect in preventing death due to severe hemorrhage. Description An educational technique using a pork shoulder was implemented to provide students with experience in wound packing. Clinical Advantage(s) Students describe this activity as a beneficial way to gain experience on an important skill not often seen in the clinical education setting. Conclusion(s) Faculty may consider implementing wound packing using a pork shoulder as a laboratory activity when teaching wound care and external hemorrhage management.

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.

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