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.

Impact of military medicine on civilian medical practice in the UK from 2009 to 2020

2021 ◽  
pp. bmjmilitary-2020-001691
Author(s):  
Katherine France ◽  
C Handford
Keyword(s):  
Medical Practice ◽  
Positive Impact ◽  
Military Medicine ◽  
Disease Outbreaks ◽  
Mass Casualty ◽  
Outbreak Management ◽  
Mass Casualty Events ◽  
Major Incidents ◽  
The Uk ◽  
The Impact

IntroductionThe positive impact of advances in military medicine and the influence these have had on civilian medical practice have been well documented throughout history: this review will be looking specifically between 2009 and 2020.AimsReview of innovations that have been implemented or have influenced civilian practice within the areas of trauma, disease outbreak management and civilian systems between 2009 and 2020. This review will also aim to explore the impact that working with or within the military can have on individuals within civilian healthcare systems and the future challenges we face to maintain skills.ResultsUsing a narrative approach to this review, we found that there have been numerous changes to trauma management within the UK, based on military practice and research during conflict, which have improved survival outcomes. In addition, the use of niche military skills as part of a coordinated response, during both internal and international disease outbreaks, are thought to have supported civilian systems enabling an efficient and prolonged response. Furthermore, adaptation of military concepts and their application to the NHS through consultant-led prehospital teams, centralisation of specialties in the form of major trauma centres and the introduction of guidelines to manage 'major incidents and mass casualty events' in 2018 have improved patient outcomes.ConclusionFrom 2009 to 2020, lessons learnt from the British and other nations’ militaries have been integrated into UK practice and have likely contributed to improved outcomes in the management of major incidents both nationally and internationally.

A systematic review and analysis of learning from major incidents and mass casualty events over the last five years

2019 ◽  
Vol 105 (3) ◽  
pp. 185-190
Author(s):  
A Phailly ◽  
D King ◽  
M Khan
Keyword(s):  
Systematic Review ◽  
Mass Casualty ◽  
Lessons Learned ◽  
Mass Casualty Events ◽  
Major Incidents ◽  
Future Events

AbstractThe dawn of the 21st century has seen a dramatic increase of mass casualty events internationally, with a number of aetiologies. The key with any healthcare evolution is to identify whether lessons learned are being implemented to help to mitigate future events. This article will explore the lessons learned from mass casualty events over the last five years.

Hospital Surge Capacity: A Web-Based Simulation Tool for Emergency Planners

2017 ◽  
Vol 12 (4) ◽  
pp. 513-522 ◽  
Author(s):  
Matthew F. Toerper ◽  
Gabor D. Kelen ◽  
Lauren M. Sauer ◽  
Jamil D. Bayram ◽  
Christina Catlett ◽  
...  
Keyword(s):  
Disaster Response ◽  
Mass Casualty ◽  
Simulation Tool ◽  
Urban Hospital ◽  
Surge Capacity ◽  
User Input ◽  
Response Strategies ◽  
Mass Casualty Events ◽  
Bed Capacity ◽  
Nationally Representative

AbstractThe National Center for the Study of Preparedness and Catastrophic Event Response (PACER) has created a publicly available simulation tool called Surge (accessible at http://www.pacerapps.org) to estimate surge capacity for user-defined hospitals. Based on user input, a Monte Carlo simulation algorithm forecasts available hospital bed capacity over a 7-day period and iteratively assesses the ability to accommodate disaster patients. Currently, the tool can simulate bed capacity for acute mass casualty events (such as explosions) only and does not specifically simulate staff and supply inventory. Strategies to expand hospital capacity, such as (1) opening unlicensed beds, (2) canceling elective admissions, and (3) implementing reverse triage, can be interactively evaluated. In the present application of the tool, various response strategies were systematically investigated for 3 nationally representative hospital settings (large urban, midsize community, small rural). The simulation experiments estimated baseline surge capacity between 7% (large hospitals) and 22% (small hospitals) of staffed beds. Combining all response strategies simulated surge capacity between 30% and 40% of staffed beds. Response strategies were more impactful in the large urban hospital simulation owing to higher baseline occupancy and greater proportion of elective admissions. The publicly available Surge tool enables proactive assessment of hospital surge capacity to support improved decision-making for disaster response. (Disaster Med Public Health Preparedness. 2018;12:513–522)

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 Ethical considerations and patient safety concerns for cancelling non-urgent surgeries during the COVID-19 pandemic: a review

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Nolan J. Brown ◽  
Bayard Wilson ◽  
Stephen Szabadi ◽  
Cameron Quon ◽  
Vera Ong ◽  
...  
Keyword(s):  
Medical Ethics ◽  
Health Care Access ◽  
Elective Surgery ◽  
Surgical Techniques ◽  
Surgical Care ◽  
Health Crisis ◽  
Surgical Safety ◽  
Care Access ◽  
Urgent Surgery ◽  
Starting Point

AbstractAt the time of writing of this article, there have been over 110 million cases and 2.4 million deaths worldwide since the start of the Coronavirus Disease 2019 (COVID-19) pandemic, postponing millions of non-urgent surgeries. Existing literature explores the complexities of rationing medical care. However, implications of non-urgent surgery postponement during the COVID-19 pandemic have not yet been analyzed within the context of the four pillars of medical ethics. The objective of this review is to discuss the ethics of elective surgery cancellation during the COVID-19 pandemic in relation to beneficence, non-maleficence, justice, and autonomy. This review hypothesizes that a more equitable decision-making algorithm can be formulated by analyzing the ethical dilemmas of elective surgical care during the pandemic through the lens of these four pillars. This paper’s analysis shows that non-urgent surgeries treat conditions that can become urgent if left untreated. Postponement of these surgeries can cause cumulative harm downstream. An improved algorithm can address these issues of beneficence by weighing local pandemic stressors within predictive algorithms to appropriately increase surgeries. Additionally, the potential harms of performing non-urgent surgeries extend beyond the patient. Non-maleficence is maintained through using enhanced screening protocols and modifying surgical techniques to reduce risks to patients and clinicians. This model proposes a system to transfer patients from areas of high to low burden, addressing the challenge of justice by considering facility burden rather than value judgments concerning the nature of a particular surgery, such as cosmetic surgeries. Autonomy can be respected by giving patients the option to cancel or postpone non-urgent surgeries. However, in the context of limited resources in a global pandemic, autonomy is not absolute. Non-urgent surgeries can ethically be postponed in opposition to the patient’s preference. The proposed algorithm attempts to uphold the four principles of medical ethics in rationing non-urgent surgical care by building upon existing decision models, using additional measures of resource burden and surgical safety to increase health care access and decrease long-term harm as much as possible. The next global health crisis will undoubtedly present its own unique challenges. This model may serve as a comprehensive starting point in determining future guidelines for non-urgent surgical care.

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.

scholarly journals Manchester Arena bombing: lessons learnt from a mass casualty incident

2018 ◽  
Vol 166 (2) ◽  
pp. 72-75 ◽  
Author(s):  
Ross J Craigie ◽  
P J Farrelly ◽  
R Santos ◽  
S R Smith ◽  
J S Pollard ◽  
...  
Keyword(s):  
Terrorist Attack ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Improvised Explosive Device ◽  
Lessons Learnt ◽  
Simulation And Training ◽  
The Uk ◽  
Improvised Explosive ◽  
London Bombings ◽  
And Training

On 22 May 2017 Salman Abedi detonated an improvised explosive device in the Manchester Arena resulting in 23 deaths (including the attacker). This was the deadliest terrorist attack on UK soil since the 2005 London bombings, but was only one of five mass casualty terrorist attacks in the UK in 2017. Preparation for mass casualty incidents (MCI) is obligatory, involving such methods as multiagency tabletop exercises, mock hospital exercises, as well as simulation and training for clinicians in managing the injuries that would be anticipated in such an event. Even in the best prepared units, such an incident will pose significant challenges due to the unpredictable nature of these events with respect to timing and number of casualties. Following an MCI, local and national reviews are undertaken to assess the effectiveness of the response, but also to identify areas where lessons can be learnt and to disseminate these to allow inclusion in future planning. We present the experience following a mass casualty terrorist incident along with a number of lessons learnt from this event.

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