scholarly journals Methodologies Utilized and Lessons Learned in High Threat Environments and Mass Casualty Environments.

2019 ◽  
pp. 1-7
Author(s):  
Andrew Bennett
Keyword(s):  
First Responders ◽  
The United States ◽  
Mass Casualty ◽  
Lessons Learned ◽  
Great Opportunity ◽  
Special Operations ◽  
Innovative Products ◽  
High Threat ◽  
Austere Environments ◽  
Learn Network

In May 2019, the author was awarded the Australian Tactical Medical Association (ATMA) study grant to attend the Special Operations Medicine Scientific Assembly (SOMSA) 2019 in Charlotte, North Carolina in the United States of America. Whilst in the U.S. the author had the opportunity to hear many talks, attend labs and talk to many first responders in high threat and austere environments to learn about how they operate, and the lessons learned from their experiences. This report highlights the two objectives of the study grant: Record the key content and lessons learned by attendance at SOMSA 2019. Discuss techniques utilized and lessons learned by first responders operating in high threat environments and mass casualty incidents. The SOMSA brings together many like-minded pre-hospital, tactical, wilderness, austere, disaster and deployed medicine operators from all around the world to share their learnings with a primary goal to advance the art and science of special operations medical care. It is a great opportunity for military and civilian providers to learn, network and engage with industry partners showcasing innovative products and technology.

scholarly journals Integration of Unmanned Aircraft Systems into the National Airspace System-Efforts by the University of Alaska to Support the FAA/NASA UAS Traffic Management Program

2020 ◽  
Vol 12 (19) ◽  
pp. 3112
Author(s):  
Michael Hatfield ◽  
Catherine Cahill ◽  
Peter Webley ◽  
Jessica Garron ◽  
Rebecca Beltran
Keyword(s):  
Traffic Management ◽  
Federal Aviation Administration ◽  
The United States ◽  
Lessons Learned ◽  
Unmanned Aircraft ◽  
Unmanned Aircraft Systems ◽  
National Airspace System ◽  
Great Opportunity ◽  
Aircraft Systems ◽  
The University

Over the past decade Unmanned Aircraft Systems (UAS, aka “drones”) have become pervasive, touching virtually all aspects of our world. While UAS offer great opportunity to better our lives and strengthen economies, at the same time these can significantly disrupt manned flight operations and put our very lives in peril. Balancing the demanding and competing requirements of safely integrating UAS into the United States (US) National Airspace System (NAS) has been a top priority of the Federal Aviation Administration (FAA) for several years. This paper outlines efforts taken by the FAA and the National Aeronautics and Space Administration (NASA) to create the UAS Traffic Management (UTM) system as a means to address this capability gap. It highlights the perspectives and experiences gained by the University of Alaska Fairbanks (UAF) Alaska Center for Unmanned Aircraft Systems Integration (ACUASI) as one of the FAA’s six UAS test sites participating in the NASA-led UTM program. The paper summarizes UAF’s participation in the UTM Technical Capability Level (TCL1-3) campaigns, including flight results, technical capabilities achieved, lessons learned, and continuing challenges regarding the implementation of UTM in the NAS. It also details future efforts needed to enable practical Beyond-Visual-Line-of-Sight (BVLOS) flights for UAS operations in rural Alaska.

scholarly journals Confusion, Chaos, and Bridging the Gap: A Prospective Study Gauging Disaster Triage Methodologies and Usage Across First Responder Professions

2019 ◽  
Vol 34 (s1) ◽  
pp. s111-s111
Author(s):  
Brenna Adelman
Keyword(s):  
National Policy ◽  
First Responders ◽  
The United States ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Future Research ◽  
Field Triage ◽  
Mass Casualty Event ◽  
A Prospective Study ◽  
National Trends

Introduction:Disasters are unique in that they impact all socioeconomic, class, and social divides. They are complex, hard to conceptualize and operationally define, and occur sporadically without warning. However, regardless of each disasters innate unpredictability, there is one common need that directly impacts patient morbidity and mortality: effective triage.Aim:Currently the United States has no uniform triage mandate. The purpose of this study is to gather descriptive data on the type of mass-casualty triage currently being utilized by first responders (Emergency Medical Services/Fire/Nurses) and improve our understanding regarding the prevalence of mass casualty triage.Methods:A descriptive mixed methods survey is being distributed to first responders/nurses in the Appalachian region. This survey collects respondents demographics, profession, and MCI triage data. Data will be analyzed and descriptive statistics will be generated. GIS will be utilized to graph findings and visualize local and national trends.Results:Results of this study are pending.Discussion:Organizations have addressed the need for a standard triage protocol, even going so far as to create uniform criteria which each triage system should meet. However, the literature does not describe how individual professions train their members in disaster triage, or what triage is currently being utilized in each profession. Nurses and first-responders serve as linchpins in many communities. They remain in a community, both before, during, and after a mass casualty event, but they do not perform in a vacuum. During an MCI (mass-casualty incident) their scope of practice may vary, but they have common foci: the affected community. A better understanding of the type of MCI triage that each profession is using is vital in understanding how triage is being applied, and vital in identifying gaps in application that may impact the effectiveness of field triage, and affect local and national policy, practice, and future research.

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)

scholarly journals Five Challenges When Managing Mass Casualty or Disaster Situations: A Review Study

2020 ◽  
Vol 17 (9) ◽  
pp. 3068 ◽  
Author(s):  
Karin Hugelius ◽  
Julia Becker ◽  
Annsofie Adolfsson
Keyword(s):  
Web Of Science ◽  
The United States ◽  
Mass Casualty ◽  
Sudden Onset ◽  
Lessons Learned ◽  
Internal Factors ◽  
Medical Response ◽  
Review Study ◽  
Resilient Response ◽  
Mind Set

Background: Managing mass casualty or disaster incidents is challenging to any person or organisation. Therefore, this paper identifies and describes common challenges to managing such situations, using case and lessons learned reports. It focuses on sudden onset, man-made or technologically caused mass casualty or disaster situations. Methods: A management review was conducted based on a structured search in the PubMed and Web of Science databases. Results: The review included 20 case—and lessons learned reports covering natural disasters, man-made events, and accidents across Europe, the United States of Amerika (USA), Asia and the Middle East. Five common challenges were identified: (1) to identify the situation and deal with uncertainty, (2) to balance the mismatch between the contingency plan and the reality, (3) to establish a functional crisis organization, (4) to adapt the medical response to the actual and overall situation and (5) to ensure a resilient response. Conclusions: The challenges when managing mass casualty or disaster events involved were mainly related to the ability to manage uncertainty and surprising situations, using structured processes to respond. The ability to change mind set, organization and procedures, both from an organizational- and individual perspective, was essential. Non-medical factors and internal factors influenced the medical management. In order to respond in an effective, timely and resilient way, all these factors should be taken into consideration.

Characteristics of Physician Relocation Following Hurricane Katrina

2009 ◽  
Vol 95 (1) ◽  
pp. 6-12
Author(s):  
Kusuma Madamala ◽  
Claudia R. Campbell ◽  
Edbert B. Hsu ◽  
Yu-Hsiang Hsieh ◽  
James James
Keyword(s):  
Hurricane Katrina ◽  
Gulf Coast ◽  
General Medicine ◽  
The United States ◽  
Lessons Learned ◽  
Bivariate Analysis ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Factors Associated ◽  
The Impact

ABSTRACT Introduction: On Aug. 29, 2005, Hurricane Katrina made landfall along the Gulf Coast of the United States, resulting in the evacuation of more than 1.5 million people, including nearly 6000 physicians. This article examines the relocation patterns of physicians following the storm, determines the impact that the disaster had on their lives and practices, and identifies lessons learned. Methods: An Internet-based survey was conducted among licensed physicians reporting addresses within Federal Emergency Management Agency-designated disaster zones in Louisiana and Mississippi. Descriptive data analysis was used to describe respondent characteristics. Multivariate logistic regression was performed to identify the factors associated with physician nonreturn to original practice. For those remaining relocated out of state, bivariate analysis with x2 or Fisher exact test was used to determine factors associated with plans to return to original practice. Results: A total of 312 eligible responses were collected. Among disaster zone respondents, 85.6 percent lived in Louisiana and 14.4 percent resided in Mississippi before the hurricane struck. By spring 2006, 75.6 percent (n = 236) of the respondents had returned to their original homes, whereas 24.4 percent (n = 76) remained displaced. Factors associated with nonreturn to original employment included family or general medicine practice (OR 0.42, 95 percent CI 0.17–1.04; P = .059) and severe or complete damage to the workplace (OR 0.24, 95 percent CI 0.13–0.42; P < .001). Conclusions: A sizeable proportion of physicians remain displaced after Hurricane Katrina, along with a lasting decrease in the number of physicians serving in the areas affected by the disaster. Programs designed to address identified physician needs in the aftermath of the storm may give confidence to displaced physicians to return.

Winning the Argument and Moving the Fight: The Legacy of a Grassroots Humanitarian

Public Voices ◽  
2016 ◽  
Vol 14 (1) ◽  
pp. 115
Author(s):  
Mary Coleman
Keyword(s):  
Higher Education ◽  
United States ◽  
Winning Strategy ◽  
Supreme Court Decision ◽  
The United States ◽  
Colleges And Universities ◽  
Lessons Learned ◽  
The Political ◽  
Political Actors ◽  
Trade Offs

The author of this article argues that the two-decades-long litigation struggle was necessary to push the political actors in Mississippi into a more virtuous than vicious legal/political negotiation. The second and related argument, however, is that neither the 1992 United States Supreme Court decision in Fordice nor the negotiation provided an adequate riposte to plaintiffs’ claims. The author shows that their chief counsel for the first phase of the litigation wanted equality of opportunity for historically black colleges and universities (HBCUs), as did the plaintiffs. In the course of explicating the role of a legal grass-roots humanitarian, Coleman suggests lessons learned and trade-offs from that case/negotiation, describing the tradeoffs as part of the political vestiges of legal racism in black public higher education and the need to move HBCUs to a higher level of opportunity at a critical juncture in the life of tuition-dependent colleges and universities in the United States. Throughout the essay the following questions pose themselves: In thinking about the Road to Fordice and to political settlement, would the Justice Department lawyers and the plaintiffs’ lawyers connect at the point of their shared strength? Would the timing of the settlement benefit the plaintiffs and/or the State? Could plaintiffs’ lawyers hold together for the length of the case and move each piece of the case forward in a winning strategy? Who were plaintiffs’ opponents and what was their strategy? With these questions in mind, the author offers an analysis of how the campaign— political/legal arguments and political/legal remedies to remove the vestiges of de jure segregation in higher education—unfolded in Mississippi, with special emphasis on the initiating lawyer in Ayers v. Waller and Fordice, Isaiah Madison

scholarly journals The Global Limb Anatomic Staging System (GLASS) for CLTI: Improving Inter-Observer Agreement

2021 ◽  
Vol 10 (16) ◽  
pp. 3454
Author(s):  
Joep G. J. Wijnand ◽  
Devin Zarkowsky ◽  
Bian Wu ◽  
Steven T. W. van Haelst ◽  
Evert-Jan P. A. Vonken ◽  
...  
Keyword(s):  
Staging System ◽  
The United States ◽  
Lessons Learned ◽  
Observer Agreement ◽  
Lesion Length ◽  
Solid Base ◽  
Stepwise Approach ◽  
Additional Tool ◽  
Atherosclerotic Lesions ◽  
Stenosis Severity

Objective: The 2020 Global Vascular Guidelines aim at improving decision making in Chronic Limb-Threatening Ischemia (CLTI) by providing a framework for evidence-based revascularization. Herein, the Global Limb Anatomic Staging System (GLASS) serves to estimate the chance of success and patency of arterial pathway revascularization based on the extent and distribution of the atherosclerotic lesions. We report the preliminary feasibility results and observer variability of the GLASS. GLASS is a part of the new global guideline and posed as a promising additional tool for EBR strategies to predict the success of lower extremity arterial revascularization. This study reports on the consistency of GLASS scoring to maximize inter-observer agreement and facilitate its application. Methods: GLASS separately scores the femoropopliteal (FP) and infrapopliteal (IP) segment based on stenosis severity, lesion length and the extent of calcification within the target artery pathway (TAP). In our stepwise approach, we used two angiographic datasets. Each following step was based on the lessons learned from the previous step. The primary outcome was inter-observer agreement measured as Cohen’s Kappa, scored by two (step 1 + 2) and four (step 3) blinded and experienced observers, respectively. Steps 1 (n = 139) and 2 (n = 50) were executed within a dataset of a Dutch interventional RCT in CLTI. Step 3 (n = 100) was performed in randomly selected all-comer CLTI patients from two vascular centers in the United States. Results: In step 1, kappa values were 0.346 (FP) and 0.180 (IP). In step 2, applied in the same dataset, the use of other experienced observers and a provided TAP, resulted in similar low kappa values 0.406 (FP) and 0.089 (IP). Subsequently, in step 3, the formation of an altered stepwise approach using component scoring, such as separate scoring of calcification and adding a ruler to the images resulted in kappa values increasing to 0.796 (FP) and 0.730 (IP). Conclusion: This retrospective GLASS validation study revealed low inter-observer agreement for unconditioned scoring. A stepwise component scoring provides acceptable agreement and a solid base for further prospective validation studies to investigate how GLASS relates to treatment outcomes.

scholarly journals Medical Student Attitudes Toward Blood Donation in Times of Increased Need

2021 ◽  
pp. 000313482110110
Author(s):  
Rahima Khatun ◽  
Banan W. Otaibi ◽  
Anna Ssentongo ◽  
Joshua P. Hazelton ◽  
AmandaB. Cooper
Keyword(s):  
Medical Students ◽  
Student Attitudes ◽  
Response Rate ◽  
Blood Donation ◽  
Multivariable Analysis ◽  
The United States ◽  
Mass Casualty ◽  
Academic Institution ◽  
Donor Pool ◽  
Willingness To Donate

Background In situations of increased need, such as mass casualty incidents (MCIs) and COVID-19, donated blood products are in shortage across the United States. Medical students are a potential pool for blood donors. The aim of this study was to determine overall attitudes of medical students at a single academic institution toward blood donation during times of increased need. Methods Three anonymous REDCap surveys were administered to all medical students at a rural academic institution. Surveys 1 and 2 were administered preceding and after an institution-wide MCI drill, in September and November 2019, respectively. Survey 3 was administered following a student-organized COVID-19 blood drive in June 2020. Multivariable analysis was performed to determine if factors, ie, experience with MCI drills and emergency medical services (EMS) training, were associated with willingness to donate blood. Furthermore, barriers to donation among those not willing to donate were assessed. Results Overall response rate for MCI surveys (surveys 1 and 2) was 38% (mean age 25.2 years and 50% women). 91% (n = 210) of respondents were willing to donate blood. Previous participation in MCI drills and EMS training was not associated with higher willingness to donate blood. Response rate for survey 3 was 15.6% (59.4% women), and 30 (31.3%) respondents indicated they did not volunteer to donate blood during the COVID-19 drive. Most common reasons for not donating were “other,” medical concerns, and being out-of-town. Conclusions Majority of medical students are willing to donate blood during times of increased need and offer a possible solution to increase blood donor pool.

scholarly journals The COVID Army: Experiences from the Deployment of Non-Hospitalist Physician Volunteers during the 2020 COVID Pandemic

2021 ◽  
pp. 1-15
Author(s):  
Kevin Hauck ◽  
Katherine Hochman ◽  
Mark Pochapin ◽  
Sondra Zabar ◽  
Jeffrey A Wilhite ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Medical Center ◽  
The United States ◽  
Lessons Learned ◽  
Front Line ◽  
Clinical Leadership ◽  
Team Members ◽  
Medical Centers ◽  
Hospitalist Physician

Abstract Objective New York City was the epicenter of the outbreak of the 2020 COVID-19 pandemic in the United States. As a large, quaternary care medical center, NYU Langone Medical Center was one of many New York medical centers that experienced an unprecedented influx of patients during this time. Clinical leadership effectively identified, oriented, and rapidly deployed a “COVID Army”, consisting of non-hospitalist physicians, to meet the needs of this patient influx. We share feedback from our providers on our processes and offer specific recommendations for systems experiencing a similar influx in the current and future pandemics. Methods In order to assess the experiences and perceived readiness of these physicians (n=183), we distributed a 32-item survey between March and June of 2020. Thematic analyses and response rates were examined in order to develop results. Results Responses highlighted varying experiences and attitudes of our front-line physicians during an emerging pandemic. Thematic analyses revealed a series of lessons learned, including the need to: (1) provide orientations, (2) clarify roles/ workflow, (3) balance team workload, (4) keep teams updated on evolving policies, (5) make team members feel valued, and (6) ensure they have necessary tools available. Conclusions Lessons from our deployment and assessment are scalable at other institutions.

scholarly journals Preparedness and response to an emerging health threat—Lessons learned from Candida auris outbreaks in the United States

2021 ◽  
pp. 1-6
Author(s):  
Diane Meyer ◽  
Elena K. Martin ◽  
Syra Madad ◽  
Priya Dhagat ◽  
Jennifer B. Nuzzo
Keyword(s):  
United States ◽  
New York ◽  
Qualitative Interviews ◽  
The United States ◽  
Lessons Learned ◽  
Infection Prevention And Control ◽  
Healthcare Organizations ◽  
Candida Auris ◽  
Term Care ◽  
Healthcare Facilities

Abstract Objective: Candida auris infections continue to occur across the United States and abroad, and healthcare facilities that care for vulnerable populations must improve their readiness to respond to this emerging organism. We aimed to identify and better understand challenges faced and lessons learned by those healthcare facilities who have experienced C. auris cases and outbreaks to better prepare those who have yet to experience or respond to this pathogen. Design: Semi-structured qualitative interviews. Setting: Health departments, long-term care facilities, acute-care hospitals, and healthcare organizations in New York, Illinois, and California. Participants: Infectious disease physicians and nurses, clinical and environmental services, hospital leadership, hospital epidemiology, infection preventionists, emergency management, and laboratory scientists who had experiences either preparing for or responding to C. auris cases or outbreaks. Methods: In total, 25 interviews were conducted with 84 participants. Interviews were coded using NVivo qualitative coding software by 2 separate researchers. Emergent themes were then iteratively discussed among the research team. Results: Key themes included surveillance and laboratory capacity, inter- and intrafacility communication, infection prevention and control, environmental cleaning and disinfection, clinical management of cases, and media concerns and stigma. Conclusions: Many of the operational challenges noted in this research are not unique to C. auris, and the ways in which we address future outbreaks should be informed by previous experiences and lessons learned, including the recent outbreaks of C. auris in the United States.

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