An algorithm for the evaluation and management of red, yellow, and green zone patients during a botulism mass casualty incident

2009 ◽  
Vol 4 (4) ◽  
pp. 192-198 ◽  
Author(s):  
Paul Rega MD, FACEP ◽  
Kelly Burkholder-Allen, RN, MSEd ◽  
Christopher Bork, PhD, PT, EMT-B, FASAHP
Keyword(s):  
Botulinum Toxin ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Healthcare Personnel ◽  
Toxic Substances ◽  
Initial Management ◽  
Green Zone

Botulinum toxin is one of the most toxic substances known to humankind. It is one among the six Category A agents in the CDC bioterrorism lexicon. This suggests that, while the possibility of a botulism mass casualty incident (MCI) is remote, its unique acute and long-term ramifications must be addressed and planned for. However, an in-depth knowledge of the disease and its tactical management in the acute MCI phase is inconsistent or superficial among healthcare personnel. Therefore, an algorithm has been developed to assist first receivers with the initial management of multiple probable and potential botulism patients when equipment resources are strained and when expert personnel are not readily available. The algorithm is specifically structured to assist with the identification and management of potential respiratory deterioration of suspected botulism patients.

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.

scholarly journals Kuala Lumpur Train Collision During the COVID-19 Pandemic

2021 ◽  
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 24th 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. 214 passengers were in the trains. 64 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%) (56) were discharged home. Six (9.4%) needed surgery. The Covid-19 tests were conducted on seven patients (10.9%) and was 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.

Treatment of spasticity of different origins with botulinum toxin A: long-term results

2008 ◽  
Vol 35 (S 01) ◽  
Author(s):  
K Kollewe ◽  
S Baloush ◽  
K Krampfl ◽  
H Bigalke ◽  
R Dengler ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin A ◽  
Long Term Results ◽  
Toxin A ◽  
Different Origins

Immunological mechanisms of chronic liver lesions under the influence of chemicals

2020 ◽  
pp. 536-537
Author(s):  
G. S. Agzamova ◽  
M. M. Abdullaeva
Keyword(s):  
The Body ◽  
Chronic Liver ◽  
Toxic Substances ◽  
Liver Lesions ◽  
Industrial Chemicals ◽  
Toxic Agent ◽  
Chronic Poisoning ◽  
Immunological Mechanisms ◽  
T System

The immunological profile of chronic liver lesions depending on the toxic agent was studied. It was revealed that chronic poisoning by industrial toxic substances causes changes in the functional state of the T-system of immunity, long-term contact with industrial chemicals leads to increased sensitization to autoantigens of the body.

scholarly journals Prehospital Triage by Lay Person First Responders: A Scoping Review and Proposal for a new Prehospital Triage Tool

2021 ◽  
pp. 1-11
Author(s):  
Wesley D Jetten ◽  
Jeroen Seesink ◽  
Markus Klimek
Keyword(s):  
Scoping Review ◽  
Life Support ◽  
First Responders ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Mass Casualty Incidents ◽  
Lay People ◽  
Online Databases ◽  
Healthcare Experience ◽  
Prehospital Triage

Abstract Objective: The primary aim of this study is to review the available tools for prehospital triage in case of mass casualty incidents and secondly, to develop a tool which enables lay person first responders (LPFRs) to perform triage and start basic life support in mass casualty incidents. Methods: In July 2019, online databases were consulted. Studies addressing prehospital triage methods for lay people were analyzed. Secondly, a new prehospital triage tool for LPFRs was developed. Therefore, a search for prehospital triage models available in literature was conducted and triage actions were extracted. Results: The search resulted in 6188 articles, and after screening, a scoping review of 4 articles was conducted. All articles stated that there is great potential to provide accurate prehospital triage by people with no healthcare experience. Based on these findings, and combined with the pre-existing prehospital triage tools, we developed a, not-yet validated, prehospital triage tool for lay people, which may improve disaster awareness and preparedness and might positively contribute to community resilience. Conclusion: The prehospital triage tool for lay person first responders may be useful and may help professional medical first responders to determine faster, which casualties most urgently need help in a mass casualty incident.

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.

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