Mechanical ventilation in disaster situations: A new paradigm using the AGILITIES Score System

2019 ◽  
Vol 14 (4) ◽  
pp. 311-326
Author(s):  
Eric P. Wilkens, MD, MPH ◽  
Gary M. Klein, MD, MPH, MBA
Keyword(s):  
Mechanical Ventilation ◽  
Hurricane Katrina ◽  
The United States ◽  
Mass Casualty ◽  
Government Agencies ◽  
Critical Systems ◽  
New Paradigm ◽  
Mechanical Ventilators ◽  
Use Of Resources ◽  
Mass Casualty Event

Background: The failure of life-critical systems such as mechanical ventilators in the wake of a pandemic or a disaster may result in death, and therefore, state and federal government agencies must have precautions in place to ensure availability, reliability, and predictability through comprehensive preparedness and response plans.Methods: All 50 state emergency preparedness response plans were extensively examined for the attention given to the critically injured and ill patient population during a pandemic or mass casualty event. Public health authorities of each state were contacted as well.Results: Nine of 51 state plans (17.6 percent) included a plan or committee for mechanical ventilation triage and management in a pandemic influenza event. All 51 state plans relied on the Centers for Disease Control and Prevention Flu Surge 2.0 spreadsheet to provide estimates for their influenza planning. In the absence of more specific guidance, the authors have developed and provided guidelines recommended for ventilator triage and the implementation of the AGILITIES Score in the event of a pandemic, mass casualty event, or other catastrophic disaster.Conclusions: The authors present and describe the AGILITIES Score Ventilator Triage System and provide related guidelines to be adopted uniformly by government agencies and hospitals. This scoring system and the set of guidelines are to be used in disaster settings, such as Hurricane Katrina, and are based on three key factors: relative health, duration of time on mechanical ventilation, and patients’ use of resources during a disaster. For any event requiring large numbers of ventilators for patients, the United States is woefully unprepared. The deficiencies in this aspect of preparedness include (1) lack of accountability for physical ventilators, (2) lack of understanding with which healthcare professionals can safely operate these ventilators, (3) lack of understanding from where additional ventilator resources exist, and (4) a triage strategy to provide ventilator support to those patients with the greatest chances of survival.

Mechanical ventilation in disaster situations: A new paradigm using the AGILITIES Score System

2010 ◽  
Vol 5 (6) ◽  
pp. 369-384 ◽  
Author(s):  
Eric P. Wilkens, MD, MPH ◽  
Gary M. Klein, MD, MPH, MBA
Keyword(s):  
Mechanical Ventilation ◽  
Hurricane Katrina ◽  
The United States ◽  
Mass Casualty ◽  
Government Agencies ◽  
Critical Systems ◽  
New Paradigm ◽  
Mechanical Ventilators ◽  
Use Of Resources ◽  
Mass Casualty Event

Background: The failure of life-critical systems such as mechanical ventilators in the wake of a pandemic or a disaster may result in death, and therefore, state and federal government agencies must have precautions in place to ensure availability, reliability, and predictability through comprehensive preparedness and response plans.Methods: All 50 state emergency preparedness response plans were extensively examined for the attention given to the critically injured and ill patient population during a pandemic or mass casualty event. Public health authorities of each state were contacted as well.Results: Nine of 51 state plans (17.6 percent) included a plan or committee for mechanical ventilation triage and management in a pandemic influenza event. All 51 state plans relied on the Centers for Disease Control and Prevention Flu Surge 2.0 spreadsheet to provide estimates for their influenza planning. In the absence of more specific guidance, the authors have developed and provided guidelines recommended for ventilator triage and the implementation of the AGILITIES Score in the event of a pandemic, mass casualty event, or other catastrophic disaster.Conclusions: The authors present and describe the AGILITIES Score Ventilator Triage System and provide related guidelines to be adopted uniformly by government agencies and hospitals.This scoring system and the set of guidelines are to be used in disaster settings, such as Hurricane Katrina, and are based on three key factors: relative health, duration of time on mechanical ventilation, and patients’ use of resources during a disaster. For any event requiring large numbers of ventilators for patients, the United States is woefully unprepared. The deficiencies in this aspect of preparedness include (1) lack of accountability for physical ventilators, (2) lack of understanding with which healthcare professionals can safely operate these ventilators, (3) lack of understanding from where additional ventilator resources exist, and (4) a triage strategy to provide ventilator support to those patients with the greatest chances of survival.

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.

A state survey of emergency department preparedness for the care of children in a mass casualty event

2009 ◽  
Vol 4 (4) ◽  
pp. 227-232 ◽  
Author(s):  
Tonya Thompson, MD ◽  
Kristen Lyle, MD ◽  
S. Hope Mullins, MPH ◽  
Rhonda Dick, MD ◽  
James Graham, MD
Keyword(s):  
Emergency Department ◽  
Planning Process ◽  
The United States ◽  
Mass Casualty ◽  
Institute Of Medicine ◽  
Medical Care System ◽  
Emergency Medical ◽  
Mass Casualty Event ◽  
Medical Directors ◽  
Mailed Survey

Objective: The Institute of Medicine has issued two reports over the past 10 years raising concerns about the care of children in the emergency medical care system of the United States. Given that children are involved in most mass casualty events and there are deficiencies in the day-to-day emergency care of children, this project was undertaken to document the preparedness of hospitals in AR for the care of children in mass casualty or disaster situations.Design: Mailed survey to all emergency department medical directors in AR. Nonresponders received a second mailed survey and an attempt at survey via phone.Participants: Medical directors of the emergency departments of the 80 acute care hospitals in AR.Results: Seventy-two of 80 directors responded (90 percent response rate). Only 13 percent of hospitals reported they have pediatric mass casualty protocols and in only 28 percent of hospitals the disaster plan includes pediatric-specific issues such as parental reunification. Most hospitals hold mass casualty training events (94 percent), at least annually, but only 64 percent report including pediatric patients in their disaster drills. Most hospitals include local fire (90 percent), police (82 percent), and emergency medical services (77 percent) in their drills, but only 23 percent report involving local schools in the disaster planning process. Eighty-three percent of hospitals responding reported their staff is trained in decontamination procedures.Thirty-five percent reported having warm water showers available for infant/children decontamination. Ninety-four percent of hospitals have a plan for calling in extra staff in a disaster situation, which most commonly involves a phone tree (43 percent). Ninety-three percent reported the availability of Ham Radios, walkie-talkie, or Arkansas Wireless Information Network (AWIN) units for communication in case of land line loss, but only 16 percent reported satellite phone or Tandberg units. Twelve percent reported reliance on cell phones in this situation.Conclusions: This survey demonstrated important deficiencies in the preparedness of hospitals in AR for the care of children in disaster. Although many hospitals are relatively well prepared for the care of adults in disaster situations, the needs of children are different and hospitals in AR are not as well prepared for pediatric disaster care.

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.

Home Free

2020 ◽  
Author(s):  
David S. Kirk
Keyword(s):  
Hurricane Katrina ◽  
Natural Experiment ◽  
The United States ◽  
Social Worlds ◽  
Residential Relocation ◽  
Criminal Opportunities ◽  
Alternate Reality ◽  
Desistance From Crime ◽  
Residential Change ◽  
Rare Opportunity

This book is about building credible science to address the challenge of criminal recidivism. It does so by drawing upon a unique natural experiment that presented an opportunity to witness an alternate reality. More than 625,000 individuals are released from prison in the United States each year, and roughly half of these individuals will be back in prison within just three years. A likely contributor to the churning of the same individuals in and out of prison is the fact that many released prisoners return home to the same environment with the same criminal opportunities and criminal peers that proved so detrimental to their behavior prior to incarceration. This study uses Hurricane Katrina as a natural experiment for examining the question of whether residential relocation away from an old neighborhood can lead to desistance from crime. Many prisoners released soon after Katrina could not go back to their old neighborhoods, as they normally would have done. Their neighborhoods were devastated by a once-in-a-generation storm that damaged the vast majority of housing units in New Orleans. Hurricane Katrina provided a rare opportunity to investigate what happens when individuals move not just a short distance, but to entirely different cities, counties, and social worlds. This study draws upon both quantitative and qualitative evidence to reveal where newly released prisoners resided in the wake of the Katrina, the effect of residential relocation on the likelihood of reincarceration through eight years post-release, and the mechanisms revealing why residential change is so important after release from prison.

Non-Pediatric Nurses’ Willingness to Provide Care to Pediatric Patients during a Disaster: An Assessment of Pediatric Surge Capacity in Four Midwestern Hospitals

2021 ◽  
pp. 1-6
Author(s):  
Terri Rebmann ◽  
Rachel L. Charney ◽  
Rebecca L. Eschmann ◽  
M. Colleen Fitzpatrick
Keyword(s):  
Pediatric Patients ◽  
Response Rate ◽  
Mass Casualty ◽  
Pediatric Care ◽  
Pediatric Nurses ◽  
Surge Capacity ◽  
Factors Associated ◽  
Pediatric Hospitals ◽  
Survey Response Rate ◽  
Mass Casualty Event

Abstract Objective: To assess non-pediatric nurses’ willingness to provide care to pediatric patients during a mass casualty event (MCE). Methods: Nurses from 4 non-pediatric hospitals in a major metropolitan Midwestern region were surveyed in the fall of 2018. Participants were asked about their willingness to provide MCE pediatric care. Hierarchical logistical regression was used to describe factors associated with nurses’ willingness to provide MCE pediatric care. Results: In total, 313 nurses were approached and 289 completed a survey (response rate = 92%). A quarter (25.3%, n = 73) would be willing to provide MCE care to a child of any age; 12% (n = 35) would provide care only to newborns in the labor and delivery area, and 16.6% (n = 48) would only provide care to adults. Predictors of willingness to provide care to a patient of any age during an MCE included providing care to the youngest-age children during routine duties, reporting confidence in calculating doses and administering pediatric medications, working in the emergency department, being currently or previously certified in PALS, and having access to pediatric-sized equipment in the unit or hospital. Conclusion: Pediatric surge capacity is lacking among nurses. Increasing nurses’ pediatric care self-efficacy could improve pediatric surge capacity and minimize morbidity and mortality during MCEs.

scholarly journals Estimating mouse and rat use in American laboratories by extrapolation from Animal Welfare Act-regulated species

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Larry Carbone
Keyword(s):  
United States ◽  
Animal Welfare ◽  
The United States ◽  
Animal Research ◽  
Government Agencies ◽  
Laboratory Rats ◽  
Tier System ◽  
Western Nations ◽  
Rats And Mice ◽  
Usage Data

AbstractAlone among Western nations, the United States has a two-tier system for welfare protections for vertebrate animals in research. Because its Animal Welfare Act (AWA) excludes laboratory rats and mice (RM), government veterinarians do not inspect RM laboratories and RM numbers are only partially reported to government agencies1. Without transparent statistics, it is impossible to track efforts to reduce or replace these sentient animals’ use or to project government resources needed if AWA coverage were expanded to include them. I obtained annual RM usage data from 16 large American institutions and compared RM numbers to institutions’ legally-required reports of their AWA-covered mammals. RM comprised approximately 99.3% of mammals at these representative institutions. Extrapolating from 780,070 AWA-covered mammals in 2017–18, I estimate that 111.5 million rats and mice were used per year in this period. If the same proportion of RM undergo painful procedures as are publicly reported for AWA-covered animals, then some 44.5 million mice and rats underwent potentially painful experiments. These data inform the questions of whether the AWA needs an update to cover RM, or whether the NIH should increase transparency of funded animal research. These figures can benchmark progress in reducing animal numbers in general and more specifically, in painful experiments. This estimate is higher than any others available, reflecting the challenges of obtaining statistics without consistent and transparent institutional reports.

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