scholarly journals Mass Casualty Management in the Emergency Department - Lessons Learned in Beirut, Lebanon - Part I

2020 ◽  
Keyword(s):  
Emergency Department ◽  
Emergency Departments ◽  
Mass Casualty ◽  
Lessons Learned ◽  
Mass Casualty Incidents ◽  
Pivotal Role ◽  
Front Door ◽  
Short Period ◽  
Effective Planning

Over the last century, mass casualty incidents (MCIs) affected many nations and their emergency departments. The unscheduled arrival of large number of injured victims over a short period of time often causes major chaos and crowding. When a rapid surge in operational needs overwhelms available Emergency Department (ED) resources and personnel, the chaos and overwhelming mismatch between needs and resources can quickly spread to the rest of the hospital.1, 2 Nonetheless, as the front door of the hospital, the ED plays a pivotal role in determining the quality and effectiveness of an institution’s MCI response. This requires effective planning, which translates into preparedness. Unfortunately, many EDs are overburdened even on regular days. Damaged infrastructure further compounds the challenge.

scholarly journals Mass Casualty Management in the Emergency Department – Lessons Learned in Beirut, Lebanon - Part II

2020 ◽  
Keyword(s):  
Emergency Department ◽  
Emergency Departments ◽  
Mass Casualty ◽  
Lessons Learned ◽  
Mass Casualty Incidents ◽  
The Past ◽  
To Receive

The first article in this series (Part I) discussed the abundant exposure of our emergency department (ED) to mass casualty incidents (MCIs), particularly over the past 14 years. This experience led us to define practical strategies that emergency departments can use to develop their own MCI response plans. In the first part, our main focus was to highlight the abrupt nature of MCIs and the subsequent need to use disaster drills. Additionally, we discussed the importance of having a tiered response and activation as well as other lessons learned from our experience to maximize the preparedness of the emergency department to receive mass casualty.In this article, we discuss the optimal way to triage patients. In addition, we will tackle the best methods for documentation and communication, which are vital yet overlooked during mass casualty incidents. We will also elaborate on what we learned from dealing with outbursts of anger and violence in the ED during MCIs and how to ensure the safety of the ED staff.

Injury patterns of mass casualty incidents involving high-speed passenger ferries presenting to accident and emergency departments in Hong Kong: a retrospective review

Injury ◽  
2020 ◽  
Vol 51 (2) ◽  
pp. 252-259 ◽  
Author(s):  
Rex Pui Kin Lam ◽  
Ronald Tat Ming Wong ◽  
Eric Ho Yin Lau ◽  
Kin Wa Wong ◽  
Arthur Chi Kin Cheung ◽  
...  
Keyword(s):  
Hong Kong ◽  
Retrospective Review ◽  
Emergency Departments ◽  
High Speed ◽  
Mass Casualty ◽  
Mass Casualty Incidents ◽  
Injury Patterns ◽  
Accident And Emergency

scholarly journals Design Strategies to Improve Emergency Departments’ Performance During Mass Casualty Incidents: A Survey of Caregivers

2019 ◽  
Vol 13 (1) ◽  
pp. 206-220
Author(s):  
Shabboo Valipoor ◽  
Hesamedin Hakimjavadi ◽  
Giuliano De Portu
Keyword(s):  
Emergency Departments ◽  
Patient Flow ◽  
Care Facility ◽  
Emergency Operation ◽  
Mass Casualty ◽  
Physical Design ◽  
Mass Casualty Incidents ◽  
Design Strategies ◽  
Online Questionnaire ◽  
Critical Patients

Objectives: To identify effective facility design strategies to improve the performance of healthcare providers and patient flow during mass casualty incidents (MCIs) in emergency departments. Background: Emergency departments (EDs) are the first line of medical care in MCIs. While operational surge management plans are well described in literature, physical design strategies to improve performance and patient flow during disasters are discussed scarcely. Method: An online questionnaire was sent to EDs’ caregivers nationwide asking them to rate the effectiveness of nine physical design strategies, discussed in the literature, to improve caregivers’ performance and patient flow during MCIs. Assessed strategies were about providing expandable departments and care areas, alternate care facilities for the least sick to maximize care areas for critical patients, care areas from nonemergency units, increased number of decontamination units, dedicated isolation units, within-hospital and close emergency operation centers, and within-hospital media areas. Results: All suggested strategies were rated as effective. The most effective and agreed-upon solution was identified as maximizing the care area for critical patients by establishing an alternate care facility with separate entrance and exit doors from the emergency department for the least critical patients. The least effective and agreed-upon strategy was identified as locating a media unit within the hospital outside of the ED. Conclusions: Caregivers who work in EDs consider design strategies to be effective in surge management during disasters. Designers can consider implementing identified strategies in designing new emergency departments or expansion and renovation projects.

An In Situ Simulation-Based Training Approach to Active Shooter Response in the Emergency Department

2018 ◽  
Vol 13 (02) ◽  
pp. 345-352 ◽  
Author(s):  
Mark S. Mannenbach ◽  
Carol J. Fahje ◽  
Kharmene L. Sunga ◽  
Matthew D. Sztajnkrycer
Keyword(s):  
Emergency Department ◽  
Emergency Departments ◽  
Low Frequency ◽  
Training Model ◽  
The United States ◽  
Lessons Learned ◽  
Added Value ◽  
Active Shooter ◽  
In Situ Simulation

ABSTRACTWith an increased number of active shooter events in the United States, emergency departments are challenged to ensure preparedness for these low frequency but high stakes events. Engagement of all emergency department personnel can be very challenging due to a variety of barriers. This article describes the use of an in situ simulation training model as a component of active shooter education in one emergency department. The educational tool was intentionally developed to be multidisciplinary in planning and involvement, to avoid interference with patient care and to be completed in the true footprint of the work space of the participants. Feedback from the participants was overwhelmingly positive both in terms of added value and avoidance of creating secondary emotional or psychological stress. The specific barriers and methods to overcome implementation are outlined. Although the approach was used in only one department, the approach and lessons learned can be applied to other emergency departments in their planning and preparation. (Disaster Med Public Health Preparedness. 2019;13:345–352)

scholarly journals MP26: Development and evaluation of a novel emergency physician fan-out mechanism at an urban centre for use in mass casualty incidents

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S51
Author(s):  
J. Melegrito ◽  
B. Granberg ◽  
K. Hanrahan
Keyword(s):  
Emergency Department ◽  
Emergency Physician ◽  
Large Scale ◽  
Response Rate ◽  
Text Message ◽  
Mass Casualty ◽  
Mass Casualty Incidents ◽  
Process Mapping ◽  
Emergency Physicians ◽  
Physician Response

Background: Understaffing in mass casualty incidents limits flow in the overwhelmed emergency department, which is further compounded by inefficient use of those same human resources. Process mapping analysis of a “Code Orange” exercise at a tertiary academic hospital exposed the failures of telephone-based emergency physician fan-out protocols to address these issues. As such, a quality improvement and patient safety initiative was undertaken to design, implement, and evaluate a new mass casualty incident fan-out mechanism. Aim Statement: By February 2019, emergency physician fan-out will be accomplished within 1 hour of Code Orange declaration, with a response rate greater than 20%. Measures & Design: Process mapping of a Code Orange simulation highlighted telephone fan-out to be ineffective in mobilizing emergency physicians to provide care in mass casualty incidents: available staff were pulled from their usual duties to help unit clerks unsuccessfully reach off-duty physicians by telephone for hours. Stakeholders subsequently identified automation and computerization as a compelling change idea. A de-novo automated bidirectional text-messaging system was thus developed. Early trials were analyzed for process measures including fan-out speed, unit clerk involvement, and physician response rate, with further large-scale tests planned for early 2019. Evaluation/Results: Only 50% of telephone fan-out was completed after a 2-hour exercise despite 3 staff supplementing the 2 on-shift unit clerks, with a 4% physician response rate. In contrast, data from initial trials of the automated system suggest that full fan-out can be performed within 1 hour of Code Orange declaration and require only 1 unit clerk, with text-messages projected to yield higher physician response rates than telephone calls. Early findings have thus far affirmed stakeholder sentiments that automating fan-out can improve speed, unit clerk efficiency, and physician response rate. Discussion/Impact: Automated text-message systems can expedite fan-out protocol in mass casualty incidents, relieve allied health staff strain, and more reliably recruit emergency physicians. Large-scale trials of the novel system are therefore planned for early 2019, with future expansion of the protocol to other medical personnel under consideration. Thus, automated text-message systems can be implemented in urban centres to improve fan-out efficiency and aid overall emergency department flow in mass casualty incidents.

scholarly journals (P1-38) Emergency Department Preparedness for Training Management Plan towards Mass Casualty Incidents

2011 ◽  
Vol 26 (S1) ◽  
pp. s110-s111
Author(s):  
W.L. Chan
Keyword(s):  
Emergency Department ◽  
Food Poisoning ◽  
Management Plan ◽  
Mass Casualty ◽  
Mass Casualty Incidents ◽  
Working Relationships ◽  
Work Processes ◽  
Hospital Emergency ◽  
New Information ◽  
Planning Department

It is important to equip emergency department (ED) staff with skills to manage mass casualty incidents (MCI) as disasters strike without warning. Our hospital, Tan Tock Seng Hospital, has been the national screening centre for severe acute respiratory distress syndrome (SARS) and H1N1 outbreaks in 2003 and 2009. Furthermore, our ED has managed casualties from mass food poisoning in the community. We would like to share our experiences in training our staff for MCI. For the ED to operate smoothly in a MCI, comprehensive training of staff during “peace” time is essential. We have a selected team of doctors and nurses as the department disaster workgroup. This team, together with the hospital emergency planning department, prepare the disaster protocols using an “all hazard approach concept” and aim to minimise variations between different protocols (Conventional, Infectious disease, Hazmat, Radioactive MCI). These protocols are updated regularly, with new information disseminated to all staff. Next, all staff must be well-versed in the protocols. New staffs undergo orientation programmes to familiarize them with the work processes. Regular audits are conducted to ensure that the quality is well-maintained. Additionally, training also occurs at the inter-departmental and national levels. There are regular activation exercises to test inter-departmental response to MCI and collaborations with Ministry of Health to conduct disaster exercises e.g. the biennial Kingfisher Exercise in preparation for radiation-related MCI. Such exercises improve communication and working relationships within the ED and with other departments. The camaraderie developed can act as a pillar of support during stressful times of MCI. Lastly, the ED staffs attend local and international courses and conferences to update ourselves on the latest training and knowledge in the handling of MCI. This allows us to share our ideas and to learn from our local and international counterparts, and helps better prepare ourselves.

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