2013 Boston Marathon Bombings: Overview of an Emergency Department Response to a Mass Casualty Incident

2013 ◽  
Vol 7 (2) ◽  
pp. 118-121 ◽  
Author(s):  
Shawn M. D'Andrea ◽  
Eric Goralnick ◽  
Stephanie R. Kayden
Keyword(s):  
Emergency Department ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Boston Marathon

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 A Surprise Mass Casualty Incident Simulation: Does It Improve Knowledge or Is It Just a Bit of Fun?

2019 ◽  
Vol 34 (s1) ◽  
pp. s18-s19
Author(s):  
Brad Mitchell ◽  
Karen Hammad ◽  
Dana Aldwin
Keyword(s):  
Emergency Department ◽  
Low Cost ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Major Incident ◽  
Likert Scales ◽  
The Past ◽  
Emergency Department Nurses ◽  
Major Incidents ◽  
Simulation Scenario

Introduction:We opened a national conference in Australia with a surprise mass casualty simulation scenario of a van versus multiple persons outside the conference venue. The purpose of this exercise was to increase awareness of, and preparation for, mass casualty incident (MCI) events for the conference delegates who were paramedics, emergency department nurses, and doctors.Aim:The aim of the research is to understand whether a surprise MCI simulation is a useful way to increase knowledge and motivate preparedness.Methods:A survey hosted on Qualtrics was circulated to delegates via email. The survey was designed by the research team and had 38 questions about demographics and respondents’ experience with MCIs, as well as their perceptions of the simulation exercise. The questions were a mixture of 5-point Likert scales, multiple choice, and short answers.Results:The majority of respondents were clinicians (n = 66, 76%) and those who worked in emergency departments or the prehospital setting (n = 75, 86%). While the majority had not responded to an MCI in the past 5 years (n = 67, 77%), more than half (n = 50, 57%) had undertaken MCI training during this time. Overall, a vast majority of respondents found the simulation to be a worthwhile exercise that increased knowledge and preparedness. An overwhelming majority also reported that the simulation was relevant to practice, of high quality, and a useful way to teach about major incidents.Discussion:Our surprise major incident simulation was a fun and effective way to raise awareness and increase knowledge in prehospital and emergency department clinicians about MCI response. This approach to simulation can be easily replicated at relatively low cost and is, therefore, a useful solution to training a group of multidisciplinary health professionals outside of the workplace.

scholarly journals Westgate Shootings: An Emergency Department Approach to a Mass-casualty Incident

2014 ◽  
Vol 29 (5) ◽  
pp. 538-541 ◽  
Author(s):  
Benjamin W. Wachira ◽  
Ramadhani O. Abdalla ◽  
Lee A. Wallis
Keyword(s):  
Emergency Department ◽  
Emergency Preparedness ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
University Hospital ◽  
Shopping Mall ◽  
Major Incident ◽  
Local Health ◽  
Publication Type ◽  
Communication Assessment

AbstractAt approximately 12:30 pm on Saturday September 21, 2013, armed assailants attacked the upscale Westgate shopping mall in the Westlands area of Nairobi, Kenya. Using the seven key Major Incident Medical Management and Support (MIMMS) principles, command, safety, communication, assessment, triage, treatment, and transport, the Aga Khan University Hospital, Nairobi (AKUH,N) emergency department (ED) successfully coordinated the reception and care of all the casualties brought to the hospital.This report describes the AKUH,N ED response to the first civilian mass-casualty shooting incident in Kenya, with the hope of informing the development and implementation of mass-casualty emergency preparedness plans by other EDs and hospitals in Kenya, appropriate for the local health care system.WachiraBW, AbdallaRO, WallisLA. Westgate shootings: an emergency department approach to a mass-casualty incident. Prehosp Disaster Med. 2014;29(5):1-4.

The effect of training and experience on mass casualty incident triage performance: Evidence from emergency personnel in a high complexity university hospital

2019 ◽  
Vol 14 (2) ◽  
pp. 113-119 ◽  
Author(s):  
Juan P. Vargas, MD, MSc ◽  
Ives Hubloue, MD, PhD ◽  
Jazmín J. Pinzón, MD ◽  
Alejandra Caycedo Duque, MD
Keyword(s):  
Emergency Department ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
University Hospital ◽  
Trauma Patients ◽  
Post Intervention ◽  
Cross Sectional ◽  
Emergency Department Staff ◽  
Department Staff ◽  
Before And After

Mass casualty incident (MCI) can occur at any time and place and health care institutions must be prepared to deal with these incidents. Emergency department staff rarely learn how to triage MCI patients during their medical or nurse degrees, or through on-the-job training. This study aims to evaluate the effect of training and experience on the MCI triage performance of emergency personnel.Methodology: This was a cross-sectional prospective study that analyzed the performance of 94 emergency department staff on the triage classifications of 50 trauma patients, before and after a short training in MCI triage, while taking into account their academic background and work experience.Results: The participants were assigned initially to one of two groups: low experience if they had less than 5 years of practice, and high experience if they had more than 5 years of practice. In the low experience group, the initial accuracy was 45.76 percent, over triage 45.84 percent, and subtriage 8.38 percent. In the high experience group, the initial accuracy was 53.80 percent, over triage 37.66 percent, and sub triage 8.57 percent.Postintervention Results: In the low experience group, the post intervention accuracy was 63.57 percent, over triage 21.15 percent, and subtriage 15.30 percentage. In the high experience group, the post-intervention accuracy was 67.66 percentage, over triage 15.19 percentage, and subtriage 17.14 percentage.  Conclusion: Upon completion of this study, it can be concluded that MCI triage training significantly improved the performance of all those involved in the workshop and that experience plays an important role in MCI triage performance.

scholarly journals Point-of-Care Ultrasonography in a Domestic Mass Casualty Incident: The Boston Marathon Experience

2016 ◽  
Vol 2 (2) ◽  
pp. 32-35 ◽  
Author(s):  
Andrew J. Eyre ◽  
◽  
Michael B. Stone ◽  
Heidi H. Kimberly ◽  
◽  
...  
Keyword(s):  
Point Of Care ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Boston Marathon ◽  
Point Of Care Ultrasonography

Managing a Mass CO Poisoning: Critical Issues and Solutions From the Field to the Hyperbaric Chamber

2016 ◽  
Vol 11 (2) ◽  
pp. 251-255 ◽  
Author(s):  
Adriano Valerio ◽  
Matteo Verzè ◽  
Francesco Marchiori ◽  
Igor Rucci ◽  
Lucia De Santis ◽  
...  
Keyword(s):  
Emergency Department ◽  
Carbon Monoxide ◽  
Emergency Services ◽  
Carbon Monoxide Poisoning ◽  
Heating System ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Accidental Poisoning ◽  
Complex Situation ◽  
First Case

AbstractCarbon monoxide acute intoxication is a common cause of accidental poisoning in industrialized countries and sometimes it produces a real mass casualty incident. The incident described here occurred in a church in the province of Verona, when a group of people was exposed to carbon monoxide due to a heating system malfunction. Fifty-seven people went to the Emergency Department. The mean carboxyhemoglobin (COHb) level was 10.1±5.7% (range: 3-25%). The clinicians, after medical examination, decided to move 37 patients to hyperbaric chambers for hyperbaric oxygen (HBO) therapy. This is the first case report that highlights and analyses the logistic difficulties of managing a mass carbon monoxide poisoning in different health care settings, with a high influx of patients in an Emergency Department and a complex liaison between emergency services. This article shows how it is possible to manage a complex situation with good outcome. (Disaster Med Public Health Preparedness. 2017;11:251–255)

scholarly journals The Experience of a Mass Casualty Incident Call in a Tertiary Hospital after the 2018 Hualien Earthquake

2019 ◽  
Vol 34 (s1) ◽  
pp. s131-s131
Author(s):  
Hsing Chia Cheng ◽  
Kuang Yu Niu ◽  
Ming Han Ho
Keyword(s):  
Emergency Department ◽  
Healthcare Providers ◽  
Task Assignment ◽  
Tertiary Hospital ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Incident Command System ◽  
Incident Command ◽  
Efficiency And Effectiveness ◽  
Training Courses

Introduction:After a 6.0 magnitude earthquake struck Hualien on February 6, 2018, over one hundred and fifty patients crammed into the emergency department of a nearby tertiary hospital within two hours. The mass casualty incident (MCI) call was activated, and over 300 related personnel responded to the call and engaged with the MCI management.Aim:This research aimed to analyze the practice of an MCI call and to form the strategies to improve its efficiency and effectiveness.Methods:The research was conducted in a tertiary hospital in Hualien, Taiwan. Questionnaires regarding the practice of the MCI call were sent out to the healthcare providers in the emergency department who responded to that MCI operation.Results:Thirty-seven responders in the emergency department were involved in this study. 78% had participated in training courses for hospital incident command system (HICS) or MCI management before this event. On arrival at the emergency department, 69.4% of the responders were aware of the check-in station and received a clear task assignment and briefing. During the operation, 25.7% reported the lack of confidence carrying out the assigned tasks and 54.1% of the participants experienced great stress (stress score over 7 out of 10).Discussion:MCI is an uncommon event for hospital management. It is universally challenging owing to its unpredictable and time-sensitive nature. Furthermore, the administration could be further complicated by the associated disasters. Despite regular exercises and drills, there are still a significant number of participants experiencing stress and confusion during the operation. The chaotic situation may further compromise the performance of the participants. This study showed that optimizing task briefing and on-site directions may improve the performance of the MCI participants.

Impact of a Two-step Emergency Department Triage Model with START, then CTAS, on Patient Flow During a Simulated Mass-casualty Incident

2015 ◽  
Vol 30 (4) ◽  
pp. 390-396 ◽  
Author(s):  
James S. Lee ◽  
Jeffrey M. Franc
Keyword(s):  
Emergency Department ◽  
Patient Flow ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Mean Difference ◽  
Time Intervals ◽  
Simulation Exercise ◽  
Physician Assessment ◽  
Emergency Department Triage ◽  
The Difference

AbstractIntroductionA high influx of patients during a mass-casualty incident (MCI) may disrupt patient flow in an already overcrowded emergency department (ED) that is functioning beyond its operating capacity. This pilot study examined the impact of a two-step ED triage model using Simple Triage and Rapid Treatment (START) for pre-triage, followed by triage with the Canadian Triage and Acuity Scale (CTAS), on patient flow during a MCI simulation exercise.Hypothesis/ProblemIt was hypothesized that there would be no difference in time intervals nor patient volumes at each patient-flow milestone.MethodsPhysicians and nurses participated in a computer-based tabletop disaster simulation exercise. Physicians were randomized into the intervention group using START, then CTAS, or the control group using START alone. Patient-flow milestones including time intervals and patient volumes from ED arrival to triage, ED arrival to bed assignment, ED arrival to physician assessment, and ED arrival to disposition decision were compared. Triage accuracy was compared for secondary purposes.ResultsThere were no significant differences in the time interval from ED arrival to triage (mean difference 108 seconds; 95% CI, -353 to 596 seconds; P=1.0), ED arrival to bed assignment (mean difference 362 seconds; 95% CI, -1,269 to 545 seconds; P=1.0), ED arrival to physician assessment (mean difference 31 seconds; 95% CI, -1,104 to 348 seconds; P=0.92), and ED arrival to disposition decision (mean difference 175 seconds; 95% CI, -1,650 to 1,300 seconds; P=1.0) between the two groups. There were no significant differences in the volume of patients to be triaged (32% vs 34%; 95% CI for the difference -16% to 21%; P=1.0), assigned a bed (16% vs 21%; 95% CI for the difference -11% to 20%; P=1.0), assessed by a physician (20% vs 22%; 95% CI for the difference -14% to 19%; P=1.0), and with a disposition decision (20% vs 9%; 95% CI for the difference -25% to 4%; P=.34) between the two groups. The accuracy of triage was similar in both groups (57% vs 70%; 95% CI for the difference -15% to 41%; P=.46).ConclusionExperienced triage nurses were able to apply CTAS effectively during a MCI simulation exercise. A two-step ED triage model using START, then CTAS, had similar patient flow and triage accuracy when compared to START alone.LeeJS, FrancJM. Impact of a two-step emergency department triage model with START, then CTAS, on patient flow during a simulated mass-casualty incident. Prehosp Disaster Med. 2015;30(4):1–7.

Use of Alternate Healthcare Facilities as Alternate Transport Destinations during a Mass-Casualty Incident

2010 ◽  
Vol 25 (2) ◽  
pp. 178-182 ◽  
Author(s):  
Erik S. Glassman ◽  
Steven J. Parrillo
Keyword(s):  
Emergency Department ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Urgent Care ◽  
Definitive Treatment ◽  
Severely Injured ◽  
Severe Injuries ◽  
Healthcare Facilities ◽  
Ambulatory Surgery Centers ◽  
Injured Patients

AbstractThe purpose of this discussion is to review the use of destinations other than the hospital emergency department, to transport patients injured as a result of a mass-casualty incident (MCI). A MCI has the ability to overwhelm traditional hospital resources normally thought of as appropriate destinations for the transport of injured patients. As a result, those with less severe injuries often are required to wait before they can receive definitive treatment. This waiting period, either at the scene of the incident or in the emergency department, can increase morbidity and drain resources that can be better directed toward the transport and care of those more severely injured. Potential alternate transport destinations include physician office buildings, ambulatory care centers, ambulatory surgery centers, and urgent care centers. By allowing for transport to alternate locations, these less severely injured patients can be removed rapidly from the scene, treated, and potentially released. This effort can decrease the strain on traditional resources within the system, better allowing these resources to treat more seriously injured patients.

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