Factors Influencing the Prioritization of Injured Patients for Transfer to a Burn or Trauma Center Following a Mass Casualty Event

2020 ◽  
pp. 1-8
Author(s):  
Elizabeth A. Lancet ◽  
Wei Wei Zhang ◽  
Patricia Roblin ◽  
Bonnie Arquilla ◽  
Rachel Zeig-Owens ◽  
...  
Keyword(s):  
New York ◽  
Large Scale ◽  
Local Community ◽  
Injury Severity ◽  
Community Hospital ◽  
Clinical Information ◽  
Mass Casualty ◽  
Patient Profile ◽  
Mass Casualty Event ◽  
Consultation Team

ABSTRACT Objectives: In New York City, a multi-disciplinary Mass Casualty Consultation team is proposed to support prioritization of patients for coordinated inter-facility transfer after a large-scale mass casualty event. This study examines factors that influence consultation team prioritization decisions. Methods: As part of a multi-hospital functional exercise, 2 teams prioritized the same set of 69 patient profiles. Prioritization decisions were compared between teams. Agreement between teams was assessed based on patient profile demographics and injury severity. An investigator interviewed team leaders to determine reasons for discordant transfer decisions. Results: The 2 teams differed significantly in the total number of transfers recommended (49 vs 36; P = 0.003). However, there was substantial agreement when recommending transfer to burn centers, with 85.5% agreement and inter-rater reliability of 0.67 (confidence interval: 0.49–0.85). There was better agreement for patients with a higher acuity of injuries. Based on interviews, the most common reason for discordance was insider knowledge of the local community hospital and its capabilities. Conclusions: A multi-disciplinary Mass Casualty Consultation team was able to rapidly prioritize patients for coordinated secondary transfer using limited clinical information. Training for consultation teams should emphasize guidelines for transfer based on existing services at sending and receiving hospitals, as knowledge of local community hospital capabilities influence physician decision-making.

Analysis of Emergency Health Care Workforce and Service Readiness for a Mass Casualty Event in the Republic of Ireland

2018 ◽  
Vol 13 (02) ◽  
pp. 243-255 ◽  
Author(s):  
Tener Goodwin Veenema ◽  
Fiona Boland ◽  
Declan Patton ◽  
Tom O’Connor ◽  
Zena Moore ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Response ◽  
Large Scale ◽  
Mass Casualty ◽  
Republic Of Ireland ◽  
Emergency Responders ◽  
Mass Casualty Event ◽  
Service Readiness ◽  
The Republic ◽  
Professional Disciplines

ABSTRACTObjectiveUltimately, a country’s capacity for a large-scale major emergency response will be directly related to the competence of its health care provider (HCP) workforce and communication between emergency responders and hospitals. The purpose of this study was to assess HCP preparedness and service readiness for a major emergency involving mass casualties (mass casualty event or MCE) in Ireland.MethodsA cross-sectional study using a 53-item survey was administered to a purposive sample of emergency responders and HCPs in the Republic of Ireland. Data collection was achieved using the Qualtrics® Research Suite. Descriptive statistics and appropriate tests of comparison between professional disciplines were conducted using Stata 13.ResultsA total of 385 respondents, registered nurses (43.4%), paramedics (37.9%), medical doctors (10.1%), and administrators/managers (8.6%), participated in the study. In general, a level of knowledge of MCEs and knowledge of clinical response activities and self-assessed clinical competence varied drastically across many aspects of the survey. Knowledge and confidence also varied across professional disciplines (P<0.05) with nurses, in general, reporting the least knowledge and/or confidence.ConclusionsThe results demonstrate that serious deficits exist in HCP knowledge, skills, and self-perceived abilities to participate in a large-scale MCE. Results also suggest a poor knowledge base of existing major emergency response plans. (Disaster Med Public Health Preparedness. 2019;13:243–255)

Utilizing a Pediatric Disaster Coalition Model to Increase Pediatric Critical Care Surge Capacity in New York City

2017 ◽  
Vol 11 (4) ◽  
pp. 473-478 ◽  
Author(s):  
Michael Frogel ◽  
Avram Flamm ◽  
Mayer Sagy ◽  
Katharine Uraneck ◽  
Edward Conway ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Critical Care ◽  
York City ◽  
Emergency Preparedness ◽  
Mass Casualty ◽  
Surge Capacity ◽  
Pediatric Critical Care ◽  
Mass Casualty Event ◽  
Care Surgery

AbstractA mass casualty event can result in an overwhelming number of critically injured pediatric victims that exceeds the available capacity of pediatric critical care (PCC) units, both locally and regionally. To address these gaps, the New York City (NYC) Pediatric Disaster Coalition (PDC) was established. The PDC includes experts in emergency preparedness, critical care, surgery, and emergency medicine from 18 of 25 major NYC PCC-capable hospitals. A PCC surge committee created recommendations for making additional PCC beds available with an emphasis on space, staff, stuff (equipment), and systems. The PDC assisted 15 hospitals in creating PCC surge plans by utilizing template plans and site visits. These plans created an additional 153 potential PCC surge beds. Seven hospitals tested their plans through drills. The purpose of this article was to demonstrate the need for planning for disasters involving children and to provide a stepwise, replicable model for establishing a PDC, with one of its primary goals focused on facilitating PCC surge planning. The process we describe for developing a PDC can be replicated to communities of any size, setting, or location. We offer our model as an example for other cities. (Disaster Med Public Health Preparedness. 2017;11:473–478)

scholarly journals A Forced March for Failing Schools: Lessons from the New York City Chancellor's District.

2005 ◽  
Vol 13 ◽  
pp. 40 ◽  
Author(s):  
Deinya Phenix ◽  
Dorothy Siegel ◽  
Ariel Zaltsman ◽  
Norm Fruchter
Keyword(s):  
New York ◽  
New York City ◽  
School Improvement ◽  
York City ◽  
Large Scale ◽  
Local Community ◽  
Significant Proportion ◽  
School Level ◽  
Report Cards ◽  
Low Performing Schools

In the mid-nineties, the New York City Schools Chancellor created a citywide improvement zone to take over a significant proportion of the city's lowest performing schools whose local community school districts had failed to improve them. This "Chancellor's District" defined centralized management, rather than local control, as the critical variable necessary to initiate, enforce and ensure the implementation of school improvement. This large-scale intervention involved both a governance change and a set of capacity-building interventions presumably unavailable under local sub-district control. Our study retrospectively examined the origins, structure and components of the Chancellor's District, and analyzed the characteristics and outcomes of the elementary schools mandated to receive these interventions. Our longitudinal analysis compared Chancellor's District schools to New York City's other state-identified low performing schools, based on a school-level panel of performance, demographic, human resource, and expenditure data collected from district Annual School Report Cards and School Based Expenditure Reports from 1998-99 through 2001-02. The results suggest that the Chancellor's District intervention improved these schools' instructional capacity and academic outcomes, both relative to where these schools would have been and relative to comparable schools.

scholarly journals The shipboard Beirut terrorist bombing experience: a historical account and recommendations for preparedness in events of mass neurological injuries

2018 ◽  
Vol 45 (6) ◽  
pp. E18
Author(s):  
Zachary S. Hubbard ◽  
Fraser Henderson ◽  
Rocco A. Armonda ◽  
Alejandro M. Spiotta ◽  
Robert Rosenbaum ◽  
...  
Keyword(s):  
World War Ii ◽  
Large Scale ◽  
Spinal Cord Injuries ◽  
Task Force ◽  
Skull Fracture ◽  
Medical Personnel ◽  
Mass Casualty ◽  
Neurological Injury ◽  
World War ◽  
Mass Casualty Event

On a Sunday morning at 06:22 on October 23, 1983, in Beirut, Lebanon, a semitrailer filled with TNT sped through the guarded barrier into the ground floor of the Civilian Aviation Authority and exploded, killing and wounding US Marines from the 1st Battalion 8th Regiment (2nd Division), as well as the battalion surgeon and deployed corpsmen. The truck bomb explosion, estimated to be the equivalent of 21,000 lbs of TNT, and regarded as the largest nonnuclear explosion since World War II, caused what was then the most lethal single-day death toll for the US Marine Corps since the Battle of Iwo Jima in World War II. Considerable neurological injury resulted from the bombing. Of the 112 survivors, 37 had head injuries, 2 had spinal cord injuries, and 9 had peripheral nerve injuries. Concussion, scalp laceration, and skull fracture were the most common cranial injuries.Within minutes of the explosion, the Commander Task Force 61/62 Mass Casualty Plan was implemented by personnel aboard the USS Iwo Jima. The wounded were triaged according to standard protocol at the time. Senator Humphreys, chairman of the Preparedness Committee and a corpsman in the Korean War, commented that he had never seen such a well-executed evolution. This was the result of meticulous preparation that included training not only of the medical personnel but also of volunteers from the ship’s company, frequent drilling with other shipboard units, coordination of resources throughout the ship, the presence of a meticulous senior enlisted man who carefully registered each of the wounded, the presence of trained security forces, and a drilled and functioning communication system.Viewed through the lens of a neurosurgeon, the 1983 bombings and mass casualty event impart important lessons in preparedness. Medical personnel should be trained specifically to handle the kinds of injuries anticipated and should rehearse the mass casualty event on a regular basis using mock-up patients. Neurosurgery staff should participate in training and planning for events alongside other clinicians. Training of nurses, corpsmen, and also nonmedical personnel is essential. In a large-scale evolution, nonmedical personnel may monitor vital signs, work as scribes or stretcher bearers, and run messages. It is incumbent upon medical providers and neurosurgeons in particular to be aware of the potential for mass casualty events and to make necessary preparations.

Integrated Plan to Augment Surge Capacity

2008 ◽  
Vol 23 (2) ◽  
pp. 113-119 ◽  
Author(s):  
Christopher Dayton ◽  
Jamil Ibrahim ◽  
Michael Augenbraun ◽  
Steven Brooks ◽  
Kiaran Mody ◽  
...  
Keyword(s):  
Public Health ◽  
New York ◽  
Medical Care ◽  
Large Scale ◽  
Local Level ◽  
New York State ◽  
Federal State ◽  
Medical Care System ◽  
Surge Capacity ◽  
Mass Casualty Event

AbstractIntroduction:Surge capacity is defined as a healthcare system's ability to rapidly expand beyond normal services to meet the increased demand for appropriate space, qualified personnel, medical care, and public health in the event of bioterrorism, disaster, or other large-scale, public health emergencies. There are many individuals and agencies, including policy makers, planners, administrators, and staff at the federal, state, and local level, involved in the process of planning for and executing policy in respect to a surge in the medical requirements of a population. They are responsible to ensure there is sufficient surge capacity within their own jurisdiction.Problem:The [US] federal government has required New York State to create a system of hospital bed surge capacity that provides for 500 adult and pediatric patients per 1 million population, which has been estimated to be an increase of 15–20% in bed availability. In response, the New York City Department of Health and Mental Hygiene (NYC DOH) has requested that area hospitals take an inventory of available beds and set a goal to provide for a 20% surge capacity to be available during a mass-casualty event or other conditions calling for increased inpatient bed availability.Methods:In 2003, under the auspices of the NYC DOH, the New York Institute of All Hazard Preparedness (NYIHP) was formed from four unaffiliated, healthcare facilities in Central Brooklyn to address this and other goals.Results:The NYIHP hospitals have developed a surge capacity plan to provide necessary space and utilities. As these plans have been applied, a bed surge capacity of approximately 25% was identified and created for Central Brooklyn to provide for the increased demand on the medical care system that may accompany a disaster. Through the process of developing an integrated plan that would engage a public health incident, the facilities of NYIHP demonstrate that a model of cooperation may be applied to an inherently fractioned medical system.

scholarly journals (A233) Preparedness For A Mega Mass-Casualty Event (MMCE)

2011 ◽  
Vol 26 (S1) ◽  
pp. s63-s64
Author(s):  
A. Blumenfeld
Keyword(s):  
Large Scale ◽  
Emergency Services ◽  
Command And Control ◽  
Mass Casualty ◽  
Clinical Aspects ◽  
Recent Experience ◽  
Mass Casualty Event ◽  
Future Events ◽  
National Headquarters ◽  
And Control

A Mega Mass-Casualty Event (MMCE) is a unique and exceptional event, that results in a very large number of casualties (500–5000) needing emergency care in the prehospital and hospital settings. This type of event usually goes beyond the capabilities of a certain region and requires reinforcement of resources from adjacent and remote regions. Due to its exceptional nature, a MMCE dictates a different organization of all emergency services and agencies involved. As a result of the recent experience, and in order to adequately prepare for such future events, a novel MMCE doctrine was developed by a committee of diverse emergency professionals. This doctrine was transferred to guidelines referring to MMCE recognition and the following series of actions that need to taken at all levels. It holds organizational, operational, and clinical aspects, as well as command and control elements. In November 2009, a large-scale drill of 1,000 mock casualties was performed in order to validate and evaluate the MMCE plan. This drill emphasized the need for the involvement of all pertinent emergency services and agencies, and their optimal collaboration and coordination, subjected to regional and national headquarters' command and control. In addition, the need for dedicated educational programs and o-going training was recognized. It was accepted that adequate planning is obligatory for better outcomes in the future.

scholarly journals (A47) Pediatric Mass-Casualty Triage: The New York City Approach

2011 ◽  
Vol 26 (S1) ◽  
pp. s16-s16
Author(s):  
A. Cooper ◽  
D. Gonzalez ◽  
M. Frogel ◽  
A. Flamm ◽  
D. Prezant ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Critically Ill ◽  
York City ◽  
Emergency Preparedness ◽  
Early Recognition ◽  
Trauma Surgery ◽  
Mass Casualty ◽  
Infants And Children ◽  
Mass Casualty Event

IntroductionA Mass-Casualty Event (MCE) involving pediatric victims could overwhelm existing pediatric resources. Therefore, early recognition of critically ill infants and children is essential for proper distribution among pediatric capable hospitals. However, emergency medical services (EMS) personnel have limited experience with pediatric assessments, and less with pediatric mass-casualty triage (MCT). To address these gaps, the New York City (NYC) Pediatric Disaster Coalition (PDC) in collaboration with the Fire Department (FDNY) and Office of Emergency Management, made simple alterations to the START-based NYC-MCT Algorithm that can be rapidly and accurately applied by EMS personnel in the field with minimal additional education and preparation, obviating the requirement for extensive and expensive retraining.MethodsThe PDC includes experts in pediatric emergency preparedness, emergency medicine, critical care, and trauma surgery in NYC, as well as DOHMH, FDNY-OMA, and OEM. Its Triage Subcommittee determined the minimum essential pediatric alterations to the Algorithm, which then was tested by FDNY-EMS.ResultsAfter focused literature review and multiple draft revisions aimed to maximize pediatric benefit yet minimize unnecessary complexity, the Algorithm was modified to ensure that: (1) five rescue breaths will be provided to infants or children prior to being categorized as Dead or Expectant; (2) infants under 12 months old will be categorized as Critical and receive priority transport, and (3) children initially categorized as Delayed or Minor will be uptriaged to a new Urgent (Orange) category to receive such care in a rapid manner. To date, > 3,000 FDNY personnel have been trained in its use, and tested its accuracy using tabletop scenarios. Mean accuracy is 80–90%.ConclusionsThe model is an effective, multidisciplinary approach to planning. Minimum alterations to the Algorithm were adopted by the regional EMS system. The Modified Algorithm improves identification of critically ill infants and children. This approach could be adopted by other large urban centers.

Using a Logic Model to Enable and Evaluate Long-Term Outcomes of a Mass Casualty Training Program: A Single Center Case Study

2021 ◽  
pp. 1-7
Author(s):  
Nicholas B Dadario ◽  
Simon Bellido ◽  
Andrew Restivo ◽  
Miriam Kulkarni ◽  
Maninder Singh ◽  
...  
Keyword(s):  
New York ◽  
Training Program ◽  
Emergency Preparedness ◽  
Disaster Preparedness ◽  
Mass Casualty ◽  
Logic Model ◽  
Self Directed Learning ◽  
Academic Center ◽  
Mass Casualty Event

Abstract Purpose: Global health disasters are on the rise and can occur at any time with little advance warning, necessitating preparation. The authors created a comprehensive evidence-based Emergency Preparedness Training Program focused on long-term retention and sustained learner engagement. Method: A prospective observational study was conducted of a simulation-based mass casualty event training program designed using an outcomes-based logic model. A total of 25 frontline healthcare workers from multiple hospital sites in the New York metropolitan area participated in an 8-hour immersive workshop. Data was collected from assessments, and surveys provided to participants 3 weeks prior to the workshop, immediately following the workshop, and 3 months after completion of the workshop. Results: The mean percentage of total knowledge scores improved across pre-workshop, post-workshop and retention (3 months post-workshop) assessments (53.2% vs. 64.8% vs. 67.6%, P < 0.05). Average comfort scores in the core MCI competencies increased across pre-workshop, post-workshop and retention self-assessments (P < 0.01). Of the participants assessed at 3 months retention (n = 14, 56%), 50.0% (n = 7) assisted in updating their hospital’s emergency operations plan and 50.0% (n = 7) pursued further self-directed learning in disaster preparedness medicine. Conclusions: The use of the logic model provided a transparent framework for the design, implementation, and evaluation of a competency-based EPT program at a single academic center.

The changing role of GP clinicians working in community hospitals.

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X696713
Author(s):  
David Seamark ◽  
Deborah Davidson ◽  
Helen Tucker ◽  
Angela Ellis-Paine ◽  
Jon Glasby
Keyword(s):  
Medical Care ◽  
Local Community ◽  
Community Hospital ◽  
Clinical Care ◽  
Hospital Setting ◽  
Community Hospitals ◽  
Recruitment Challenges ◽  
Acute Hospitals ◽  
Changing Role

BackgroundIn 2000 20% of UK GPs had admitting rights to community hospitals. In subsequent years the number of GPs engaged in community hospital clinical care has decreased.AimWhat models of medical care exist in English community hospitals today and what factors are driving changes?MethodInterviews with community hospital clinical staff conducted as part of a multimethod study of the community value of community hospitals.ResultsSeventeen interviews were conducted and two different models of medical care observed: GP led and Trust employed doctors. Factors driving changes were GP workload and recruitment challenges; increased medical acuity of patients admitted; fewer local patients being admitted; frustration over the move from ‘step-up’ care from the local community to ‘step-down’ care from acute hospitals; increased burden of GP medical support; inadequate remuneration; and GP admission rights removed due to bed closures or GP practices withdrawing from community hospital work.ConclusionMultiple factors have driven changes in the role of GP community hospital clinicians with a consequent loss of GP generalist skills in the community hospital setting. The NHS needs to develop a focused strategy if GPs are to remain engaged with community hospital care.

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