The Importance of Preparedness for Emergency Response to Railway Incidents

2017 ◽  
Author(s):  
John Cockle ◽  
Larry Day
Keyword(s):  
Public Transportation ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Mass Casualties ◽  
Shared Resources ◽  
Use Of Time ◽  
Mass Casualty Events ◽  
Large Numbers ◽  
Time And Energy ◽  
Large Groups

Public transportation provides opportunities for people to share a common platform or mode of transportation as they move from place to place, often amassing persons in large groups or quantities. Rail transportation in particular has the benefit of accommodating very large numbers of people in one movement, often upwards of 1000 persons. The benefits to society are considerable: shared resources, lower impacts on the environment, and more efficient use of time and energy. The consequence when something goes wrong, however, can also be considerable: mass casualties (fatalities and/or injuries) from a single event, disrupted supply chains, and environmental damages to name a few. Even if persons are not physically harmed, the effects of an incident can be felt by a far greater number of persons. Adequate preparation can play a key role in minimizing the effects of mass casualty events such as railway collisions or derailments. Indeed, lives can be saved or lost depending on the resources, training, and organization that are employed when responding to a mass casualty incident.

(A285) Hospital Preparation for Mass Casualty Events

2011 ◽  
Vol 26 (S1) ◽  
pp. s79-s79
Author(s):  
G. Margalit
Keyword(s):  
National Level ◽  
Task Assignment ◽  
Emergency Situation ◽  
Hospital Staff ◽  
Mass Casualty ◽  
Mass Casualties ◽  
Trauma Patients ◽  
Industrial Accidents ◽  
Car Accidents ◽  
Mass Casualty Events

BackgroundHospitals handle numerous tasks whose fundamental purpose is to provide medical treatment. Amongst these, the hospital prepares for the treatment of trauma patients who have been involved in car accidents, injuries at work and industrial accidents. These preparations, although part of the operative conventions of the hospital, do not guarantee the ability to handle Mass Casualty Events which require unique and dedicated preparation and a different operational approach. This paper presents the hospital approach of handling Emergency Mass Casualty Events.The ApproachThe preparations require involvement of a national level that must participate in the definition of the activities, task assignment and preparation of an annual plan. The peak of the preparations is a multidisciplinary drill, implemented as part of the annual activity of the hospital.The ImplementationIn an emergency situation, the aim is for the hospital staff to be capable of providing its patients (and family members) the best professional care in any given scenario. To achieve the above, the hospital is required to perform the following tasks: Defining procedures, personnel training, logistics infrastructure, control, drills and lesson learned implementation. The tasks should be performed under a multi-annual plan that covers various Mass Casualties Events scenarios including: a train accident, an event involving dangerous industrial materials (e.g. ammonia spill), biological scenarios (e.g. bird-flu) and radiation events (e.g. nuclear reaction).ConclusionsOnly precise preparations, disconnected completely from the on-going hospital routine can answer the need to handle Mass Casualties Events.

scholarly journals Actionable, Revised (v.3), and Amplified American Burn Association Triage Tables for Mass Casualties: A Civilian Defense Guideline

2020 ◽  
Vol 41 (4) ◽  
pp. 770-779
Author(s):  
Randy D Kearns ◽  
Amanda P Bettencourt ◽  
William L Hickerson ◽  
Tina L Palmieri ◽  
Paul D Biddinger ◽  
...  
Keyword(s):  
Healthcare System ◽  
Burn Injury ◽  
Standard Of Care ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Standards Of Care ◽  
Mass Casualties ◽  
Institute Of Medicine ◽  
Burn Care ◽  
Civilian Defense

Abstract Burn care remains among the most complex of the time-sensitive treatment interventions in medicine today. An enormous quantity of specialized resources are required to support the critical and complex modalities needed to meet the conventional standard of care for each patient with a critical burn injury. Because of these dependencies, a sudden surge of patients with critical burn injuries requiring immediate and prolonged care following a burn mass casualty incident (BMCI) will place immense stress on healthcare system assets, including supplies, space, and an experienced workforce (staff). Therefore, careful planning to maximize the efficient mobilization and rational use of burn care resources is essential to limit morbidity and mortality following a BMCI. The U.S. burn care profession is represented by the American Burn Association (ABA). This paper has been written by clinical experts and led by the ABA to provide further clarity regarding the capacity of the American healthcare system to absorb a surge of burn-injured patients. Furthermore, this paper intends to offer responders and clinicians evidence-based tools to guide their response and care efforts to maximize burn care capabilities based on realistic assumptions when confronted with a BMCI. This effort also aims to align recommendations in part with those of the Committee on Crisis Standards of Care for the Institute of Medicine, National Academies of Sciences. Their publication guided the work in this report, identified here as “conventional, contingency, and crisis standards of care.” This paper also includes an update to the burn Triage Tables- Seriously Resource-Strained Situations (v.2).

Comparison of Outcome Tools Used to Test Mass-Casualty Algorithms in the Pediatric Population

2021 ◽  
pp. 1-5
Author(s):  
J. Joelle Donofrio ◽  
Alaa Shaban ◽  
Amy H. Kaji ◽  
Genevieve Santillanes ◽  
Mark X. Cicero ◽  
...  
Keyword(s):  
Injury Severity ◽  
Pediatric Population ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Study Objective ◽  
Large Numbers ◽  
Triage Category ◽  
Level I ◽  
Outcome Tool ◽  
Trauma Activation

Abstract Introduction: Mass-casualty incident (MCI) algorithms are used to sort large numbers of patients rapidly into four basic categories based on severity. To date, there is no consensus on the best method to test the accuracy of an MCI algorithm in the pediatric population, nor on the agreement between different tools designed for this purpose. Study Objective: This study is to compare agreement between the Criteria Outcomes Tool (COT) to previously published outcomes tools in assessing the triage category applied to a simulated set of pediatric MCI patients. Methods: An MCI triage category (black, red, yellow, and green) was applied to patients from a pre-collected retrospective cohort of pediatric patients under 14 years of age brought in as a trauma activation to a Level I trauma center from July 2010 through November 2013 using each of the following outcome measures: COT, modified Baxt score, modified Baxt combined with mortality and/or length-of-stay (LOS), ambulatory status, mortality alone, and Injury Severity Score (ISS). Descriptive statistics were applied to determine agreement between tools. Results: A total of 247 patients were included, ranging from 25 days to 13 years of age. The outcome of mortality had 100% agreement with the COT black. The “modified Baxt positive and alive” outcome had the highest agreement with COT red (65%). All yellow outcomes had 47%-53% agreement with COT yellow. “Modified Baxt negative and <24 hours LOS” had the highest agreement with the COT green at 89%. Conclusions: Assessment of algorithms for triaging pediatric MCI patients is complicated by the lack of a gold standard outcome tool and variability between existing measures.

Mass Casualty Incident Management Preparedness: A Survey of the American College of Surgeons Committee on Trauma

2016 ◽  
Vol 82 (12) ◽  
pp. 1227-1231 ◽  
Author(s):  
Aaron M. Lewis ◽  
Salvador Sordo ◽  
Leonard J. Weireter ◽  
Michelle A. Price ◽  
Leopoldo Cancio ◽  
...  
Keyword(s):  
Public Transportation ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Incident Management ◽  
Trauma Centers ◽  
Select Group ◽  
Level Ii ◽  
American College Of Surgeons ◽  
Level I ◽  
Trauma Surgeons

Mass casualty incidents (MCIs) are events resulting in more injured patients than hospital systems can handle with standard protocols. Several studies have assessed hospital preparedness during MCIs. However, physicians and trauma surgeons need to be familiar with their hospital's MCI Plan. The purpose of this survey was to assess hospitals’ and trauma surgeon's preparedness for MCIs. Online surveys were e-mailed to members of the American College of Surgeons committee on Trauma Ad Hoc Committee on Disaster and Mass Casualty Management before the March 2012 meeting. Eighty surveys were analyzed (of 258). About 76 per cent were American College of Surgeons Level I trauma centers, 18 per cent were Level II trauma centers. Fifty-seven per cent of Level I and 21 per cent of Level II trauma centers had experienced an MCI. A total of 98 per cent of respondents thought it was likely their hospital would see a future MCI. Severe weather storm was the most likely event (95%), followed by public transportation incident (86%), then explosion (85%). About 83 per cent of hospitals had mechanisms to request additional physician/surgeons, and 80 per cent reported plans for operative triage. The majority of trauma surgeons felt prepared for an MCI and believed an event was likely to occur in the future. The survey was limited by the highly select group of respondents and future surveys will be necessary.

Mass Casualty Imaging—Policy, Planning, and Radiology Response to Mass Casualty Incidents

2020 ◽  
Vol 71 (3) ◽  
pp. 388-395
Author(s):  
Siobhán B. O’Neill ◽  
Brian Gibney ◽  
Michael E. O’Keeffe ◽  
Sarah Barrett ◽  
Luck Louis
Keyword(s):  
Health Care Providers ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Radiology Department ◽  
Policy Planning ◽  
Care Providers ◽  
Planning Stage ◽  
Large Numbers ◽  
Routine Procedures ◽  
Regional Hospitals

A mass casualty incident (MCI) is an event that generates more patients at one time than locally available resources can manage using routine procedures. By their nature, many of these incidents have no prior notice but result in large numbers of casualties with injuries that range in severity. They can happen anywhere and at any time and regional hospitals and health-care providers have to mount a response quickly and effectively to save as many lives as possible. Radiologists must go from passenger to pilot when it comes to MCI planning. When involved at the hospital-wide planning stage, they can offer valuable expertise on how radiology can improve triage accuracy and at what cost in terms of time and resources and thereby contribute a pragmatic understanding of radiology’s role and value during MCIs. By taking ownership of MCI planning in their own departments, radiologists can ensure that the radiology department can respond quickly and effectively to unforeseen emergencies. Well-designed radiology protocols will save lives in an MCI setting.

scholarly journals Healthcare under siege: a qualitative study of health-worker responses to targeting and besiegement in Syria

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e029651 ◽  
Author(s):  
Nasser Fardousi ◽  
Yazan Douedari ◽  
Natasha Howard
Keyword(s):  
Qualitative Study ◽  
Health Worker ◽  
Resource Constraints ◽  
Health Workers ◽  
Resource Conservation ◽  
Mass Casualty ◽  
Health Facilities ◽  
Mass Casualties ◽  
Emotional Resilience ◽  
Mass Casualty Events

ObjectivesTo explore health-worker perspectives on security, improving safety, managing constrained resources and handling mass casualties during besiegement in Syria.DesignA qualitative study using semi-structured key informant interviews, conducted remotely over WhatsApp and Skype, and analysed thematically using inductive coding.SettingSecondary and tertiary health facilities affected by besiegement in Aleppo (from July to December 2016) and Rural Damascus (from August 2013 to February 2018).ParticipantsTwenty-one male Syrian health-workers and service-users who had experienced besiegement and targeting of their health facilities.ResultsParticipants described four related challenges of: (i) conflict-related responses, particularly responding to mass casualties; (ii) targeted attack responses, particularly preventing/surviving facility bombings; (iii) besiegement responses, particularly mitigating severe resource constraints; and (iv) chronic risk responses, particularly maintaining emotional resilience. Mass casualty response involved triage and training to prioritise mortality reduction and available resources, for example those with greatest need and likelihood of survival. Targeting response was largely physical, including fortification, working underground, reducing visibility and services dispersal. Besiegement response required resource conservation, for example, controlling consumption, reusing consumables, low-technology equipment, finding alternative supply routes, stockpiling and strengthening available human resources through online trainings and establishing a medical school in Ghouta. Risk responses included managing safety worries, finding value in work and maintaining hope.ConclusionBesieged health-workers were most affected by severe resource constraints and safety concerns while responding to overwhelming mass casualty events. Lessons for targeting/besiegement planning include training staff and preparing for: (i) mass casualties, through local/online health-worker training in triage, emergency response and resource conservation; allowing task-shifting; and providing access to low-technology equipment; (ii) attacks, through strengthened facility security, for example, protection and deterrence through fortification, working underground and reducing visibility; and (iii) besiegement, through ensuring access to internet, electricity and low-technology/reusable equipment; securely stockpiling fuel, medicines and supplies; and establishing alternative supply routes.

Die a Hero or Live Long Enough to Become the Villain: Mass Casualty Preparedness in Hospitals and Protecting Doctors from Liability during Mass Casualty Events

2015 ◽  
Vol 6 (1) ◽  
Author(s):  
Ashley Tseung
Keyword(s):  
Public Health ◽  
United States ◽  
Emergency Preparedness ◽  
Preventive Measures ◽  
The United States ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Public Health Emergency ◽  
Terrorist Attacks ◽  
Mass Casualty Events

AbstractSince 9/11, the United States and the international community have emphasized the need to protect people from terrorist attacks. The Boston Bombing that took place on April 15, 2013, showed that even with all of the preventive measures in place, the United States is not immune from terrorist attacks. If there had been a bioterrorist attack in Boston instead of a homemade bomb, the amount of casualties would likely have been a lot higher. Many hospitals lack effective emergency preparedness plans that address bioterrorist attacks. One area that will help prepare nations during a mass casualty incident or public health emergency involves implementing effective mass casualty preparedness plans for hospitals. This paper analyzes mass casualty preparedness in hospitals and demonstrates the need to have legislation in place to protect doctors who treat patients during mass casualty events.

scholarly journals (A281) Protecting and Preparing Critical Hospital Infrastructure — Redundancy, Security, and Disaster Response

2011 ◽  
Vol 26 (S1) ◽  
pp. s78-s78
Author(s):  
A.G. Robertson ◽  
M.G. Leclercq ◽  
C. Wilkinson
Keyword(s):  
Disaster Response ◽  
Capital Investment ◽  
Critical Infrastructure ◽  
Early Stage ◽  
Tertiary Hospital ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Medium Size ◽  
Mass Casualties ◽  
Health Infrastructure

Western Australia (WA) currently is undergoing a major rebuild of its key metropolitan and regional hospitals, with the planned construction of a major tertiary hospital, pediatric hospital, and several large general hospitals in the metropolitan area, and a range of small and medium size hospitals in WA over the next five years. Protecting these hospitals from major internal failure and external assault, while preparing them to cope with mass casualties, has been a major focus of the WA Department of Health over the last five years. This program has involved capital investment in current infrastructure, including critical asset protection, and detailed planning to ensure that the new health infrastructure will have both the redundant systems, to allow for continued operations in a range of infrastructure failure and disaster scenarios, and the facilities to deal with a mass-casualty incident. This presentation will review the implementation of this critical infrastructure program, the evolving issues facing hospitals working to ensure their continued operations in a range of scenarios, the security and infrastructure threats facing major hospitals, and the planning required to ensure that these threats are addressed at an early stage of hospital development. Issues as diverse as the placement of underground garages to minimize bomb threats, the location of helicopter landing pads, and the consideration of how to lock down hospitals to prevent the uncontrolled access of contaminated patients, are some of the challenges that need measured consideration and a planned response. The preparations and planning for such contingencies, and the infrastructure to facilitate continued operations and an appropriate disaster response, are key elements in protecting critical health infrastructure.

Testing the START Triage Protocol: Can It Improve the Ability of Nonmedical Personnel to Better Triage Patients During Disasters and Mass Casualties Incidents ?

2017 ◽  
Vol 11 (3) ◽  
pp. 305-309 ◽  
Author(s):  
Stefano Badiali ◽  
Aimone Giugni ◽  
Lucia Marcis
Keyword(s):  
Group Versus ◽  
Time Frame ◽  
Mass Casualty Incident ◽  
Medical Intervention ◽  
Mass Casualty ◽  
Mass Casualties ◽  
Exact Test ◽  
Triage Protocol ◽  
Train System ◽  
Improve Patient

AbstractObjectiveSTART (Simple Triage and Rapid Treatment) triage is a tool that is available even to nonmedical rescue personnel in case of a disaster or mass casualty incident (MCI). In Italy, no data are available on whether application of the START protocol could improve patient outcomes during a disaster or MCI. We aimed to address whether “last-minute” START training of nonmedical personnel during a disaster or MCI would result in more effective triage of patients.MethodsIn this case-control study, 400 nonmedical ambulance crew members were randomly assigned to a non-START or a START group (200 per group). The START group received last-minute START training. Each group examined 6000 patients, obtained from the Emergo Train System (ETS Italy, Bologna, Italy) victims database, and assigned patients a triage code (black-red-yellow-green) along with a reason for the assignment. Each rescuer triaged 30 patients within a 30-minute time frame. Results were analyzed according to Fisher’s exact test for a P value<0.01. Under- and over-triage ratios were analyzed as well.ResultsThe START group completed the evaluations in 15 minutes, whereas the non-START group took 30 minutes. The START group correctly triaged 94.2% of their patients, as opposed to 59.83% of the non-START group (P<0.01). Under- and over-triage were, respectively, 2.73% and 3.08% for the START group versus 13.67% and 26.5% for the non-START group. The non-START group had 458 “preventable deaths” on 6000 cases because of incorrect triage, whereas the START group had 91.ConclusionsEven a “last-minute” training on the START triage protocol allows nonmedical personnel to better identify and triage the victims of a disaster or MCI, resulting in more effective and efficient medical intervention. (Disaster Med Public Health Preparedness. 2017;11:305–309)

Comparison of Electronic Versus Manual Mass-Casualty Incident Triage

2018 ◽  
Vol 33 (3) ◽  
pp. 273-278 ◽  
Author(s):  
Claudie Bolduc ◽  
Nisreen Maghraby ◽  
Patrick Fok ◽  
The Minh Luong ◽  
Valerie Homier
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Simulated Patients ◽  
Mass Casualties ◽  
Care Providers ◽  
Manual Method ◽  
Computer Based ◽  
Triage Time

AbstractIntroductionMass-casualty incidents (MCIs) easily overwhelm a health care facility’s human and material resources through the extraordinary influx of casualties. Efficient and accurate triage of incoming casualties is a critical step in the hospital disaster response.Hypothesis/ProblemTraditionally, triage during MCIs has been manually performed using paper cards. This study investigated the use of electronic Simple Triage and Rapid Treatment (START) triage as compared to the manual method.MethodsThis observational, crossover study was performed during a live MCI simulation at an urban, Canadian, Level 1 trauma center on May 26, 2016. Health care providers (two medical doctors [MDs], two paramedics [PMs], and two registered nurses [RNs]) each triaged a total of 30 simulated patients - 15 by manual (paper-based) and 15 by electronic (computer-based) START triage. Accuracy of triage categories and time of triage were analyzed. Post-simulation, patients and participating health care providers also completed a feedback form.ResultsThere was no difference in accuracy of triage between the electronic and manual methods overall, 83% and 80% (P=1.0), between providers or between triage categories. On average, triage time using the manual method was estimated to be 8.4 seconds faster (P<.001) for PMs; and while small differences in triage times were observed for MDs and RNs, they were not significant. Data from the participant feedback survey showed that the electronic method was preferred by most health care providers. Patients had no preference for either method. However, patients perceived the computer-based method as “less personal” than the manual triage method, but they also perceived the former as “better organized.”ConclusionHospital-based electronic START triage had the same accuracy as hospital-based manual START triage, regardless of triage provider type or acuity of patient presentations. Time of triage results suggest that speed may be related to provider familiarity with a modality rather than the modality itself. Finally, according to patient and provider perceptions, electronic triage is a feasible modality for hospital triage of mass casualties. Further studies are required to assess the performance of electronic hospital triage, in the context of a rapid surge of patients, and should consider additional efficiencies built in to electronic triage systems. This study presents a framework for assessing the accuracy, triage time, and feasibility of digital technologies in live simulation training or actual MCIs.BolducC, MaghrabyN, FokP, LuongTM, HomierV. Comparison of electronic versus manual mass-casualty incident triage. Prehosp Disaster Med. 2018;33(3):273–278.

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