[Management of a mass casualty incident according to the recommendations of the Federal Office of Civil Protection and Disaster Assistance and the principles of the Terror and Disaster Surgical Care Concept in a regional trauma center]

Dealing with a mass casualty incident presents many challenges in the clinical and preclinical situation. There are various systems and structures to address this problem. In the present work, the management of the train accident near Garmisch-Partenkirchen on 3 June 2022 is evaluated with the aid of the recommendations of the Federal Office for Civil Protection and Disaster Relief for hospital alarm and deployment planning as well as the recommendations from the terror and disaster surgical care training of the German Academy of Trauma Surgery and the findings are presented from the perspective of a regional trauma center. It also discusses which key factors in the present case have proved to be successful and in which areas there is still a need for improvement.

Development of the Aerial Remote Triage System using drones in mass casualty scenarios: A survey of international experts

The use of drones for triage in mass-casualty incidents has recently emerged as a promising technology. However, there is no triage system specifically adapted to a remote usage. Our study aimed to develop a remote triage procedure using drones. The research was performed in three stages: literature review, the development of a remote triage algorithm using drones and evaluation of the algorithm by experts. Qualitative synthesis and the calculation of content validity ratios were done to achieve the Aerial Remote Triage System. This algorithm assesses (in this order): major bleeding, walking, consciousness and signs of life; and then classify the injured people into several priority categories: priority 1 (red), priority 2 (yellow), priority 3 (green) and priority * (violet). It includes the possibility to indicate save-living interventions to injured people and bystanders, like the compression of bleeding injuries or the adoption of the recovery position. The Aerial Remote Triage System may be a useful way to perform triage by drone in complex emergencies when it is difficult to access to the scene due to physical, chemical or biological risks.

Mental Illness, Mass Shootings, and the Future of Psychiatric Research into American Gun Violence

ABSTRACT

This article outlines a four-part strategy for future research in mental health and complementary disciplines that will broaden understanding of mass shootings and multi-victim gun homicides. First, researchers must abandon the starting assumption that acts of mass violence are driven primarily by diagnosable psychopathology in isolated "lone wolf" individuals. The destructive motivations must be situated, instead, within larger social structures and cultural scripts. Second, mental health professionals and scholars must carefully scrutinize any apparent correlation of violence with mental illness for evidence of racial bias in the official systems that define, measure, and record psychiatric diagnoses, as well as those that enforce laws and impose criminal justice sanctions. Third, to better understand the role of firearm access in the occurrence and lethality of mass shootings, research should be guided by an overarching framework that incorporates social, cultural, legal, and political, but also psychological, aspects of private gun ownership in the United States. Fourth, effective policies and interventions to reduce the incidence of mass shootings over time-and to prevent serious acts of violence more generally-will require an expanded body of well-funded interdisciplinary research that is informed and implemented through the sustained engagement of researchers with affected communities and other stakeholders in gun violence prevention. Emerging evidence that the coronavirus pandemic has produced a sharp increase both in civilian gun sales and in the social and psychological determinants of injurious behavior adds special urgency to this agenda.

Translating COVID-19 Pandemic Surge Theory to Practice in the Emergency Department: How to Expand Structure

Multiple professional societies, nongovernment and government agencies have studied the science of sudden onset disaster mass casualty incidents to create and promote surge response guidelines. The COVID-19 pandemic has presented the health-care system with challenges that have limited science to guide the staff, stuff, and structure surge response.This study reviewed the available surge science literature specifically to guide an emergency department's surge structural response using a translational science approach to answer the question: How does the concept of sudden onset mass casualty incident surge capability apply to the process to expand COVID-19 pandemic surge structure response?The available surge structural science literature was reviewed to determine the application to a pandemic response. The on-line ahead of print and print COVID-19 scientific publications, as well as gray literature were studied to learn the best available COVID-19 surge structural response science. A checklist was created to guide the emergency department team's COVID-19 surge structural response.

The impact of imposed delay in elective pediatric neurosurgery: an informed hierarchy of need in the time of mass casualty crisis

SARS-CoV-2 COVID-19, coronavirus, has created unique challenges for the medical community after national guidelines called for the cancellation of all elective surgery. While there are clear cases of elective surgery (benign cranial cosmetic defect) and emergency surgery (hemorrhage, fracture, trauma, etc.), there is an unchartered middle ground in pediatric neurosurgery. Children, unlike adults, have dynamic anatomy and are still developing neural networks. Delaying seemingly elective surgery can affect a child's already vulnerable health state by further impacting their neurocognitive development, neurologic functioning, and potential long-term health states. The purpose of this paper is to demonstrate that "elective" pediatric neurosurgery should be risk-stratified, and multi-institutional informed guidelines established.

A civilian tactical survival chain for incidents involving multiple intentionalinjury victims: the Victory I Consensus Report

International guidelines recommend adapting military health care protocols to emergencies involving multiple intentional-injury victims in civilian environments. Adaptations can reflect similarities in types of injuries or issues of provider safety and that arise in military and some civilian emergencies. Because more experience with such incidents has been gained in the United States, most of the literature on this topic discusses emergency medical systems that differ from the ones operating in the autonomous communities of Spain, where varying resources and procedures are mandated by local authorities charged with preparing for emergencies. However, common elements are present, offering a framework and principles to apply when drafting evidence-based plans for effective, efficient response to multiple-victim emergencies. We think that participants at each point in the chain of survival must have clear missions and understand the roles they play in the various zones that comprise the scene of an emergency. Therefore this consensus paper attempts to define the relevant principles and roles for participants at all levels, from occasional first responders up to staff at trauma referral centers.

Stop the Bleed: Is Mass Education the Best Approach?

The Stop the Bleed (STB) course teaches trainees prehospital hemorrhage control with a focus on mass education. Identifying populations most likely to benefit can help save on the significant cost and limited resources. In this study, we attempted to identify those populations and performed a cost analysis. Trainees underwent STB education and completed a survey on completion to assess demographics and prior experiences where STB skills could have been useful. Five hundred seventy-one trainees categorized as first responders (14%), students (56%), and the working public (30%) completed the survey. Most trainees found the lecture and simulation helpful, 96 per cent and 98 per cent, respectively. There were significant differences among groups who had previously been in situations where the STB course would have been helpful (88% first responders versus 40% students versus 43% public workers) (P < 0.001). Teaching a class of 10 students costs approximately $455; the cost can be as high as $1246 for a class of 50 students. Most STB trainees found the course helpful. First responders are most likely to be exposed to situations where course information could be helpful. Focusing on specific high-yield groups rather than mass education might be a more efficient approach to STB education.

Mass gatherings medicine: public health issues arising from mass gathering religious and sporting events

Mass gathering events are associated with major public health challenges. The 2014 Lancet Series on the new discipline of mass gatherings medicine was launched at the World Health Assembly of Ministers of Health in Geneva in May, 2014. The Series covered the planning and surveillance systems used to monitor public health risks, public health threats, and experiences of health-care providers from mass gathering events in 2012 and 2013. This follow-up Review focuses on the main public health issues arising from planned mass gathering events held between 2013 and 2018. We highlight public health and research data on transmission of infectious diseases and antibiotic-resistant bacteria, mass casualty incidents, and non-communicable diseases, including thermal disorders. In the events discussed in this Review, the combination of a large influx of people, many from countries with outbreak-prone infectious diseases, with a high degree of crowd interactions imposed substantial burdens on host countries' health systems. The detection and transmission of antibiotic-resistant bacteria in pilgrims attending the Kumbh Mela and the Hajj raise concern of possible globalisation from mass-gathering religious events. Priorities for further investments and opportunities for research into prevention, surveillance, and management of these public health issues are discussed.

What have we learned from the time trend of mass shootings in the U.S.?

Little is known regarding the time trend of mass shootings and associated risk factors. In the current study, we intended to explore the time trend and relevant risk factors for mass shootings in the U.S. We attempted to identify factors associated with incidence rates of mass shootings at the population level. We evaluated if state-level gun ownership rate, serious mental illness rate, poverty percentage, and gun law permissiveness could predict the state-level mass shooting rate, using the Bayesian zero-inflated Poisson regression model. We also tested if the nationwide incidence rate of mass shootings increased over the past three decades using the non-homogenous Poisson regression model. We further examined if the frequency of online media coverage and online search interest levels correlated with the interval between two consecutive incidents. The results suggest an increasing trend of mass shooting incidences over time (p < 0.001). However, none of the state-level variables could predict the mass shooting rate. Interestingly, we have found inverse correlations between the interval between consecutive shootings and the frequency of on-line related reports as well as on-line search interests, respectively (p < 0.001). Therefore, our findings suggest that online media might correlate with the increasing incidence rate of mass shootings. Future research is warranted to continue monitoring if the incidence rates of mass shootings change with any population-level factors in order to inform us of possible prevention strategies.

Findings from an Assessment and Inventory of a Regional, Decentralized Stockpile

Stockpiles can aid with healthcare surge that occurs after a disaster, and experts recommend that these caches be assessed at least annually to ensure supply integrity. The purpose of this study was to assess a regional stockpile to determine its viability and readiness. An assessment was performed in the summer and fall of 2016 on a regionally funded stockpile that was decentralized through a regional network of 15 local hospitals. Each supply was assessed to determine whether the correct amount was present, if it was in a safe and usable condition (ie, deployable), and whether it had expired. Stockpiled materials were categorized by the type of supply or equipment for analysis. The percent of deployable materials was calculated for each item, each category of supplies, and for the entire cache. Almost all sites (93.3%, n = 14) reported that they inventory their cache at least once a year. On average, 60.1% of each site's cache materials were present and deployable (range: 22.1%-87.5%). The best-maintained supplies included personal protective equipment (79.4% deployable) and general medical supplies (73.5% deployable). Decontamination equipment and pediatric supplies had the lowest percentages of deployability (29.0% and 37.7%, respectively). Although almost all sites claimed to assess the stockpile annually, results from this study indicate that almost half of the supplies are either missing or in an unusable condition. This not only represents wasted resources, but it could also hinder disaster response, leading to increased morbidity and mortality. Facilities may need to invest in infrastructure to maintain stockpiled materials after purchase to ensure viability.

Preparedness Is More Than a Plan: Medical Considerations for Radiation Response

The goals herein are to describe and discuss existing plans for the medical preparedness and response to a radiological incident/nuclear detonation, present the systems approach to nuclear response, introduce methods to assess operational capabilities, and posit suggestions for the way forward to implementation. This discussion seeks to review where these U.S. government efforts began 10 y ago, then moves through the collective National progress in preparedness planning for an improvised nuclear device detonation and differentiates between important preparedness planning efforts and the challenges of understanding national implementation. Finally, a way forward for the immediate future is suggested.

Radiological Preparedness in the Land of Lincoln

The paper will provide a brief overview of past preparedness efforts in Illinois with special emphasis on the Chicago urban area for an improvised nuclear device (IND) event, current status, and near- and long-term plans to address this daunting challenge. The planning assumption involved the detonation of a 10 kT IND in downtown Chicago at noon on a workday. Major efforts began in 2010 involving over 300 federal, state, and local public and private entities. The planning efforts included three summits and 16 workshops that produced essential response planning documents. Many capability gaps were identified during the planning process, and all essential major tasks were identified. Task sequencing, interdependencies of the task sequencing, time-phased task sequencing, and resource constrained time-phased task sequencing were reviewed in detail by the various working groups, and a draft integrated response plan and associated appendices were prepared. A Federal Emergency Management Agency (FEMA) Region V integrated IND Senior Leaders Tabletop Exercise involving six major tasks of the draft plan was conducted on 5 December 2013. Although all six tasks were performed "with some challenges," much more preparedness work is still needed. Future preparedness efforts regarding INDs and radiological dispersal devices (RDDs) will be described. One of the major capability deficiencies noted during the planning process is the lack of adequate technical resources necessary to provide assistance and support for response, recovery, and population monitoring. This paper will highlight two of the ongoing national efforts to address this deficiency. Specifically, these programs are: (1) Radiological Operations Support Specialist (ROSS) initiative, which is a collaboration of the U.S. Department of Homeland Security's FEMA, U.S. Department of Energy's National Nuclear Security Administration (NNSA) and the Conference of Radiation Control Program Directors, Inc. (CRCPD); and (2) the Radiation Response Volunteer Corps Program of the CRCPD and the Centers for Disease Control and Prevention. Ultimately, these efforts will aid in providing the requisite resources in a manner consistent with the existing Emergency Management Assistance Compact currently in place for all hazards.

The ROSS: A Radiological/Nuclear Subject Matter Expert Filling a Critical National Need

This paper was created from a presentation the author made at the 2017 National Council on Radiation Protection and Measurements (NCRP) Annual Meeting on 6 March 2017. The Fifty-Third Annual Meeting of the NCRP was titled Assessment of National Efforts in Emergency Preparedness for Nuclear Terrorism: Is There a Need for Realignment to Close Remaining Gaps? Like the presentation, this paper describes one effort to fill what has been identified as one of the more critical gaps in our U.S. nuclear and radiological emergency preparedness. The Radiological Operations Support Specialist (ROSS) may help address the national need for subject matter experts that can help the nation, states, and municipalities respond to and recover from radiological and nuclear emergencies. The author is one of the four members of the ROSS Steering Committee and was the first state health physicist to serve as a ROSS at a national-level improvised nuclear device exercise. From his experiences, the ROSS is described from its genesis 3 y ago to its status today, along with some thoughts about where the ROSS will be in the future.

A comprehensive approach to managing threats of violence on a university or college campus

Horrifying, high profile acts of violence on campuses remain relatively rare, nevertheless, academic administrators are required to manage threats of violence on campus on an increasingly regular basis. These threats take two primary forms, those in which the perpetrator and the intended victim(s) are clearly identified, often involving repeated threats and threatening behaviour towards an individual; and those involving anonymous threats to commit acts of larger scale violence. Complicating factors in managing these threats include: fear contagion; mass media and social media attention; responsibilities to all members of the university community sometimes including individuals issuing the threat and the intended victims; demands for safety and security measures that are often at odds with professional advice; and permeable campus boundaries that cause security challenges. This paper considers the changing landscape of threat assessment and risk assessment on university and college campuses and suggests opportunities for partnerships between forensic mental health professionals and academic administrators.