Back to Basics: Mass Casualty Incidents

A systematic review of hemorrhage and vascular injuries in civilian public mass shootings

BACKGROUND

Civilian public mass shootings (CPMSs) are a major public health issue and in recent years several events have occurred worldwide. The aim of this systematic review was to characterize injuries and mortality after CPMSs focusing on in-hospital management of hemorrhage and vascular injuries.

METHOD

A systematic review of all published literature was undertaken in Medline, Embase and Web of Science January 1st, 1968, to February 22nd, 2021, according to the PRISMA guidelines. Literature was eligible for inclusion if the CPMS included three or more people shot, injured or killed, had vascular injuries or hemorrhage.

RESULTS

The search identified 2884 studies; 34 were eligible for inclusion in the analysis. There were 2039 wounded in 45 CPMS events. The dominating anatomic injury location per event was the extremity followed by abdomen and chest. The median number of operations and operated patients per event was 22 (5-101) and 10.5 (4-138), respectively. A total of 899 deaths were reported with a median mortality rate of 36.1% per event (15.9-71.4%) Thirty-eight percent (13/34) of all studies reported on vascular injuries. Vascular injuries ranged from 8 to 29%; extremity vascular injury the most frequent. Specific vascular injuries included thoracic aorta 18% (42/232), carotid arteries 6% (14/232), and abdominal aorta 5% (12/232). Vascular injuries were involved in 8.3%-10% of all deaths.

CONCLUSION

This systematic review showed an overall high mortality after CPMS with injuries mainly located to the extremities, thorax and abdomen. About one quarter of deaths was related to hemorrhage involving central large vessel injuries. Further understanding of these injuries, and structured and uniform reporting of injuries and treatment protocols may help improve evaluation and management in the future. Level of Evidence Systematic review and meta-analysis, level III.

Emotional and psychological implications for healthcare professionals in disasters or mass casualties: A systematic review

AIM

To synthesize and describe the emotional and psychological implications for healthcare professionals who provided care in a mass casualty incident or disaster.

BACKGROUND

The experience of healthcare providers immersed in the actual uncertainty of an ongoing disaster is real, challenging, complex and strongly connected with emotions. Identifying these implications for healthcare professionals is essential for developing strategies to help these professionals deliver high-quality care.

EVALUATION

A systematic review was conducted in PubMed, CINAHL, Scopus, Nursing & Allied Health Database and PsycINFO using published data until February 2021 and following the PRISMA guidelines.

KEY ISSUES

Nineteen articles were included. Factors associated with negative psychological implications were identified and different strategies have been synthesized to prevent or reduce them when caring for the victims of a disaster.

CONCLUSIONS

Feelings of sadness, helplessness, fear and blockage, among others, were identified as common reactions among nurses and other healthcare professionals dealing in mass casualties or disasters. These reactions may lead to post-traumatic disorder, turning professionals into hidden victims.

IMPLICATIONS FOR NURSING MANAGEMENT

Organizations, senior charge nurses and other health service managers need to foster resilience and flexibility among their workforce to improve self-care during a disaster, as well as ensure policies to address a lack of emotional preparedness among their personnel. Some strategies to consider include cognitive behavioural therapy, psychoeducation or meditation.

Staff Perspectives of Mass Casualty Incident Preparedness

Introduction Mass casualty incidents (MCI) are low-frequency, high-risk events that disrupt the day-to-day operations of medical centers. Day-to-day protocols are insufficient for effectively managing MCI events, creating a need to develop and test MCI-specific protocols. The aim of this project was to utilize interviews to gain insight into staff experience and perspective on MCIs and their institution's response plans. Methods Staff members who participated in an MCI drill were asked semi-structured interview questions regarding their perspectives on their current priorities, the information needed to perform their role, and their greatest concerns about an MCI. This quality improvement (QI) project utilized a qualitative methodology to thematically organize the results of the staff responses. Results A total of 64 staff members with various levels of patient care experience were interviewed to reach thematic saturation. The use of staff interviews helped to identify the four primary themes that emerged, which were: 1) process, 2) supplies and resources, 3) communication, and 4) roles. Furthermore, each theme also included a number of subthemes. Conclusions This project demonstrated the importance of staff experiences related to MCI simulation training and preparedness, which may be useful for future training and emergency response planning. Additionally, the results may be helpful for other institutions when building a robust MCI simulation training program or designing an emergency response plan.

War surgery in Afghanistan: a model for mass causalities in terror attacks?

PURPOSE

The aim of the study was to identify solution strategies from a non-governmental (NGO) hospital in a war region for violence-related injuries and to show how high-income countries (HIC) might benefit from this expertise.

METHODS

NGO trauma hospital in Lashkar Gah, Afghanistan. Four hundred eighty-four war victims admitted in a three month period (February 2016-May 2016) were included. Patients´ characteristics were analyzed.

RESULTS

The mean age was 23.5 years. Four hundred thirty-four (89.9%) were male, and 50 (10.1%) were female. The most common cause of injury was bullet injuries, shell injuries, and mine injuries. The most common injured body region was the lower extremity, upper extremity, and the chest or the face. Apart from surgical wound care and debridements, which were performed on every wound in the operation theatre, laparotomy was the most common surgical procedure, followed by installation of a chest drainage and amputation.

CONCLUSION

The surgical expertise and clear pathways outweigh modern infrastructure. In case of a mass casualty incident, fast decision-making with basic diagnostic means in order to take rapid measurements for life-saving therapies could make the difference.