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Gehrie EA, Young PP, Basavaraju SV, Bracey AW, Cap AP, Culler L, Dunbar NM, Homer M, Isufi I, Macedo R, Petraszko T, Ramsey G, Tormey CA, Kaufman RM, Snyder EL. Addressing platelet insecurity - A national call to action. Transfusion 2024. [PMID: 39133194 DOI: 10.1111/trf.17987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 07/30/2024] [Accepted: 07/31/2024] [Indexed: 08/13/2024]
Affiliation(s)
- Eric A Gehrie
- The American Red Cross, Biomedical Services, Washington, DC, USA
| | - Pampee P Young
- The American Red Cross, Biomedical Services, Washington, DC, USA
- Department of Pathology, Microbiology and Immunology, Vanderbilt University, Nashville, Tennessee, USA
| | - Sridhar V Basavaraju
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Andrew P Cap
- Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
| | - Liz Culler
- Blood Assurance, Chattanooga, Tennessee, USA
| | - Nancy M Dunbar
- Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Mary Homer
- Division of Chemical, Biological, Radiological and Nuclear Countermeasures, Biomedical Advanced Research and Development Authority, Administration for Strategic Preparedness and Response, US Department of Health and Human Services, Washington, DC, USA
| | - Iris Isufi
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Rob Macedo
- National Weather Service, Boston, Massachusetts, USA
| | - Tanya Petraszko
- Canadian Blood Services, Vancouver, British Columbia, Canada
| | - Glenn Ramsey
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | | | - Edward L Snyder
- Yale University School of Medicine, New Haven, Connecticut, USA
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Valiño EM, Castro-Delgado R, Sola Muñoz S, Lynam B, Castro P. Factors Associated with the Number of Injured and Fatalities in Motor Vehicle Intentional Mass-Casualty Incidents: A Timely Aid for Scaling the Emergency Response. Prehosp Disaster Med 2024; 39:65-72. [PMID: 38204194 PMCID: PMC10882554 DOI: 10.1017/s1049023x23006726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Intentional mass-casualty incidents (IMCIs) involving motor vehicles (MVs) as weapons represent a growing trend in Western countries. This method has resulted in the highest casualty rates per incident within the field of IMCIs. Consequently, there is an urgent requirement for a timely and accurate casualty estimation in MV-induced IMCIs to scale and adjust the necessary health care resources. STUDY OBJECTIVE The objective of this study is to identify the factors associated with the number of casualties during the initial phase of MV-IMCIs. METHODS This is a retrospective, observational, analytical study on MV-IMCIs world-wide, from 2000-2021. Data were obtained from three different sources: Targeted Automobile Ramming Mass-Casualty Attacks (TARMAC) Attack Database, Global Terrorism Database (GTD), and the vehicle-ramming attack page from the Wikipedia website. Jacobs' formula was used to estimate the population density in the vehicle's route. The primary outcome variables were the total number of casualties (injured and fatalities). Associations between variables were analyzed using Spearman's correlation coefficient and simple linear regression. RESULTS Forty-six MV-IMCIs resulted in 1,636 casualties (1,430 injured and 206 fatalities), most of them caused by cars. The most frequent driving pattern was accelerating whilst approaching the target, with an average speed range between four to 130km/h and a distance traveled between ten to 2,260 meters. The people estimated in the MV-IMCI scenes ranged from 36-245,717. A significant positive association was found of the number affected with the estimated crowd in the scene (R2: 0.64; 95% CI, 0.61-0.67; P <.001) and the average vehicle speed (R2: 0.42; 95% CI, 0.40-0.44; P = .004). CONCLUSION The estimated number of people in the affected area and vehicle's average speed are the most significant variables associated with the number of casualties in MV-IMCIs, helping to enable a timely estimation of the casualties.
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Affiliation(s)
- Eva Maria Valiño
- Emergency Medical System, Catalonia, Spain
- University of Barcelona, Barcelona, Spain
| | - Rafael Castro-Delgado
- Department of Medicine, Oviedo University, Oviedo, Spain
- Health Service of the Principality of Asturias (SAMU-Asturias), Health Research Institute of the Principality of Asturias (Research Group on Prehospital Care and Disasters, GIAPREDE), Oviedo, Spain
- RINVEMER-SEMES (Research Network on Prehospital Care-Spanish Society of Emergency Medicine), Madrid, Spain
| | - Silvia Sola Muñoz
- Emergency Medical System, Catalonia, Spain
- RINVEMER-SEMES (Research Network on Prehospital Care-Spanish Society of Emergency Medicine), Madrid, Spain
| | | | - Pedro Castro
- University of Barcelona, Barcelona, Spain
- Medical Intensive Care Unit, Hospital Clinic of Barcelona; IDIBAPS; University of Barcelona, Barcelona, Spain
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Igra NM, Schmulevich D, Geng Z, Guzman J, Biddinger PD, Gates JD, Spinella PC, Yazer MH, Cannon JW. Optimizing Mass Casualty Triage: Using Discrete Event Simulation to Minimize Time to Resuscitation. J Am Coll Surg 2024; 238:41-53. [PMID: 37870239 DOI: 10.1097/xcs.0000000000000894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
BACKGROUND Urban areas in the US are increasingly focused on mass casualty incident (MCI) response. We simulated prehospital triage scenarios and hypothesized that using hospital-based blood product inventories for on-scene triage decisions would minimize time to treatment. STUDY DESIGN Discrete event simulations modeled MCI casualty injury and patient flow after a simulated blast event in Boston, MA. Casualties were divided into moderate (Injury Severity Score 9 to 15) and severe (Injury Severity Score >15) based on injury patterns. Blood product inventories were collected from all hospitals (n = 6). The primary endpoint was the proportion of casualties managed with 1:1:1 balanced resuscitation in a target timeframe (moderate, 3.5 U red blood cells in 6 hours; severe, 10 U red blood cells in 1 hour). Three triage scenarios were compared, including unimpeded casualty movement to proximate hospitals (Nearest), equal distribution among hospitals (Equal), and blood product inventory-based triage (Supply-Guided). RESULTS Simulated MCIs generated a mean ± SD of 302 ± 7 casualties, including 57 ± 2 moderate and 15 ± 2 severe casualties. Nearest triage resulted in significantly fewer overall casualties treated in the target time (55% vs Equal 86% vs Supply-Guided 91%, p < 0.001). These differences were principally due to fewer moderate casualties treated, but there was no difference among strategies for severe casualties. CONCLUSIONS In this simulation study comparing different triage strategies, including one based on actual blood product inventories, nearest hospital triage was inferior to equal distribution or a Supply-Guided strategy. Disaster response leaders in US urban areas should consider modeling different MCI scenarios and casualty numbers to determine optimal triage strategies for their area given hospital numbers and blood product availability.
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Affiliation(s)
- Noah M Igra
- From the Department of Surgery, Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Igra, Geng, Cannon)
- School of Medicine, Tel Aviv University, Tel Aviv, Israel (Igra, Yazer)
| | | | - Zhi Geng
- From the Department of Surgery, Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Igra, Geng, Cannon)
| | - Jessica Guzman
- Department of Surgery, University of California Davis Medical Center, Sacramento, CA (Guzman)
| | - Paul D Biddinger
- Center for Disaster Medicine, Massachusetts General Hospital, Boston, MA (Biddinger)
| | | | - Philip C Spinella
- Departments of Surgery (Spinella), University of Pittsburgh Medical Center, Pittsburgh, PA
- Critical Care Medicine (Spinella), University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Mark H Yazer
- School of Medicine, Tel Aviv University, Tel Aviv, Israel (Igra, Yazer)
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA (Yazer)
| | - Jeremy W Cannon
- From the Department of Surgery, Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Igra, Geng, Cannon)
- Department of Surgery, Uniformed Services University F Edward Hébert School of Medicine, Bethesda, MD (Cannon)
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Alruqi F, Aglago EK, Cole E, Brohi K. Factors Associated With Delayed Pre-Hospital Times During Trauma-Related Mass Casualty Incidents: A Systematic Review. Disaster Med Public Health Prep 2023; 17:e525. [PMID: 37947290 DOI: 10.1017/dmp.2023.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Critically injured patients have experienced delays in being transported to hospitals during Mass Casualty Incidents (MCIs). Extended pre-hospital times (PHTs) are associated with increased mortality. It is not clear which factors affect overall PHT during an MCI. This systematic review aimed to investigate PHTs in trauma-related MCIs and identify factors associated with delays for triaged patients at incident scenes. METHODS This systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Web of Science, CINAHL, MEDLINE, and EMBASE were searched between January and February 2022 for evidence. Research studies of any methodology, and grey literature in English, were eligible for inclusion. Studies were narratively synthesized according to Cochrane guidance. RESULTS Of the 2025 publications identified from the initial search, 12 papers met the inclusion criteria. 6 observational cohort studies and 6 case reports described a diverse range of MCIs. PHTs were reported variably across incidents, from a median of 35 minutes to 8 hours, 8 minutes. Factors associated with prolonged PHT included: challenging incident locations, concerns about scene safety, and adverse decision-making in MCI triage responses. Casualty numbers did not consistently influence PHTs. Study quality was rated moderate to high. CONCLUSION PHT delays of more than 2 hours were common. Future MCI planning should consider responses within challenging environments and enhanced timely triage decision-making.
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Affiliation(s)
- Fayez Alruqi
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
- Emergency Medical Services Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Elom K Aglago
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Elaine Cole
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
| | - Karim Brohi
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
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Nyberger K, Strömmer L, Wahlgren CM. A systematic review of hemorrhage and vascular injuries in civilian public mass shootings. Scand J Trauma Resusc Emerg Med 2023; 31:30. [PMID: 37337265 DOI: 10.1186/s13049-023-01093-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/07/2023] [Indexed: 06/21/2023] Open
Abstract
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.
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Affiliation(s)
- Karolina Nyberger
- Department of Molecular Medicine and Surgery, Karolinska Institute, 171 76, Stockholm, Sweden.
- Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
| | - Lovisa Strömmer
- Division of Surgery, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
| | - Carl-Magnus Wahlgren
- Department of Molecular Medicine and Surgery, Karolinska Institute, 171 76, Stockholm, Sweden
- Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
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Ohbe H, Sasabuchi Y, Kumazawa R, Matsui H, Yasunaga H. Intensive Care Unit Occupancy in Japan, 2015-2018: A Nationwide Inpatient Database Study. J Epidemiol 2022; 32:535-542. [PMID: 33840654 PMCID: PMC9643790 DOI: 10.2188/jea.je20210016] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Detailed data on intensive care unit (ICU) occupancy in Japan are lacking. Using a nationwide inpatient database in Japan, we aimed to assess ICU bed occupancy to guide critical care utilization planning. METHODS We identified all ICU patients admitted from January 1, 2015 to December 31, 2018 to ICU-equipped hospitals participating in the Japanese Diagnosis Procedure Combination inpatient database. We assessed the trends in daily occupancy by counting the total number of occupied ICU beds on a given day divided by the total number of licensed ICU beds in the participating hospitals. We also assessed ICU occupancy for patients with mechanical ventilation, patients with extracorporeal membrane oxygenation, and patients without life-supportive therapies. RESULTS Over the 4 study years, 1,379,618 ICU patients were admitted to 495 hospitals equipped with 5,341 ICU beds, accounting for 75% of all ICU beds in Japan. Mean ICU occupancy on any given day was 60%, with a range of 45.0% to 72.5%. Mean ICU occupancy did not change over the 4 years. Mean ICU occupancy was about 9% higher on weekdays than on weekends and about 5% higher in the coldest season than in the warmest season. For patients with mechanical ventilation, patients with extracorporeal membrane oxygenation, and patients without life-supportive therapies, mean ICU occupancy was 24%, 0.5%, and 30%, respectively. CONCLUSION Only one-fourth of ICU beds were occupied by mechanically ventilated patients, suggesting that the critical care system in Japan has substantial surge capacity under normal temporal variation to care for critically ill patients.
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Affiliation(s)
- Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | | | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Terrorist Attacks Against Performing Arts Venues: Global Trends and Characteristics Spanning 50 Years. Prehosp Disaster Med 2022; 37:593-599. [PMID: 35942627 PMCID: PMC9474675 DOI: 10.1017/s1049023x22001145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION In fostering community and culture through entertainment in shared spaces, performing arts venues have also become targets of terrorism. A greater understanding of these attacks is needed to assess the risk posed to different types of venues, to inform medical disaster preparedness, to anticipate injury patterns, and to reduce preventable deaths. METHODS A search of the Global Terrorism Database (GTD) was conducted from the year 1970 through 2019. Using pre-coded variables for target/victim type and target subtype, attacks involving "business" and "entertainment/cultural/stadium/casino" were identified. Attacks targeting performing arts venues were selected using the search terms "theater," "theatre," "auditorium," "center," "hall," "house," "concert," "music," "opera," "cinema," and "movie." Manual review by two authors was performed to confirm appropriateness for inclusion of entries involving venues where the primary focus of the audience was to view a performance. Descriptive statistics were performed using R (version 3.6.1). RESULTS A total of 312 terrorist attacks targeting performing arts venues were identified from January 1, 1970 through December 31, 2019. Two-hundred nine (67.0%) attacks involved cinemas or movie theaters, 80 (25.6%) involved unspecified theaters, and 23 (7.4%) specifically targeted live music performance venues. Two-hundred thirty-four (75.0%) attacks involved a bombing or explosion, 50 (16.0%) damaged a facility or infrastructure, and 17 (5.4%) included armed assault. Perpetrators used explosives in 234 (75.0%) attacks, incendiary weapons in 50 (16.0%) attacks, and firearms in 19 (6.1%) attacks. In total, attacks claimed the lives of 1,307 and wounded 4,201 persons. Though fewer in number, attacks against music venues were responsible for 29.4% of fatalities and 35.0% of those wounded, and more frequently involved the use of firearms. Among 95 attacks falling within the highest quartile for victims killed or wounded (>two killed and/or >ten wounded), 83 (87.4%) involved explosives, seven (7.4%) involved firearms, and three (3.2%) involved incendiary methods. CONCLUSION While uncommon, terrorist attacks against performing arts venues carry the risk for mass casualties, particularly when explosives and firearms are used.
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Jost D, Lemoine S, Lemoine F, Derkenne C, Beaume S, Lanoë V, Maurin O, Louis-Delaurière E, Delacote M, Dang-Minh P, Franchin-Frattini M, Bihannic R, Savary D, Levrat A, Baudouin C, Trichereau J, Salomé M, Frattini B, Ha VHT, Jouffroy R, Seguineau E, Titreville R, Roquet F, Stibbe O, Vivien B, Verret C, Bignand M, Travers S, Martinaud C, Arock M, Raux M, Prunet B, Ausset S, Sailliol A, Tourtier JP. Prehospital Lyophilized Plasma Transfusion for Trauma-Induced Coagulopathy in Patients at Risk for Hemorrhagic Shock: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2223619. [PMID: 35881397 PMCID: PMC9327575 DOI: 10.1001/jamanetworkopen.2022.23619] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
IMPORTANCE Blood transfusion is a mainstay of therapy for trauma-induced coagulopathy, but the optimal modalities for plasma transfusion in the prehospital setting remain to be defined. OBJECTIVE To determine whether lyophilized plasma transfusion can reduce the incidence of trauma-induced coagulopathy compared with standard care consisting of normal saline infusion. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was performed at multiple centers in France involving prehospital medical teams. Participants included 150 adults with trauma who were at risk for hemorrhagic shock and associated coagulopathy between April 1, 2016, and September 30, 2019, with a 28-day follow-up. Data were analyzed from November 1, 2019, to July 1, 2020. INTERVENTION Patients were randomized in a 1:1 ratio to receive either plasma or standard care with normal saline infusion (control). MAIN OUTCOMES AND MEASURES The primary outcome was the international normalized ratio (INR) on arrival at the hospital. Secondary outcomes included the need for massive transfusion and 30-day survival. As a safety outcome, prespecified adverse events included thrombosis, transfusion-related acute lung injury, and transfusion-associated circulatory overload. RESULTS Among 150 randomized patients, 134 were included in the analysis (median age, 34 [IQR, 26-49] years; 110 men [82.1%]), with 68 in the plasma group and 66 in the control group. Median INR values were 1.21 (IQR, 1.12-1.49) in the plasma group and 1.20 (IQR, 1.10-1.39) in the control group (median difference, -0.01 [IQR, -0.09 to 0.08]; P = .88). The groups did not differ significantly in the need for massive transfusion (7 [10.3%] vs 4 [6.1%]; relative risk, 1.78 [95% CI, 0.42-8.68]; P = .37) or 30-day survival (hazard ratio for death, 1.07 [95% CI, 0.44-2.61]; P = .89). In the full intention-to-treat population (n = 150), the groups did not differ in the rates of any of the prespecified adverse events. CONCLUSIONS AND RELEVANCE In this randomized clinical trial including severely injured patients at risk for hemorrhagic shock and associated coagulopathy, prehospital transfusion of lyophilized plasma was not associated with significant differences in INR values vs standard care with normal saline infusion. Nevertheless, these findings show that lyophilized plasma transfusion is a feasible and safe procedure for this patient population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02736812.
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Affiliation(s)
- Daniel Jost
- Paris Fire Brigade Medical Emergency Department, Paris, France
| | - Sabine Lemoine
- Paris Fire Brigade Medical Emergency Department, Paris, France
| | | | | | | | - Vincent Lanoë
- Paris Fire Brigade Medical Emergency Department, Paris, France
| | - Olga Maurin
- Paris Fire Brigade Medical Emergency Department, Paris, France
| | - Emilie Louis-Delaurière
- Direction de la Formation, de la Recherche et de l’Innovation, Service de Santé des Armées, Paris, France
| | - Maëlle Delacote
- Paris Fire Brigade Medical Emergency Department, Paris, France
| | | | | | - René Bihannic
- Paris Fire Brigade Medical Emergency Department, Paris, France
| | - Dominique Savary
- Emergency Department, Angers University Hospital, Angers, France
- Research Institute for Environmental and Occupational Health–Unité Mixte de Recherche (UMR)_S 1085, France Emergency Department, Angers University Hospital, Angers, France
| | - Albrice Levrat
- Department of Intensive Care, Annecy Hospital, Annecy, France
| | - Clémence Baudouin
- Service Mobile d’Urgence et de Réanimation de Paris, Hôpital Lariboisière, Assistance Publique–Hôpitaux de Paris (AP-HP) and Université de Paris, Paris, France
| | | | - Marina Salomé
- Paris Fire Brigade Medical Emergency Department, Paris, France
| | - Benoit Frattini
- Paris Fire Brigade Medical Emergency Department, Paris, France
| | | | - Romain Jouffroy
- Paris Fire Brigade Medical Emergency Department, Paris, France
- Intensive Care Unit, Ambroise Paré Hospital, AP-HP and Paris Saclay University, Boulogne Billancourt, France
| | | | - Rudy Titreville
- Paris Fire Brigade Medical Emergency Department, Paris, France
| | - Florian Roquet
- Paris Fire Brigade Medical Emergency Department, Paris, France
- Service d’Anesthésie-Réanimation, Hôpital Européen Georges-Pompidou, AP-HP, Paris, France
- Service de Biostatistique et Informatique Médicale, Unité Institut National de la Santé et de la Recherche Médicale, UMR 1153, Université Paris Diderot, Paris, France
| | - Olivier Stibbe
- Paris Fire Brigade Medical Emergency Department, Paris, France
| | - Benoit Vivien
- Service d’Aide Médicale Urgente de Paris, Hôpital Necker-Enfants Malades, AP-HP and Université de Paris, Paris, France
| | - Catherine Verret
- Direction de la Formation, de la Recherche et de l’Innovation, Service de Santé des Armées, Paris, France
| | - Michel Bignand
- Paris Fire Brigade Medical Emergency Department, Paris, France
| | | | - Christophe Martinaud
- Department of Clinical Operations, French Military Blood Institute, Clamart, France
| | - Michel Arock
- Laboratory of Hematology, Pitié-Salpêtrière Hospital, Paris, France
| | - Mathieu Raux
- Département d’Anesthésie Réanimation, AP-HP Groupe Hospitalier Universitaire, AP-HP–Sorbonne Université, Site Pitié-Salpêtrière, Paris, France
| | - Bertrand Prunet
- Paris Fire Brigade Medical Emergency Department, Paris, France
| | - Sylvain Ausset
- Department of Anesthesiology and Intensive Care, Percy Military Teaching Hospital, Clamart, France
| | - Anne Sailliol
- Department of Clinical Operations, French Military Blood Institute, Clamart, France
| | - Jean-Pierre Tourtier
- Paris Fire Brigade Medical Emergency Department, Paris, France
- Department of Anesthesiology and Intensive Care, Bégin Military Teaching Hospital, Saint-Mandé, France
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Py N, Martinez T, Pasquier P. Transfusion Requirement During Mass Casualty Events: Improving Preparedness Through Simulation and Real-Life Experience. Shock 2022; 57:316. [PMID: 34014889 DOI: 10.1097/shk.0000000000001813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Thibault Martinez
- Federation of Anesthesiology, Intensive Care Unit, Burns and Operating Theater, Percy Military Training Hospital, Clamart, France
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Van Boxstael S, Borgers F, Sabbe M. Response to Dr. Corcostegui concerning use of tourniquet in France. J Trauma Acute Care Surg 2021; 91:e147-e148. [PMID: 34538820 DOI: 10.1097/ta.0000000000003413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Corcostegui SP, Galant J, Boutillier du Retail C. Use of tourniquet in France: Advances in military and civilian settings. J Trauma Acute Care Surg 2021; 91:e146-e147. [PMID: 34538822 DOI: 10.1097/ta.0000000000003414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pre-hospital critical care at major incidents. Br J Anaesth 2021; 128:e82-e85. [PMID: 34776123 DOI: 10.1016/j.bja.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 09/15/2021] [Accepted: 10/01/2021] [Indexed: 11/22/2022] Open
Abstract
The identification, triage, and extrication of casualties followed by on-scene management and transport to an appropriate hospital after mass casualty incidents can be complicated, delivered to variable standards, and add significant delays to care. An effective pre-hospital pathway can both increase the chances of survival of individual patients and significantly influence the effectiveness of the entire emergency response.
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Bouillon-Minois JB, Roux V, Pereira B, Flannery M, Pelissier C, Occelli C, Schmidt J, Navel V, Dutheil F. Stress among Emergency Health Care Workers on Nuclear or Radiation Disaster: A Preliminary State Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168384. [PMID: 34444134 PMCID: PMC8393601 DOI: 10.3390/ijerph18168384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/02/2021] [Accepted: 08/05/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The nuclear or radiation disaster risk within the French Auvergne-Rhone-Alpes state is low (but not absent) due to its proximity to four Nuclear Power Generation Centers and two regional cancer control centers. This study aims to compare subjective stress ratings for emergency health care workers regarding nuclear and radiation disasters between two locations: at work versus at home. MATERIALS AND METHODS We distributed an anonymous online questionnaire via RedCap® to all emergency health care workers who could be involved in patient care after a nuclear or radiation disaster. It comprised 18 questions divided into three parts-theoretical knowledge and practical assessment, stress assessment, and sociodemographic criteria. RESULTS We analyzed 107 responses. There was a significant 11-point increase in stress levels between work and home regarding nuclear or radiation disaster risks (p = 0.01). Less than 25% of emergency health care workers surveyed benefited from annual training. CONCLUSION The stress levels of emergency health care workers regarding nuclear or radiation disaster were higher at work than at home and increased without annual training. It is important to increase knowledge about these protocols and to mandate yearly training for all workers potentially involved in these disasters.
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Affiliation(s)
- Jean-Baptiste Bouillon-Minois
- Emergency Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France;
- Correspondence: ; Tel.: +33-6-74-36-04-23; Fax: +33-4-73-27-46-49
| | - Vincent Roux
- CNRS, LaPSCo, Université Clermont Auvergne, Physiological and Psychosocial Stress, 63000 Clermont-Ferrand, France; (V.R.); (F.D.)
| | - Bruno Pereira
- Clinical Research and Innovation Direction, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France;
| | - Mara Flannery
- Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, New York University Langone Health, New York, NY 10016, USA;
| | - Carole Pelissier
- Service de Santé au Travail, CHU de Saint-Étienne, Saint-Étienne, France. Univ Lyon 1, Univ St Etienne, 42005 Saint-Étienne, France;
| | - Céline Occelli
- CHU Nice, Emergency Department, Université Côte d’Azur, 06000 Nice, France;
| | - Jeannot Schmidt
- Emergency Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France;
| | - Valentin Navel
- Translational Approach to Epithelial Injury and Repair, Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, INSERM, GReD., 63000 Clermont-Ferrand, France;
- Ophthalmology, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Frédéric Dutheil
- CNRS, LaPSCo, Université Clermont Auvergne, Physiological and Psychosocial Stress, 63000 Clermont-Ferrand, France; (V.R.); (F.D.)
- Occupational and Environmental Medicine, CHU Clermont-Ferrand, WittyFit, 63000 Clermont-Ferrand, France
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Descamps C, Hamada S, Hanouz JL, Vardon-Bounes F, James A, Garrigue D, Abback P, Cardinale M, Dubreuil G, Chatelon J, Cook F, Neuschwander A, de Garambé N, Ausset S, Boutonnet M. Gunshot and stab wounds in France: descriptive study from a national trauma registry. Eur J Trauma Emerg Surg 2021; 48:3821-3829. [PMID: 34232339 DOI: 10.1007/s00068-021-01742-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/24/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Severe trauma is a major problem worldwide. In France, blunt trauma (BT) is predominant and few studies are available on penetrating trauma (PT). The purpose of this study was to perform a descriptive analysis of severe gunshot (GSW) and stab wounds (SW) in patients who were treated in French trauma centers. METHODS Retrospective study on prospectively collected data in a national trauma registry. All adult (> 15 years) trauma patients primarily admitted in 1 of the 17 trauma centers members of the Traumabase between January 2015 to December 2018 were included. Data from patients who had a PT were compared with those who had suffered a BT over the same period. Due to the known differences between GSW and SW, sub-group analyses on data from GSW, SW and BT were also performed. RESULTS 8128 patients were included. Twelve percent of the study group had a PT. The main mechanism of PT was SW (68.1%). Five hundred and eighty patients with PT (59.4%) required surgery within the first 24 h. Severe hemorrhage was more frequent in penetrating traumas (11.2% vs. 7.8% p < 0.001). Hospital mortality following PT was 8.9% vs 11% for blunt trauma (p = 0.047). Among PT the mortality after GSW was ten times higher than after SW (23.8% vs 2%). CONCLUSION This work is the largest study to date that has specifically focused on GSW and SW in France, and will help improving knowledge in managing such patients in our country.
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Affiliation(s)
- Chloé Descamps
- Anesthesiology and Intensive Care Unit, Percy Military Teaching Hospital, Clamart, France
| | - Sophie Hamada
- Department of Anaesthesiology and Critical Care, Université de Paris, AP-HP, Hôpital Européen Georges Pompidou, 25, rue Leblanc, 75015, Paris, France.,CESP, INSERM, Univ. Paris-Sud, UVSQ, Université Paris-Saclay, Maison de Solenn, 97, boulevard de Port-Royal, 75014, Paris, France
| | - Jean-Luc Hanouz
- Department of Anesthesiology and Intensive Care Medicine, Caen University Hospital, and Normandie Univ, UNICAEN, Caen, France
| | - Fanny Vardon-Bounes
- Department of Anesthesiology and Critical Care, Toulouse University Hospital, Toulouse, France
| | - Arthur James
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Département d'Anesthésie Réanimation, 75013, Paris, France
| | - Delphine Garrigue
- Department of Anesthesiology and Critical Care, Centre Hospitalier Universitaire de Lille, 59000, Lille, France
| | - Paer Abback
- Department of Anaesthesiology and Intensive Care, DMU PARABOL, AP-HP.Nord, Beaujon Hospital, University of Paris, Clichy, France
| | - Mickaël Cardinale
- Anesthesiology and Intensive Care Unit, Sainte Anne Military Teaching Hospital, Toulon, France
| | - Guillaume Dubreuil
- Department of Anesthesia and Critical Care, AP-HP, Bicêtre Hospital, Paris, France
| | - Jeanne Chatelon
- Anesthesiology and Intensive Care Unit. Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - Fabrice Cook
- Department of Anesthesia and Surgical Intensive Care, Henri Mondor University Hospital of Paris, Paris-Est Créteil University, 51, Avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France
| | - Arthur Neuschwander
- Department of Anaesthesiology and Critical Care, Université de Paris, AP-HP, Hôpital Européen Georges Pompidou, 25, rue Leblanc, 75015, Paris, France
| | - Nathalie de Garambé
- Anesthesiology and Intensive Care Unit, Percy Military Teaching Hospital, Clamart, France
| | - Sylvain Ausset
- French Military Health Service Schools, Lyon-Bron, France
| | - Mathieu Boutonnet
- Anesthesiology and Intensive Care Unit, Percy Military Teaching Hospital, Clamart, France. .,Val-de-Grâce Military Health Academy, Paris, France.
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15
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Birnbaum R, Bitton R, Pirracchio R, Féral-Pierssens AL, Constant AL, Dubost C, Chousterman B, Lescot T, Lortat-Jacob B, Harrois A, Abback PS, Belbachir A, Basto E, Castier Y, Laitselart P, Carli P, Lapostolle F, Tourtier JP, Langlois M, Raux M, Mounier R. Terror in Paris: Incidence and risk factors for infections related to high-energy ammunition injuries. Anaesth Crit Care Pain Med 2021; 40:100908. [PMID: 34174462 DOI: 10.1016/j.accpm.2021.100908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND We aimed to assess the incidence and the risk factors for secondary wound infections associated to high-energy ammunition injuries (HEAI) in the cohort of civilian casualties from the 2015 terrorist attacks in Paris. METHODS This retrospective multi-centric study included casualties presenting at least one HEAI who underwent surgery during the first 48 h following hospital admission. HEAI-associated infection was defined as a wound infection occurring within the initial 30 days following trauma. Risk factors were assessed using univariate and multivariate analysis. RESULTS Among the 200 included victims, the rate of infected wounds was 11.5%. The median time between admission and the surgical revision for secondary wound infection was 11 days [IQR 9-20]. No patient died from an infectious cause. Infections were polymicrobial in 44% of the cases. The major risk factors for secondary wound infection were ISS (p < 0.001), SAPS II (p < 0.001), MGAP (p < 0.001), haemorrhagic shock (p = 0.003), use of vasopressors (p < 0.001), blood transfusion (p < 0.001), abdominal penetrating trauma (p = 0.003), open fracture (p = 0.01), vascular injury (p = 0.001), duration of surgery (p = 0.009), presence of surgical material (p = 0.01). In the multivariate analysis, the SAPS II score (OR 1.07 [1.014-1.182], p = 0.019) and the duration of surgery (OR 1.005 [1.000-1.012], p = 0.041) were the only risk factors identified. CONCLUSION We report an 11.5% rate of secondary wound infection following high-energy ammunition injuries. Risk factors were an immediately severe condition and a prolonged surgery.
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Affiliation(s)
- Ron Birnbaum
- Anaesthesia and Intensive Care Department, Paris-Est Créteil University, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France.
| | - Rudy Bitton
- Anaesthesia and Intensive Care Department, Paris-Est Créteil University, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Romain Pirracchio
- Department of Anesthesia and Perioperative Medicine, University of California, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, USA
| | - Anne-Laure Féral-Pierssens
- Emergency Department, University Paris Descartes, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Anne-Laure Constant
- Anaesthesia and Intensive Care Department, University Paris Descartes, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Clément Dubost
- Intensive Care Unit, Begin Military Teaching Hospital, Saint-Mandé, France
| | - Benjamin Chousterman
- Anaesthesia and Intensive Care Department, Paris-Nord University, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Thomas Lescot
- Anaesthesia and Intensive Care Department, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Brice Lortat-Jacob
- Anaesthesia and Intensive Care Department, Paris-Nord University, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anatole Harrois
- Anaesthesia and Intensive Care Department, Paris-Saclay University, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Paer-Selim Abback
- Anaesthesia and Intensive Care Department, Paris-Nord University, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Anissa Belbachir
- Anaesthesia and Intensive Care Department, Paris-Centre University, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emmanuel Basto
- Anaesthesia and Intensive Care Department, Paris-Nord University, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Yves Castier
- Thoracic and Vascular Surgery Department, Paris-Nord University, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Philippe Laitselart
- Anaesthesia and Intensive Care Department, Percy Military Teaching Hospital, Clamart, France
| | - Pierre Carli
- SAMU de Paris, Anaesthesia and Intensive Care Unit Department, Paris-Centre University, Necker Hospital, Paris, France
| | - Frédéric Lapostolle
- SAMU 93, UF Research-Teaching-Quality, Paris-Nord University, Avicenne Hospital, Bobigny, France, INSERM U942, Sorbonne University, Paris, France
| | | | | | - Mathieu Raux
- Anaesthesia and Intensive Care Department, Paris-Sorbonne University, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Sorbonne University, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Roman Mounier
- Anaesthesia and Intensive Care Department, Paris-Est Créteil University, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France; Paris-Est Créteil University, INSERM U955, Team 15, Créteil, France
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Dark P, Smith M, Ziman H, Carley S, Lecky F. Healthcare system impacts of the 2017 Manchester Arena bombing: evidence from a national trauma registry patient case series and hospital performance data. Emerg Med J 2021; 38:746-755. [PMID: 33888513 PMCID: PMC8461451 DOI: 10.1136/emermed-2019-208575] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/04/2021] [Accepted: 04/08/2021] [Indexed: 11/14/2022]
Abstract
Introduction In response to detonation of an improvised explosive device at the Manchester Arena on 22 May 2017, we aimed to use detailed information about injured patients flowing through hospital healthcare to objectively evaluate the preplanned responses of a regional trauma care system and to show how routinely collected hospital performance data can be used to assess impact on regional healthcare. Methods Data about injury severity, management and outcome for patients presenting to hospitals were collated using England’s major trauma registry for 30 days following hospital attendance. System-wide data about hospital performance were collated by National Health Service England’s North West Utilisation Management Unit and presented as Shewhart charts from 15 April 2017 to 25 June 2017. Results Detailed information was obtained on 153 patients (109 adults and 44 children) who attended hospital emergency departments after the incident. Within 6 hours, a network of 11 regional trauma care hospitals received a total of 138 patients (90%). For the whole patient cohort, median Injury Severity Score (ISS) was 1 (IQR 1–10) and median New ISS (NISS) was 2 (IQR 1–14). For the 75 patients (49%) attending a major trauma centre, median ISS was 7.5 (IQR 1–14) and NISS was 10 (IQR 3–22). Limb and torso body regions predominated when injuries were classified as major life threatening (Abbreviated Injury Scale>3). Ninety-three patients (61%) required hospital admission following emergency department management, with 21 (14%) requiring emergency damage control surgery and 24 (16%) requiring critical care. Three fatalities occurred during early resuscitative treatment and 150 (98%) survived to day 30. The increased system-wide hospital admissions and care activity was linked to increases in regional hospital care capacity through cancellations of elective surgery and increased community care. Consequently, there were sustained system-wide hospital service improvements over the following weeks. Conclusions The systematic collation of injured patient and healthcare system data has provided an objective evaluation of a regional major incident plan and provided insight into healthcare system resilience. Hospital patient care data indicated that a prerehearsed patient dispersal plan at incident scene was implemented effectively.
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Affiliation(s)
- Paul Dark
- Humanitarian and Conflict Response Institute, University of Manchester, Manchester, UK
| | - Martin Smith
- Emergency Department, Salford Royal Hospitals NHS Trust, Salford, UK
| | | | - Simon Carley
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Fiona Lecky
- Centre for Urgent and Emergency Care Research, The University of Sheffield, Sheffield, UK
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James A, Yordanov Y, Ausset S, Langlois M, Tourtier JP, Carli P, Riou B, Raux M. Assessment of the mass casualty triage during the November 2015 Paris area terrorist attacks: towards a simple triage rule. Eur J Emerg Med 2021; 28:136-143. [PMID: 33252375 DOI: 10.1097/mej.0000000000000771] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKROUND Triage is key in the management of mass casualty incidents. OBJECTIVE The objective of this study was to assess the prehospital triage performed during the 2015 Paris area terrorist attack. DESIGN SETTING AND PARTICIPANT This was a retrospective cohort study that included all casualties of the attacks on 13 November 2015 in Paris area, France, that were admitted alive at the hospital within the first 24 h after the events. Patients were triaged as absolute emergency or relative emergency by a prehospital physician or nurse. This triage was then compared to the one of an expert panel that had retrospectively access to all prehospital and hospital files. OUTCOMES MEASURES AND ANALYSIS The primary endpoints were the rate of overtriage and undertriage, defined as number of patients misclassified in one triage category, divided by the total number of patients in this triage category. MAIN RESULT Among 337 casualties admitted to the hospital, 262 (78%) were triaged during prehospital care, with, respectively, 74 (28%) and 188 (72%) as absolute and relative emergencies. Among these casualties, the expert panel classified 96 (37%) patients as absolute emergencies and 166 (63%) as relative emergency. The rate of undertriage and overtriage was 36% [95% confidence interval (CI), 27-47%] and 8% (95% CI, 4-13%), respectively. Among undertriaged casualties, 8 (23%) were considered as being severely undertriaged. Among overtriaged casualties, 10 (77%) were considered as being severely overtriaged. CONCLUSION A simple prehospital triage for trauma casualties during the 13 November terrorist attack in Paris could have been performed triaged in 78% of casualties that were admitted to the hospital, with a 36% rate of undertriage and 8% of overtriage. Qualitative analysis of undertriage and overtriage indicate some possibilities for further improvement.
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Affiliation(s)
- Arthur James
- Sorbonne Université
- Department of Anaesthesiology and Critical Care Paris, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP)
| | - Youri Yordanov
- Sorbonne Université
- UMRS Inserm 1136
- Department of Emergency Medicine and Surgery, Hôpital Saint-Antoine
- Department of Emergency, APHP
| | - Sylvain Ausset
- Department of Anesthesiology and Critical Care, Hôpital d'Instruction des armées (HIA), Clamart
| | - Matthieu Langlois
- Department of Anaesthesiology and Critical Care Paris, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP)
- Service Médical du RAID, Bièvres
| | | | - Pierre Carli
- Service d'Aide Médicale Urgente 75, Hôpital Necker-Enfants Malades, APHP
- Université de Paris
| | - Bruno Riou
- Sorbonne Université
- Department of Emergency Medicine and Surgery, Hôpital Saint-Antoine
- UMRS Inserm 1166, IHU ICAN
- Department of Emergency Medicine and Surgery, Hôpital Pitié-Salpêtrière
| | - Mathieu Raux
- Sorbonne Université
- Department of Anaesthesiology and Critical Care Paris, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP)
- UMRS Inserm 1158, Paris, France
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Varpio L, Bader-Larsen K, Hamwey M, Durning S, Meyer H, Cruthirds D, Artino A. Delivering patient care during large-scale emergency situations: Lessons from military care providers. PLoS One 2021; 16:e0248286. [PMID: 33788854 PMCID: PMC8011761 DOI: 10.1371/journal.pone.0248286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/23/2021] [Indexed: 11/18/2022] Open
Abstract
Background Today, physicians are at the front lines of a pandemic response. Military physicians are uniquely trained to excel in such large-scale emergency situations. Civilian physicians can harness military know-how, but it will require research into military healthcare responses—specifically, we need to learn lessons from military interprofessional healthcare teams (MIHTs). Methods This research answers two questions: What are the characteristics of successful MIHTs? Why are those characteristics important to MIHT success in large-scale emergency situations? Using a Grounded Theory approach, 30 interviews were conducted soliciting perspectives from the broadest range of healthcare professionals who had experiences working in and leading MIHTs. Purposive sampling was used to recruit participants broadly across: contexts where MIHTs work; military branches; ranks; genders; and healthcare professions. Data were iteratively collected and analyzed. Results 30 participants were interviewed (18 male (60%); 21 officers (70%); 9 enlisted (30%)) who held various healthcare occupations (medic/tech/corpsman (9); nurse (7); physician (7); dentist (2); occupational therapist (2); chaplain (1); physician’s assistant (1); and psychiatrist (1)). Six characteristics of successful MIHTs that are directly applicable to large-scale emergency situations were identified thatthat clustered into two themes: own your purposes and responsibilities (through mission focus and ethical bearing) and get it done, safely (via situational awareness, adaptability, and leadership with followership). Conclusions This study provides insights, informed by decades of military service and training, to help civilian physicians succeed in large-scale emergency situations. These experiences from the war front can support today’s pandemic responses on the home front.
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Affiliation(s)
- Lara Varpio
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
| | - Karlen Bader-Larsen
- The Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
| | - Meghan Hamwey
- The Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
| | - Steven Durning
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
| | - Holly Meyer
- The Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
| | - Danette Cruthirds
- Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
| | - Anthony Artino
- Department of Health, Human Function, and Rehabilitation Sciences, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America
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Boutonnet M, Benbrika W, Facione J, Travers S, Boddaert G, Colas MD, Hornez E, Mathieu L, de Régloix S, Daban JL, Leclerc T, Pasquier P, Ausset S. Traum'cast: an online, open-access educational video podcast series for teaching military trauma care to all healthcare providers. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2021; 7:438-440. [DOI: 10.1136/bmjstel-2020-000799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 02/10/2021] [Accepted: 02/24/2021] [Indexed: 11/04/2022]
Abstract
The aim of this paper was to describe the development of ‘Traum’cast’, an ambitious project to create a high-quality, open-access, 12-week video podcast programme providing evidence-based continuing medical education for civilian and military healthcare practitioners dedicated to the management of trauma caused by weapons of war. The management of such patients became a particular public health issue in France following the 2015 terrorist attacks in Paris, which highlighted the need for all healthcare professionals to have appropriate knowledge and training in such situations. In 2016, the French Health General Direction asked the French Military Medical Service (FMMS) to create a task force and to use its unique and considerable experience to produce high-quality educational material on key themes including war injuries, combat casualty care, triage, damage control surgery, transfusion strategies, psychological injury and rehabilitation. The material was produced by FMMS and first broadcast in French and for free, on the official FMMS YouTube channel in September 2020. Traum’cast provides evidence-based continuing medical education for civilian and military healthcare practitioners. Traum’cast is an educational innovation that meets a public health requirement.
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Evaluation of Interaction Between Emergency Medical System and Hospital Network During a Train Derailment in Milano. Disaster Med Public Health Prep 2021; 16:829-834. [PMID: 33583481 DOI: 10.1017/dmp.2020.410] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
On January 25, 2018 a 5-car train derailed in Pioltello, 10 kilometers North-East of Milano City. A standardized post-hoc form was distributed to the hospitals involved in the management of the victims and allowed for an evaluation of the response to the incident.The management of the incident by EMS (Emergency Medical System) was effective in terms of organization of the scene and distribution of the patients, although the time for the first severe patient to reach the closest appropriate hospital was very long (2 hours). This can be partially explained by the extrication time.None of the alerted hospitals exceeded their capacity, as patients were distributed carefully among the hospitals. The overall outcome was quite satisfactory; no deaths were reported except for those on scene. Some responding hospitals reported that there was an over-activation based on the services ultimately needed. However this is common in MCIs, as an over-activation is preferable to an under-estimation. To address this concern, as more data are available, activation should be scaled down based on a plan established prior to it; this mechanism of scaling down seems to have failed in this event.It is of note that the highest performing hospitals underwent recently to an educational program on MCI management.
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Blood product needs and transfusion timelines for the multisite massive Paris 2015 terrorist attack: A retrospective analysis. J Trauma Acute Care Surg 2021; 89:496-504. [PMID: 32301884 DOI: 10.1097/ta.0000000000002729] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Hemorrhage is the leading cause of death after terrorist attack, and the immediacy of labile blood product (LBP) administration has a decisive impact on patients' outcome. The main objective of this study was to evaluate the transfusion patterns of the Paris terrorist attack victims, November 13, 2015. METHODS We performed a retrospective analysis including all casualties admitted to hospital, aiming to describe the transfusion patterns from admission to the first week after the attack. RESULTS Sixty-eight of 337 admitted patients were transfused. More than three quarters of blood products were consumed in the initial phase (until November 14, 11:59 PM), where 282 packed red blood cell (pRBC) units were transfused along with 201 plasma and 25 platelet units, to 55 patients (16% of casualties). Almost 40% of these LBPs (134 pRBC, 73 plasma, 8 platelet units) were transfused within the first 6 hours after the attack. These early transfusions were massive transfusion (MT) for 20 (6%) of 337 patients, and the average plasma/red blood cell ratio was 0.8 for MT patients who received 366 (72%) of 508 LBPs.The median time from admission to pRBC transfusion was 57 (25-108) minutes and 208 (52-430) minutes for MT and non-MT patients, respectively. These same time intervals were 119 (66-202) minutes and 222 (87-381) minutes for plasma and 225 (131-289) minutes and 198 (167-230) minutes for platelets. CONCLUSION Our data suggest that improving transfusion procedures in mass casualty setting should rely more on shortening the time to bring LBP to the bedside than in increasing the stockpile. LEVEL OF EVIDENCE Epidemiological study, Therapeutic IV.
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Crenn V, El Kinani M, Pietu G, Leteve M, Persigant M, Toanen C, Varenne Y, Goffinet N, Buffenoir K, Javaudin F, Montassier E. Impact of the COVID-19 lockdown period on adult musculoskeletal injuries and surgical management: a retrospective monocentric study. Sci Rep 2020; 10:22442. [PMID: 33384443 PMCID: PMC7775434 DOI: 10.1038/s41598-020-80309-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 12/18/2020] [Indexed: 01/07/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has led to the worldwide implementation of unprecedented public protection measures. On the 17th of March, the French government announced a lockdown of the population for 8 weeks. This monocentric study assessed the impact of this lockdown on the musculoskeletal injuries treated at the emergency department as well as the surgical indications. We carried out a retrospective study in the Emergency Department and the Surgery Department of Nantes University Hospital from 18 February to 11 May 2020. We collected data pertaining to the demographics, the mechanism, the type, the severity, and inter-hospital transfer for musculoskeletal injuries from our institution. We compared the 4-week pre-lockdown period and the 8-week lockdown period divided into two 4-week periods: early lockdown and late lockdown. There was a 52.1% decrease in musculoskeletal injuries among patients presenting to the Emergency Department between the pre-lockdown and the lockdown period (weekly incidence: 415.3 ± 44.2 vs. 198.5 ± 46.0, respectively, p < .001). The number of patients with surgical indications decreased by 33.4% (weekly incidence: 44.3 ± 3.8 vs. 28.5 ± 10.2, p = .048). The policy for inter-hospital transfers to private entities resulted in 64 transfers (29.4%) during the lockdown period. There was an increase in the incidence of surgical high severity trauma (Injury Severity Score > 16) between the pre-lockdown and the early lockdown period (2 (1.1%) vs. 7 (7.2%), respectively, p = .010) as well as between the pre-lockdown and the late lockdown period (2 (1.1%) vs. 10 (8.3%), respectively, p = .004). We observed a significant increase in the weekly emergency department patient admissions between the early and the late lockdown period (161.5 ± 22.9, 235.5 ± 27.7, respectively, p = .028). A pronounced decrease in the incidence of musculoskeletal injuries was observed secondary to the lockdown measures, with emergency department patient admissions being halved and surgical indications being reduced by a third. The increase in musculoskeletal injuries during the late confinement period and the higher incidence of severe trauma highlights the importance of maintaining a functional trauma center organization with an inter-hospital transfer policy in case of a COVID-19s wave lockdown.
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Affiliation(s)
- V Crenn
- Orthopedics and Trauma Department, University Hospital Hôtel-Dieu, UHC of Nantes, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 1, France. .,PhyOs 1238, INSERM, University of Nantes, Nantes, France.
| | - M El Kinani
- Orthopedics and Trauma Department, University Hospital Hôtel-Dieu, UHC of Nantes, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 1, France
| | - G Pietu
- Orthopedics and Trauma Department, University Hospital Hôtel-Dieu, UHC of Nantes, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 1, France
| | - M Leteve
- Orthopedics and Trauma Department, University Hospital Hôtel-Dieu, UHC of Nantes, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 1, France
| | - M Persigant
- Orthopedics and Trauma Department, University Hospital Hôtel-Dieu, UHC of Nantes, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 1, France
| | - C Toanen
- Orthopedics and Trauma Department, University Hospital Hôtel-Dieu, UHC of Nantes, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 1, France
| | - Y Varenne
- Orthopedics and Trauma Department, University Hospital Hôtel-Dieu, UHC of Nantes, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 1, France
| | - N Goffinet
- Emergency Department, University Hospital Hôtel-Dieu, UHC of Nantes, Nantes, France
| | - K Buffenoir
- Neurosurgery Department, University Hospital Hôtel-Dieu, UHC of Nantes, Nantes, France
| | - F Javaudin
- Emergency Department, University Hospital Hôtel-Dieu, UHC of Nantes, Nantes, France
| | - E Montassier
- Emergency Department, University Hospital Hôtel-Dieu, UHC of Nantes, Nantes, France
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23
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Exploring Peaks in Hospital Blood Component Utilization: A 10-Year Retrospective Study at a Large Multisite Academic Centre. Transfus Med Rev 2020; 35:37-45. [PMID: 33341326 DOI: 10.1016/j.tmrv.2020.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/28/2020] [Accepted: 10/10/2020] [Indexed: 12/16/2022]
Abstract
Peak demand analysis is common in industries such as the energy sector, but can also be applied to the field of transfusion to characterize the nature and timing of peak days in hospital blood utilization. This information can be used to forecast future peak days or to inform hospital emergency preparedness plans. The aims of this study are to characterize peak days in red blood cell (RBC) utilization over the past 10 years at our hospital, and to compare RBC peaks with peaks in platelet, plasma, and cryoprecipitate utilization. This was a retrospective cohort study of RBC, platelet, plasma, and cryoprecipitate transfusions in the inpatient and emergency department setting between May 2009 and April 2019 at a large academic hospital, containing regional trauma and cardiovascular surgery centers. For each blood product, a peak in utilization was defined as a day with a ≥50% increase in the number of units transfused compared to the previous 90-day average. Descriptive and inferential analyses were performed to characterize peak days. There were on average 20,501 RBCs transfused per year and 56 RBCs transfused per day over the 10-year period. A total of 134 peaks in RBC utilization occurred over the study period, with an average of 14 peaks per year. RBC peak days required on average 69% more RBC units compared to nonpeak days (P< .0001). 77% of RBC peaks were caused either solely or in part by surgical bleeding, 34% were caused entirely or in part by trauma, and other causes were infrequent. RBC peaks occurred most often on Fridays and least often on weekends (P< .0001). While there were 134 RBC peaks over the study period, there was a larger number of platelet (n = 292), plasma (n = 467), and cryoprecipitate peaks (n = 579). RBC peak days often coincided with plasma peak days, but less frequently with platelet and cryoprecipitate peaks. More studies are needed to determine whether analysis of peak usage will be of value to hospital blood banks for emergency planning and blood inventory management.
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Tracqui A, Deguette C, Delabarde T, Delannoy Y, Plu I, Sec I, Hamza L, Taccoen M, Ludes B. An overview of forensic operations performed following the terrorist attacks on November 13, 2015, in Paris. Forensic Sci Res 2020; 5:202-207. [PMID: 33209503 PMCID: PMC7646576 DOI: 10.1080/20961790.2020.1811487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
On the evening of November 13, 2015, the city of Paris and its surroundings was hit by a series of attacks committed by terrorist groups, using firearms and explosives. The final toll was 140 people deceased (130 victims and 10 terrorists or their relatives) and more than 413 injured, making these attacks the worst mass killings ever recorded in Paris in peacetime. This article presents the forensic operations carried out at the Medicolegal Institute of Paris (MLIP) following these attacks. A total of 68 autopsies of bodies or body fragments and 83 external examinations were performed within 7 days, and the overall forensic operations (including formal identification of the latest victims) were completed 10 days after the attacks. Over this period, 156 body presentations (some bodies were presented several times) were provided to families or relatives. Regarding the 130 civilian casualties, 129 died from firearm wounds and one died from blast injuries after an explosion. Of the 10 terrorists or their relatives who were killed, eight died from suicide bombing, one was shot by police and one died from crush injuries due to partial collapse of a building following the police raid against a terrorist’s hideout after the attacks. All mass shootings were perpetrated with AK-47 or Zastava M70 assault rifles using 7.62 mm × 39 mm cartridges. In the case of ballistic injuries, death was most often obviously caused by craniocerebral injuries, extensive organ lacerations and/or massive haemorrhage. Among the terrorists killed by bombing, the lesion patterns were body transection, multiple amputations, extreme organ lacerations and the presence of foreign bodies owing to the shrapnel load (steel nuts, glass fragments) or the explosive charge fastening system of the devices. This discussion highlights the particular difficulties of interpretation encountered within the framework of ballistic injuries, a conclusion that should lead to a modest and realistic approach in these exceptional situations where forensic operations involve a very large number of victims in a constrained time.
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Affiliation(s)
- Antoine Tracqui
- Medico-Legal Institute of Besançon, Saint-Jacques Hospital, Besançon, France.,Medico-Legal Institute of Paris, Paris, France
| | - Céline Deguette
- Medico-Legal Institute of Paris, Paris, France.,Forensic Medical Emergency Service, Hôtel-Dieu Hospital, Paris, France
| | - Tania Delabarde
- Medico-Legal Institute of Paris, Paris, France.,Université de Paris, BABEL, CNRS, Paris, France
| | - Yann Delannoy
- Medico-Legal Institute of Paris, Paris, France.,Medico-Legal Institute of Lille, Lille, France
| | - Isabelle Plu
- Medico-Legal Institute of Paris, Paris, France.,Sorbonne University, Paris, France
| | - Isabelle Sec
- Medico-Legal Institute of Paris, Paris, France.,Forensic Medical Emergency Service, Hôtel-Dieu Hospital, Paris, France
| | - Lilia Hamza
- Medico-Legal Institute of Paris, Paris, France.,Service d'Accueil des Urgences, Hôpital Avicenne, Bobigny, France
| | | | - Bertrand Ludes
- Medico-Legal Institute of Paris, Paris, France.,Université de Paris, BABEL, CNRS, Paris, France
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Bauer J, Brüggmann D, Klingelhöfer D, Maier W, Schwettmann L, Weiss DJ, Groneberg DA. Access to intensive care in 14 European countries: a spatial analysis of intensive care need and capacity in the light of COVID-19. Intensive Care Med 2020; 46:2026-2034. [PMID: 32886208 PMCID: PMC7472675 DOI: 10.1007/s00134-020-06229-6] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 08/21/2020] [Indexed: 11/30/2022]
Abstract
Purpose The coronavirus disease 2019 (COVID-19) poses major challenges to health-care systems worldwide. This pandemic demonstrates the importance of timely access to intensive care and, therefore, this study aims to explore the accessibility of intensive care beds in 14 European countries and its impact on the COVID-19 case fatality ratio (CFR). Methods We examined access to intensive care beds by deriving (1) a regional ratio of intensive care beds to 100,000 population capita (accessibility index, AI) and (2) the distance to the closest intensive care unit. The cross-sectional analysis was performed at a 5-by-5 km spatial resolution and results were summarized nationally for 14 European countries. The relationship between AI and CFR was analyzed at the regional level. Results We found national-level differences in the levels of access to intensive care beds. The AI was highest in Germany (AI = 35.3), followed by Estonia (AI = 33.5) and Austria (AI = 26.4), and lowest in Sweden (AI = 5) and Denmark (AI = 6.4). The average travel distance to the closest hospital was highest in Croatia (25.3 min by car) and lowest in Luxembourg (9.1 min). Subnational results illustrate that capacity was associated with population density and national-level inventories. The correlation analysis revealed a negative correlation of ICU accessibility and COVID-19 CFR (r = − 0.57; p < 0.001). Conclusion Geographical access to intensive care beds varies significantly across European countries and low ICU accessibility was associated with a higher proportion of COVID-19 deaths to cases (CFR). Important differences in access are due to the sizes of national resource inventories and the distribution of health-care facilities relative to the human population. Our findings provide a resource for officials planning public health responses beyond the current COVID-19 pandemic, such as identifying potential locations suitable for temporary facilities or establishing logistical plans for moving severely ill patients to facilities with available beds. Electronic supplementary material The online version of this article (10.1007/s00134-020-06229-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jan Bauer
- Division of Health Services Research, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt, Germany.
| | - Dörthe Brüggmann
- Division of Health Services Research, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Doris Klingelhöfer
- Division of Health Services Research, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Werner Maier
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
| | - Lars Schwettmann
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
- Department of Economics, Martin Luther University Halle-Wittenberg, 06099, Halle an der Saale, Germany
| | - Daniel J Weiss
- Nuffield Department of Medicine, Malaria Atlas Project, Big Data Institute, University of Oxford, Roosevelt Drive, Oxford, OX3 7FY, UK
| | - David A Groneberg
- Division of Health Services Research, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt, Germany
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26
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Soussy N, Dufayet L, Rey-Salmon C, Gorgiard C. The attack on November 13, 2015: organisation of the medico-judicial unit of the Hôtel-Dieu Hospital in Paris. Forensic Sci Res 2020; 5:232-235. [PMID: 33209507 PMCID: PMC7646567 DOI: 10.1080/20961790.2020.1768629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The main aims of a medico-judicial unit are to ensure the examination of assault victims or persons in custody and to perform sampling necessary for investigations. Forensic examination is essential to describe the wounds and to evaluate the consequences of an assault by determining days of total incapacity for work (ITT). After the Paris attack on November 13, 2015, 121 victims were examined at the medico-judicial units of Paris. An initial forensic certificate was issued by forensic physicians with an assessment of physical ITT. A consultation with a forensic psychiatrist was systematically scheduled on the same day to obtain a forensic certificate for the psychological ITT. The average age of the victims was (33 ± 7) years and the sex ratio was 1.26. Most victims were in the Bataclan concert hall (78/121 or 64.5%). Of the 121 victims, 73 (60.3%) had projectile lesions (bullets, bolts and nuts, metal fragments, etc.) and 48 (39.7%) had non-projectile lesions (bruises, hematomas, etc.). The average physical ITT was 27 days (0; 190). The evaluation of the number of days of physical ITT was often complicated as some patients were still in medical care at the time of the initial examination. This experience enabled the Paris medico-judicial unit to anticipate the management required should any future event of this magnitude occur. It also reinforced cooperation between the medico-judicial unit and other departments, mostly emergency services and the forensic psychiatric unit. The Paris medico-judicial unit was thus able to offer a unique place of care by providing both physical and psychological examinations.
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Affiliation(s)
- Nicolas Soussy
- Medico-Judicial Unit, Hôpital Hôtel-Dieu de Paris, APHP, Paris, France
| | - Laurène Dufayet
- Medico-Judicial Unit, Hôpital Hôtel-Dieu de Paris, APHP, Paris, France.,Centre AntiPoison et de Toxicovigilance, Hôpital Fernand Widal, APHP, Paris, France
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27
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Ramsey G. Blood transfusions in mass casualty events: recent trends. Vox Sang 2020; 115:358-366. [PMID: 32253763 DOI: 10.1111/vox.12916] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/20/2020] [Accepted: 03/10/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVES The US AABB disaster task force recommends estimating 3 RBC units per admission (UPA) for mass casualty events (MCEs). In a previous analysis, median MCE UPA were 2·7 RBCs, 1·2 plasmas and 0·27 platelet doses (Vox Sang 2017; 112:648). Additional recent data were sought from the current era of balanced massive transfusion protocols (bMTPs). MATERIALS AND METHODS Publications in English from 1980 to 2020 were reviewed for MCEs using ≥50 RBCs/event and with numbers of admissions available. MCE reports were stratified by era and event-wide or trauma-centre source. The bMTP era included all MCEs since 2010 plus a 2008 bMTP military report. STATISTICS Mann-Whitney test. RESULTS Thirty-two MCEs met analysis criteria. Event-wide reports used medians [interquartile ranges] of 1·8 [1·2-3·9] RBC, 0·6 [0·3-0·9] plasma and 0·14 [0·06-0·26] platelet-dose UPA. Trauma centres transfused 3·4 [2·7-6·3] RBC, 2·4 [1·3-4·1] plasma and 0·41 [0·34-0·50] platelet-dose UPA, all P < 0·05 vs event-wide. Same-event median post-day-1 transfusions were 50% of day-1 use for RBC, 28% for plasma and 16% for platelets. Compared to prior years, the median plasma/RBC transfusion ratio rose from 0·28 to 0·67 in the bMTP era (P < 0·01). In recent mass shootings, trauma centres transfused up to 42 platelets (range 0·45-0·57 UPA) on day 1. CONCLUSION Based on available mass casualty data, we recommend planning for 3 RBC, 1 plasma and one-fourth platelet-dose units per admission for blood centres (event-wide), and 6, 4 and one-half UPA, respectively, for trauma centres, which have seen rising plasma usage and large mass-shooting platelet needs.
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Affiliation(s)
- Glenn Ramsey
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA.,Blood Bank, Department of Pathology, Northwestern Memorial Hospital, Chicago, Illinois, USA
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28
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Robba C, Sonneville R, Meyfroidt G. Focus on neuro-critical care: combined interventions to improve relevant outcomes. Intensive Care Med 2020; 46:1027-1029. [PMID: 32206844 DOI: 10.1007/s00134-020-06014-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/16/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Chiara Robba
- Anesthesia and Intensive Care, Policlinico San Martino, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Romain Sonneville
- INSERM UMR1148, Team 6, Université de Paris, 75018, Paris, France.,Department of Intensive Care Medicine and Infectious Diseases, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France
| | - Geert Meyfroidt
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium. .,Laboratory of Intensive Care Medicine, University of Leuven (KU Leuven), Leuven, Belgium.
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29
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Badami KG, Mercer S, Chiu M, Yi M, Warrington S. Analysis of transfusion therapy during the March 2019 mass shooting incident in Christchurch, New Zealand. Vox Sang 2020; 115:424-432. [DOI: 10.1111/vox.12907] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/09/2020] [Accepted: 02/10/2020] [Indexed: 12/18/2022]
Affiliation(s)
| | - Susan Mercer
- New Zealand Blood Service Christchurch New Zealand
| | - May Chiu
- New Zealand Blood Service Christchurch New Zealand
| | - Ma Yi
- Canterbury District Health Board Christchurch New Zealand
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