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Ranse J, Mackie B, Crilly J, Heslop D, Wilson B, Mitchell M, Weber S, Watkins N, Sharpe J, Handy M, Hertelendy A, Currie J, Hammad K. Strengthening emergency department response to chemical, biological, radiological, and nuclear disasters: A scoping review. Australas Emerg Care 2024:S2588-994X(24)00056-3. [PMID: 39358090 DOI: 10.1016/j.auec.2024.09.003] [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: 07/26/2024] [Revised: 09/08/2024] [Accepted: 09/23/2024] [Indexed: 10/04/2024]
Abstract
INTRODUCTION Natural hazards resulting in disasters are increasing globally, impacting communities and disrupting industries. In addition to planning for these natural hazard disasters, emergency departments (EDs) should prepare for chemical, biological, radiological, and nuclear (CBRN) incidents that result in surges of patient presentations. Chemical, biological, radiological, and nuclear incidents differ in preparedness to natural hazards, requiring an understanding of patient management and health system-related challenges. METHODS This scoping review used the Arksey and O'Malley five-step framework. Manuscripts were retrieved from four databases and search engines using keywords relating to impacts on the ED from real world CBRN event(s). Analysis focused on the characteristics of CBRN event, ED impact, and lessons learnt against four surge capacity domains that including staff, stuff, space, and systems. RESULTS A total of 44 paper were included in this review. Most of the incidents were chemical in nature (n = 36/44, 81.8 %). The majority of CBRN incidents were accidental (n = 34/44, 77.3 %). Between 1 and 1470 people (Mdn=56, IQR: 18-228) presented to an ED from each event. Most patients were discharged from the ED, but this was variably reported. Some key lessons related to secondary exposure to ED staff, repurposing spaces, and coordination of CBRN incidents. CONCLUSION With the increasing number of CBRN incidents, strategies to strengthen EDs and limit the impact from a surge in patient presentations are paramount. An understanding of local CBRN risk to inform a top-hazards approach to CBRN preparedness, and the implementation of pre-emptive CBRN clinical pathways is recommended. Additionally, strategies should be implemented to protect staff from the risk of secondary exposure to a CBRN event. These strategies may include adequate education, training, and personal protective equipment for staff.
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Affiliation(s)
- Jamie Ranse
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia; Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia.
| | - Benjamin Mackie
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia; 2nd Health Battalion, Australian Army, Australia
| | - Julia Crilly
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia; Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - David Heslop
- School of Population Health, University of New South Wales, NSW, Australia
| | - Bridget Wilson
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Marion Mitchell
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | - Sarah Weber
- Emergency Department, Princess Alexandra Hospital, Queensland, Australia
| | - Nathan Watkins
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Joseph Sharpe
- Trauma Service, Townsville Hospital, Townsville Hospital and Health Service, Queensland, Australia
| | - Michael Handy
- Surgical and Perioperative Services, Royal Brisbane and Women's Hospital, Queensland, Australia; School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Attila Hertelendy
- BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, FL, USA
| | - Jane Currie
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia; Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Queensland, Australia
| | - Karen Hammad
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia; Fiji National University, Fiji
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Fuchko D, King-Shier K, Gabriel V. Burn mass casualty incident planning in Alberta: A case study. Burns 2024; 50:1128-1137. [PMID: 38461081 DOI: 10.1016/j.burns.2024.02.019] [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] [Received: 07/24/2023] [Revised: 12/21/2023] [Accepted: 02/21/2024] [Indexed: 03/11/2024]
Abstract
Burn mass casualty incident (BMCI) preparedness is lacking across Canada. A focused exploration of the current policies, protocols and practices in Alberta that address the response to a BMCI was conducted. In this case study, data were gathered from documents outlining the health system response to a mass casualty incident and health care professionals directly involved. Interviews were conducted online, recorded and transcribed. Qualitative description was used to code common themes across documents and transcripts. Fifteen documents and nine participant interviews were included in this study. Overall, the current policies, protocols and practices in place were limited to all-hazards mass casualty incident planning and did not address the specialized needs of burn patients. Deficiencies included no burn-specific plan at each of the two burn centres, a lack of provincial-level recognition of the unique challenges associated with a BMCI and no established Canadian burn disaster communication plan. Suggestions of strategies for a burn plan included forward triage, patient movement, use of telemedicine, partnering skilled and non-skilled staff, and procuring additional supplies. For best patient outcomes the provincial health authority needs to provide dedicated time for burn care experts to develop BMCI response plans to better address this unique hazard.
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Affiliation(s)
- Danielle Fuchko
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada.
| | - Kathryn King-Shier
- Faculty of Nursing and Department of Community Health Sciences, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Vincent Gabriel
- Departments of Clinical Neurosciences and Surgery, Foothills Medical Centre, 1403-29 Street NW, Calgary, AB T2N 2T9, Canada
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Zhu Z, Xu B, Shao J, Wang S, Jin R, Weng T, Xia S, Zhang W, Yang M, Han C, Wang X. Use of the Braden Scale to Predict Injury Severity in Mass Burn Casualties. MEDICAL SCIENCE MONITOR : INTERNATIONAL MEDICAL JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2022; 28:e934039. [PMID: 35105848 PMCID: PMC8820233 DOI: 10.12659/msm.934039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background Mass burn casualties impose an enormous burden on triage systems. The triage capacity of the Braden Scale for detecting injury severity has not been evaluated in mass burn casualties. Material/Methods The New Injury Severity Score (NISS) was used to dichotomize the injury severity of patients. The Braden Scale and other potentially indicative measurement tools were evaluated using univariate analysis and multivariate logistic regression. The relationships between the Braden Scale and other continuous variables with injury severity were further explored by correlation analysis and fitted with regression models. Receiver operating characteristic (ROC) curve analysis was used to validate triage capacity and compare prognostic accuracy. Results A total of 160 hospitalized patients were included in our study; 37 were severely injured, and 123 were not. Injury severity was independently associated with the Numerical Rating Scale (adjusted OR, 1.816; 95% CI, 1.035–3.187) and Braden Scale (adjusted OR, 0.693; 95% CI, 0.564–0.851). The ROC curve of the fitted quadratic model of the Braden Scale was 0.896 (0.840–0.953), and the cut-off value was 17. The sensitivity was 81.08% (64.29–91.44%) and the specificity was 82.93% (74.85–88.89%). Comparison of ROC curves demonstrated an infinitesimal difference between the Braden Scale and NISS for predicting 30-day hospital discharge (Z=0.291, P=0.771) and Intensive Care Unit admission (Z=2.016, P=0.044). Conclusions The Braden Scale is a suitable triage tool for predicting injury severity and forecasting disability-related outcomes in patients affected by mass burn casualty incidents.
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Affiliation(s)
- Zhikang Zhu
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Bin Xu
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Jiaming Shao
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Shuangshuang Wang
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland).,Wenling First People's Hospital, Taizhou, Zhejiang, China (mainland)
| | - Ronghua Jin
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Tingting Weng
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Sizhan Xia
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Wei Zhang
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Min Yang
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Chunmao Han
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Xingang Wang
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
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Chuang S, Woods DD, Reynolds M, Ting HW, Balkin A, Hsu CW. Rethinking preparedness planning in disaster emergency care: lessons from a beyond-surge-capacity event. World J Emerg Surg 2021; 16:59. [PMID: 34844626 PMCID: PMC8628445 DOI: 10.1186/s13017-021-00403-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/18/2021] [Indexed: 02/06/2023] Open
Abstract
Background Large-scale burn disasters can produce casualties that threaten medical care systems. This study proposes a new approach for developing hospital readiness and preparedness plan for these challenging beyond-surge-capacity events.
Methods The Formosa Fun Coast Dust Explosion (FFCDE) was studied. Data collection consisted of in-depth interviews with clinicians from four initial receiving hospitals and their relevant hospital records. A detailed timeline of patient flow and emergency department (ED) workload changes of individual hospitals were examined to build the EDs' overload patterns. Data analysis of the multiple hospitals' responses involved chronological process-tracing analysis, synthesis, and comparison analysis in developing an integrated adaptations framework. Results A four-level ED overload pattern was constructed. It provided a synthesis of specifics on patient load changes and the process by which hospitals' surge capacity was overwhelmed over time. Correspondingly, an integrated 19 adaptations framework presenting holistic interrelations between adaptations was developed. Hospitals can utilize the overload patterns and overload metrics to design new scenarios with diverse demands for surge capacity. The framework can serve as an auxiliary tool for directive planning and cross-check to address the insufficiencies of preparedness plans. Conclusions The study examined a wide-range spectrum of emergency care responses to the FFCDE. It indicated that solely depending on policies or guidelines for preparedness plans did not contribute real readiness to MCIs. Hospitals can use the study's findings and proposal to rethink preparedness planning for the future beyond surge capacity events. Supplementary Information The online version contains supplementary material available at 10.1186/s13017-021-00403-x.
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Affiliation(s)
- Sheuwen Chuang
- Graduate Institute of Data Science, Taipei Medical University, Taipei, Taiwan. .,TMU Research Center of Health and Welfare Policy, Taipei Medical University, 12F, No. 172-1, Sec. 2 Keelung Rd. Da an Dist., Taipei City, Taiwan.
| | - David D Woods
- Department of Integrated Systems Engineering, The Ohio State University, Columbus, OH, US
| | - Morgan Reynolds
- Department of Integrated Systems Engineering, The Ohio State University, Columbus, OH, US
| | - Hsien-Wei Ting
- Department of Neurosurgery, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Asher Balkin
- Department of Integrated Systems Engineering, The Ohio State University, Columbus, OH, US
| | - Chin-Wang Hsu
- Emergency Department, Taipei Municipal Wanfang Hospital, Taipei, Taiwan
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Tsai YL, Yi T, Chiang HH, Lan HY, Chiang HH, Liaw JJ. Calling nurses to care for burn victims after color-dust explosion. Nurs Ethics 2021; 28:1389-1401. [PMID: 34240657 DOI: 10.1177/09697330211003239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Healthcare professionals follow codes of ethics, making them responsible for providing holistic care to all disaster victims. However, this often results in ethical dilemmas due to the need to provide rapid critical care while simultaneously attending to a complex spectrum of patient needs. These dilemmas can cause negative emotions to accumulate over time and impact physiological and psychological health, which can also threaten nurse-patient relationships. AIM This study aimed to understand the experience of nurses who cared for burn victims of the color-dust explosion and the meaning of ethical relationships between nurse and patient. RESEARCH DESIGN A qualitative descriptive study using a phenomenological approach. PARTICIPANTS AND RESEARCH CONTEXT Clinical nurses who provided care to the patients of the Formosa color-dust explosion of 2015 were selected by purposive sampling (N = 12) from a medical center in Taiwan. Data were collected using individual in-depth semi-structured interviews. Audiotaped interviews were transcribed and analyzed using Colaizzi's method. ETHICAL CONSIDERATIONS This study was approved by the institutional review board of the study hospital. All participants provided written informed consent. FINDINGS Three main themes described the essence of the ethical dilemmas experienced by nurses who cared for the burn-injured patients: (1) the calling must be answered, (2) the calling provoked my feelings, and (3) the calling called out my strengths. CONCLUSIONS Healthcare providers should recognize that nurses believed they had an ethical responsibility to care for color-dust explosion burn victims. Understanding the feelings of nurses during the care of patients and encouraging them to differentiate between the self and the other by fostering patient-nurse relationships based on intersubjectivity could help nurses increase self-care and improve patient caregiving.
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Affiliation(s)
| | - Tin Yi
- National Defense Medical Center; Tri-Service General Hospital
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Lin MW, Pan CL, Wen JC, Lee CH, Wu ZP, Chang CF, Chiu CW. An innovative emergency transportation scenario for mass casualty incident management: Lessons learnt from the Formosa Fun Color Dust explosion. Medicine (Baltimore) 2021; 100:e24482. [PMID: 33725935 PMCID: PMC7982245 DOI: 10.1097/md.0000000000024482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 12/31/2020] [Indexed: 01/05/2023] Open
Abstract
The purpose of this research is to analyze and introduce a new emergency medical service (EMS) transportation scenario, Emergency Medical Regulation Center (EMRC), which is a temporary premise for treating moderate and minor casualties, in the 2015 Formosa Fun Color Dust Party explosion in Taiwan. In this mass casualty incident (MCI), although all emergency medical responses and care can be considered as a golden model in such an MCI, some EMS plans and strategies should be estimated impartially to understand the truth of the successful outcome.Factors like on-scene triage, apparent prehospital time (appPHT), inhospital time (IHT), and diversion rate were evaluated for the appropriateness of the EMS transportation plan in such cases. The patient diversion risk of inadequate EMS transportation to the first-arrival hospital is detected by the odds ratios (ORs). In this case, the effectiveness of the EMRC scenario is estimated by a decrease in appPHT.The average appPHTs (in minutes) of mild, moderate, and severe patients are 223.65, 198.37, and 274.55, while the IHT (in minutes) is 18384.25, 63021.14, and 83345.68, respectively. The ORs are: 0.4016 (95% Cl = 0.1032-1.5631), 0.1608 (95% Cl = 0.0743-0.3483), and 4.1343 (95% Cl = 2.3265-7.3468; P < .001), respectively. The appPHT has a 47.61% reduction by employing an EMRC model.Due to the relatively high appPHT, diversion rate, and OR value in severe patients, the EMS transportation plan is distinct from a prevalent response and develops adaptive weaknesses of MCIs in current disaster management. Application of the EMRC scenario reduces the appPHT and alleviates the surge pressure upon emergency departments in an MCI.
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Affiliation(s)
- Ming-Wei Lin
- Graduate School of Engineering Science and Technology
| | - Chih-Long Pan
- Bachelor Program in Interdisciplinary Studies, College of Future
| | - Jet-Chau Wen
- Department and Graduate School of Safety Health and Environmental Engineering
- Research Center for Soil & Water Resources and Natural Disaster Prevention (SWAN), National Yunlin University of Science & Technology, 123, Section 3, University Road, Douliu, Yunlin 640
| | - Cheng-Haw Lee
- Department of Resources Engineering, National Cheng Kung University, 1, University Road, East District, Tainan city 701
| | - Zong-Ping Wu
- Graduate School of Disaster Management, Central Police University, 56, Shujen Road, Kueishan District, Taoyuan City 333
| | - Chin-Fu Chang
- Department of Emergency and Critical Care Medicine, Changhua Christian Hospital, 135, Nan-Hsiao Street, Changhua 500, Taiwan, ROC
| | - Chun-Wen Chiu
- Department of Emergency and Critical Care Medicine, Changhua Christian Hospital, 135, Nan-Hsiao Street, Changhua 500, Taiwan, ROC
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