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Difino M, Stucchi R, Weinstein ES, De Pellegrin M, Zoli A, Sechi GM, Faccincani R. What If Nice Terrorist Attack Would Have Happened in Milan? Drawing a Disaster Plan for Mass Casualty Incidents Involving the Pediatric Population. Disaster Med Public Health Prep 2024; 18:e94. [PMID: 38812439 DOI: 10.1017/dmp.2024.45] [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: 05/31/2024]
Abstract
Terrorist attacks involving children raised concern regarding the preparedness to treat pediatric trauma patients during mass casualty incidents (MCIs). The purpose of this project was to assess the resources available in Milan to respond to MCIs as the 2016 Bastille Day attack in Nice. Literature and guidelines were reviewed and minimal standard requirements of care of pediatric trauma patients in MCIs were identified. The hospitals that took part in the study were asked to answer a survey regarding their resource availability. An overall surge capability of 40-44 pediatric trauma patients was identified, distributed based on age and severity, hospital resources, and expertise. The findings showed that adult and pediatric hospitals should work in synergy with pediatric trauma centers, or offer an alternative if there is none, and should be included in disaster plans for MCIs. Simulations exercises need to be carried out to evaluate and validate the results.
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Affiliation(s)
| | - Riccardo Stucchi
- AAT 118 Milano, Agenzia Regionale Emergenza Urgenza (AREU), Milan, Italy
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Eric S Weinstein
- Assistant Professor of Emergency Medicine, University of South Florida, Tampa, Fl, USA
- Research Associate, CRIMEDIM, Novara, Italy
| | - Maurizio De Pellegrin
- Pediatric Orthopedic Unit, Piccole Figlie Hospital, Parma, Italy
- Department of Orthopedics, Regional Health Care and Social Agency Papa Giovanni XXIII, Bergamo, Italy
| | - Alberto Zoli
- Agenzia Regionale Emergenza Urgenza (AREU), Milan, Italy
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Berthail B, Trousselard M, Lecouvey G, Le Roy B, Fraisse F, Peschanski D, Eustache F, Gagnepain P, Dayan J. Differences in predictive factors for post-traumatic stress disorder encompassing partial PTSD and full PTSD: a cross-sectional study among individuals exposed to the November 13, 2015 Paris attacks. Front Psychiatry 2024; 15:1351695. [PMID: 38606406 PMCID: PMC11007703 DOI: 10.3389/fpsyt.2024.1351695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/26/2024] [Indexed: 04/13/2024] Open
Abstract
Background When faced with a surge of physically injured individuals, especially following a traumatic event like an attack, frontline practitioners prioritize early triage. Detecting potential psychological injuries soon after such events remains challenging. Some individuals might develop post-traumatic stress disorder (PTSD) according to DSM-V criteria. Others may exhibit PTSD symptoms without meeting full diagnostic criteria, termed partial or sub-syndromal PTSD, a less-explored area in literature. This study aims to identify predictive factors for both full and partial PTSD. Method In a cohort of victims of the 2015 Paris attacks, multinomial logistic regressions explored predictive factors for partial or full PTSD status 8 to 18 months post-attacks. Analyses considered pre, peri, and posttraumatic factors chosen from literature review and univariate analysis within each group. Results Within the cohort, 50 individuals showed no signs of PTSD, 35 experienced partial PTSD, and 30 presented with full PTSD. After logistic regression, risk factors associated with full PTSD included a history of trauma (OR = 1.30, CI [1.02-1.66], p < 0.05), the intensity of peri-traumatic physical reactions (OR = 1.22, CI [1.09-1.36], p < 0.001), the difficulties in suppressing intrusive thoughts (OR = 1.11, CI [1.02-1.21], p < 0.013). Only the intensity of peri-traumatic physical reactions emerged as a risk factor for partial PTSD (OR = 1.13, [CI 1.02-1.24], p < 0.001). Discussion This study revealed that a history of trauma, the intensity of peri-traumatic physical reactions (e.g., tachycardia, trembling, flushes, numbness.), and the difficulties in suppressing intrusive thoughts constitute risk factors for the development of full PTSD. Moreover, the study identified that only the intensity of peri-traumatic physical reactions emerged as a risk factor for partial PTSD. These findings seem to underscore the significance of peri-traumatic experiences in influencing the development of post-traumatic stress symptoms. Conclusion This study emphasizes the significance of examining peri-traumatic reactions in PTSD development, suggesting its potential as a straightforward screening tool for post-traumatic stress disorder. It also underscores the influence of prior traumatic experiences, before de novo traumatization, in shaping vulnerability to PTSD and illuminates the crucial role of compromised control of intrusive thoughts that could perpetuate PTSD.
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Affiliation(s)
- Benoit Berthail
- French Military Health Service Academy, Ecole du Val de Grace, 1 Place Alphonse Laveran, Paris, France
- Neuropsychology and Imaging of Human Memory (NIMH) Research Unit, GIP Cyceron, INSERM U1077, Caen University Hospital, PSL, EPHE, Caen University, Caen, France
| | - Marion Trousselard
- Stress Neurophysiology Unit, French Armed Forces Biomedical Research Institute, Brétigny-sur-Orge, France
- University of Lorraine, Inserm, INSPIIRE UMR 1319, F-54000, Nancy, France
| | - Gregory Lecouvey
- Neuropsychology and Imaging of Human Memory (NIMH) Research Unit, GIP Cyceron, INSERM U1077, Caen University Hospital, PSL, EPHE, Caen University, Caen, France
| | - Barbara Le Roy
- Stress Neurophysiology Unit, French Armed Forces Biomedical Research Institute, Brétigny-sur-Orge, France
| | - Florence Fraisse
- Neuropsychology and Imaging of Human Memory (NIMH) Research Unit, GIP Cyceron, INSERM U1077, Caen University Hospital, PSL, EPHE, Caen University, Caen, France
| | - Denis Peschanski
- Paris I Pantheon Sorbonne University, HESAM University , EHESS, CNRS, UMR8209, Paris, France
| | - Francis Eustache
- Neuropsychology and Imaging of Human Memory (NIMH) Research Unit, GIP Cyceron, INSERM U1077, Caen University Hospital, PSL, EPHE, Caen University, Caen, France
| | - Pierre Gagnepain
- Neuropsychology and Imaging of Human Memory (NIMH) Research Unit, GIP Cyceron, INSERM U1077, Caen University Hospital, PSL, EPHE, Caen University, Caen, France
| | - Jacques Dayan
- Neuropsychology and Imaging of Human Memory (NIMH) Research Unit, GIP Cyceron, INSERM U1077, Caen University Hospital, PSL, EPHE, Caen University, Caen, France
- Child and Adolescent Psychiatry University Hospital Pole, Guillaume Régnier Hospital Center, Rennes 1 University, 35700 Rennes, France
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Xu Y, Malik N, Chernbumroong S, Vassallo J, Keene D, Foster M, Lord J, Belli A, Hodgetts T, Bowley D, Gkoutos G. Triage in major incidents: development and external validation of novel machine learning-derived primary and secondary triage tools. Emerg Med J 2024; 41:176-183. [PMID: 37751994 PMCID: PMC10894820 DOI: 10.1136/emermed-2022-212440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/12/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Major incidents (MIs) are an important cause of death and disability. Triage tools are crucial to identifying priority 1 (P1) patients-those needing time-critical, life-saving interventions. Existing expert opinion-derived tools have limited evidence supporting their use. This study employs machine learning (ML) to develop and validate models for novel primary and secondary triage tools. METHODS Adults (16+ years) from the UK Trauma Audit and Research Network (TARN) registry (January 2008-December 2017) served as surrogates for MI victims, with P1 patients identified using predefined criteria. The TARN database was split chronologically into model training and testing (70:30) datasets. Input variables included physiological parameters, age, mechanism and anatomical location of injury. Random forest, extreme gradient boosted tree, logistic regression and decision tree models were trained to predict P1 status, and compared with existing tools (Battlefield Casualty Drills (BCD) Triage Sieve, CareFlight, Modified Physiological Triage Tool, MPTT-24, MSTART, National Ambulance Resilience Unit Triage Sieve and RAMP). Primary and secondary candidate models were selected; the latter was externally validated on patients from the UK military's Joint Theatre Trauma Registry (JTTR). RESULTS Models were internally tested in 57 979 TARN patients. The best existing tool was the BCD Triage Sieve (sensitivity 68.2%, area under the receiver operating curve (AUC) 0.688). Inability to breathe spontaneously, presence of chest injury and mental status were most predictive of P1 status. A decision tree model including these three variables exhibited the best test characteristics (sensitivity 73.0%, AUC 0.782), forming the candidate primary tool. The proposed secondary tool (sensitivity 77.9%, AUC 0.817), applicable via a portable device, includes a fourth variable (injury mechanism). This performed favourably on external validation (sensitivity of 97.6%, AUC 0.778) in 5956 JTTR patients. CONCLUSION Novel triage tools developed using ML outperform existing tools in a nationally representative trauma population. The proposed primary tool requires external validation prior to consideration for practical use. The secondary tool demonstrates good external validity and may be used to support decision-making by healthcare workers responding to MIs.
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Affiliation(s)
- Yuanwei Xu
- Centre for Computational Biology, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Health Data Science Centre, University of Birmingham, Birmingham B15 2TT, UK
| | - Nabeela Malik
- NIHR Surgical Reconstruction Microbiology Research Centre, Edgbaston, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Academic Department of Military Surgery & Trauma, Royal Centre for Defence Medicine, Mindelsohn Way, Edgbaston, Birmingham B152WB, UK
| | - Saisakul Chernbumroong
- Centre for Computational Biology, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- NIHR Surgical Reconstruction Microbiology Research Centre, Edgbaston, UK
| | - James Vassallo
- Emergency Department, Derriford Hospital, Plymouth, UK
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Damian Keene
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Academic Department of Military Surgery & Trauma, Royal Centre for Defence Medicine, Mindelsohn Way, Edgbaston, Birmingham B152WB, UK
| | - Mark Foster
- NIHR Surgical Reconstruction Microbiology Research Centre, Edgbaston, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Academic Department of Military Surgery & Trauma, Royal Centre for Defence Medicine, Mindelsohn Way, Edgbaston, Birmingham B152WB, UK
| | - Janet Lord
- NIHR Surgical Reconstruction Microbiology Research Centre, Edgbaston, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Antonio Belli
- NIHR Surgical Reconstruction Microbiology Research Centre, Edgbaston, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Douglas Bowley
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Academic Department of Military Surgery & Trauma, Royal Centre for Defence Medicine, Mindelsohn Way, Edgbaston, Birmingham B152WB, UK
| | - George Gkoutos
- Centre for Computational Biology, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Health Data Science Centre, University of Birmingham, Birmingham B15 2TT, UK
- NIHR Surgical Reconstruction Microbiology Research Centre, Edgbaston, UK
- Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- MRC Health Data Research UK (HDR UK), Birmingham, UK
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Muysewinkel E, Vesentini L, Van Deynse H, Vanclooster S, Bilsen J, Van Overmeire R. A day in the life: psychological impact on emergency responders during the 22 March 2016 terrorist attacks. Front Psychiatry 2024; 15:1353130. [PMID: 38410678 PMCID: PMC10894950 DOI: 10.3389/fpsyt.2024.1353130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 01/19/2024] [Indexed: 02/28/2024] Open
Abstract
Introduction Terrorist attacks can cause severe long-term mental health issues that need treatment. However, in the case of emergency responders, research is often vague on the type of stressors that emergency responders encounter. For example, in addition to the threat that they work under, studies have shown that ill-preparation adds to the stress experienced by emergency responders. However, few studies have looked into the experience of emergency responders. In this study, we looked at the experience of emergency responders during the 22 March 2016 terrorist attacks in Belgium. Methods We used a qualitative design, in which we interviewed different types of emergency responders. Police officers, nurses, soldiers, firefighters, and Red Cross volunteers were included. Interviews were coded by two researchers and analyzed using a thematic approach. Results Four large themes were developed: constant threat and chaos, frustrations with lack of preparedness and training, ethical decisions, and debriefings. In addition, although emergency responders encountered constant threat, they often felt that they were ill-prepared for such attacks. One specific example was their lack of training in tourniquet usage. Furthermore, in a disaster setting, the emergency responders had to make life-and-death decisions for which they were not always prepared. Finally, debriefings were conducted in the aftermath of the attacks. Whereas most were perceived as positive, the debriefings among police officers were viewed as insufficient. Conclusions Emergency responding to terrorist attacks has many different dimensions of events that can cause stress. Our study revealed that preparation is key, not only in terms of material but also in terms of ethics and debriefings.
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Affiliation(s)
- Emilie Muysewinkel
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
- Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium
| | - Lara Vesentini
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Helena Van Deynse
- Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium
| | - Stephanie Vanclooster
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Johan Bilsen
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Roel Van Overmeire
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
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Ugelvik KS, Thomassen Ø, Braut GS, Geisner T, Sjøvold JE, Agri J, Montan C. Evaluation of prehospital preparedness for major incidents on a national level, with focus on mass casualty incidents. Eur J Trauma Emerg Surg 2023:10.1007/s00068-023-02386-7. [PMID: 38117294 DOI: 10.1007/s00068-023-02386-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/21/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE To investigate prehospital preparedness work for Mass Casualty Incidents (MCI) and Major Incidents (MI) in Norway. METHOD A national cross-sectional descriptive study of Norway's prehospital MI preparedness through a web-based survey. A representative selection of Rescue and Emergency Services were included, excluding Non-Governmental Organisations and military. The survey consisted of 59 questions focused on organisation, planning, education/training, exercises and evaluation. RESULTS Totally, 151/157 (96%) respondents answered the survey. The results showed variance regarding contingency planning for MCI/MI, revisions of the plans, use of national triage guidelines, knowledge requirements, as well as haemostatic and tactical first aid skills training. Participation in interdisciplinary on-going life-threatening violence (PLIVO) exercises was high among Ambulance, Police and Fire/Rescue Emergency Services. Simulations of terrorist attacks or disasters with multiple injured the last five years were reported by 21/151 (14%) on a regional level and 74/151 (48%) on a local level. Evaluation routines after MCI/MI events were reported by half of the respondents (75/151) and 70/149 (47%) described a dedicated function to perform such evaluation. CONCLUSION The study indicates considerable variance and gaps among Prehospital Rescue and Emergency Services in Norway regarding MCI/MI preparedness work, calling for national benchmarks, minimum requirements, follow-up routines of the organisations and future reassessments. Implementation of mandatory PLIVO exercises seems to have contributed to interdisciplinary exercises between Fire/Rescue, Police and Ambulance Emergency Service. Repeated standardised surveys can be a useful tool to assess and follow-up the MI preparedness work among Prehospital Rescue and Emergency Services at a national, regional and local level.
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Affiliation(s)
- Kristina Stølen Ugelvik
- University of Bergen, Bergen, Norway.
- Regional Trauma Centre, Haukeland University Hospital, Bergen, Norway.
| | - Øyvind Thomassen
- University of Bergen, Bergen, Norway
- HEMS, Haukeland University Hospital, Bergen, Norway
- Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Geir Sverre Braut
- Stavanger University Hospital, Stavanger, Norway
- Western Norway University of Applied Sciences, Stavanger, Norway
| | - Thomas Geisner
- Gastrosurgical Department, Haukeland University Hospital, Bergen, Norway
| | | | - Joakim Agri
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Carl Montan
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Valence TD, Suppan L. Time to Reconsider Analgesia in Mass Casualty Incidents. Wilderness Environ Med 2023; 34:524-527. [PMID: 37923685 DOI: 10.1016/j.wem.2023.09.003] [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: 04/05/2023] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 11/07/2023]
Abstract
The provision of analgesia in mass casualty incidents has traditionally been viewed as low-priority and reserved for later stages of care. Poor pain management is commonplace in trauma victims, and inadequate acute pain management can hinder evacuation efforts and may lead to the development of chronic pain and posttraumatic stress disorder. New, safe, and simple methods for administering quality analgesia have proven to be safe and effective in the prehospital setting and, as such, could easily be implemented into mass casualty incident protocols and allow for analgesia at earlier stages in such incidents, thereby improving patient care.
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Affiliation(s)
- Timothee de Valence
- Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.
| | - Laurent Suppan
- Division of Emergency Medicine, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
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Turner MD, Sapp J. Nord-Ost: Russia's Medical Failure in the 2002 Crisis. Mil Med 2023:usad467. [PMID: 38019675 DOI: 10.1093/milmed/usad467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/16/2023] [Accepted: 11/22/2023] [Indexed: 12/01/2023] Open
Abstract
The 2002 hostage crisis at a Moscow theater transfixed the attention of the world. While the initial assault, led by Spetsnaz commandos, successfully secured the building, the Russian security force's utter failure at coordinating with medical services led to the preventable deaths of over 100 hostages.
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Affiliation(s)
- Matthew D Turner
- U.S. Army, Emergency Medicine Program, Penn State Hershey S. Milton Medical Center, Hershey, PA 17033, USA
| | - Jason Sapp
- U.S. Army, Transitional Year Program/Department of Medicine, Madigan Army Medical Center, Joint Base Lewis-McChord, WA 98431, USA
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Hatami M, Marzaleh MA, Bijani M, Peyravi M. Factors affecting the preparedness of Helicopter Emergency Medical Services (HEMS) in disasters: a systematic review. BMC Emerg Med 2023; 23:135. [PMID: 37953223 PMCID: PMC10641982 DOI: 10.1186/s12873-023-00908-5] [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: 08/28/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND One of the most significant advantages of Helicopter Emergency Medical Service (HEMS) in disaster relief efforts is their ability to reach inaccessible or remote areas quickly. This is especially important in the aftermath of natural disasters such as earthquakes, floods, or hurricanes, where roads may be blocked or damaged, and conventional ground transportation may not be available. There are many factors can affect the performance of Helicopter Emergency Medical Service (HEMS) in disasters. This study aims to investigate the factors affecting the Helicopter Emergency Medical Service (HEMS) in disasters. METHODS The systematic search in Cochran Library, PubMed, Scopus, Science Direct, Web of Science, ProQuest, and Google Scholar databases between the first of January in 1975 and the thirty-first of May in 2023. The articles were selected based on the keywords of the authors. At last, the criteria were extracted from the selected ones. RESULTS The primary search included 839 articles. After studying their title, abstract, and full context, only nine articles, including two qualitative and seven quantitative ones, were chosen for analysis. After analysis and extracting data from the final studies, the preparation factors were categorized into 6 general classes of human resources: training and practicing, management, instructions and standards, equipment, and structure. Among these, the role of training is highlighted by holding practice and maneuvers to improve and prepare the personnel and manage disasters and incidents. CONCLUSION The results obtained from this systematic review provide a total view of the factors affecting the preparation of the air ambulance during disasters and incidents. It is recommended that senior managers and policy makers use the findings of the present study to identify the factors which affect preparedness of HEMS in disasters and take the necessary measures to eliminate to obstacles.
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Affiliation(s)
- Mahmoud Hatami
- Department of Health in Disasters and Emergencies, Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Milad Ahmadi Marzaleh
- Department of Health in Disasters and Emergencies, Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mostafa Bijani
- Department of Medical Surgical Nursing, School of Nursing, Fasa University of Medical Sciences, Fasa, Iran
| | - Mahmoudreza Peyravi
- Department of Health in Disasters and Emergencies, Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
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Hansen PM, Mikkelsen S, Alstrøm H, Damm-Hejmdal A, Rehn M, Berlac PA. The Field's mass shooting: emergency medical services response. Scand J Trauma Resusc Emerg Med 2023; 31:71. [PMID: 37919753 PMCID: PMC10621148 DOI: 10.1186/s13049-023-01140-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/25/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Major incidents (MI) happen infrequently in Scandinavia and mass shootings are even less frequently occurring. Case reports and research are called for, as literature is scarce. On 3rd July 2022, a mass shooting took place at the shopping mall Field's in Copenhagen, Denmark. Three people were killed and seven injured by a gunman, firing a rifle inside the mall. A further 21 people suffered minor injuries during the evacuation of the mall. In this case report, we describe the emergency medical services (EMS) incident response and evaluate the EMS´ adherence to the MI management guidelines to identify possible areas of improvement. CASE PRESENTATION Forty-eight EMS units including five Tactical Emergency Medical Service teams were dispatched to the incident. Four critically injured patients were taken to two trauma hospitals. The deceased patients were declared dead at the scene and remained there for the sake of the investigation. A total of 24 patients with less severe and minor injuries were treated at four different hospitals in connection with the attack. The ambulance resources were inherently limited in the initial phase of the MI, mandating improvisation in medical incident command. Though challenged, Command and Control, Safety, Communication, Assessment, Triage, Treatment, Transport (CSCATTT) principles were followed. CONCLUSIONS The EMS response generally adhered to national guidelines for MI. The activation of EMS and the hospital preparedness program was relevant. Important findings were communication shortcomings; inherent lack of readily available ambulance resources in the initial critical phase; uncertainty regarding the number of perpetrators; uncertainty regarding number of casualties and social media rumors that unnecessarily hampered and prolonged the response. The incident command had to use non-standard measures to mitigate potential challenges.
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Affiliation(s)
- Peter Martin Hansen
- The Mobile Emergency Care Unit, Department of Anesthesiology and Intensive Care, Odense University Hospital Svendborg, Svendborg, Denmark.
- Danish Air Ambulance, Aarhus, Denmark.
- The Prehospital Research Unit, Region of Southern Denmark, Odense University Hospital, Odense, Denmark.
| | - Søren Mikkelsen
- The Prehospital Research Unit, Region of Southern Denmark, Odense University Hospital, Odense, Denmark
- The Mobile Emergency Care Unit, Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Henrik Alstrøm
- Department of Anesthesiology and Intensive Care, Herlev and Gentofte Hospital, Herlev, Denmark
- Copenhagen Emergency Medical Services, Ballerup, Denmark
| | | | - Marius Rehn
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Dept. of Research and Development, Norwegian Air Ambulance Foundation, Oslo, Norway
- Air Ambulance Department, Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Peter Anthony Berlac
- Copenhagen Emergency Medical Services, Ballerup, Denmark
- Department of Anesthesiology and Intensive Care, Hvidovre and Amager Hospital, Hvidovre, Denmark
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Granholm F, Tin D, Doyle L, Ciottone G. A Gray Future: The Role of the Anesthesiologist in Hybrid Warfare. Anesthesiology 2023; 139:563-567. [PMID: 37665727 DOI: 10.1097/aln.0000000000004706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
During the last few decades, the increasing use of asymmetric and multimodal tactics by terrorists has led anesthesiologists worldwide to analyze and discuss their role in mass casualty scenarios in more depth. Now anesthesiologists must address the new situation of hybrid threats and hybrid warfare. This will have a direct impact on anesthesiology and intensive care, and in the end, the health and well-being of critical patients of all ages. To be able to respond to a hybrid threat efficiently and effectively, it is imperative that anesthesiologists play an early and integral role in mitigation and response planning.
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Affiliation(s)
| | - Derrick Tin
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Leilani Doyle
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital Civic Campus, University of Ottawa, Ottawa, Canada
| | - Gregory Ciottone
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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De Cauwer H, Barten D, Willems M, Van der Mieren G, Somville F. Communication failure in the prehospital response to major terrorist attacks: lessons learned and future directions. Eur J Trauma Emerg Surg 2023; 49:1741-1750. [PMID: 36214838 DOI: 10.1007/s00068-022-02131-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 10/01/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Communication is key in efficient disaster management. However, in many major incidents, prehospital communication failure led to insufficient upscaling, safety concerns for the emergency responders, logistical problems and inefficient disaster management. METHODS A review of medical reports and news articles of mass-casualty terrorist attacks was performed using PubMed-archived and (non-)governmental reports. The terrorist attacks in Tokyo 1995, Oklahoma 1995, Omagh 1998, New York 2001, Myyr-manni 2002, Istanbul 2003, Madrid 2004, London 2005, Oslo/Utøya 2011, Boston 2013, Paris 2015, Berlin 2016, Brussels 2016, Wuerzburg 2016, Manchester 2017, London 2017 were included. RESULTS In all mass-casualty terrorist attacks, communication failure was reported. Some failures had significant impact on casualty numbers. Outdated communication equipment, overwhelmed communication services, failure due to damaged infrastructure by the terrorist attack itself, and lack of training were the major issues. Communication failures were most commonly observed in both attacks between 1995-2009 and 2011-2017. DISCUSSION Communication failure was reported in all mass-casualty terrorist incidents. In several cases, communication between the different responding actors was poor or non-existing. Malfunctioning of (outdated) telecommunication services, inadequate training in the use of communication devices, unfortunate damage of telecommunication network infrastructure were also worrisome. CONCLUSION Despite reports of lessons learned in previous EMS responses, communication failures were still reported in most recent terrorist attacks. Governments should provide sufficient resources to equip hospitals, emergency departments, and ambulance services with (back-up) communication systems and invest in training. A European registration system is warranted. We provide proposals for improvement.
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Affiliation(s)
- Harald De Cauwer
- Department of Neurology, Ziekenhuis Geel, Geel, Belgium.
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.
| | - Dennis Barten
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, The Netherlands
| | - Melvin Willems
- Department of Emergency Medicine, Hospital Hasselt, Hasselt, Belgium
- Department of Emergency Medicine, Ziekenhuis Geel, Geel, Belgium
- Faculty of medicine, University of Leuven, Leuven, Belgium
| | | | - Francis Somville
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- Department of Emergency Medicine, Ziekenhuis Geel, Geel, Belgium
- Faculty of medicine, University of Leuven, Leuven, Belgium
- CREEC (Center for research and education in Emergency Care), Universiteit Leuven, Leuven, Belgium
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12
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Hermann B, Benghanem S, Jouan Y, Lafarge A, Beurton A. The positive impact of COVID-19 on critical care: from unprecedented challenges to transformative changes, from the perspective of young intensivists. Ann Intensive Care 2023; 13:28. [PMID: 37039936 PMCID: PMC10088619 DOI: 10.1186/s13613-023-01118-9] [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: 12/05/2022] [Accepted: 03/04/2023] [Indexed: 04/12/2023] Open
Abstract
Over the past 2 years, SARS-CoV-2 infection has resulted in numerous hospitalizations and deaths worldwide. As young intensivists, we have been at the forefront of the fight against the COVID-19 pandemic and it has been an intense learning experience affecting all aspects of our specialty. Critical care was put forward as a priority and managed to adapt to the influx of patients and the growing demand for beds, financial and material resources, thereby highlighting its flexibility and central role in the healthcare system. Intensivists assumed an essential and unprecedented role in public life, which was important when claiming for indispensable material and human investments. Physicians and researchers around the world worked hand-in-hand to advance research and better manage this disease by integrating a rapidly growing body of evidence into guidelines. Our daily ethical practices and communication with families were challenged by the massive influx of patients and restricted visitation policies, forcing us to improve our collaboration with other specialties and innovate with new communication channels. However, the picture was not all bright, and some of these achievements are already fading over time despite the ongoing pandemic and hospital crisis. In addition, the pandemic has demonstrated the need to improve the working conditions and well-being of critical care workers to cope with the current shortage of human resources. Despite the gloomy atmosphere, we remain optimistic. In this ten-key points review, we outline our vision on how to capitalize on the lasting impact of the pandemic to face future challenges and foster transformative changes of critical care for the better.
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Affiliation(s)
- Bertrand Hermann
- Service de Médecine Intensive - Réanimation, Hôpital Européen Georges Pompidou (HEGP), Groupe hospitalo-universitaire Assistance Publique - Hôpitaux de Paris, Centre - Université Paris Cité (GHU AP-HP Centre - Université Paris Cité), Paris, France
- Faculté de Médecine, Université Paris Cité, Paris, France
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris (IPNP), Paris, France
| | - Sarah Benghanem
- Faculté de Médecine, Université Paris Cité, Paris, France
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris (IPNP), Paris, France
- Service de Médecine Intensive - Réanimation, Hôpital Cochin, Groupe hospitalo-universitaire Assistance Publique - Hôpitaux de Paris, Centre - Université Paris Cité (GHU AP-HP Centre - Université Paris Cité), Paris, France
| | - Youenn Jouan
- Service de Médecine Intensive - Réanimation, CHRU Tours, Tours, France
- Service de Réanimation Chirurgicale Cardiovasculaire & Chirurgie Cardiaque, CHRU Tours, Tours, France
- INSERM U1100 Centre d'Etudes des Pathologies Respiratoires, Faculté de Médecine de Tours, Tours, France
| | - Antoine Lafarge
- Faculté de Médecine, Université Paris Cité, Paris, France
- Service de Médecine Intensive - Réanimation, Hôpital Saint Louis, Groupe hospitalo-universitaire Assistance Publique - Hôpitaux de Paris, Nord - Université Paris Cité (AP-HP Nord - Université Paris Cité), Paris, France
| | - Alexandra Beurton
- Service de Médecine Intensive - Réanimation, Hôpital Tenon, Groupe hospitalo-universitaire Assistance Publique - Hôpitaux de Paris, Sorbonne Université (GHU AP-HP Sorbonne Université), Paris, France.
- Service de Médecine Intensive - Réanimation, Hôpital Pitié Salpêtrière, Groupe hospitalo-universitaire Assistance Publique - Hôpitaux de Paris, Sorbonne Université, Paris, France.
- UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France.
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13
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Terrorist Attacks against Sports Venues: Emerging Trends and Characteristics Spanning 50 Years. Prehosp Disaster Med 2023:1-5. [PMID: 36938664 DOI: 10.1017/s1049023x23000377] [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: 03/21/2023]
Abstract
INTRODUCTION Sports venues foster community and support local economies. Due to their capacity to host hundreds to thousands of spectators, sports venues are vulnerable to becoming targets of terrorism. Types of venues targeted, regional trends, and methods of attack employed world-wide have not been well-described. METHODS A search of the Global Terrorism Database (GTD) was conducted from 1970 through the end of 2019. Pre-coded variables for target type "business" and target subtype "entertainment/cultural/stadium/casino" were used to identify attacks involving venues where sports events might be viewed by spectators as part of an audience. Sports venues were specifically identified using the search terms "sport," "stadium," "arena," and "ring," as well as mention of any specific sport. Two authors then manually reviewed each entry for specific information to confirm appropriateness for inclusion, selecting preferentially for attacks against venues where watching a sports event was the primary focus for the majority of the attendees. Descriptive statistics were performed using R (3.6.1). RESULTS Seventy-four (74) terrorist attacks targeting sports venues were identified from January 1, 1970 through December 31, 2019. Thirty-three (33) attacks, or 44.6% of attacks, involved soccer stadiums or soccer venues, while 33.8% of attacks (25 attacks) involved unspecified sports venues. A bombing or explosion was the most frequent method of attack employed, comprising 87.8% of attacks. The highest number of attacks occurred in the Middle East & North Africa. In total, 213 persons died and 699 more were wounded in attacks against sports venues. CONCLUSION Although terrorist attacks against sports venues are uncommon, they carry the risk of mass casualties, especially when explosives are used. A greater understanding of the threat posed by terrorist attacks against sports venues can aid emergency preparedness planning and future medical responses.
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Friberg FF, Nilsson H, Leonardsen ACL. When disaster strikes: staff recall and the use of staff recall systems during mass patient influx at Norwegian emergency primary health care centers - a cross-sectional study. BMC Emerg Med 2023; 23:25. [PMID: 36907847 PMCID: PMC10008708 DOI: 10.1186/s12873-023-00802-0] [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: 01/12/2023] [Accepted: 03/06/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND In Norway, planning for disasters has been specifically emphasized since the incidents on July 22nd, 2011. Every municipality is now legislated to have a contingency plan that includes plans for staff recall during situations with mass influx of patients. Whether the primary health care services in Norway are prepared for mass influx of patients remains unclear. AIMS OF THE STUDY The aims of this study were (1) to assess the experiences of head doctors at emergency primary health care centers (EPHCC) in Norway with mass influx of patients, (2) to explore mass influx and staff recall procedures in use, (3) to assess head doctors' experiences with staff recall systems, and (4) to assess their perspective on automatized staff recall systems. We also wanted to assess whether there were differences between small and large EPHCCs regarding whether they had plans in place. METHODS The study had a cross-sectional, multicenter design, using a self-developed questionnaire. The questionnaire was developed utilizing recommendations from the Delphi technique, including an expert group and piloting. A purposive sampling strategy was used, including head doctors from Norwegian EPHCCs (n = 169). Data were analyzed using the Statistical Package for the Social Sciences, and included descriptive statistics, Chi-Square tests and Shapiro-Wilks. Free-text answers were analyzed by content analysis. RESULTS A total of 64 head doctors responded to the questionnaire. The results show that 25% of the head doctors had experienced mass influx of patients at their EPHCC. In total 54.7% of Norwegian EPHCCs did not have disaster plans that consider mass influx situations. The majority of EPHCCs plan to recall staff one by one (60.3%) or through Short-Message-Systems (34.4%). Most EPHCCs had available telephone "alarm" lists (81.4%), that are updated regularly (60.9%). However, only 17.2% had plans that consider loss of mobile phone connection or internet. In total, 67,2% of the head doctors reported to have little experience with automatized staff recall systems, and 59,7% reported to have little knowledge about such systems. There were no significant difference between small and large EPHCCs in having plans or not. CONCLUSION Even though our results show that few EPHCCs experience mass influx of patients, it is important to be prepared when such incidents do occur. Our results indicate that it is still potential for improvement regarding plans for staff recall and implementation of staff recall systems at Norwegian EPHCCs. Involving national disaster medicine experts in the process of generating tools or checklists could aid when constructing disaster plans. Education and implementation of training for mass influx situations at all levels should always be highlighted.
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Affiliation(s)
- Fredrik Femtehjell Friberg
- Department of Anesthesiology and Intensive Care, Oslo University Hospital, Ullevål, NO-0450, Oslo, Norway. .,Department of Anesthesiology and Intensive Care, Ostfold Hospital Trust, NO-1714, Grålum, Norway.
| | - Heléne Nilsson
- The Swedish Civil Contingencies Agency, SE-65181, Karlstad, Sweden.,Faculty of Medicine and Health Science, University of Linköping, SE-58183, Linköping, Sweden
| | - Ann-Chatrin Linqvist Leonardsen
- Ostfold University College, NO-1757, Halden, Norway.,Department of Anesthesiology and Intensive Care, Ostfold Hospital Trust, NO-1714, Grålum, Norway
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15
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Hoth P, Roth J, Bieler D, Friemert B, Franke A, Paffrath T, Blätzinger M, Achatz G. Education and training as a key enabler of successful patient care in mass-casualty terrorist incidents. Eur J Trauma Emerg Surg 2023; 49:595-605. [PMID: 36810695 PMCID: PMC10175327 DOI: 10.1007/s00068-023-02232-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 01/17/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND AND PURPOSE The increase in terrorist attacks with sometimes devastating numbers of victims has become a reality in Europe and has led to a fundamental change in thinking and a reorientation in many fields including health policy. The purpose of this original work was to improve the preparedness of hospitals and to provide recommendations for training. MATERIAL AND METHODS We conducted a retrospective literature search based on the Global Terrorism Database (GTD) for the period 2000 to 2017. Using defined search strategies, we were able to identify 203 articles. We grouped relevant findings into main categories with 47 statements and recommendations on education and training. In addition, we included data from a prospective questionnaire-based survey on this topic that we conducted at the 3rd Emergency Conference of the German Trauma Society (DGU) in 2019. RESULTS Our systematic review identified recurrent statements and recommendations. A key recommendation was that regular training should take place on scenarios that should be as realistic as possible and should include all hospital staff. Military expertise and competence in the management of gunshot and blast injuries should be integrated. In addition, medical leaders from German hospitals considered current surgical education and training to be insufficient for preparing junior surgeons to manage patients who have sustained severe injuries by terrorist events. CONCLUSION A number of recommendations and lessons learned on education and training were repeatedly identified. They should be included in hospital preparations for mass-casualty terrorist incidents. There appear to be deficits in current surgical training which may be offset by establishing courses and exercises.
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Affiliation(s)
- Patrick Hoth
- Department of Trauma Surgery and Orthopaedics, Reconstructive and Septic Surgery, Sportstraumatology, Trauma Surgery Research Group, German Armed Forces Hospital, Oberer Eselsberg 40, 89081, Ulm, Germany.
| | - Johanna Roth
- Department of Trauma Surgery and Orthopaedics, Reconstructive and Septic Surgery, Sportstraumatology, Trauma Surgery Research Group, German Armed Forces Hospital, Oberer Eselsberg 40, 89081, Ulm, Germany.,Department of Radiotherapy and Radiooncology, Hospital of the State Capital Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - Dan Bieler
- Department of Orthopaedics and Trauma Surgery, Reconstructive Surgery, Hand Surgery, and Burn Medicine, German Armed Forces Central Hospital, Rübenacher Straße 170, 56072, Koblenz, Germany.,Department of Orthopedics and Trauma Surgery, Medical Faculty University Hospital Düsseldorf, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Benedikt Friemert
- Department of Trauma Surgery and Orthopaedics, Reconstructive and Septic Surgery, Sportstraumatology, Trauma Surgery Research Group, German Armed Forces Hospital, Oberer Eselsberg 40, 89081, Ulm, Germany
| | - Axel Franke
- Department of Orthopaedics and Trauma Surgery, Reconstructive Surgery, Hand Surgery, and Burn Medicine, German Armed Forces Central Hospital, Rübenacher Straße 170, 56072, Koblenz, Germany
| | - Thomas Paffrath
- General-, Visceral-, Thoracic and Trauma Surgery, Severinsklösterchen-Hospital Köln, Jacobstr. 27-31, 50678, Cologne, Germany
| | - Markus Blätzinger
- AUC (Academy for Trauma Surgery) of the German Trauma Society, Wilhelm-Hale-Str. 46B, 80639, Munich, Germany
| | - Gerhard Achatz
- Department of Trauma Surgery and Orthopaedics, Reconstructive and Septic Surgery, Sportstraumatology, Trauma Surgery Research Group, German Armed Forces Hospital, Oberer Eselsberg 40, 89081, Ulm, Germany
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16
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Penta S. Interdisciplinary Collaboration in International Crisis Medical Relief: A Look at the Nepal Earthquake and Ebola Relief Efforts. Disaster Med Public Health Prep 2023; 17:e305. [PMID: 36789768 DOI: 10.1017/dmp.2022.270] [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: 02/16/2023]
Abstract
OBJECTIVE This study explores interprofessional collaboration among medical and non-medical personnel planning and implementing international crisis health and medical relief efforts, and how disciplinary and professional background influences these activities. METHODS This study analyzes semi-structured interviews with individuals involved in organizations medical or health services to the Ebola epidemic in West Africa (2014-2016) or the 2015 Nepal earthquake. RESULTS Disciplinary background, sometimes coupled with organization role, shaped how relief workers engaged in the process of planning and implementing crisis medical relief. There were 3 thematic areas where these differences emerged: issue focus, problem -solving approaches, and decision-making approaches. Solutions from the field emerged as a fourth theme. CONCLUSIONS The study demonstrates medical relief required collaboration across medical and non-medical professions and highlights the importance of relief workers' disciplinary background in shaping the planning and implementation of crisis medical relief. Successful collaboration requires that people involved in crisis relief communicate the relevance of their own expertise, identify limits of their own and others' disciplinary perspective(s), seek out strengths in others' expertise, and can identify/ respond appropriately to others who do not see their own disciplinary limits, as well as learn these skills before engaging in relief.
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Affiliation(s)
- Samantha Penta
- Department of Emergency Management and Homeland Security, University at Albany, State University of New York, Albany, NY, USA
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17
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Berthail B, Trousselard M, Lecouvey G, Fraisse F, Peschanski D, Eustache F, Gagnepain P, Dayan J. Peritraumatic physical symptoms and the clinical trajectory of PTSD after a terrorist attack: a network model approach. Eur J Psychotraumatol 2023; 14:2225154. [PMID: 37458735 DOI: 10.1080/20008066.2023.2225154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 05/28/2023] [Accepted: 05/28/2023] [Indexed: 07/20/2023] Open
Abstract
Introduction: Following a mass casualty event, such as the Paris terrorist attacks of 13 November 2015, first responders need to identify individuals at risk of PTSD. Physical peritraumatic symptoms involving the autonomic nervous system may be useful in this task.Objective: We sought to determine the trajectory of physical response intensity in individuals exposed to the Paris terrorist attacks using repeated measures, and to examine its associations with PTSD. Using network modelling, we examined whether peritraumatic physical symptom associations differed by PTSD status.Methods: Physical reactions were assessed using the Subjective Physical Reactions Scale at three time points: peritraumatic by retrospective recall, then current at one year (8-18 months) and three years (30-42 months) after the attacks. Interaction networks between peritraumatic physical reactions were compared according to PTSD status.Results: On the one hand, the reported intensity of physical reactions was significantly higher in the PTSD group at all time points. On the other hand, using the dynamic approach, more robust positive interactions between peritraumatic physical reactions were found in the PTSD group one and three years after the attacks. Negative interactions were found in the no-PTSD group at one year. Peritraumatic physical numbness was found to be the most central network symptom in the PTSD group, whereas it was least central in the no-PTSD group.Discussion: Network analysis of the interaction between peritraumatic physical subjective responses, particularly physical numbness, may provide insight into the clinical course of PTSD. Our knowledge of the brain regions involved in dissociation supports the hypothesis that the periaqueductal grey may contribute to the process leading to physical numbing.Conclusions: Our findings highlight the role of peritraumatic somatic symptoms in the course of PTSD. Peritraumatic physical numbness appears to be a key marker of PTSD and its identification may help to improve early triage.
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Affiliation(s)
- Benoit Berthail
- French Military Health Service Academy, Paris, France
- Normandie Université, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | - Marion Trousselard
- French Armed Forces Biomedical Research Institute, Brétigny-sur-Orge, France
- APEMAC, Université de Lorraine, Metz, France
| | - Gregory Lecouvey
- Normandie Université, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | - Florence Fraisse
- Normandie Université, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | - Denis Peschanski
- EHESS, CNRS, UMR8209, Université Paris I Panthéon Sorbonne, HESAM Université, Paris, France
| | - Francis Eustache
- Normandie Université, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | - Pierre Gagnepain
- Normandie Université, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | - Jacques Dayan
- Normandie Université, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
- Centre Hospitalier Guillaume Régnier, Pôle Hospitalo-Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Université Rennes 1, Rennes, France
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18
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Nicolas-Robin A, Fleury N. From operating theatre to "out of the walls" COVID-19 ICU and return… or not! Anaesth Crit Care Pain Med 2022; 41:101064. [PMID: 35472587 PMCID: PMC9035617 DOI: 10.1016/j.accpm.2022.101064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 12/04/2022]
Affiliation(s)
- Armelle Nicolas-Robin
- Neuro-Intensive Care Unit, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.
| | - Nadia Fleury
- Department of Anaesthesiology and Critical Care, DMU DREAM, Assistance Publique-Hôpitaux de Paris - Sorbonne Université, Paris, France
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Development and Evaluation of Innovative and Practical Table-top Exercises Based on a Real Mass-Casualty Incident. Disaster Med Public Health Prep 2022; 17:e200. [PMID: 35575292 DOI: 10.1017/dmp.2022.95] [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: 02/08/2023]
Abstract
PURPOSE The aim of this work was to develop a table-top exercise (TTX) program for mass-casualty incident (MCI) response based on a real incident to evaluate the program. METHODS The TTX program was developed based on the 8 TTX design steps. Convenience sampling was adopted to recruit recently graduated physicians in China. After the TTX training, the participants completed a self-designed questionnaire, as well as the Simulation Design Scale (SDS) and Educational Practices in Simulation Scale (EPSS). RESULTS In total, 148 valid questionnaires were collected. The difficulty score of the TTX program was 3.69 ± 0.8. The participants evaluated the program highly, with a score of 4.72 ± 0.54 out of 5. Both the SDS and the EPSS had average scores higher than 4.5. Guided reflection/feedback (M = 4.68, SD = 0.41) and fidelity (M =4.66, SD = 0.57) were the 2 highest-rated SDS subscales. For the EPSS, diverse ways of learning and collaboration were the 2 highest-rated subscales. Multivariate stepwise regression analysis showed that the participants' evaluations of the TTX training course were related to the EPSS score, the difficulty rating, the evaluation of the instructional props, and the degree of participant involvement (F = 24.385, P < 0.001). CONCLUSIONS A TTX program for MCIs was developed based on the 2014 Shanghai New Year Crush. The TTX kit is practical and sophisticated, and it provides an effective strategy for MCI training.
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21
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Lessons learned from terror attacks: thematic priorities and development since 2001-results from a systematic review. Eur J Trauma Emerg Surg 2022; 48:2613-2638. [PMID: 35024874 PMCID: PMC8757406 DOI: 10.1007/s00068-021-01858-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/29/2021] [Indexed: 11/03/2022]
Abstract
Purpose The threat of national and international terrorism remains high. Preparation is the key requirement for the resilience of hospitals and out-of-hospital rescue forces. The scientific evidence for defining medical and tactical strategies often feeds on the analysis of real incidents and the lessons learned derived from them. This systematic review of the literature aims to identify and systematically report lessons learned from terrorist attacks since 2001. Methods PubMed was used as a database using predefined search strategies and eligibility criteria. All countries that are part of the Organization for Economic Cooperation and Development (OECD) were included. The time frame was set between 2001 and 2018. Results Finally 68 articles were included in the review. From these, 616 lessons learned were extracted and summarized into 15 categories. The data shows that despite the difference in attacks, countries, and casualties involved, many of the lessons learned are similar. We also found that the pattern of lessons learned is repeated continuously over the time period studied. Conclusions The lessons from terrorist attacks since 2001 follow a certain pattern and remained constant over time. Therefore, it seems to be more accurate to talk about lessons identified rather than lessons learned. To save as many victims as possible, protect rescue forces from harm, and to prepare hospitals at the best possible level it is important to implement the lessons identified in training and preparation.
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22
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Khorram-Manesh A, Burkle FM, Goniewicz K, Robinson Y. Estimating the Number of Civilian Casualties in Modern Armed Conflicts-A Systematic Review. Front Public Health 2021; 9:765261. [PMID: 34778192 PMCID: PMC8581199 DOI: 10.3389/fpubh.2021.765261] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/01/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To examine the possibility of estimating the number of civilian casualties in modern armed conflicts. Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using PubMed, Scopus, and Web of Science search engines. The outcome was analyzed using a qualitative inductive thematic analysis. The scientific evidence of selected article was assessed, using the Health Evidence Quality Assessment Tool. Findings: The review of 66 included articles in this study indicates that with an increasing number of public health emergencies and the lack of vital elements of life such as water and food, emerging armed conflicts seem to be inevitable. In contrast to military-led cross-border traditional wars, modern armed conflicts affect internally on local communities and take civilian lives. Consequently, the measures and tools used in traditional military-led cross-border wars to adequately tally wounded and dead for many decades under the mandates of the International Humanitarian Law, is insufficient for modern warfare. While casualty counting during modern conflicts is deficient due to organizational, political or strategic reasons, the international organizations responsible for collecting such data (the International Federation of Red Cross and Red Crescent and International Institute of Humanitarian Law) face difficulties to access the conflict scene, resulting in under-reported, unreliable or no-reported data. Conclusion: There are challenges in estimating and counting the number of civilian casualties in modern warfare. Although the global need for such data is evident, the risks and barriers to obtaining such data should be recognized, and the need for new international involvement in future armed conflicts should be emphasized.
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Affiliation(s)
- Amir Khorram-Manesh
- Institute of Clinical Sciences, Gothenburg University, Sahlgrenska Academy, Gothenburg, Sweden.,Department of Research and Development, Armed Forces Center for Defense Medicine, Gothenburg, Sweden
| | - Frederick M Burkle
- Harvard Humanitarian Initiative, T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Krzysztof Goniewicz
- Department of Aviation Security, Military University of Aviation, Dȩblin, Poland
| | - Yohan Robinson
- Institute of Clinical Sciences, Gothenburg University, Sahlgrenska Academy, Gothenburg, Sweden.,Department of Research and Development, Armed Forces Center for Defense Medicine, Gothenburg, Sweden
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23
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Tallach R, Einav S, Brohi K, Abayajeewa K, Abback PS, Aylwin C, Batrick N, Boutonnet M, Cheatham M, Cook F, Curac S, Davidson S, Eason H, Fiore N, Gaarder C, Garusinghe S, Goralnick E, Grimaldi D, Kritayakirana K, Levraut J, Lindner T, Märdian S, Padayachee A, Qureshi S, Ramessur S, Raux M, Ratnayake A, Römer M, Roy H, Tole E, Tose S, Fuentes FT, Gauss T. Learning from terrorist mass casualty incidents: a global survey. Br J Anaesth 2021; 128:e168-e179. [PMID: 34749991 DOI: 10.1016/j.bja.2021.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/30/2021] [Accepted: 10/03/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Reports published directly after terrorist mass casualty incidents frequently fail to capture difficulties that may have been encountered. An anonymised consensus-based platform may enable discussion and collaboration on the challenges faced. Our aim was to identify where to focus improvement for future responses. METHODS We conducted a mixed methods study by email of clinicians' experiences of leading during terrorist mass casualty incidents. An initial survey identified features that worked well, or failed to, during terrorist mass casualty incidents plus ongoing challenges and changes that were implemented as a result. A follow-up, quantitative survey measured agreement between responses within each of the themes using a Likert scale. RESULTS Thirty-three participants responded from 22 hospitals that had received casualties from a terrorist incident, representing 17 cities in low-middle, middle and high income countries. The first survey identified themes of sufficient (sometimes abundant) human resource, although coordination of staff was a challenge. Difficulties highlighted were communication, security, and management of blast injuries. The most frequently implemented changes were education on specific injuries, revising future plans and preparatory exercises. Persisting challenges were lack of time allocated to training and psychological well-being. The follow-up survey recorded highest agreement amongst correspondents on the need for re-triage at hospital (90% agreement), coordination roles (85% agreement), flexibility (100% agreement), and large-scale exercises (95% agreement). CONCLUSION This survey collates international experience gained from clinicians managing terrorist mass casualty incidents. The organisation of human response, rather than consumption of physical supplies, emerged as the main finding. NHSH Clinical Effectiveness Unit project registration number: 2020/21-036.
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Affiliation(s)
- Rosel Tallach
- Royal London Hospital, London, UK; Raigmore Hospital, Inverness, UK.
| | | | | | | | | | | | | | | | | | | | | | | | - Hilary Eason
- Royal Manchester Children's Hospital, Manchester, UK
| | - Nick Fiore
- Sunrise Children's Hospital, Las Vegas, NV, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Eunice Tole
- Aga Khan University Hospital, Nairobi, Kenya
| | - Sheila Tose
- Salford Royal Foundation Trust Hospital, Manchester, UK
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Teaching and Evaluation Methods of the Use of the Tourniquet in Severe Limb Bleeding among Health Care Professionals: A Systematic Review. Prehosp Disaster Med 2021; 36:747-755. [PMID: 34665084 DOI: 10.1017/s1049023x21001114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION AND OBJECTIVES Massive hemorrhage (MH) is a growing pathology in military settings and increasingly in civilian settings; it is now considered a public health problem in the United States with large-scale programs. Tourniquets are the fastest and most effective intervention in MH if direct pressure is not effective.The Liaison Committee on Resuscitation (ILCOR) recognizes a knowledge gap in optimal education techniques for first aid providers. This review aims to describe training and evaluation methods for teaching tourniquet use to both health care and military professionals. METHODS The MEDLINE, CINAHL, WEB of Science, and Scopus databases were reviewed (from 2010 through April 2020). The quality of the selected studies was assessed using the Consolidated Standards of Reporting Trials (CONSORT) scale. Studies that met at least 65% of the included items were included. Data were extracted independently by two reviewers. RESULTS Ten of the 172 articles found were selected, of which three were randomized clinical trials. Heterogeneity was observed in the design of the studies and in the training and evaluative methods that limit the comparison between studies. CONCLUSIONS The results suggest that the training strategies studied are effective in improving knowledge, attitudes, and practical skills. There is no universal method, learning is meaningful but research should be directed to find out which ones work best.
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Hansen PM, Jepsen SB, Mikkelsen S, Rehn M. The Great Belt train accident: the emergency medical services response. Scand J Trauma Resusc Emerg Med 2021; 29:140. [PMID: 34556163 PMCID: PMC8461896 DOI: 10.1186/s13049-021-00954-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/14/2021] [Indexed: 11/27/2022] Open
Abstract
Background Major incidents (MI) are rare occurrences in Scandinavia. Literature depicting Scandinavian MI management is scarce and case reports and research is called for. In 2019, a trailer falling off a freight train struck a passing high-speed train on the Great Belt Bridge in Denmark, killing eight people instantly and injuring fifteen people. We aim to describe the emergency medical services (EMS) response to this MI and evaluate adherence to guidelines to identify areas of improvement for future MI management. Case presentation Nineteen EMS units were dispatched to the incident site. Ambulances transported fifteen patients to a trauma centre after evacuation. Deceased patients were pronounced life-extinct on-scene. Radio communication was partly compromised, since 38.9% of the radio shifts were not according to the planned radio grid and presented a potential threat to patient outcome and personnel safety. Access to the incident site was challenging and delayed due to traffic congestion and safety issues. Conclusion Despite harsh weather conditions and complex logistics, the availability of EMS units was sufficient and patient treatment and evacuation was uncomplicated. Triage was relevant, but at the physicians’ discretion. Important findings were communication challenges and the consequences of difficult access to the incident site. There is a need for an expansion of capacity in formal education in MI management in Denmark. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00954-7.
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Affiliation(s)
- Peter Martin Hansen
- The Mobile Emergency Care Unit, Department of Anaesthesiology and Intensive Care Medicine, Odense University Hospital Svendborg, Baagøes Allé 31, 5700, Svendborg, Denmark. .,Danish Air Ambulance, Olof Palmes Allé 34, 1. Sal, 8200, Aarhus N, Denmark. .,Faculty of Health Sciences, University of Stavanger, Kjell Arholms Gate 41, 4021, Stavanger, Norway.
| | - Søren Bruun Jepsen
- The Mobile Emergency Care Unit, Department of Anaesthesiology and Intensive Care, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense, Denmark
| | - Søren Mikkelsen
- The Mobile Emergency Care Unit, Department of Anaesthesiology and Intensive Care, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense, Denmark.,The Prehospital Research Unit, Region of Southern Denmark, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense, Denmark.,Department of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
| | - Marius Rehn
- Department of Research and Development, Norwegian Air Ambulance Foundation, Postboks 414 Sentrum, Oslo, Norway.,Air Ambulance Department, Division of Prehospital Services, Oslo University Hospital, Kirkeveien 166, 0450, Oslo, Norway.,Faculty of Health Sciences, University of Stavanger, Kjell Arholms Gate 41, 4021, Stavanger, Norway
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MacKinnon RJ, Slater D, Pukk-Härenstam K, von Thiele Schwarz U, Stenfors T. Adaptations to practice and resilience in a paediatric major trauma centre during a mass casualty incident. Br J Anaesth 2021; 128:e120-e126. [PMID: 34563337 DOI: 10.1016/j.bja.2021.07.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/05/2021] [Accepted: 07/08/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Innovation and human adaptation in the face of unfolding catastrophe is the cornerstone of an effective systemwide response. Capturing, analysing, and disseminating this is fundamental in developing resilience for future events. The aim of this study was to understand the characteristics of adaptations to practice early in a paediatric major trauma centre during a mass casualty incident. METHODS A qualitative interview study of 40 healthcare staff at a paediatric major trauma centre in the immediate aftermath of a terrorist bombing was conducted. An inductive thematic analysis approach was used, followed by a deductive analysis of the identified adaptations informed by constructs of resilience engineering. RESULTS Five themes of adaptations to practice that enhanced the resilient performance of the hospital were identified: teamworking; psychologically supporting patients, families, and staff; reconfiguring infrastructure; working around the hospital electronic systems; and maintaining hospital safety. Examples of resilience potential in terms of respond, monitor, anticipate, and learn are presented. CONCLUSIONS Our study shows how adaptations to practice sustained the resilient performance of a paediatric major trauma centre during a mass casualty incident. Rapid, early capture of these data during a mass casualty incident provides key insights into enhancing future emergency preparedness, response, and resilience planning.
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Affiliation(s)
- Ralph J MacKinnon
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden; Department of Paediatric Anaesthesia, Royal Manchester Children's Hospital, Manchester, UK.
| | - David Slater
- School of Engineering, Cardiff University, Cardiff, UK
| | - Karin Pukk-Härenstam
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden; Paediatric Emergency Department, Karolinska University Hospital, Stockholm, Sweden
| | - Ulrica von Thiele Schwarz
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden; School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Terese Stenfors
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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Gouraud C, Airagnes G, Kab S, Courtin E, Goldberg M, Limosin F, Lemogne C, Zins M. Changes in benzodiazepine use in the French general population after November 2015 terrorist attacks in Paris: an interrupted time series analysis of the national CONSTANCES cohort. BMJ Open 2021; 11:e044891. [PMID: 34535472 PMCID: PMC8451294 DOI: 10.1136/bmjopen-2020-044891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To determine whether the terrorist attacks occurring in Paris on November 2015 have changed benzodiazepine use in the French population. DESIGN Interrupted time series analysis. SETTING National population-based cohort. PARTICIPANTS 90 258 individuals included in the population-based CONSTANCES cohort from 2012 to 2017. OUTCOME MEASURES Benzodiazepine use was evaluated according to two different indicators using objective data from administrative registries: weekly number of individuals with a benzodiazepine delivered prescriptions (BDP) and weekly number of defined daily dose (DDD). Two sets of analyses were performed according to sex and age (≤50 vs >50). Education, income and area of residence were additional stratification variables to search for at-risk subgroups. RESULTS Among women, those with younger age (incidence rate ratios (IRR)=1.18; 95% CI=1.05 to 1.32 for BDP; IRR=1.14; 95% CI=1.03 to 1.27 for DDD), higher education (IRR=1.23; 95% CI=1.03 to 1.46 for BDP; IRR=1.23; 95% CI=1.01 to 1.51 for DDD) and living in Paris (IRR=1.27; 95% CI=1.05 to 1.54 for BDP) presented increased risks for benzodiazepine use. Among participants under 50, an overall increase in benzodiazepine use was identified (IRR=1.14; 95% CI=1.02 to 1.28 for BDP and IRR=1.12; 95% CI=1.01 to 1.25 for DDD) and in several strata. In addition to women, those with higher education (IRR=1.22; 95% CI=1.02 to 1.47 for BDP), lower income (IRR=1.17; 95% CI=1.02 to 1.35 for BDP) and not Paris residents (IRR=1.13; 95% CI=1.02 to 1.26 for BDP and IRR=1.13; 95% CI=1.03 to 1.26 for DDD) presented increased risks for benzodiazepine use. CONCLUSION Terrorist attacks might increase benzodiazepine use at a population level, with at-risk subgroups being particularly concerned. Information and prevention strategies are needed to provide appropriate care after such events.
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Affiliation(s)
- Clement Gouraud
- Centre Ambulatoire d'Addictologie, AP-HP.Centre-Université de Paris, Hôpital européen Georges-Pompidou, Paris, France
| | - Guillaume Airagnes
- Centre Ambulatoire d'Addictologie, AP-HP.Centre-Université de Paris, Hôpital européen Georges-Pompidou, Paris, France
| | - Sofiane Kab
- UMS 011, Population-based Epidemiological Cohorts, INSERM, Villejuif, France
| | - Emilie Courtin
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Marcel Goldberg
- UMS 011, Population-based Epidemiological Cohorts, INSERM, Villejuif, France
| | - Frédéric Limosin
- Service de Psychiatrie de l'adulte et du sujet âgé, AP-HP.Centre-Université de Paris, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, Université de Paris, INSERM, Paris, France
| | - Cedric Lemogne
- Service de Psychiatrie de l'adulte et du sujet âgé, AP-HP.Centre-Université de Paris, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, Université de Paris, INSERM, Paris, France
| | - Marie Zins
- UMS 011, Population-based Epidemiological Cohorts, INSERM, Villejuif, France
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Guillon A, Laurent E, Duclos A, Godillon L, Dequin PF, Agrinier N, Kimmoun A, Grammatico-Guillon L. Case fatality inequalities of critically ill COVID-19 patients according to patient-, hospital- and region-related factors: a French nationwide study. Ann Intensive Care 2021; 11:127. [PMID: 34410543 PMCID: PMC8375279 DOI: 10.1186/s13613-021-00915-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/04/2021] [Indexed: 12/02/2022] Open
Abstract
Background The COVID-19 sanitary crisis inflicted different challenges regarding the reorganization of the human and logistic resources, particularly in intensive care unit (ICU). Interdependence between regional pandemic burden and individual outcome remains unknown. The study aimed to assess the association between ICU bed occupancy and case fatality rate of critically ill COVID-19 patients. Methods A cross-sectional study was performed in France, using the national hospital discharge database from March to May, 2020. All patients admitted to ICU for COVID-19 were included. Case fatality was described according to: (i) patient’s characteristics (age, sex, comorbid conditions, ICU interventions); (ii) hospital’s characteristics (baseline ICU experience assessed by the number of ICU stays in 2019, number of ICU physicians per bed), and (iii) the regional outbreak-related profiles (workload indicator based on ICU bed occupancy). The determinants of lethal outcome were identified using a logistic regression model. Results 14,513 COVID-19 patients were admitted to ICU; 4256 died (29.3%), with important regional inequalities in case fatality (from 17.6 to 33.5%). Older age, multimorbidity and clinical severity were associated with higher mortality, as well as a lower baseline ICU experience of the health structure. Regions with more than 10 days with ≥ 75% of ICU occupancy by COVID-19 patients experienced an excess of mortality (up to adjusted OR = 2.2 [1.9–2.6] for region with the highest occupancy rate of ICU beds). Conclusions The regions with the highest burden of care in ICU were associated with up to 2.2-fold increase of death rate. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00915-4.
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Affiliation(s)
- Antoine Guillon
- Intensive Care Unit, Tours University Hospital, Research Center for Respiratory Diseases, INSERM U1100, University of Tours, Tours, France
| | - Emeline Laurent
- Epidemiology Unit EpiDcliC, Service of Public Health, Tours University Hospital, 2 Bd Tonnellé, 37044, Tours Cedex 9, France.,Research Unit EA1075 (Education Ethique et Santé), University of Tours, Tours, France
| | - Antoine Duclos
- Research on Healthcare Performance Lab (RESHAPE) INSERM U1290, University of Claude Bernard Lyon 1, Lyon, France.,Health Data Department, Hospices Civils de Lyon, Lyon, France
| | - Lucile Godillon
- Epidemiology Unit EpiDcliC, Service of Public Health, Tours University Hospital, 2 Bd Tonnellé, 37044, Tours Cedex 9, France
| | - Pierre-François Dequin
- Intensive Care Unit, Tours University Hospital, Research Center for Respiratory Diseases, INSERM U1100, University of Tours, Tours, France
| | - Nelly Agrinier
- CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie Clinique, 54000, Nancy, France
| | - Antoine Kimmoun
- Teaching Hospital of Nancy, Intensive Care Unit, University of Lorraine, Nancy, France
| | - Leslie Grammatico-Guillon
- Epidemiology Unit EpiDcliC, Service of Public Health, Tours University Hospital, 2 Bd Tonnellé, 37044, Tours Cedex 9, France. .,MAVIVH, INSERM U1259; University of Tours, Tours, France.
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Carlton E, Weber EJ. Lessons learnt in ethical publishing from mass casualty events: the Manchester bombing experience. Emerg Med J 2021; 38:744-745. [PMID: 34376466 DOI: 10.1136/emermed-2021-211661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Edward Carlton
- Emergency Department, North Bristol NHS Trust, Westbury on Trym, UK .,School of Health and Social Care, University of the West of England Bristol, Bristol, UK
| | - Ellen J Weber
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
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Hoth P, Bieler D, Friemert B, Franke A, Blätzinger M, Achatz G. [Safety aspects, emergency preparedness and hazard prevention in hospitals concerning mass casualty incidents (MCI)/terror-related MCI : Prospects on future challenges based on survey results from the 3rd emergency conference of the DGU]. Unfallchirurg 2021; 125:542-552. [PMID: 34338840 PMCID: PMC9256572 DOI: 10.1007/s00113-021-01046-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 11/25/2022]
Abstract
Hintergrund Weltweite terroristische Aktivitäten seit „9/11“ und folgend auch im europäischen Raum haben im Rahmen der Bewertung von kritischer Infrastruktur in Deutschland zu einem Umdenken auch hinsichtlich der Sicherheit an und in Kliniken geführt. Ziel der Arbeit Die vorliegende Publikation befasst sich mit der Bewertung vorliegender Konzepte zu Themen wie „Alarmierung“, „Sicherheit“, „Kommunikation“ und „Vorbereitung“ im vorgenannten Kontext. Material und Methoden Anhand einer Literatursichtung sowie einer Umfrage unter den Teilnehmern*innen der 3. Notfallkonferenz der DGU (Deutsche Gesellschaft für Unfallchirurgie) werden diese Thematik und die aktuell vorliegende Situation weiter analysiert und vorgestellt. Ergebnisse Die gewonnenen Daten verdeutlichen, dass ein Großteil der Kliniken zwar über eine Krankenhausalarm- und Einsatzplanung verfügt, jedoch die Frequenz der Aktualisierungen und die innerklinische Kommunikation zur Steigerung der Wahrnehmung eine deutliche Streuung zeigen. Weiterhin verdeutlichen die Ergebnisse eine Heterogenität der vorliegenden innerklinischen Alarmierungskonzepte sowie einen Mangel an Sicherheitskonzepten und Kooperationen mit Sicherheits- und Wachdiensten. Zudem zeigt sich, dass die Thematik einer möglichen CBRN(chemical, biological, radiological, nuclear)-Bedrohung in der Risikoanalyse noch nicht adäquat wahrgenommen wird bzw. umgesetzt ist. Diskussion Zusammenfassend scheint die latente Bedrohung durch terroristische Aktivitäten dazu geführt zu haben, dass sich deutsche Kliniken in der Bewertung als kritische Infrastruktur mit der Thematik „Krankenhausalarm- und Einsatzplanung“ auseinandergesetzt und diese überwiegend auch umgesetzt haben. Allerdings zeigt sich für die nachgeordneten Bereiche und die aus der Alarmplanung ableitbaren Konsequenzen noch nicht die nötige Stringenz, um letztendlich adäquate Reaktionen in diesen besonderen Szenarien im Hinblick auf die Sicherheit in und an deutschen Kliniken zu gewährleisten.
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Affiliation(s)
- Patrick Hoth
- Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland.
| | - Dan Bieler
- Klinik für Unfallchirurgie und Orthopädie, Wiederherstellungs- und Handchirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Rübenacher Straße 170, 56072, Koblenz, Deutschland.,Klinik für Orthopädie und Unfallchirurgie, Heinrich-Heine-Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland
| | - Benedikt Friemert
- Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
| | - Axel Franke
- Klinik für Unfallchirurgie und Orthopädie, Wiederherstellungs- und Handchirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Rübenacher Straße 170, 56072, Koblenz, Deutschland
| | - Markus Blätzinger
- Akademie der Unfallchirurgie GmbH, Wilhelm-Hale-Straße 46b, 80639, München, Deutschland
| | - Gerhard Achatz
- Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
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Abstract
The anesthesiologist, upon completion of their training, is expected to be the liaison to the operating room and the patient. Key components of the anesthesiologist's training and daily routine make them an ideal participant and leader when it comes to their potential involvement in a mass casualty event. Airway expertise, vascular access, ongoing triage, hemodynamic vigilance, resuscitation, and real-time adaptation to a changing and critical care environment are a few of the skills that encompass the daily routine and value the anesthesiologist brings to an emergency management team.
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Affiliation(s)
- Derek Nicholas Lodico
- Naval Trauma Training Center, Los Angeles County + University of Southern California Medical Center, Keck School of Medicine, 1200 North State Street, Room 1050, Los Angeles, CA 90033, USA; Uniformed Services University of Health Sciences, Bethesda, MD, USA.
| | - Rear Admiral Darin Via
- Uniformed Services University of Health Sciences, Bethesda, MD, USA; Naval Medical Forces Atlantic, Navy Medicine East, 620 John Paul Jones Circle, Building 3, Suite 1400, Portsmouth, VA 23708, USA
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Malik NS, Chernbumroong S, Xu Y, Vassallo J, Lee J, Bowley DM, Hodgetts T, Moran CG, Lord JM, Belli A, Keene D, Foster M, Gkoutos GV. The BCD Triage Sieve outperforms all existing major incident triage tools: Comparative analysis using the UK national trauma registry population. EClinicalMedicine 2021; 36:100888. [PMID: 34308306 PMCID: PMC8257989 DOI: 10.1016/j.eclinm.2021.100888] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Natural disasters, conflict, and terrorism are major global causes of death and disability. Central to the healthcare response is triage, vital to ensure the right care is provided to the right patient at the right time. The ideal triage tool has high sensitivity for the highest priority (P1) patients with acceptably low over-triage. This study compared the performance of major incident triage tools in predicting P1 casualty status in adults in the prospective UK Trauma Audit and Research Network (TARN) registry. METHODS TARN patients aged 16+ years (January 2008-December 2017) were included. Ten existing triage tools were applied using patients' first recorded pre-hospital physiology. Patients were subsequently assigned triage categories (P1, P2, P3, Expectant or Dead) based on pre-defined, intervention-based criteria. Tool performance was assessed by comparing tool-predicted and intervention-based priority status. FINDINGS 195,709 patients were included; mortality was 7·0% (n=13,601); median Injury Severity Score (ISS) was 9 (IQR 9-17); 97·1% sustained blunt injuries. 22,144 (11·3%) patients fulfilled intervention-based criteria for P1 status, exhibiting higher mortality (12·8% vs. 5·0%, p<0.001), increased intensive care requirement (52·4% vs 5·0%, p<0.001), and more severe injuries (median ISS 21 vs 9, p<0.001) compared with P2 patients.In 16-64 year olds, the highest performing tool was the Battlefield Casualty Drills (BCD) Triage Sieve (Prediction of P1 status: 70·4% sensitivity, over-triage 70·9%, area under the receiver operating curve (AUC) 0·068 [95%CI 0·676-0·684]). The UK National Ambulance Resilience Unit (NARU) Triage Sieve had sensitivity of 44·9%; over-triage 56·4%; AUC 0·666 (95%CI 0·662-0·670). All tools performed poorly amongst the elderly (65+ years). INTERPRETATION The BCD Triage Sieve performed best in this nationally representative population; we recommend it supersede the NARU Triage Sieve as the UK primary major incident triage tool. Validated triage category definitions are recommended for appraising future major incidents. FUNDING This study is funded by the National Institute for Health Research (NIHR) Surgical Reconstruction and Microbiology Research Centre. GVG also acknowledges support from the MRC Heath Data Research UK (HDRUK/CFC/01). The views expressed are those of the authors and not necessarily those of the NIHR, the Department of Health and Social Care, or the Ministry of Defence.
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Affiliation(s)
- Nabeela S. Malik
- NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
- 212 (Yorkshire) Field Hospital, Endcliffe Hall, Endcliffe Vale Road, Sheffield S10 3EU, UK
- Corresponding author at: NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK.
| | - Saisakul Chernbumroong
- NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Yuanwei Xu
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - James Vassallo
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Justine Lee
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
- University Hospitals Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
- NHS England London, Skipton House, 80 London Road, London SE1 6LH, UK
| | - Douglas M. Bowley
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
- Academic Department of Military Surgery & Trauma, Royal Centre for Defence Medicine, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
- University Hospitals Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Timothy Hodgetts
- Army Health, Army Headquarters, Monxton Road, Andover SP11 8HT, UK
| | - Christopher G Moran
- NHS England London, Skipton House, 80 London Road, London SE1 6LH, UK
- Nottingham University Hospitals NHS Trust, Derby Road, Nottingham NG7 2UH, UK
| | - Janet M Lord
- NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
| | - Antonio Belli
- NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
- University Hospitals Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Damian Keene
- Academic Department of Military Surgery & Trauma, Royal Centre for Defence Medicine, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
- University Hospitals Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Mark Foster
- NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, UK
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
- University Hospitals Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Georgios V Gkoutos
- NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
- Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK
- MRC Health Data Research UK (HDR UK), Midlands Site, B15 2TT UK
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Lefrant JY, Pirracchio R, Benhamou D, Dureuil B, Pottecher J, Samain E, Joannes-Boyau O, Bouaziz H. ICU bed capacity during COVID-19 pandemic in France: From ephemeral beds to continuous and permanent adaptation. Anaesth Crit Care Pain Med 2021; 40:100873. [PMID: 33910085 PMCID: PMC8069631 DOI: 10.1016/j.accpm.2021.100873] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jean-Yves Lefrant
- UR-UM103 IMAGINE, Université de Montpellier, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, Nîmes, France.
| | - Romain Pirracchio
- Department of Anaesthesia and Perioperative Medicine, Zuckerberg San Francisco General Hospital and Trauma Centre, University of California San Francisco, San Francisco, California, United States
| | - Dan Benhamou
- Service d'Anesthésie Réanimation Médecine Péri Opératoire, AP-HP, Université Paris Saclay, Hôpital Bicêtre - 78, rue du Général Leclerc, 94275 Le Kremlin Bicêtre Cedex, France
| | - Bertrand Dureuil
- Department of Anaesthesia and Critical Care, Rouen University Hospital, Rouen, France
| | - Julien Pottecher
- Hôpitaux Universitaires de Strasbourg, Pôle d'Anesthésie-Réanimation & Médecine Péri-Opératoire, Service d'Anesthésie-Réanimation & Médecine Péri-Opératoire Hôpital de Hautepierre - Université de Strasbourg, Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), UR3072 Strasbourg, France
| | - Emmanuel Samain
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Besancon, EA 3920, Bourgogne Franche-Comte University, France
| | - Olivier Joannes-Boyau
- Service d'Anesthésie-Réanimation Sud, Centre Médico-Chirurgical Magellan, Centre Hospitalier Universitaire (CHU) de Bordeaux, 33000 Bordeaux, France
| | - Hervé Bouaziz
- Département d'Anesthésie Réanimation, Hôpital Central - CHRU Nancy, Nancy, 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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Verdonk F, Garnier M, Bonnet F, Jabaudon M. The 'ephemeral' intensive care units that saved the French healthcare system, a new concept to be preserved. Eur J Anaesthesiol 2021; 38:441-442. [PMID: 33661828 DOI: 10.1097/eja.0000000000001320] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Franck Verdonk
- From the Department of Anaesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France (FV, MG, FB), Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California (FV), Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France (MJ) and Division of Allergy, Pulmonary, and Critical Care Medicine Vanderbilt University Medical Center, Nashville (MJ)
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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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Laubscher M, Ferreira N, Birkholtz FF, Graham SM, Maqungo S, Held M. Civilian gunshot injuries in orthopaedics: a narrative review of ballistics, current concepts, and the South African experience. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:923-930. [PMID: 33760996 DOI: 10.1007/s00590-021-02934-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/08/2021] [Indexed: 11/30/2022]
Abstract
The incidence of civilian gunshot injuries is on the rise worldwide.Unfortunately, there is a lack of high-level evidence guiding management. The treatment of orthopaedic injuries from gunshots is complex and requires consideration of multiple aspects, including energy transfer to the tissue, severity of the wound, possible contamination, presence of fractures and associated injuries. With this narrative review we aim to discuss some of the relevant ballistics, current concepts, and controversies in the general management of civilian gunshot-related orthopaedic injuries based on the available evidence and personal experience. Important points which will be highlighted are the initial management in the emergency room, the assessment and management of soft tissue injuries, associated injuries, use of antibiotics, indication and techniques for fracture fixation, and gunshot injuries to joints.
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Affiliation(s)
- Maritz Laubscher
- Orthopaedic Research Unit, Division of Orthopaedic Surgery, H49 OMB, Groote Schuur Hospital, University of Cape Town, Cape Town, 7925, South Africa.
| | - Nando Ferreira
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7505, South Africa
| | - Franz Friedrich Birkholtz
- Walk-A-Mile Centre and Department of Orthopaedics, University of Pretoria, Pretoria, 0002, South Africa
| | - Simon Matthew Graham
- Orthopaedic Research Unit, Division of Orthopaedic Surgery, H49 OMB, Groote Schuur Hospital, University of Cape Town, Cape Town, 7925, South Africa.,Institute of Population Health Sciences, University of Liverpool, Liverpool, UK.,Department of Orthopaedic and Trauma Surgery, Liverpool University Teaching Hospital Trust, Liverpool, UK
| | - Sithombo Maqungo
- Orthopaedic Research Unit, Division of Orthopaedic Surgery, H49 OMB, Groote Schuur Hospital, University of Cape Town, Cape Town, 7925, South Africa
| | - Michael Held
- Orthopaedic Research Unit, Division of Orthopaedic Surgery, H49 OMB, Groote Schuur Hospital, University of Cape Town, Cape Town, 7925, South Africa
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Khorram-Manesh A, Burkle FM, Phattharapornjaroen P, Ahmadi Marzaleh M, Sultan MA, Mäntysaari M, Carlström E, Goniewicz K, Santamaria E, Comandante JD, Dobson R, Hreckovski B, Torgersen GE, Mortelmans LJ, de Jong M, Robinson Y. The Development of Swedish Military Healthcare System: Part II-Re-evaluating the Military and Civilian Healthcare Systems in Crises Through a Dialogue and Study Among Practitioners. Mil Med 2021; 186:e442-e450. [PMID: 33135765 PMCID: PMC7665683 DOI: 10.1093/milmed/usaa364] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/28/2020] [Accepted: 09/07/2020] [Indexed: 12/25/2022] Open
Abstract
Introduction Historical changes have transformed Sweden from being an offensive to a defensive and collaborative nation with national and international engagement, allowing it to finally achieve the ground for the civilian–military collaboration and the concept of a total defense healthcare. At the same time, with the decreasing number of international and interstate conflicts, and the military’s involvement in national emergencies and humanitarian disaster relief, both the need and the role of the military healthcare system within the civilian society have been challenged. The recent impact of the COVID-19 in the USA and the necessity of military involvement have led health practitioners to anticipate and re-evaluate conditions that might exceed the civilian capacity of their own countries and the need to have collaboration with the military healthcare. This study investigated both these challenges and views from practitioners regarding the benefits of such collaboration and the manner in which it would be initiated. Material and Method A primary study was conducted among responsive countries using a questionnaire created using the Nominal Group Technique. Relevant search subjects and keywords were extracted for a systematic review of the literature, according to the PRISMA model. Results The 14 countries responding to the questionnaire had either a well-developed military healthcare system or units created in collaboration with the civilian healthcare. The results from the questionnaire and the literature review indicated a need for transfer of military medical knowledge and resources in emergencies to the civilian health components, which in return, facilitated training opportunities for the military staff to maintain their skills and competencies. Conclusions As the world witnesses a rapid change in the etiology of disasters and various crises, neither the military nor the civilian healthcare systems can address or manage the outcomes independently. There is an opportunity for both systems to develop future healthcare in collaboration. Rethinking education and training in war and conflict is indisputable. Collaborative educational initiatives in disaster medicine, public health and complex humanitarian emergencies, international humanitarian law, and the Geneva Convention, along with advanced training in competency-based skill sets, should be included in the undergraduate education of health professionals for the benefit of humanity.
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Affiliation(s)
- Amir Khorram-Manesh
- Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, Gothenburg University, 405 30, Gothenburg, Sweden.,Department of Research and Development, Swedish Armed Forces Center for Defense Medicine, 426 76 Västra Frolunda, Gothenburg, Sweden
| | - Frederick M Burkle
- Harvard Humanitarian Initiative, T.H. Chan School of Public Health, Harvard University, Cambridge, MA 02138, USA
| | - Phatthranit Phattharapornjaroen
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok, 10400, Thailand
| | - Milad Ahmadi Marzaleh
- Department of Health in Disasters and Emergencies, Health Human Resources Research Center, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, 14336-71348, Iran
| | - Mohammed Al Sultan
- Department of Emergency Medicine, King Khalid Hospital, Najran, 66262, Saudi Arabia
| | - Matti Mäntysaari
- Aeromedical Centre, Centre for Military Medicine, PO BOX 5, 11311 Riihimäki, Helsinki, Finland
| | - Eric Carlström
- Health and Crisis Management and Policy, Sahlgrenska Academy, Gothenburg University, Gothenburg, 40530, Sweden.,Department of Business, History, and Social Sciences, University of South-Eastern Norway, 3679 Notodden, Kongsberg, Norway
| | | | - Emelia Santamaria
- Health Emergencies and Disasters (HEAD) Study Group, National Institute of Health, University of the Philippines-Manila, 623 Pedro Gil Street, Ermita 1000 Manila, the Philippines
| | - John David Comandante
- Department of Emergency Medicine, Prehospital Disaster and Ambulatory Care Medicine, Ospital ng Makati, Makati City, 1218 Metro Manila, the Philippines
| | - Robert Dobson
- London Ambulance Service UK, 220 Waterloo Road, SE1 8SD, London, UK
| | - Boris Hreckovski
- Department of Surgery, General Hospital, Slavonski Brod 35000, Croatia
| | - Glenn-Egil Torgersen
- Harvard Humanitarian Initiative, T.H. Chan School of Public Health, Harvard University, Cambridge, MA 02138, USA
| | - Luc J Mortelmans
- Center for Research and Education in Emergency Care, University of Leuven, Oude Markt 13, 3000, Leuven, Belgium
| | - Mirjam de Jong
- Major Incident Hospital, University Medical Center (UMC) Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, Netherland
| | - Yohan Robinson
- Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, Gothenburg University, 405 30, Gothenburg, Sweden.,Department of Research and Development, Swedish Armed Forces Center for Defense Medicine, 426 76 Västra Frolunda, Gothenburg, Sweden
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Dutour M, Kirchhoff A, Janssen C, Meleze S, Chevalier H, Levy-Amon S, Detrez MA, Piet E, Delory T. Family medicine practitioners' stress during the COVID-19 pandemic: a cross-sectional survey. BMC FAMILY PRACTICE 2021; 22:36. [PMID: 33583410 PMCID: PMC7882249 DOI: 10.1186/s12875-021-01382-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 02/04/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND The COVID-19 pandemic has shaken the world in early 2020. In France, General Practitioners (GPs) were not involved in the care organization's decision-making process before and during the first wave of the COVID-19 pandemic. This omission could have generated stress for GPs. We aimed first to estimate the self-perception of stress as defined by the 10-item Perceived Stress Score (PSS-10), at the beginning of the pandemic in France, among GPs from the Auvergne-Rhône-Alpes, a french administrative area severely impacted by COVID-19. Second, we aimed to identify factors associated with a self-perceived stress (PSS-10 ≥ 27) among socio-demographic characteristics of GPs, their access to reliable information and to personal protective equipment during the pandemic, and their exposure to well established psychosocial risk at work. METHODS We conducted an online cross-sectional survey between 8th April and 10th May 2020. The self-perception of stress was evaluated using the PSS-10, so to see the proportion of "not stressed" (≤20), "borderline" (21 ≤ PSS-10 ≤ 26), and "stressed" (≥27) GPs. The agreement to 31 positive assertions related to possible sources of stress identified by the scientific study committee was measured using a 10-point numeric scale. In complete cases, factors associated with stress (PSS-10 ≥ 27) were investigated using logistic regression, adjusted on gender, age and practice location. A supplementary analysis of the verbatims was made. RESULTS Overall, 898 individual answers were collected, of which 879 were complete. A total of 437 GPs (49%) were stressed (PSS-10 ≥ 27), and 283 GPs (32%) had a very high level of stress (PSS-10 ≥ 30). Self-perceived stress was associated with multiple components, and involved classic psychosocial risk factors such as emotional requirements. However, in this context of health crisis, the primary source of stress was the diversity and quantity of information from diverse sources (614 GPs (69%, OR = 2.21, 95%CI [1.40-3.50], p < 0.001). Analysis of verbatims revealed that GPs felt isolated in a hospital-based model. CONCLUSION The first wave of the pandemic was a source of stress for GPs. The diversity and quantity of information received from the health authorities were among the main sources of stress.
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Affiliation(s)
- Marion Dutour
- Infectious disease department, Annecy-Genevois hospital, Annecy, France.
| | - Anna Kirchhoff
- Infectious disease department, Annecy-Genevois hospital, Annecy, France
| | - Cécile Janssen
- Infectious disease department, Annecy-Genevois hospital, Annecy, France
| | - Sabine Meleze
- Institut national d'études démographiques (Ined), UR 14, Aubervillers, France
| | | | | | | | - Emilie Piet
- Infectious disease department, Annecy-Genevois hospital, Annecy, France
| | - Tristan Delory
- Institut national d'études démographiques (Ined), UR 14, Aubervillers, France
- Clinical research unit, Annecy-Genevois hospital, Annecy, France
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Morimura N, Mizobata Y, Sugita M, Takeda S, Kiyozumi T, Shoko T, Inoue Y, Otomo Y, Sakurai A, Koido Y, Tanabe S, Okumura T, Yamasawa F, Tanaka H, Kinoshi T, Kaku K, Matsuda K, Kitamura N, Hayakawa T, Kuroda Y, Kuroki Y, Sasaki J, Oda J, Inokuchi M, Kakuta T, Arai S, Sato N, Matsuura H, Nozawa M, Osamura T, Yamashita K, Okudera H, Kawana A, Koshinaga T, Hirano S, Sugawara E, Kamata M, Tajiri Y, Kohno M, Suzuki M, Nakase H, Suehiro E, Yamase H, Otake H, Morisaki H, Ozawa A, Takahashi S, Otsuka K, Harikae K, Kishi K, Mizuno H, Nakajima H, Ueta H, Nagayama M, Kikuchi M, Yokota H, Shimazu T, Yukioka T. Medicine at mass gatherings: current progress of preparedness of emergency medical services and disaster medical response during 2020 Tokyo Olympic and Paralympic Games from the perspective of the Academic Consortium (AC2020). Acute Med Surg 2021; 8:e626. [PMID: 33552526 PMCID: PMC7852170 DOI: 10.1002/ams2.626] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 12/23/2020] [Indexed: 01/08/2023] Open
Abstract
Mass gatherings are events characterized by “the concentration of people at a specific location for a specific purpose over a set period of time that have the potential to strain the planning and response resources of the host country or community.” Previous reports showed that, as a result of the concentration of people in the limited area, injury and illness occurred due to several factors. The response plan should aim to provide timely medical care to the patients and to reduce the burden on emergency hospitals, and to maintain a daily emergency medical services system for residents of the local area. Although a mass gathering event will place a significant burden on the local health‐care system, it can provide the opportunity for long‐term benefits of public health‐care and improvement of daily medical service systems after the end of the event. The next Olympic and Paralympic Games will be held in Tokyo, during which mass gatherings will occur on a daily basis in the context of the coronavirus disease (COVID‐19) epidemic. The Academic Consortium on Emergency Medical Services and Disaster Medical Response Plan during the Tokyo Olympic and Paralympic Games in 2020 (AC2020) was launched 2016, consisting of 28 academic societies in Japan, it has released statements based on assessments of medical risk and publishing guidelines and manuals on its website. This paper outlines the issues and countermeasures for emergency and disaster medical care related to the holding of this big event, focusing on the activities of the academic consortium.
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Affiliation(s)
- Naoto Morimura
- Japanese Association for Acute Medicine Tokyo Japan.,The Scientific Research Group of Ministry of Health, Labor and Welfare of Japan Tokyo Japan
| | | | | | - Satoshi Takeda
- The Education and Training Working Group of AC2020 Tokyo Japan.,AED Foundation of Japan Tokyo Japan
| | | | - Tomohisa Shoko
- The Education and Training Working Group of AC2020 Tokyo Japan
| | - Yoshiaki Inoue
- The Education and Training Working Group of AC2020 Tokyo Japan
| | - Yasuhiro Otomo
- The Scientific Research Group of Ministry of Health, Labor and Welfare of Japan Tokyo Japan.,Japanese Association for the Surgery of Trauma Tokyo Japan
| | | | - Yuichi Koido
- Japanese Association for Disaster Medicine Tokyo Japan
| | - Seizan Tanabe
- Japanese Association for Disaster Medicine Tokyo Japan
| | - Tetsu Okumura
- Japanese Society for Clinical Toxicology Tokyo Japan
| | | | | | - Tomoya Kinoshi
- Japanese Association of First Aid and Emergency Medicine Kyoto Japan
| | - Koki Kaku
- Japanese Society for Infection Prevention and Control Tokyo Japan
| | - Kiyoshi Matsuda
- Japan Prehospital Trauma Evaluation and Care Council Tokyo Japan
| | | | | | - Yasuhiro Kuroda
- Japanese Society of Intensive Care Medicine Tokyo Japan.,Japanese Society of Reanimatology Ube Japan
| | - Yumiko Kuroki
- Japanese Society for Clinical Toxicology Tokyo Japan
| | - Junichi Sasaki
- Japanese Society for Burn Injuries Tokyo Japan.,Japanese Association for Infectious Diseases Tokyo Japan
| | - Jun Oda
- Japanese Society for Burn Injuries Tokyo Japan
| | | | | | | | - Noriaki Sato
- Japanese Association for Emergency Nursing Tokyo Japan
| | | | | | | | | | - Hiroshi Okudera
- Japanese Association of First Aid and Emergency Medicine Kyoto Japan
| | - Akihiko Kawana
- Japanese Association for Infectious Diseases Tokyo Japan
| | | | | | - Erisa Sugawara
- Japanese Society for Infection Prevention and Control Tokyo Japan
| | | | | | | | | | | | | | | | | | | | - Akiko Ozawa
- Japanese Society of Anesthesiologists Kobe Japan
| | - Sho Takahashi
- Japanese Society of Psychiatry and Neurology Tokyo Japan
| | - Kotaro Otsuka
- Japan Society of Plastic and Reconstructive Surgery Tokyo Japan
| | - Kiyokazu Harikae
- Japan Prehospital Trauma Evaluation and Care Council Tokyo Japan
| | - Kazuo Kishi
- Japan Society of Plastic and Reconstructive Surgery Tokyo Japan
| | - Hiroshi Mizuno
- Japan Society of Plastic and Reconstructive Surgery Tokyo Japan
| | | | | | | | | | - Hiroyuki Yokota
- The Scientific Research Group of Ministry of Health, Labor and Welfare of Japan Tokyo Japan
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French civilian surgical expertise still inadequately prepared for mass casualties 3 years after major terror attacks in Paris (2015) and Nice (2016). J Trauma Acute Care Surg 2021; 89:S26-S31. [PMID: 32044874 DOI: 10.1097/ta.0000000000002606] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Three years after the terror attacks in Paris and Nice, this study aims to determine the level of interest, the technical skills and level of surgical activity in exsanguinating trauma care for a nonselected population of practicing French surgeons. METHODS A questionnaire was sent between July and December 2017 to French students and practicing surgeons, using the French Surgical Colleges' mailing lists. Items analyzed included education, training, interest and clinical activity in trauma care and damage-control surgery (DCS). RESULTS 622 questionnaires were analyzed and was composed of 318 (51%) certificated surgeons, of whom 56% worked in university teaching hospitals and 47% in Level I trauma centers (TC1); 44% were digestive surgeons and 7% were military surgeons. The mean score of 'interest in trauma care' was 8/10. Factors associated with a higher score were being a resident doctor (p = 0.01), a digestive surgeon (p = 0.0013), in the military (p = 1,71 × 10) and working in TC1 (p = 0.034). The mean "DCS techniques knowledge" score was 6.2/10 and factors significantly associated with a higher score were being a digestive surgeon (respectively, p = 0.0007 and p = 0.001) and in the military (respectively p = 1.74 × 10 and p = 3.94 × 10). Reported clinical activity in trauma and DCS were low. Additional continuing surgical education courses in trauma were completed by 23% of surgeons. CONCLUSION French surgeons surveyed showed considerable interest in trauma care and treatment. Despite this, and regardless of surgical speciality, their theoretical and practical knowledge of necessary DCS skills remain inadequate. LEVEL OF EVIDENCE Level III, Study Type Survey.
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Bala M, Worlton T, Ratnayake A. The gap of educational standards - Another reason for unsuccessful management of mass casualty incidents. Am J Emerg Med 2020; 45:576-577. [PMID: 33384192 DOI: 10.1016/j.ajem.2020.12.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Miklosh Bala
- Department of Trauma, Hadassah- Hebrew University Medical Center, Kiryat Hadassah, POB 12000, Jerusalem 91120, Israel
| | - Tamara Worlton
- Department of Surgery, Military Hospital Narahenpita, 08 Elvitigala Mawatha, Colombo 00800, Sri Lanka.
| | - Amila Ratnayake
- Department of Surgery, Military Hospital Narahenpita, 08 Elvitigala Mawatha, Colombo 00800, Sri Lanka; Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20889, USA
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Khorram-Manesh A, Plegas P, Högstedt Å, Peyravi M, Carlström E. Immediate response to major incidents: defining an immediate responder! Eur J Trauma Emerg Surg 2020; 46:1309-1320. [PMID: 30953109 PMCID: PMC7691304 DOI: 10.1007/s00068-019-01133-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/01/2019] [Indexed: 12/02/2022]
Abstract
PURPOSE There is a gap in time between the occurrence of a mass casualty incident (MCI) and the arrival of the first responders to the scene, which offers an opportunity for the public (immediate responders) to perform life-saving measures. The purpose of this study was to identify these measures and the public's willingness to conduct them. METHOD An extensive literature review was performed to identify the possible measures that can be undertaken by the public. A group of experts were asked to prioritize and rank the feasibility of performing the measures by the public. Finally, the public was asked whether they were willing to do the chosen measures before and after an appropriate education. RESULTS Twenty different measures were identified and presented in a questionnaire as statements, which were prioritized and ranked by the expert group into four categories: what (1) should be done, (2) is good to know how, (3) is not necessary to know, and (4) should not be done. All statements were converted into understandable statements and were sent to the public. There were some differences and some agreements between the experts and the public regarding what an immediate responder should do. However, the willingness of the public to perform most of the measures was high and increased after being offered an appropriate education. CONCLUSION The use of immediate responders is a life-saving approach in MCIs and in situations when every minute counts and every human resource is an invaluable asset. Multiple steps, such as education, empowerment, and access, should be taken into consideration to enable bystanders to effectively help struggling survivors.
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Affiliation(s)
- Amir Khorram-Manesh
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Patricia Plegas
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Åsa Högstedt
- Emergency and Disaster Medicine, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahmoudreza Peyravi
- Unit of Prehospital Dispatching Center, Region Västra Götaland, Gothenburg, Sweden
| | - Eric Carlström
- Health and Crisis Management and Policy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- USN School of Business, University of South-Eastern Norway, Vestfold, Norway
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Skryabina E, Betts N, Reedy G, Riley P, Amlôt R. UK healthcare staff experiences and perceptions of a mass casualty terrorist incident response: a mixed-methods study. Emerg Med J 2020; 38:756-764. [PMID: 33177061 PMCID: PMC8461407 DOI: 10.1136/emermed-2019-208966] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/24/2020] [Accepted: 09/10/2020] [Indexed: 11/05/2022]
Abstract
Introduction System learning from major incidents is a crucial element of improving preparedness for response to any future incidents. Sharing good practice and limitations stimulates further actions to improve preparedness and prevents duplicating mistakes. Methods This convergent parallel mixed methods study comprises data from responses to an online survey and individual interviews with healthcare staff who took part in the responses to three terrorist incidents in the UK in 2017 (Westminster Bridge attack, Manchester Arena Bombing and London Bridge attack) to understand limitations in the response and share good practices. Results The dedication of NHS staff, staff availability and effective team work were the most frequently mentioned enabling factors in the response. Effective coordination between teams and a functional major incident plan facilitated an effective response. Rapid access to blood products, by positioning the blood bank in the ED, treating children and parents together and sharing resources between trauma centres were recognised as very effective innovative practices. Recent health emergency preparedness exercises (HEPEs) were valued for preparing both Trusts and individual staff for the response. Challenges included communication between ambulance services and hospitals, difficulties with patient identification and tracking and managing the return to ‘normal’ work patterns post event. Lack of immediately available clinical protocols to deal with blast injuries was the most commonly mentioned clinical issue. The need for psychosocial support for responding and supporting staff was identified. Discussion Between-agencies communication and information sharing appear as the most common recurring problems in mass casualty incidents (MCIs). Recent HEPEs, which allowed teams, interdisciplinary groups, and different agencies to practice responding to similar simulated incidents, were important and informed actions during the real response. Immediate and delayed psychosocial support should be in place for healthcare staff responding to MCIs.
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Affiliation(s)
- Elena Skryabina
- Emergency Response Department, Science and Technology, Public Health England, Porton Down, UK
| | - Naomi Betts
- Emergency Response Department, Science and Technology, Public Health England, Porton Down, UK
| | - Gabriel Reedy
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Paul Riley
- Emergency Response Department, Public Health England, Porton Down, London, UK
| | - Richard Amlôt
- Emergency Response Department, Science and Technology, Public Health England, Porton Down, UK
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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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46
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Pfenninger E, Königsdorfer M. [Exit wave plan for structured secondary patient distribution : Logistic concept for mass victims of terrorist attacks]. Anaesthesist 2020; 68:702-710. [PMID: 31552441 DOI: 10.1007/s00101-019-00670-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Following a terrorist attack a second hit is to be feared. The adequate reaction of the emergency services on site is to clear the scene. Since in such cases no treatment areas are set up at the scene of the incident, the injured are quickly admitted to the nearest hospital, either by themselves or by the emergency services and are largely untreated. Therefore, the hospital has to be ready to take in a significantly larger number of injured people in a very short period of time than after a conventional mass casualty incident. Due to the conceivably large number of wounded persons the emergency department can ensure primary medical care but nowhere near all casualties admitted to the hospital can be definitively treated. OBJECTIVE In order to provide injured patients with individual medical care after initial treatment according to the criteria of damage control resuscitation, a concept should be developed that enables a well-organized secondary transfer to receiving hospitals with appropriate equipment. MATERIAL AND METHODS Within a radius of 100 km from Ulm, all hospitals certified by the German Society for Trauma Surgery were contacted and asked to indicate how many emergency patients of the triage categories T1 (red), T2 (yellow) and T3 (green) could be admitted and treated around the clock (24/7). Special features such as a helicopter landing pad, neurosurgical care and pediatric traumatology care were considered. RESULTS Of the 32 hospitals within a 100 km radius of Ulm 29 (91%) provided information on the admission capacity. In these hospitals 45 T1, 121 T2 and 333 T3 patients could be admitted around the clock (24/7). A helicopter landing pad is available at 26 of the 29 hospitals (90%), 11 hospitals (38%) can treat patients for emergency neurosurgery and 18 hospitals (62%) have the possibility of pediatric traumatological emergency care. Based on this information the structured exit wave plan was developed, which enables a secondary transfer of at least 100 patients to qualified trauma centers. CONCLUSION The University Hospital of Ulm has made preparations to admit at least 100 injured patients for initial medical treatment following a terrorist attack. This corresponds to 10% of the hospital beds as required in the literature. Together with the neighboring Military Hospital and the University and Rehabilitation Hospital Ulm up to 300 injured patients can be treated; however, the number of available intensive care unit (ICU) beds and capacities in normal wards for definitive care is much lower, therefore, patients treated according to the principles of damage control resuscitation have to be relocated. By documenting the capacity of the hospitals within a 100 km radius around Ulm and taking their specific features into account, an exit wave plan could be created that enables patient distribution for definitive care without time-consuming procedures.
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Affiliation(s)
- E Pfenninger
- Stabsstelle Katastrophenschutz, Universitätsklinikum Ulm, Albert-Einstein-Allee 29, 89081, Ulm, Deutschland.
| | - M Königsdorfer
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Ulm, Ulm, Deutschland
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47
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Lefrant JY, Fischer MO, Potier H, Degryse C, Jaber S, Muller L, Pottecher J, Charboneau H, Meaudre E, Lanot P, Bruckert V, Plaud B, Dureuil B, Samain E, Bouaziz H, Ecoffey C, Capdevila X. A national healthcare response to intensive care bed requirements during the COVID-19 outbreak in France. Anaesth Crit Care Pain Med 2020; 39:709-715. [PMID: 33031979 PMCID: PMC7534597 DOI: 10.1016/j.accpm.2020.09.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 09/25/2020] [Indexed: 12/12/2022]
Abstract
Background Whereas 5415 Intensive Care Unit (ICU) beds were initially available, 7148 COVID-19 patients were hospitalised in the ICU at the peak of the outbreak. The present study reports how the French Health Care system created temporary ICU beds to avoid being overwhelmed. Methods All French ICUs were contacted for answering a questionnaire focusing on the available beds and health care providers before and during the outbreak. Results Among 336 institutions with ICUs before the outbreak, 315 (94%) participated, covering 5054/5531 (91%) ICU beds. During the outbreak, 4806 new ICU beds (+95% increase) were created from Acute Care Unit (ACU, 2283), Post Anaesthetic Care Unit and Operating Theatre (PACU & OT, 1522), other units (374) or real build-up of new ICU beds (627), respectively. At the peak of the outbreak, 9860, 1982 and 3089 ICU, ACU and PACU beds were made available. Before the outbreak, 3548 physicians (2224 critical care anaesthesiologists, 898 intensivists and 275 from other specialties, 151 paediatrics), 1785 residents, 11,023 nurses and 6763 nursing auxiliaries worked in established ICUs. During the outbreak, 2524 physicians, 715 residents, 7722 nurses and 3043 nursing auxiliaries supplemented the usual staff in all ICUs. A total number of 3212 new ventilators were added to the 5997 initially available in ICU. Conclusion During the COVID-19 outbreak, the French Health Care system created 4806 ICU beds (+95% increase from baseline), essentially by transforming beds from ACUs and PACUs. Collaboration between intensivists, critical care anaesthesiologists, emergency physicians as well as the mobilisation of nursing staff were primordial in this context.
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Affiliation(s)
- Jean-Yves Lefrant
- EA 2992 IMAGINE, Univ Montpellier, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, Nîmes, France.
| | - Marc-Olivier Fischer
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Service d'Anesthésie Réanimation, 14000 Caen, France
| | - Hugo Potier
- Laboratoire de Biostatistique, Epidémiologie clinique, Santé Publique Innovation et Méthodologie (BESPIM), Pôle Pharmacie, Santé publique, CHU Nîmes, Nîmes, University of Montpellier, France
| | - Cécile Degryse
- Service d'Anesthésie Réanimation Pellegrin Tripode, CHU Bordeaux, Bordeaux, France
| | - Samir Jaber
- Department of Anaesthesia & Critical Care Medicine, University of Montpellier Saint Eloi Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Laurent Muller
- EA 2992 IMAGINE, Univ Montpellier, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, Nîmes, France
| | - Julien Pottecher
- Hôpitaux Universitaires de Strasbourg, Pôle d'Anesthésie-Réanimation & Médecine Péri-Opératoire, Service d'Anesthésie-Réanimation & Médecine Péri-Opératoire Hôpital de Hautepierre - Université de Strasbourg, Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), UR3072, Strasbourg, France
| | | | - Eric Meaudre
- Fédération d'Anesthésie-Réanimation, Hôpital d'Instruction des Armées Sainte-Anne, Toulon; Chaire d'Anesthésie-réanimation, Médecine d'Urgence, École du Val-de-Grâce, Paris, France
| | - Pierre Lanot
- GARHPA, groupe de anesthésistes réanimateurs de l'Hôpital Privé d'Antony, 92160 Antony, France
| | - Vincent Bruckert
- Pôle d'Anesthésie-Réanimation Médecine péri-opératoire et Urgences, Hôpital l'Archet 2, Centre Hospitalier Universitaire de Nice, Université de Nice, 06000 Nice, France
| | - Benoît Plaud
- Paris University & APHP. Nord. DMU PARABOL, Department of Anaesthesiology, Critical Care & Burn Unit, Saint-Louis hospital, 1, Avenue Claude Vellefaux, 75010 Paris, France
| | - Bertrand Dureuil
- Departement of Anaesthesia and Critical Care, Rouen University Hospital, Rouen, France
| | - Emmanuel Samain
- Département d'Anesthésie Réanimation, Hôpital Jean Minjoz - C.H.U. de Besançon, Besançon, France
| | - Hervé Bouaziz
- Département d'Anesthésie Réanimation, Hôpital Central - CHRU Nancy, Nancy, France
| | - Claude Ecoffey
- Département d'Anesthésie-Réanimation et Médecine Péri-Opératoire, Hôpital Pontchaillou, Université Rennes 1, Rennes, France
| | - Xavier Capdevila
- Department of Anaesthesiology and Critical Care Medicine, Lapeyronie University Hospital and Montpellier University. INSERM unit 1051, Montpellier Neurosciences Institute, Montpellier, France
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Tušer I, Bekešienė S, Navrátil J. Emergency management and internal audit of emergency preparedness of pre-hospital emergency care. QUALITY & QUANTITY 2020; 57:1-13. [PMID: 33020672 PMCID: PMC7528452 DOI: 10.1007/s11135-020-01039-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/11/2020] [Indexed: 12/01/2022]
Abstract
One of the negative components of international travel is the higher likelihood of emergencies that affect a large number of people (mass negative impact on health), for example the transmission of infectious diseases, as e.g. SARS CoV-2 pandemic. The frequency and sources of mass-casualty incidents are currently changing dynamically, especially with the onset of terrorist attacks and large-scale natural disasters. Health services and emergency medical service (EMS) take part in addressing these emergencies. For this reason, this paper deals with the EMS emergency preparedness in the Czech Republic for an emergency events with a large number of affected people. EMS in the Czech Republic are not provided by the state but by individual regions. EMS in the Czech Republic do not have central management, nor do they use uniform data documentation. The investigation of the current situation has shown that the attitudes of EMS in individual regions of the Czech Republic to the tasks of emergency preparedness for mass casualty incidents are not identical. The current method of evaluating improvements in the quality of EMS emergency preparedness lacks consistency and is not comprehensively supervised. To tackle this, the paper presents an internal audit methodology for assessing the level of emergency preparedness of the emergency medical services. The authors therefore defined the decisive criteria and indicators assessing the quality level of EMS emergency preparedness at major disaster with multiple victim incident. When developing the methodological procedure of the preparedness evaluation, an algorithm was chosen, based on the gradual verification of the evaluation criteria and indicators by an expert group. Some findings and recommendations based on a research carried out in EMS in individual regions of the Czech Republic are presented.
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Affiliation(s)
- Irena Tušer
- Department of Security and Law, AMBIS College, Prague, Czech Republic
| | - Svajonė Bekešienė
- Department of Defense Technologies, General Jonas Žemaitis Military Academy of Lithuania, Šilo Str. 5A, 10322 Vilnius, Lithuania
| | - Josef Navrátil
- Department of Security and Law, AMBIS College, Prague, Czech Republic
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50
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Gil-Anton J, Mielgo VE, Rey-Santano C, Galbarriatu L, Santos C, Unceta M, López-Fernández Y, Redondo S, Morteruel E. Addition of terlipressin to initial volume resuscitation in a pediatric model of hemorrhagic shock improves hemodynamics and cerebral perfusion. PLoS One 2020; 15:e0235084. [PMID: 32614837 PMCID: PMC7332053 DOI: 10.1371/journal.pone.0235084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 06/08/2020] [Indexed: 11/18/2022] Open
Abstract
Hemorrhagic shock is one of the leading causes of mortality and morbidity in pediatric trauma. Current treatment based on volume resuscitation is associated to adverse effects, and it has been proposed that vasopressors may be used in the pharmacological management of trauma. Terlipressin has demonstrated its usefulness in other pediatric critical care scenarios and its long half-life allows its use as a bolus in an outpatient critical settings. The aim of this study was to analyze whether the addition of a dose of terlipressin to the initial volume expansion produces an improvement in hemodynamic and cerebral perfusion at early stages of hemorrhagic shock in an infant animal model. We conducted an experimental randomized animal study with 1-month old pigs. After 30 minutes of hypotension (mean arterial blood pressure [MAP]<45 mmHg) induced by the withdrawal of blood over 30 min, animals were randomized to receive either normal saline (NS) 30 mL/kg (n = 8) or a bolus of 20 mcg/kg of terlipressin plus 30 mL/kg of normal saline (TP) (n = 8). Global hemodynamic and cerebral monitoring parameters, brain damage markers and histology samples were compared. After controlled bleeding, significant decreases were observed in MAP, cardiac index (CI), central venous pressure, global end-diastolic volume index (GEDI), left cardiac output index, SvO2, intracranial pressure, carotid blood flow, bispectral index (BIS), cerebral perfusion pressure (CPP) and increases in systemic vascular resistance index, heart rate and lactate. After treatment, MAP, GEDI, CI, CPP and BIS remained significantly higher in the TP group. The addition of a dose of terlipressin to initial fluid resuscitation was associated with hemodynamic improvement, intracranial pressure maintenance and better cerebral perfusion, which would mean protection from ischemic injury. Brain monitoring through BIS was able to detect changes caused by hemorrhagic shock and treatment.
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Affiliation(s)
- Javier Gil-Anton
- Department of Pediatric, Pediatric Intensive Care Unit. Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of Basque Country, UPV/EHU, Barakaldo, Bizkaia, Spain
- * E-mail: (VEM); (JGA)
| | - Victoria E. Mielgo
- Animal Research Unit, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
- * E-mail: (VEM); (JGA)
| | - Carmen Rey-Santano
- Animal Research Unit, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Lara Galbarriatu
- Department of Neurosurgery, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Carlos Santos
- Department of Neurophysiology, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Maria Unceta
- Biochemistry Laboratory, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Yolanda López-Fernández
- Pediatric Intensive Care Unit. Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Silvia Redondo
- Pediatric Intensive Care Unit. Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Elvira Morteruel
- Pediatric Intensive Care Unit. Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Bizkaia, Spain
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