1
|
King B, Cancio LC, Jeng JC. Military Burn Care and Burn Disasters. Surg Clin North Am 2023; 103:529-538. [PMID: 37149388 DOI: 10.1016/j.suc.2023.01.013] [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: 05/08/2023]
Abstract
Mass-casualty incidents can occur because of natural disasters; industrial accidents; or intentional attacks against civilian, police, or in case of combat, military forces. Depending on scale and type of incident, burn casualties often with a variety of concomitant injuries can be anticipated. The treatment of life-threatening traumatic injuries should take precedent but the stabilization, triage, and follow-on care of these patients will require local, state, and often regional coordination and support.
Collapse
Affiliation(s)
- Booker King
- North Carolina Jaycee Burn Center, University of North Carolina Chapel Hill, Burnett Womack Building, Campus Box 7206, Chapel Hill, NC 27599-7206, USA
| | - Leopoldo C Cancio
- U.S. Army Burn Center, U.S. Army Institute of Surgical Research, Fort Sam Houston, San Antonio, TX 78234-6315, USA
| | - James C Jeng
- University of California Irvine, 3800 West Chapman Avenue, Suite 6200, Orange, CA 92868, USA.
| |
Collapse
|
2
|
The First 15 Minutes: A Novel Disaster Simulation Exercise. Disaster Med Public Health Prep 2022; 17:e133. [PMID: 35332862 DOI: 10.1017/dmp.2022.42] [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: 02/07/2023]
Abstract
OBJECTIVE The objective was to describe a feasible, multidisciplinary pediatric mass casualty event (MCE) simulation format that was less than 2 h within emergency department space and equipment constraints. METHODS This was a prospective cohort study of an MCE in situ simulation program from June-October 2019. Participants rotated through 3 modules: (1) triage, (2) caring for a critical patient in an MCE setting, and (3) being in a disaster leadership role. Triage accuracy, knowledge, self-evaluation of preparedness, and MCE skills by means of pre- and post-test surveys were measured. Wilcoxon matched pairs signed rank test scores and McNemar's matched pair chi-squared test were performed to evaluate for statistically significant differences. RESULTS Forty-six physicians (MD), 1 physician's assistant (PA), and 22 nurses participated over 4 simulation d. Among the MD/PA group, there was a statistically significant 7% knowledge increase (95% confidence interval [CI], 3%-11%). Nurses did not show a statistically significant knowledge difference (0.04, 95% CI, 0.04%, 14%). There was a statistically significant increase in triage and resource use preparedness (P < 0.01) for all participants. CONCLUSION This efficient, feasible model for a multidisciplinary ED disaster drill provides a multi-modular exposure while improving both MD and PA knowledge and all staff preparedness for MCE.
Collapse
|
3
|
Chuang S, Woods DD, Reynolds M, Ting HW, Balkin A, Hsu CW. Rethinking preparedness planning in disaster emergency care: lessons from a beyond-surge-capacity event. World J Emerg Surg 2021; 16:59. [PMID: 34844626 PMCID: PMC8628445 DOI: 10.1186/s13017-021-00403-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/18/2021] [Indexed: 02/06/2023] Open
Abstract
Background Large-scale burn disasters can produce casualties that threaten medical care systems. This study proposes a new approach for developing hospital readiness and preparedness plan for these challenging beyond-surge-capacity events.
Methods The Formosa Fun Coast Dust Explosion (FFCDE) was studied. Data collection consisted of in-depth interviews with clinicians from four initial receiving hospitals and their relevant hospital records. A detailed timeline of patient flow and emergency department (ED) workload changes of individual hospitals were examined to build the EDs' overload patterns. Data analysis of the multiple hospitals' responses involved chronological process-tracing analysis, synthesis, and comparison analysis in developing an integrated adaptations framework. Results A four-level ED overload pattern was constructed. It provided a synthesis of specifics on patient load changes and the process by which hospitals' surge capacity was overwhelmed over time. Correspondingly, an integrated 19 adaptations framework presenting holistic interrelations between adaptations was developed. Hospitals can utilize the overload patterns and overload metrics to design new scenarios with diverse demands for surge capacity. The framework can serve as an auxiliary tool for directive planning and cross-check to address the insufficiencies of preparedness plans. Conclusions The study examined a wide-range spectrum of emergency care responses to the FFCDE. It indicated that solely depending on policies or guidelines for preparedness plans did not contribute real readiness to MCIs. Hospitals can use the study's findings and proposal to rethink preparedness planning for the future beyond surge capacity events. Supplementary Information The online version contains supplementary material available at 10.1186/s13017-021-00403-x.
Collapse
Affiliation(s)
- Sheuwen Chuang
- Graduate Institute of Data Science, Taipei Medical University, Taipei, Taiwan. .,TMU Research Center of Health and Welfare Policy, Taipei Medical University, 12F, No. 172-1, Sec. 2 Keelung Rd. Da an Dist., Taipei City, Taiwan.
| | - David D Woods
- Department of Integrated Systems Engineering, The Ohio State University, Columbus, OH, US
| | - Morgan Reynolds
- Department of Integrated Systems Engineering, The Ohio State University, Columbus, OH, US
| | - Hsien-Wei Ting
- Department of Neurosurgery, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Asher Balkin
- Department of Integrated Systems Engineering, The Ohio State University, Columbus, OH, US
| | - Chin-Wang Hsu
- Emergency Department, Taipei Municipal Wanfang Hospital, Taipei, Taiwan
| |
Collapse
|
4
|
Walker M, d'Arville A, Lacey J, Lancman B, Moloney J, Hendel S. Mass casualty, intentional vehicular trauma and anaesthesia. Br J Anaesth 2021; 128:e190-e199. [PMID: 34654520 DOI: 10.1016/j.bja.2021.08.030] [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: 08/03/2021] [Accepted: 08/25/2021] [Indexed: 11/25/2022] Open
Abstract
The use of motor vehicles to initiate mass casualty incidents is increasing in frequency and such events are called intentional vehicular assaults. Perpetrators are inspired by a range of terrorist ideologies or have extremist views, criminal intent, or mental health issues. Assaults using a motor vehicle as the principal weapon of attack are easy to launch and require little to no forward planning. This makes them difficult for police and security agencies to predict, prevent, or interdict. With the increasing frequency of intentional vehicular assaults, anaesthesiologists in various settings may be involved in caring for victims and should be engaged in preparing for them. This narrative review examines the literature on vehicle assaults committed around the world and provides an overview of the unique injury patterns and considerations for the pre-hospital, perioperative, and critical care management of victims of these mass casualty events. The article discusses planning, education, and training in an attempt to reduce the mortality and morbidity of intentional vehicular assaults.
Collapse
Affiliation(s)
- Matthew Walker
- Department of Anaesthesiology & Perioperative Medicine, Alfred Health, Melbourne, Australia; Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Asha d'Arville
- Department of Anaesthesiology & Perioperative Medicine, Alfred Health, Melbourne, Australia
| | - Jonathan Lacey
- Department of Anaesthesiology & Perioperative Medicine, Alfred Health, Melbourne, Australia
| | - Benn Lancman
- Department of Anaesthesiology & Perioperative Medicine, Alfred Health, Melbourne, Australia
| | - John Moloney
- Department of Anaesthesiology & Perioperative Medicine, Alfred Health, Melbourne, Australia; Field Emergency Medical Officer Program, Ambulance Victoria, Melbourne, Australia; School of Health, Medical and Applied Sciences, Central Queensland University, Queensland, Australia
| | - Simon Hendel
- Department of Anaesthesiology & Perioperative Medicine, Alfred Health, Melbourne, Australia; Department of Anaesthesia and Perioperative Medicine, Central Clinical School, Monash University, Melbourne, Australia; National Trauma Research Institute, Monash University and Alfred Health, Melbourne, Australia; Trauma Service, Alfred Health, Melbourne, Australia.
| |
Collapse
|
5
|
Murphy JP, Hörberg A, Rådestad M, Kurland L, Rüter A, Jirwe M. Registered nurses' experience as disaster preparedness coordinators during a major incident: A qualitative study. Nurs Open 2021; 9:329-338. [PMID: 34546003 PMCID: PMC8685889 DOI: 10.1002/nop2.1066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 08/16/2021] [Accepted: 09/02/2021] [Indexed: 11/11/2022] Open
Abstract
Aims To explore registered nurses’ experiences as disaster preparedness coordinators of hospital incident command groups’ during a major incident. Design A qualitative descriptive design using semi‐structured interview. Methods This was a qualitative study based on one focus group discussion and six individual follow‐up interviews. Participants were registered nurses in their capacity as disaster preparedness coordinators with experience from Major Incident simulations and a real‐life Major Incident. The interviews were transcribed verbatim and analysed using content analysis. The COREQ checklist was used for reporting the findings. Results The analysis of data generated the main category: Expectations, previous experience and uncertainty affect hospital incident command group response during a Major Incident and three categories, (I) Gaining situational awareness (containing two subcategories), (II) Transitioning to management (containing three subcategories) and (III) Actions taken during uncertainty (containing two subcategories).
Collapse
Affiliation(s)
- Jason P Murphy
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.,Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
| | - Anna Hörberg
- Department of Health and Welfare, Dalarna University, Falun, Sweden
| | - Monica Rådestad
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Lisa Kurland
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.,Department of Medical Sciences, Örebro University, Örebro, Sweden
| | - Anders Rüter
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.,Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
| | - Maria Jirwe
- Department of Health Sciences, Red Cross University College, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| |
Collapse
|
6
|
Murphy JP, Kurland L, Rådestad M, Rüter A. Hospital incident command groups' performance during major incident simulations: a prospective observational study. Scand J Trauma Resusc Emerg Med 2020; 28:73. [PMID: 32727519 PMCID: PMC7389443 DOI: 10.1186/s13049-020-00763-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/05/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Hospital incident command groups' (HICG) performance may have a profound impact on hospital response to major incidents. Previous research has assessed hospital incident command group capacity as opposed to performance and factors associated to performance. The objective was to assess associations between decision-making and staff procedure skills of the hospital incident command group. METHODS This was a prospective observational study using performance indicators to assess hospital incident command groups' decision-making and performance. A total of six hospitals in Stockholm, Sweden, with their respective HICGs participated. Associations between decision-making skills and staff procedure skills during major incident simulations were assessed using measurable performance indicators. RESULTS Decision-making skills are correlated to staff procedure skills and overall HICG performance. Proactive decision-making skills had significantly lower means than reactive decision-making skills and are significantly correlated to staff procedure skills. CONCLUSION There is a significant correlation between decision-making skills and staff procedural skills. Hospital incident command groups' proactive decision-making abilities tended to be less developed than reactive decision-making abilities. These proactive decision-making skills may be a predictive factor for overall hospital incident command group performance. A lack of proactive decision-making ability may hamper efforts to mitigate the effects of a major incident.
Collapse
Affiliation(s)
- Jason P Murphy
- Department of Clinical Science and Education, Karolinska Insititutet, Stockholm, Sweden. .,Sophiahemmet University, PO Box 5605, SE-11486, Stockholm, Sweden.
| | - Lisa Kurland
- Department of Clinical Science and Education, Karolinska Insititutet, Stockholm, Sweden.,Department of Medical Sciences, Örebro University, Örebro, Sweden.,Department of Neurobiology and Society, Karolinska Institutet, Stockholm, Sweden
| | - Monica Rådestad
- Department of Clinical Science and Education, Karolinska Insititutet, Stockholm, Sweden
| | - Anders Rüter
- Department of Clinical Science and Education, Karolinska Insititutet, Stockholm, Sweden.,Sophiahemmet University, PO Box 5605, SE-11486, Stockholm, Sweden
| |
Collapse
|
7
|
Woods DD. The theory of graceful extensibility: basic rules that govern adaptive systems. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s10669-018-9708-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|