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Cuthbertson J, Weinstein E, Franc JM, Jones P, Lamine H, Magalini S, Gui D, Lennquist K, Marzi F, Borrello A, Fransvea P, Fidanzio A, Benítez CY, Achaz G, Dobson B, Malik N, Neeki M, Pirrallo R, Castro Delgado R, Strapazzon G, Farah Dell’Aringa M, Brugger H, Rafalowsky C, Marzoli M, Fresu G, Kolstadbraaten KM, Lennquist S, Tilsed J, Claudius I, Cheeranont P, Callcut R, Bala M, Kerbage A, Vale L, Hecker NP, Faccincani R, Ragazzoni L, Caviglia M. Sudden-Onset Disaster Mass-Casualty Incident Response: A Modified Delphi Study on Triage, Prehospital Life Support, and Processes. Prehosp Disaster Med 2023; 38:570-580. [PMID: 37675480 PMCID: PMC10548019 DOI: 10.1017/s1049023x23006337] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/26/2023] [Accepted: 08/03/2023] [Indexed: 09/08/2023]
Abstract
The application and provision of prehospital care in disasters and mass-casualty incident response in Europe is currently being explored for opportunities to improve practice. The objective of this translational science study was to align common principles of approach and action and to identify how technology can assist and enhance response. To achieve this objective, the application of a modified Delphi methodology study based on statements derived from key findings of a scoping review was undertaken. This resulted in 18 triage, eight life support and damage control interventions, and 23 process consensus statements. These findings will be utilized in the development of evidence-based prehospital mass-casualty incident response tools and guidelines.
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Affiliation(s)
- Joe Cuthbertson
- CRIMEDIM – Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
- Monash University Disaster Resilience Initiative, Monash University, ClaytonVICAustralia
| | - Eric Weinstein
- CRIMEDIM – Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
| | - Jeffrey Michael Franc
- CRIMEDIM – Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - Peter Jones
- Assistance Publique – Hópitaux de Paris (APHP), SAMU de Paris Hôpital Necker, Paris, France
| | - Hamdi Lamine
- CRIMEDIM – Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, Italy
| | - Sabina Magalini
- Department of Surgery, Catholic University of the Sacred Heart, Policlinico Gemelli, Rome, Italy
| | - Daniele Gui
- Department of Neurosciences, Catholic University of the Sacred Heart, Policlinico Gemelli, Rome, Italy
| | - Kristina Lennquist
- Department of Neurosciences, Catholic University of the Sacred Heart, Policlinico Gemelli, Rome, Italy
| | - Federica Marzi
- Department of Neurosciences, Catholic University of the Sacred Heart, Policlinico Gemelli, Rome, Italy
| | - Alessandro Borrello
- Department of Neurosciences, Catholic University of the Sacred Heart, Policlinico Gemelli, Rome, Italy
| | - Pietro Fransvea
- Department of Neurosciences, Catholic University of the Sacred Heart, Policlinico Gemelli, Rome, Italy
| | - Andrea Fidanzio
- Department of Neurosciences, Catholic University of the Sacred Heart, Policlinico Gemelli, Rome, Italy
| | | | - Gerhard Achaz
- London Ambulance Service NHS Trust, London, London, United Kingdom
| | - Bob Dobson
- London Ambulance Service NHS Trust, London, London, United Kingdom
| | - Nabeela Malik
- University Hospitals Birmingham NHS Trust, Edgbaston, Birmingham, United Kingdom
| | - Michael Neeki
- Clinical Professor of Emergency Medicine, Arrowhead Regional Medical Center, Colton, CaliforniaUSA; Professor of Medical Education, California University of Science and Medicine, Colton, California USA
| | - Ronald Pirrallo
- Department of Emergency Medicine, Prisma Health University of South Carolina School of Medicine Greenville, Greenville, South CarolinaUSA
| | - Rafael Castro Delgado
- Health Service of the Principality of Asturias (SAMU-Asturias), Health Research Institute of the Principality of Asturias (Team Leader of the Research Group on Prehospital Care and Disasters, GIAPREDE), Oviedo, Spain
- Department of Medicine, Oviedo University, Oviedo, Spain
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy; University of Padova, Padova, Italy; International Commission for Mountain Emergency Medicine, Zurich, Switzerland
| | - Marcelo Farah Dell’Aringa
- CRIMEDIM – Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy; Medical University Innsbruck, Innsbruck, Austria; International Commission of Mountain Emergency Medicine-ICAR MedCom, Zurich, Switzerland
| | - Chaim Rafalowsky
- Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Marcello Marzoli
- Department of Fire Service, Public Rescue and Civil Defence, Ministero dell’Interno, Rome, Italy
| | - Giovanni Fresu
- Department of Surgery, Catholic University of the Sacred Heart, Policlinico Gemelli, Rome, Italy
| | | | - Stenn Lennquist
- Department of Neurosciences, Catholic University of the Sacred Heart, Policlinico Gemelli, Rome, Italy
| | - Jonathan Tilsed
- London Ambulance Service NHS Trust, London, London, United Kingdom
| | - Ilene Claudius
- Department of Emergency Medicine, Harbor-UCLA, Torrence, CaliforniaUSA
| | - Piyapan Cheeranont
- Faculty of Medicine, Praboromarajchanok Institute, Ministry of Public Health, Nonthaburi, Thailand
| | - Rachel Callcut
- University of California Davis Department of Surgery, Sacramento, CaliforniaUSA
| | - Miklosh Bala
- Department of Fire Service, Public Rescue and Civil Defence, Ministero dell’Interno, Rome, Italy
| | - Anthony Kerbage
- Department of Internal Medicine, Hôtel-Dieu de France hospital, Beirut, Lebanon
| | - Luis Vale
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, Italy
| | - Norman Philipp Hecker
- ESTES—European Society for Trauma and Emergency Surgery, Disaster and Military Surgery Section, Milan, Italy
| | - Roberto Faccincani
- ESTES—European Society for Trauma and Emergency Surgery, Disaster and Military Surgery Section, Milan, Italy
| | - Luca Ragazzoni
- CRIMEDIM – Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, Italy
| | - Marta Caviglia
- CRIMEDIM – Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
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Weinstein ES, Cuthbertson JL, Herbert TL, Voicescu GT, Bortolin M, Magalini S, Gui D, Helou M, Lennquist Montan K, Montan C, Rafalowsky C, Ratto G, Damele S, Bazurro S, Laist I, Marzi F, Borrello A, Fransvea P, Fidanzio A, Benitez CY, Faccincani R, Ragazzoni L, Caviglia M. Advancing the scientific study of prehospital mass casualty response through a Translational Science process: the T1 scoping literature review stage. Eur J Trauma Emerg Surg 2023; 49:1647-1660. [PMID: 37060443 PMCID: PMC10449715 DOI: 10.1007/s00068-023-02266-0] [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: 11/28/2022] [Accepted: 03/26/2023] [Indexed: 04/16/2023]
Abstract
PURPOSE The European Union Horizon 2020 research and innovation funding program awarded the NIGHTINGALE grant to develop a toolkit to support first responders engaged in prehospital (PH) mass casualty incident (MCI) response. To reach the projects' objectives, the NIGHTINGALE consortium used a Translational Science (TS) process. The present work is the first TS stage (T1) aimed to extract data relevant for the subsequent modified Delphi study (T2) statements. METHODS The authors were divided into three work groups (WGs) MCI Triage, PH Life Support and Damage Control (PHLSDC), and PH Processes (PHP). Each WG conducted simultaneous literature searches following the PRISMA extension for scoping reviews. Relevant data were extracted from the included articles and indexed using pre-identified PH MCI response themes and subthemes. RESULTS The initial search yielded 925 total references to be considered for title and abstract review (MCI Triage 311, PHLSDC 329, PHP 285), then 483 articles for full reference review (MCI Triage 111, PHLSDC 216, PHP 156), and finally 152 articles for the database extraction process (MCI Triage 27, PHLSDC 37, PHP 88). Most frequent subthemes and novel concepts have been identified as a basis for the elaboration of draft statements for the T2 modified Delphi study. CONCLUSION The three simultaneous scoping reviews allowed the extraction of relevant PH MCI subthemes and novel concepts that will enable the NIGHTINGALE consortium to create scientifically anchored statements in the T2 modified Delphi study.
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Affiliation(s)
- Eric S Weinstein
- CRIMEDIM-Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy.
| | - Joseph L Cuthbertson
- CRIMEDIM-Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
| | - Teri Lynn Herbert
- Research and Education Services, Medical University of South Carolina Library, Charleston, SC, USA
| | - George T Voicescu
- CRIMEDIM-Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
| | - Michelangelo Bortolin
- CRIMEDIM-Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
| | - Sabina Magalini
- Department of Surgery, Policlinico Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Daniele Gui
- Department of Surgery, Policlinico Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Mariana Helou
- School of Medicine, Department of Emergency Medicine, Lebanese American University, Beirut, Lebanon
| | - Kristina Lennquist Montan
- MRMID-International Association for Medical Response to Major Incidents and Disasters, and Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Carl Montan
- MRMID-International Association for Medical Response to Major Incidents and Disasters, and Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Chaim Rafalowsky
- Magen David Adom, National Emergency Medical, Disaster, Ambulance and Blood Bank Service, Ashkelon, Israel
| | - Giuseppe Ratto
- Emergency Department, Azienda Sociosanitaria Ligure 2, Liguria, Italy
| | - Stefano Damele
- Emergency Department, Azienda Sociosanitaria Ligure 2, Liguria, Italy
| | - Simone Bazurro
- Emergency Department, Azienda Sociosanitaria Ligure 2, Liguria, Italy
| | - Itamar Laist
- ESTES-European Society for Trauma and Emergency Surgery, Disaster and Military Surgery Section, Milan, Italy
| | - Federica Marzi
- Department of Surgery, Policlinico Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Alessandro Borrello
- Department of Surgery, Policlinico Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Pietro Fransvea
- Department of Surgery, Policlinico Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Andrea Fidanzio
- Department of Surgery, Policlinico Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Carlos Yanez Benitez
- ESTES-European Society for Trauma and Emergency Surgery, Disaster and Military Surgery Section, Milan, Italy
| | - Roberto Faccincani
- ESTES-European Society for Trauma and Emergency Surgery, Disaster and Military Surgery Section, Milan, Italy
| | - Luca Ragazzoni
- CRIMEDIM-Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department of Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, Italy
| | - Marta Caviglia
- CRIMEDIM-Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
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McDonald N, Kriellaars D, Pryce RT. Paramedic attitudes towards prehospital spinal care: a cross-sectional survey. BMC Emerg Med 2022; 22:162. [PMID: 36123619 PMCID: PMC9487099 DOI: 10.1186/s12873-022-00717-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The optimal application of spinal motion restriction (SMR) in the prehospital setting continues to be debated. Few studies have examined how changing guidelines have been received and interpreted by emergency medical services (EMS) personnel. This study surveys paramedics' attitudes, observations, and self-reported practices around the treatment of potential spine injuries in the prehospital setting. METHODS This was a cross-sectional survey of a North American EMS agency. After development and piloting, the final version of the survey contained four sections covering attitudes towards 1) general practice, 2) specific techniques, 3) assessment protocols, and 4) mechanisms of injury (MOI). Questions used Likert-scale, multiple-choice, yes/no, and free-text responses. Exploratory factor analysis (EFA) was used to identify latent constructs within responses, and factor scores were analyzed by ordinal logistic regression for associations with demographic characteristics (including qualification level, gender, and years of experience). MOI evaluations were assessed for inter-rater reliability (Fleiss' kappa). Inductive qualitative content analysis, following Elo & Kyngäs (2008), was used to examine free-text responses. RESULTS Two hundred twenty responses were received (36% of staff). Raw results indicated that respondents felt that SMR was seen as less important than in the past, that they were treating fewer patients than previously, and that they follow protocol in most situations. The EFA identified two factors: one (Judging MOIs) captured paramedics' estimation that the presented MOI could potentially cause a spine injury, and another (Treatment Value) reflected respondents' composite view of the effectiveness, importance, and applicability of SMR. Respondents with advanced life support (ALS) qualification were more likely to be skeptical of the value of SMR compared to those at the basic life support (BLS) level (OR: 2.40, 95%CI: 1.21-4.76, p = 0.01). Overall, respondents showed fair agreement in the evaluation of MOIs (k = 0.31, 95%CI: 0.09-0.49). Content analysis identified tension expressed by respondents between SMR-as-directed and SMR-as-applied. CONCLUSION Results of this survey show that EMS personnel are skeptical of many elements of SMR but use various strategies to balance protocol adherence with optimizing patient care. While identifying several areas for future research, these findings argue for incorporating provider feedback and judgement into future guideline revision.
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Affiliation(s)
- Neil McDonald
- Applied Health Sciences, University of Manitoba, Winnipeg, MB, Canada. .,Winnipeg Fire Paramedic Service, 2546 McPhillips St, Winnipeg, Manitoba, R2P 2T2, Canada.
| | - Dean Kriellaars
- College of Rehabilitation Sciences, Rady Faculty of Health Sciences University of Manitoba, 771 Mc Dermot Ave, Winnipeg, Manitoba, R3E 0T6, Canada
| | - Rob T Pryce
- Department of Kinesiology and Applied Health, Gupta Faculty of Kinesiology University of Winnipeg, 400 Spence St, Winnipeg, Manitoba, R3B 2E9, Canada
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