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Velamuri SR, Ali Y, Lanfranco J, Gupta P, Hill DM. Inhalation Injury, Respiratory Failure, and Ventilator Support in Acute Burn Care. Clin Plast Surg 2024; 51:221-232. [PMID: 38429045 DOI: 10.1016/j.cps.2023.11.001] [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: 03/03/2024]
Abstract
Sustaining an inhalation injury increases the risk of severe complications and mortality. Current evidential support to guide treatment of the injury or subsequent complications is lacking, as studies either exclude inhalation injury or design limit inferences that can be made. Conventional ventilator modes are most commonly used, but there is no consensus on optimal strategies. Settings should be customized to patient tolerance and response. Data for pharmacotherapy adjunctive treatments are limited.
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Affiliation(s)
- Sai R Velamuri
- Department of Surgery, College of Medicine, University of Tennessee, Health Science Center, Memphis, TN 38103, USA.
| | - Yasmin Ali
- Department of Surgery, College of Medicine, University of Tennessee Health Science Center, 910 Madison Avenue, 2nd floor Suite 217, Memphis, TN 38103, USA
| | - Julio Lanfranco
- Division of Pulmonary and Critical Care, University of Tennessee Health Science Center, 965 Court Avenue Room H316B, Memphis, TN 38103, USA
| | - Pooja Gupta
- Pulmonary and Critical Care, University of Tennessee Health Science Center, 965 court avenue, Room H316B, Memphis, TN 38103, USA
| | - David M Hill
- Department of Pharmacy, Regional One Health, University of Tennessee, 80 madison avenue, Memphis TN 38103, USA
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2
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Leclerc T, Sjöberg F, Jennes S, Martinez-Mendez JR, van der Vlies CH, Battistutta A, Lozano-Basanta JA, Moiemen N, Almeland SK. European Burns Association guidelines for the management of burn mass casualty incidents within a European response plan. Burns 2023; 49:275-303. [PMID: 36702682 DOI: 10.1016/j.burns.2022.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 12/19/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND A European response plan to burn mass casualty incidents has been jointly developed by the European Commission and the European Burn Association. Upon request for assistance by an affected country, the plan outlines a mechanism for coordinated international assistance, aiming to alleviate the burden of care in the affected country and to offer adequate specialized care to all patients who can benefit from it. To that aim, Burn Assessment Teams are deployed to assess and triage patients. Their transportation priority recommendations are used to distribute outnumbering burn casualties to foreign burn centers. Following an appropriate medical evacuation, these casualties receive specialized care in those facilities. METHODS The European Burns Association's disaster committee developed medical-organizational guidelines to support this European plan. The experts identified fields of interest, defined questions to be addressed, performed relevant literature searches, and added their expertise in burn disaster preparedness and response. Due to the lack of high-level evidence in the available literature, recommendations and specially designed implementation tools were provided from expert opinion. The European Burns Association officially endorsed the draft recommendations in 2019, and the final full text was approved by the EBA executive committee in 2022. RECOMMENDATIONS The resulting 46 recommendations address four fields. Field 1 underlines the need for national preparedness plans and the necessary core items within such plans, including coordination and integration with an international response. Field 2 describes Burn Assessment Teams' roles, composition, training requirements, and reporting goals. Field 3 addresses the goals of specialized in-hospital triage, appropriate severity criteria, and their effects on priorities and triage. Finally, field 4 covers medical evacuations, including their timing and organization, the composition of evacuation teams and their assets, preparation, and the principles of en route care.
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Affiliation(s)
- Thomas Leclerc
- Percy Military Teaching Hospital, Clamart, France; Val-de-Grâce Military Medical Academy, Paris, France
| | | | - Serge Jennes
- Charleroi Burn Wound Center, Skin-burn-reconstruction Pole, Grand Hôpital de Charleroi, Charleroi, Belgium
| | | | - Cornelis H van der Vlies
- Department of Trauma and Burn Surgery, Maasstad Hospital, Rotterdam, the Netherlands; Trauma Research Unit Department of Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - Anna Battistutta
- Directorate-General for European Civil Protection and Humanitarian Aid Operations (DG-ECHO), European Commission, Brussels, Belgium
| | - J Alfonso Lozano-Basanta
- Emergency Response Coordination Center, Directorate-General for European Civil Protection and Humanitarian Aid Operations (DG-ECHO), European Commission, Brussels, Belgium
| | - Naiem Moiemen
- University Hospitals Birmingham Foundation Trust, Birmingham, UK; University of Birmingham, College of Medical and Dental Sciences, Birmingham, UK
| | - Stian Kreken Almeland
- Norwegian National Burn Center, Department of Plastic, Hand, and Reconstructive Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway; Norwegian Directorate of Health, Department of Preparedness and Emergency Medical Services, Oslo, Norway.
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Sekine Y, Saitoh D, Terayama T, Nakamura T, Nemoto M. The survival rate of patients with burns induced by explosions was significantly higher than that of common burn cases: A nationwide observational study using the Japan Trauma Data Bank. Burns 2022:S0305-4179(22)00203-0. [DOI: 10.1016/j.burns.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/06/2022] [Accepted: 08/09/2022] [Indexed: 11/29/2022]
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Ho HY, Chuang S, Dai NT, Cheng CH, Kao WF. Ranking hospitals' burn care capacity using cluster analysis on open government data. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 207:106166. [PMID: 34077867 DOI: 10.1016/j.cmpb.2021.106166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 05/04/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVE To deal with burn mass casualty incidents (BMCIs), various countries have established national or regional BMCI emergency response plans (ERPs). A burn care capacity ranking model for hospitals can play an integral role in ERPs by providing essential information to emergency medical services for distributing and handling mass burn patients. Ranking models vary across countries and contexts. However, Taiwan has had no such model. The study aims to develop a ranking model for classifying hospitals' burn care capacity in preparation for the development of a national BMCI ERP. METHODS Multiple methods were adopted. An expert panel provided consultations on data selection and clustering validation. Data on 116 variables from 535 hospitals were collected via open data platforms under the Ministry of Health and Welfare. Data selection and streamlining was conducted to determine 42 variables for cluster analysis. SAS 9.4 was used to analyze the data set -via a hierarchical cluster analysis using Ward's method, followed by a tree-based model analysis to identify the criteria for each cluster. Both internal and external cluster validation were performed. RESULTS Four clusters of burn care capacity were determined to be a suitable number of clusters. All hospitals were arranged into capacity levels accordingly. Results of the Kruskal-Wallis test showed that the difference between clusters were significant. Tree-based model analysis revealed four determining variables, among which the refined level of emergency care responsibility hospital was found to be most influential on the clustering process. Responses from the questionnaire were used as an external validation tool to corroborate with the cluster analysis results. CONCLUSION The use of open government data and cluster analysis was suitable for developing a ranking model to determine hospitals' burn care capacity levels in Taiwan. The proposed ranking model can be used to develop a BMCI emergency response plan and can also serve as a reference for using cluster analysis with open government data to rank care capacity or quality in other domains.
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Affiliation(s)
- Hui Yan Ho
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Sheuwen Chuang
- Graduate Institute of Data Science, Taipei Medical University, Taipei, Taiwan; Health Policy and Care Research Center, Taipei Medical University, Taipei, Taiwan.
| | - Niann-Tzyy Dai
- Division of Plastic and Reconstructive Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Hsin Cheng
- Graduate Institute of Data Science, Taipei Medical University, Taipei, Taiwan
| | - Wei-Fong Kao
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Developing a Delphi-Based Comprehensive Core Set from the International Classification of Functioning, Disability, and Health Framework for the Rehabilitation of Patients with Burn Injuries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18083970. [PMID: 33918802 PMCID: PMC8068789 DOI: 10.3390/ijerph18083970] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 02/04/2023]
Abstract
Burn injuries cause disability and functional limitations in daily living. In a 2015 fire explosion in Taiwan, 499 young people sustained burn injuries. The construction of an effective and comprehensive rehabilitation program that enables patients to regain their previous function is imperative. The International Classification of Functioning, Disability, and Health (ICF) includes multiple dimensions that can contribute to meeting this goal. An ICF core set was developed in this study for Taiwanese patients with burns. A consensus process using three rounds of the Delphi technique was employed. A multidisciplinary team of 30 experts from various institutions was formed. The questionnaire used in this study comprised 162 ICF second-level categories relevant to burn injuries. A 5-point Likert scale was used, and participants assigned a weight to the effect of each category on daily activities after burns. The consensus among ratings was assessed using Spearman's ρ and semi-interquartile range indices. The core set for post-acute SCI was developed from categories that attained a mean score of ≥4.0 in the third round of the Delphi exercise. The core ICF set contained 68 categories. Of these, 19 comprised the component of body functions, 5 comprised body structures, 37 comprised activities and participation, and 7 comprised environmental factors. This preliminary core set offers a comprehensive system for disability assessment and verification following burn injury. The core set provides information for effective rehabilitation strategy setting for patients with burns. Further feasibility and validation studies are required in the future.
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Tsai SY, Lio CF, Shih SC, Lin CJ, Chen YT, Yu CM, Sun FJ, Kuo CF, Jia X. The predisposing factors of AKI for prophylactic strategies in burn care. PeerJ 2020; 8:e9984. [PMID: 33072437 PMCID: PMC7537615 DOI: 10.7717/peerj.9984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 08/27/2020] [Indexed: 01/22/2023] Open
Abstract
Background Acute kidney injury (AKI) is one of the most severe complications of burn injury. AKI with severe burn injury causes high mortality. This study aims to investigate the incidence of and predisposing factors for AKI in burn patients. Methods This is a single-center, retrospective, descriptive criterion standard study conducted from June 27, 2015, to March 8, 2016. We used Kidney Disease Improving Global Outcomes criteria to define and select patients with AKI. The study was conducted by recruiting in hospital patients who suffered from the flammable cornstarch-based powder explosion and were treated under primary care procedures. A total of 49 patients who suffered from flammable dust explosion-related burn injury were enrolled and admitted on June 27, 2015. The patients with more than 20% total body surface area of burn were transferred to the intensive care unit. Patients received fluid resuscitation in the first 24 hours based on the Parkland formula. The primary measurements were the incidence of and predisposing factors for AKI in these patients. Demographic characteristics, laboratory data, and inpatient outcomes were also evaluated. The incidence of AKI in this cohort was 61.2% (n = 30). The mortality rate was 2.0% (n = 1) during a 59-day follow-up period. The multivariate analysis revealed inhalation injury (adjusted OR = 22.0; 95% CI [1.4–358.2]) and meeting ≥3 American Burn Association (ABA) sepsis criteria (adjusted OR = 13.7; 95% CI [1.7–110.5]) as independent risk factors for early advanced AKI. Conclusions The incidence rate of AKI was higher in this cohort than in previous studies, possibly due to the flammable dust explosion-related burn injury. However, the mortality was lower than that expected. In clinical practice, indicators of inflammation, including ABA sepsis criteria may help in predicting the risk of AKI in patients with burn injury.
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Affiliation(s)
- Shin-Yi Tsai
- Department of Laboratory Medicine, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Graduate Institute of Biomedical Sciences; Graduate Institute of Long- Term Care, Mackay Medical College, New Taipei City, Taiwan.,Department of Health Policy and Management, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, United States of America
| | - Chon-Fu Lio
- Department of Laboratory Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shou-Chuan Shih
- Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
| | - Cheng-Jui Lin
- Department of Nephrology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yu-Tien Chen
- Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chia-Meng Yu
- Department of Plastic Surgery, Mackay Memorial Hospital, Taipei, Taiwan
| | - Fang-Ju Sun
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chien-Feng Kuo
- Institute of Infectious Disease, Mackay Memorial Hospital, Taipei, Taiwan
| | - Xiaofeng Jia
- Biomedical Engineering, Anesthesiology & Critical Care Medicine, The Johns Hopkins University, Baltimore, MD, United States of America.,Department of Neurosurgery, Orthopaedics, Anatomy & Neurobiology, University of Maryland at Baltimore, Baltimore, MD, United States of America
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Management of Major Burns in 37 Casualties of a Colored Powder Explosion: Experience of the Linkou Burn Center in Taiwan. Ann Plast Surg 2020; 82:512-519. [PMID: 30985342 DOI: 10.1097/sap.0000000000001928] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND On June 27, 2015, a colored powder explosion occurred in Taiwan. As a result, 499 people were injured, and over 200 people were in critical condition because of severe burns. Forty-nine casualties were transported to the Chang Gung Memorial Hospital. METHODS We undertook a single-center retrospective observational study using clinical data for 37 patients with major burns with more than 20% total burn surface area (TBSA). We describe the experience of managing patients with acute burn injuries in these patients. Patient-specific data were analyzed and expressed as mean ± standard deviation. RESULTS Thirty-seven major burn patients were admitted to our hospital. The mean ± SD age was 22.5 ± 5 years. The mean ± SD TBSA was 48.9% ± 20%. All patients were stabilized within 6 hours after admission, and no patient experienced hypothermia or hypovolemia. We performed 95 debridement procedures and 88 skin grafts. A mean of 5.6 surgeries were performed for each patient. The mean ± SD hospital stay was 62 ± 32 days. The ratio for hospital days/%TBSA was 1.36, and hospital charges/hospital days ratio was US $973 a day for surviving patients. Two mortalities (2/37, 5.4%) were reported: one was related to cardiac insult, and another was caused by sepsis. CONCLUSIONS We share our experience in managing 37 major burn patients in a colored powder explosion to improve the holistic care in modern mass burn casualties. Aggressive early debridement and skin grafting reduced hospital stay and costs.
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Lee CH, Lin SH, Kao CL, Hong MY, Huang PC, Shih CL, Chuang CC. Impact of climate change on disaster events in metropolitan cities -trend of disasters reported by Taiwan national medical response and preparedness system. ENVIRONMENTAL RESEARCH 2020; 183:109186. [PMID: 32078825 DOI: 10.1016/j.envres.2020.109186] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/22/2020] [Accepted: 01/24/2020] [Indexed: 05/04/2023]
Abstract
BACKGROUND Taiwan is geographically located in a zone that is vulnerable to earthquakes, typhoons, floods, and landslide hazards and has experienced various disasters. Six Regional Emergency Medical Operation Centers (REMOCs) are integrated and administered by the Ministry of Health and Welfare (MOHW) to be responsible for emergency situations during disastrous events, such as the emission of chemical toxicants, traffic accidents, industrial materials containment, and typhoons. OBJECTIVE To analyze events reported by the six REMOCs during the 2014 to 2018 for the government policy reference. METHODS Data were collected from injured and death toll reports provided by local designated hospitals in the emergency medical reporting system. Disaster events were categorized into three categories: natural disaster (NDs), disasters associated with technology (DTs), and disasters associated with security/violence/others (DSVOs). The three categories were further subdivided into sub-categories. Variables considered for trend analyses included the number of wounded and deaths, event characteristics, date/time, and triage. The frequency of disaster events among the six REMOCs was compared using the chi-square test. We used the global information system (GIS) to describe the distribution of events in Taiwan metropolitan cities. The α-level was set at 0.05. RESULTS Of 580 events during the study period, the distribution of disaster characteristics in the jurisdictions of the six REMOCs were different. The majority of disaster events were DTs (64.5%), followed by NDs (24.5%) and DSVOs (11.0%). Events for the three disaster categories in the six REMOCs were different (χ2-test, p < 0.001). Furthermore, for the Taipei branch (Northern Taiwan), other NDs, especially heatwaves and cold spells, were most reported in New Taipei City (92.2%) and showed an increasing annual trend; for the Kaohsiung branch (Southern Taiwan), DT events were the most reported, especially in Kaohsiung City; and for the Taichung branch (Central Taiwan), DSVOs were the most reported, especially in Taichung City. CONCLUSION Our data revealed that extreme weather precautions reported in the Taipei branch were increasing. Disaster characteristics were different in each metropolitan city. Upgrading the ability to respond to natural disasters is ineluctable.
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Affiliation(s)
- Chung-Hsun Lee
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Shih-Hao Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Chia-Lung Kao
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Ming-Yuan Hong
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Po-Chang Huang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Chung-Liang Shih
- Department of Medical Affairs, Ministry of Health and Welfare, Taipei City, Taiwan.
| | - Chia-Chang Chuang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Lin CH. Disaster Medicine in Taiwan. J Acute Med 2019; 9:83-109. [PMID: 32995238 PMCID: PMC7440387 DOI: 10.6705/j.jacme.201909_9(3).0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study aimed to examine scientific publications that were related to disaster medicine and were authored by emergency medicine physicians in Taiwan. This descriptive study utilized the electronic databases of PubMed, Scopus, and Web of Science. Academic works that were published between January 1, 1999, and December 31, 2018, were collected for review and analysis. Of the 53 articles included in the final analysis,40 (75.5%) were original research, 3 (5.7%) were reviews, 1 (1.9%) was a brief report, and 9 (17.0%) were perspectives. The top 5 themes were disaster response systems (17, 32.1%), endemic diseases (11, 20.8%), emergency department (ED) overcrowding (10, 18.9%), earthquakes (10, 18.9%), and ED administration (9, 17.0%). Sixteen (30.2%) articles involved international collaborations. The median, interquartile range and range of the numbers of citations of the articles were 3, 1-11, and 0-65, respectively. Twenty-four (45.3%) articles were related to specific incidents: the Chi-Chi earthquake in 1999 (n = 5), the Singapore airline crash in 2000 (n = 1), Typhoon Nari in 2001 (n = 1), the outbreak of severe acute respiratory syndrome in 2003 (n = 7), Typhoon Morakot in 2009 (n = 1), the color party explosion in Formosa Fun Coast Park in 2015 (n = 4), and the Tainan earthquake in 2016 (n = 5). Regarding the study methods, 19 (35.8%) articles were quantitative studies; 10 (18.9%) were qualitative or semiqualitative studies; 8 (15.1%) used questionnaire surveys; 3 (5.7%) were literature reviews; 3 (5.7%) used computer simulations; and 10 (18.9%) were descriptive/narrative or other types of studies. Though the number of academic publications related to disaster medicine from the EDs in Taiwan is relatively limited, the quality and diversity of research seem promising. The research environment and education programs on disaster medicine in Taiwan deserve thoughtful consideration.
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Affiliation(s)
- Chih-Hao Lin
- National Cheng Kung University Department of Emergency Medicine National Cheng Kung University Hospital College of Medicine Tainan Taiwan
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Coping With a Mass Casualty: Insights into a Hospital's Emergency Response and Adaptations After the Formosa Fun Coast Dust Explosion. Disaster Med Public Health Prep 2019; 14:467-476. [PMID: 31439072 DOI: 10.1017/dmp.2019.69] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The study provides a comprehensive insight into how an initial receiving hospital without adequate capacity adapted to coping with a mass casualty incident after the Formosa Fun Coast Dust Explosion (FFCDE). METHODS Data collection was via in-depth interviews with 11 key participants. This was combined with information from medical records of FFCDE patients and admission logs from the emergency department (ED) to build a detailed timeline of patients flow and ED workload changes. Process tracing analysis focused on how the ED and other units adapted to coping with the difficulties created by the patient surge. RESULTS The hospital treated 30 victims with 36.3% average total body surface area burn for over 5 hours alongside 35 non-FFCDE patients. Overwhelming demand resulted in the saturation of ED space and intensive care unit beds, exhaustion of critical materials, and near-saturation of clinicians. The hospital reconfigured human and physical resources differently from conventional drills. Graphical timelines illustrate anticipatory or reactive adaptations. The hospital's ability to adapt was based on anticipation during uncertainty and coordination across roles and units to keep pace with varying demands. CONCLUSION Adapting to beyond-surge capacity incident is essential to effective disaster response. Building organizational support for effective adaptation is critical for disaster planning.
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Lin CC, Wu CC, Chen CD, Chen KF. Could we employ the queueing theory to improve efficiency during future mass causality incidents? Scand J Trauma Resusc Emerg Med 2019; 27:41. [PMID: 30971299 PMCID: PMC6458797 DOI: 10.1186/s13049-019-0620-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 03/26/2019] [Indexed: 11/26/2022] Open
Abstract
Background Preparation for a disaster or accident-related mass casualty events is often based on experience. The objective measures or tools for evaluating decision-making and effectiveness during such events are underdeveloped. Queueing theory has been suggested to evaluate the effectiveness of mass causality incidents (MCI) plans. Objective Using different types of real MCI, we aimed to determine if a queueing network model could be used as a tool to assist in preparing plans to address mass causality incidents. Methods We collected information from two types of mass casualty events: a motor vehicle accident and a dust explosion. Patient characteristics, time intervals of every working station, numbers of physicians and nurses attending, and time required by physicians and nurses during these two MCIs were collected and used for calculation in a queueing network model. Balanced efficiency was determined by calculating the numbers of server, i.e., nurses and physicians, in the two MCIs. Results Efficient patient flows were found in both MCIs. However, excessive medical manpower supply was revealed when the queueing network model was applied to assess the MCIs. The best fitting result, i.e., the most efficient man power utilization, can be calculated by the queueing network models. Furthermore, balanced efficiency may be a more suitable condition than the highest efficiency man power utilization when faced with MCIs. Conclusion The queueing network model is a flexible tool that could be used in different types of MCIs to observe the degree of efficiency when handling MCIs. Electronic supplementary material The online version of this article (10.1186/s13049-019-0620-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chih-Chuan Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chin-Chieh Wu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chi-Dan Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Kuan-Fu Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan. .,Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan. .,Community Medicine Research Center, Chang Gung Memorial Hospital, 5 Fu-Shin Street, Gueishan Village, Keelung, Taoyuan, Taiwan, 333.
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Lin CH, Lin CH, Tai CY, Lin YY, Shih FFY. Challenges of Burn Mass Casualty Incidents in the Prehospital Setting: Lessons From the Formosa Fun Coast Park Color Party. PREHOSP EMERG CARE 2018; 23:44-48. [PMID: 30118365 DOI: 10.1080/10903127.2018.1479473] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective: A burn mass casualty incident (BMCI) involving 499 patients occurred at a "color party" in Taiwan in June 27, 2015. We implemented a study to identify critical challenges regarding the prehospital emergency care in BMCIs. Methods: A 3-stage, mixed methods study was conducted in 2016. First, a statistical analysis of prehospital management using the data retrieved from the Emergency Medical Management System of the Ministry of Health and Welfare, Taiwan was performed. This was followed by a face-to-face, open-ended interview with the emergency medical technicians and the staff of the emergency operations center who responded to the incident; and the transcription of the interview data into constructed themes. Results: Our study indicated that the signs of inhalation injury needed to be incorporated in the field triage protocol for BMCIs; the collaborative utilization of regional emergency medical services may improve the surge capacity in the field; and an "island-hopping" strategy for patient transportation may allow the healthcare systems to manage the surge of burn patients more efficiently. Conclusions: Current field triage protocols may be insufficient for burn patients and should be further investigated. The practices in field triage, transport capacity, and transfer strategy can be considered as a part of an efficient prehospital emergency response to BMCIs.
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Clinical features, outcomes, and molecular characteristics of an outbreak of Staphylococcus haemolyticus infection, among a mass-burn casualty patient group, in a tertiary center in northern Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2018; 51:847-855. [PMID: 30166249 DOI: 10.1016/j.jmii.2018.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 07/27/2018] [Accepted: 07/29/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND/PURPOSE We reported an outbreak of Staphylococcus haemolyticus (SH) infection in a group of young patients (mean age 21.6) simultaneously hospitalized due to a mass-burn incident. This study analyzed the clinical features of these patients and the microbiological characteristics of the outbreak. METHODS All 50 patients hospitalized for burns were enrolled, and their clinical differences were analyzed based on culture results. A drug sensitivity test and pulsed-field gel electrophoresis (PFGE) were conducted to analyze the microbiological difference between SH isolates from the mass-burn casualty patients (the study group) and SH isolates from other patients hospitalized during the same period (the control group) with the intention of identifying the strain of SH outbreak. RESULTS Patients with isolated SH (N = 36) had a significantly higher disease severity (higher revised Baux score, APACHE II score, and concurrent bacteremia rate), and a significantly poorer clinical outcome (longer ICU and hospital stay, and longer MV usage). Significant differences in the phenotype (antibiotics drug sensitivity test) and genotype (PFGE typing) were observed between the study and control groups. The dominant PFGE type C identified among the study group was related to poorer outcomes in a subgroup analysis. CONCLUSION A dominant PFGE type of SH infection was found in these mass-burn casualty patients. Pathogenesis or virulence factors may have contributed to our results. Further study of isolated SH should be conducted.
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Rezaei F, Maracy MR, Yarmohammadian MH, Sheikhbardsiri H. Hospitals preparedness using WHO guideline: A systematic review and meta-analysis. HONG KONG J EMERG ME 2018. [DOI: 10.1177/1024907918760123] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Hospitals play a critical role in providing communities with essential medical care during disasters. Objectives: In this article, the key components and recommended actions of WHO (World Health Organization) Hospital emergency response checklist have been considered to identify current practices in disaster/emergency hospital preparedness in actual or potential incidents. Methods: Articles were obtained through bibliographic databases, including ISI Web of Science, PubMed, Science Direct, Scopus, Google Scholar, and SID: Scientific information database. Keywords were “Disaster,” “Preparedness,” “Emergency Preparedness,” “Disaster Planning,” “Mass Casualty Incidents,” “Hospital Emergency Preparedness,” “Health Emergency Preparedness,” “Preparedness Response,” and “Emergency Readiness.” Independent reviewers (F.R. and M.H.Y.) screened abstracts and titles for eligibility. STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) checklist was used to qualifying the studies for this review. Results: Of 1545 identified studies, 26 articles were implied inclusion criteria. They accounted for nine key components and 92 recommended actions. The majority of principles that had been rigorously recommended at any level of the hospital emergency preparedness were command and control and post-disaster recovery. Surge capacity was considered less frequently. Conclusion: We recommend considering the proposed disaster categories by FEMA (Federal Emergency Management Agency). In this framework, different weights for nine components can be considered based on disaster categories. Thus, a more valid and reliable preparedness checklist could be developed.
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Affiliation(s)
- Fatemeh Rezaei
- Department of Health in Disaster and Emergencies, Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Maracy
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad H Yarmohammadian
- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Kao HK, Loh CYY, Kou HW, Kao KC, Hu HC, Chang CM, Lee CH, Hsu HH. Optimizing mass casualty burns intensive care organization and treatment using evidence-based outcome predictors. Burns 2018; 44:1077-1082. [PMID: 29563014 DOI: 10.1016/j.burns.2018.02.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 02/01/2018] [Accepted: 02/21/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Majority of current research focuses on pre-hospital care in mass casualty incidents (MCI) whereas this study is the first to examine multifactorial aspects of intensive care unit (ICU) resource management during a surge in massive burn injury (MBI) patients whilst identifying key outcome predictors that resulted in successful disaster managements. METHODS Both critical care, surgical parameters and cost-effectiveness are investigated in patients admitted with severe burns resulting from the explosion. A fully integrated trauma response and expansion of critical care resources in Linkou Chang Gung Memorial Hospital (CGMH) in this incident is analyzed. RESULTS 52 burn patients were treated in CGMH and 27 patients (51.9%) had TBSA greater than 45% with the mean TBSA of 44.6±20.3%. ICU based management of MBI including early debridement and resource strategizing. The overall mortality rate was 2/52 (3.85%). Patients had an average of 14.8days on mechanical ventilation and 43days as an inpatient in total. Operative treatment wise, 44.2% of patients received escharotomies and each patient received an average of 2 skin grafting procedures. The initial TBSA was a significant predictor for burn wound infection (OR 1.107, 95% CI 1.023-1.298; p=0.011). Each patient cost an average of USD 1035 per TBSA% with an average total cost of USD 50415. CONCLUSION With ever increasing chances of terrorist activity in urban areas, hospitals can hopefully increase their preparedness using outcome-predictors presented in this study.
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Affiliation(s)
- Huang-Kai Kao
- Department of Plastic and Reconstructive Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
| | - Charles Yuen Yung Loh
- Department of Plastic and Reconstructive Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Hao-Wei Kou
- Department of Plastic and Reconstructive Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Kuo-Chin Kao
- Department of Pulmonary and Critical Care Medicine, Department of Respiratory Therapy, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Han-Chung Hu
- Department of Pulmonary and Critical Care Medicine, Department of Respiratory Therapy, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Chia-Ming Chang
- Department of Psychiatry, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Chia-Hui Lee
- Department of Pharmaceutical Materials Management, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsiang-Hao Hsu
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
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Kuo LW, Yen CI, Fu CY, Pan CH, Hsu CP, Hsiao YC, Hsieh CH, Hsu YP. The role of preliminary hospitals in the management of a mass burn casualty disaster. Burns 2017; 44:800-806. [PMID: 29258727 DOI: 10.1016/j.burns.2017.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/19/2017] [Accepted: 11/30/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE The Formosa Fun Coast explosion is an internationally-known event that occurred in Taiwan on June 27th, 2015. The blast involved 495 casualties in total, with 253 patients receiving 2nd degree or deeper burns on greater than 40% of the total body surface area (TBSA). Questions were raised regarding whether these victims were sent to the appropriate hospitals or not. Therefore, we analyzed the effect of the initial admission destination in this study. MATERIAL AND METHODS We retrospectively reviewed all of the victims from the explosion who were sent to the emergency department of Linkou and Keelung Chang Gung Memorial Hospitals. Patients were divided by direct admission and received via transfer. The basic demographics, the efficacy of the initial resuscitation and the clinical outcomes were analyzed. RESULTS In total, forty-six patients were included. Thirty-five of them were primarily admitted, and eleven of them were received via transfer. Between the two groups, there was no significant difference in the resuscitation outcome. The ratio of delaying intubation was similar (14.3% vs 27.3%, p=0.322). The rate of delayed-detected ischemic events was significantly increased in the referral group (0% vs 27.3%, p=0.001). However, there was no amputation event in either group. No difference in mortality was observed between groups (5.7% vs 9.1%, p=0.692). CONCLUSION Our preliminary findings suggest that local hospitals are capable of providing high-quality acute care to mass casualty burn victims. Our results suggest that patients with suspected limb ischemia should be rapidly transferred to a regional burn center to ensure optimal care. Systemic pre-planning such as employing telemedicine and personnel collaboration, should be considered by the administration to maximize the function of preliminary hospitals in burn care.
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Affiliation(s)
- Ling-Wei Kuo
- Chang Gung Memorial Hospital, Trauma and Critical Care Center, Linkou, Taoyuan, Taiwan
| | - Cheng-I Yen
- Chang Gung Memorial Hospital, Burn Center, Linkou, Taoyuan, Taiwan
| | - Chih-Yuan Fu
- Chang Gung Memorial Hospital, Trauma and Critical Care Center, Linkou, Taoyuan, Taiwan.
| | - Chun-Hao Pan
- Chang Gung Memorial Hospital, Department of Plastic & Reconstructive Surgery, Keelung, Taiwan
| | - Chih-Po Hsu
- Chang Gung Memorial Hospital, Trauma and Critical Care Center, Linkou, Taoyuan, Taiwan
| | - Yen-Chang Hsiao
- Chang Gung Memorial Hospital, Burn Center, Linkou, Taoyuan, Taiwan
| | - Chi-Hsun Hsieh
- Chang Gung Memorial Hospital, Trauma and Critical Care Center, Linkou, Taoyuan, Taiwan
| | - Yu-Pao Hsu
- Chang Gung Memorial Hospital, Trauma and Critical Care Center, Linkou, Taoyuan, Taiwan
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18
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Tseng HM, Shih WM, Shen YC, Ho LH, Wu CF. Work Stress, Resilience, and Professional Quality of Life Among Nurses Caring for Mass Burn Casualty Patients After Formosa Color Dust Explosion. J Burn Care Res 2017; 39:798-804. [DOI: 10.1093/jbcr/irx053] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Hsu-Min Tseng
- Department of Healthcare Management, Chang Gung University, Taoyuan City, Taiwan
- Medical Education Research Centre, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Whei-Mei Shih
- Graduate Institute of Health Care, Chang Gung University of Science and Technology, Taoyuan City, Taiwan
- Department of Rheumatology, Linkou Chang Gung Memorial Hospital
| | - Yung-Chao Shen
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Lun-Hui Ho
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Chu-Fang Wu
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
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19
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Towards a reliable paradigm shift in emergency medical service for improving mass burn casualty response. Burns 2017; 43:1821-1822. [DOI: 10.1016/j.burns.2017.07.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 07/22/2017] [Indexed: 11/18/2022]
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20
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Huang PY, Shie SS, Ye JJ, Lin SP, Liu TP, Wu TS, Wu TL, Chuang SS, Cheng MH, Hsieh YC, Huang CT. Acquisition and clearance of multidrug resistant Acinetobacter baumannii on healthy young adults concurrently burned in a dust explosion in Taiwan: the implication for antimicrobial stewardship. BMC Infect Dis 2017; 17:598. [PMID: 28854887 PMCID: PMC5575946 DOI: 10.1186/s12879-017-2682-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 08/15/2017] [Indexed: 11/10/2022] Open
Abstract
Background Information is limited about the effect of restricted carbapenem use on clearance of multi-drug resistant Acinetobacter baumannii (MDRAB). We sought to determine the time effect of antibiotic exposure on multi-drug resistant Acinetobacter baumannii (MDRAB) acquisition and clearance. Methods We conducted a retrospective observational study at the intensive care units of a tertiary medical center. Forty-two of a cohort of previously healthy young adults who were concurrently burned by a dust explosion was included. Cases consisted of those from whom MDRAB was isolated during hospitalization. Controls consisted of patients from whom MDRAB was not isolated in the same period. Use of antimicrobial agents was compared based on days of therapy per 1,000 patient-days (DOT/1,000PD). A 2-state Markov multi-state model was used to estimate the risk of acquisition and clearance of MDRAB. Results MDRAB was discovered in 9/42 (21.4%) individuals. The cases had significantly higher use of carbapenem (652 DOT/1,000PD vs. 385 DOT/1,000PD, P < 0.001) before MDRAB isolation. For the cases, clearance of MDRAB was associated with lower use of carbapenem (469 DOT/1,000PD vs. 708 DOT/1,000PD, P = 0.003) and higher use of non-carbapenem beta-lactam (612 DOT/1,000PD vs. 246 DOT/1,000PD, P <0.001). In multi-state model, each additional DOT of carbapenem increased the hazard of acquiring MDRAB (hazard ratio (HR), 1.08; 95% confidence interval (CI) 1.01–1.16) and each additional DOT of non-carbapenem beta-lactam increased the protection of clearing MDRAB (HR, 1.25; 95% CI 1.07–1.46). Conclusions Both acquisition and clearance of MDRAB were related to antibiotic exposure in a homogeneous population. Our findings suggest that early discontinuation of carbapenem could be an effective measure in antibiotic stewardship for the control of MDRAB spreading.
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Affiliation(s)
- Po-Yen Huang
- Division of Infectious Diseases, Department of Medicine, Chang Gung Memorial Hospital and Chang Gung University, 5 Fu-Shin St., Kweishan, 333, Taoyuan, Taiwan.,Infection Control Committee, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Shian-Sen Shie
- Division of Infectious Diseases, Department of Medicine, Chang Gung Memorial Hospital and Chang Gung University, 5 Fu-Shin St., Kweishan, 333, Taoyuan, Taiwan
| | - Jung-Jr Ye
- Division of Infectious Diseases, Department of Medicine, Chang Gung Memorial Hospital and Chang Gung University, 5 Fu-Shin St., Kweishan, 333, Taoyuan, Taiwan
| | - Shih-Pin Lin
- Division of Biostatistics, Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.,Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Tsui-Ping Liu
- Infection Control Committee, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Department of Laboratory Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Ting-Shu Wu
- Division of Infectious Diseases, Department of Medicine, Chang Gung Memorial Hospital and Chang Gung University, 5 Fu-Shin St., Kweishan, 333, Taoyuan, Taiwan.,Infection Control Committee, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Tsu-Lan Wu
- Department of Laboratory Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Shiow-Shuh Chuang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Ming-Huei Cheng
- Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yu-Chia Hsieh
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University College of Medicine, 5 Fu-Shin St., Kweishan, 333, Taoyuan, Taiwan.
| | - Ching-Tai Huang
- Division of Infectious Diseases, Department of Medicine, Chang Gung Memorial Hospital and Chang Gung University, 5 Fu-Shin St., Kweishan, 333, Taoyuan, Taiwan.
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21
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Chiu YJ, Ma H, Liao WC, Shih YC, Chen MC, Shih CC, Chen TW, Perng CK. Extracorporeal membrane oxygenation support may be a lifesaving modality in patients with burn and severe acute respiratory distress syndrome: Experience of Formosa Water Park dust explosion disaster in Taiwan. Burns 2017; 44:118-123. [PMID: 28756973 DOI: 10.1016/j.burns.2017.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 06/13/2017] [Accepted: 06/23/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) has been reported to improve outcomes in patients with refractory respiratory failure. These successful experiences have stimulated interest in using ECMO as a potential therapy for patients with acute pulmonary failure resulting from burn and inhalation lung injury. Current literature has supported the use of ECMO in critically-ill, pediatric burn patients. On the other hand, it is controversial to apply ECMO in adult burn patients, and the evidence is limited by the shortcomings of small sample size. We share our successful experience of ECMO treatment in the casualties of the Formosa Water Park Dust Explosion Disaster. METHODS We investigated the data from the dust explosion event, which happened on June 27, 2015, in New Taipei, Taiwan. The medical records of five patients with severe acute respiratory distress syndrome receiving ECMO were evaluated. RESULTS The mean study subject age was 21.8 years, with a mean total body surface area burned of 82.9%. The average time to ECMO setup was 48.6 days. Survivors and non-survivors averaged four days and 77.7 days, respectively. The overall mortality rate was 40%. Three survivors were discharged without any ECMO-related complications or pulmonary sequelae after one year of follow up. CONCLUSIONS ECMO may be a lifesaving modality for burn patients with severe lung injury who are nonresponsive to maximal medical management, especially for young patients with early ECMO intervention.
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Affiliation(s)
- Yu-Jen Chiu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsu Ma
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Chieh Liao
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Chung Shih
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Mei-Chun Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chun-Che Shih
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tai-Wei Chen
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan
| | - Cherng-Kang Perng
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Hu HC, Chang CH, Hsu HH, Chang CM, Huang CC, Chuang SS, Kao KC. Inhalation injury caused by cornstarch dust explosion in intubated patients-A single center experience. Burns 2017; 44:134-139. [PMID: 28751122 DOI: 10.1016/j.burns.2017.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 06/12/2017] [Accepted: 06/23/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Around 10%-20% of burned patients have inhalation injuries, and the severity of these injuries is correlated with mortality. Fiberoptic bronchoscopy is an important tool for the early diagnosis of inhalation injury. This study investigated correlations between the severity of inhalation injury and outcomes of patients involved in a cornstarch dust explosion in northern Taiwan in 2015. METHODS Patients with burns who were intubated after the explosion were enrolled. Their medical records were reviewed, and data including patient characteristics, percentage of total body surface area (%TBSA) burned, severity of the inhalation injury, mechanical ventilation settings, and outcomes were collected and analyzed. RESULTS Twenty patients underwent fiberoptic bronchoscopy during the first 24h to evaluate an inhalation injury. Their mean age was 22.4±5.5 years and the mean %TBSA burned was 55.7±19.4%. Fourteen patients had a grade 1 inhalation injury and six had a grade 2 injury. There was a higher %TBSA burned in the grade 1 group than in the grade 2 group, although the difference did not reach statistical significance (60.0±20.3% versus 45.5±13.5%, p=0.129). Compared to the grade 2 group, the grade 1 group had a significantly higher white blood cell count (29.4±9.3 versus 18.6±4.6, p=0.015) and frequency of facial burns (85.7% versus 33.3%, p=0.037). The overall intensive care unit mortality rate was 10% (n=2), with no significant intergroup difference (grade 1, 14.3% versus grade 2, 0%, p=0.192). CONCLUSION Although the explosion resulted in a high rate of inhalation injuries in critically ill patients, there was no significant correlation between mortality and the severity of the inhalation injuries.
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Affiliation(s)
- Han-Chung Hu
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Respiratory Therapy, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Chih-Hao Chang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsiang-Hao Hsu
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Chia-Ming Chang
- Department of Psychiatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chung-Chi Huang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Respiratory Therapy, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Shiow-Shuh Chuang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuo-Chin Kao
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Respiratory Therapy, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
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Mathews AL, Cheng MH, Muller JM, Lin MCY, Chang KWC, Chung KC. Cost Analysis of 48 Burn Patients in a Mass Casualty Explosion Treated at Chang Gung Memorial Hospital. Injury 2017; 48:80-86. [PMID: 27553390 PMCID: PMC5186334 DOI: 10.1016/j.injury.2016.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/04/2016] [Accepted: 08/15/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Little is known about the costs of treating burn patients after a mass casualty event. A devastating Color Dust explosion that injured 499 patients occurred on June 27, 2015 in Taiwan. This study was performed to investigate the economic effects of treating burn patients at a single medical center after an explosion disaster. METHODS A detailed retrospective analysis on 48 patient expense records at Chang Gung Memorial Hospital after the Color Dust explosion was performed. Data were collected during the acute treatment period between June 27, 2015 and September 30, 2015. The distribution of cost drivers for the entire patient cohort (n=48), patients with a percent total body surface area burn (%TBSA)≥50 (n=20), and those with %TBSA <50 (n=28) were analyzed. RESULTS The total cost of 48 burn patients over the acute 3-month time period was $2,440,688, with a mean cost per patient of $50,848 ±36,438. Inpatient ward fees (30%), therapeutic treatment fees (22%), and medication fees (11%) were found to be the three highest cost drivers. The 20 patients with a %TBSA ≥50 consumed $1,559,300 (63.8%) of the total expenses, at an average cost of $77,965±34,226 per patient. The 28 patients with a %TBSA <50 consumed $881,387 (36.1%) of care expenses, at an average cost of $31,478±23,518 per patient. CONCLUSIONS In response to this mass casualty event, inpatient ward fees represented the largest expense. Hospitals can reduce this fee by ensuring wound dressing and skin substitute materials are regionally stocked and accessible. Medication fees may be higher than expected when treating a mass burn cohort. In preparation for a future event, hospitals should anticipate patients with a %TBSA≥50 will contribute the majority of inpatient expenses.
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Affiliation(s)
- Alexandra L Mathews
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Medical School, United States
| | - Ming-Huei Cheng
- Department of Plastic and Reconstructive Surgery, Center for Tissue Engineering, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taiwan
| | | | - Miffy Chia-Yu Lin
- Department of Plastic and Reconstructive Surgery, Center for Tissue Engineering, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taiwan
| | - Kate W C Chang
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, United States
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Medical School, United States.
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Adjunctive hyperbaric oxygen therapy in severe burns: Experience in Taiwan Formosa Water Park dust explosion disaster. Burns 2016; 43:852-857. [PMID: 28034667 DOI: 10.1016/j.burns.2016.10.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 10/08/2016] [Accepted: 10/12/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND Despite major advances in therapeutic strategies for the management of patients with severe burns, significant morbidity and mortality is observed. Hyperbaric oxygen therapy (HBOT) increases the supply of oxygen to burn areas. The aim of this study was to determine whether HBOT is effective in the treatment of major thermal burns. METHODS On June 27, 2015 in New Taipei, Taiwan, a mass casualty disaster occurred as fire erupted over a large crowd, injuring 499 people. Fifty-three victims (20 women and 33 men) were admitted to Tri-Service General Hospital. Thirty-eight patients underwent adjunctive HBOT (HBOT group), and 15 patients received routine burn therapy (control group). Serum procalcitonin (PCT) level, a sepsis biomarker, was measured until it reached normal levels (<0.5μg/L). The records of all patients from June 2015 to March 2016 were analyzed retrospectively. Outcome measures that were compared between the groups included the use of tracheostomy and hemodialysis, total body surface area (TBSA) and the number of skin graft operations, length of hospital stay, infection status, and mortality. RESULTS The mean age of the patients was 22.4 years, and the mean TBSA was 43%. All the patients survived and were discharged without requiring limb amputation or being permanently disabled. Patient characteristics did not differ significantly between the groups. PCT levels returned to normal significantly faster (p=0.007) in the HBOT group. CONCLUSION Multidisciplinary burn care combined with adjunctive HBOT improves sepsis control compared with standard treatment without HBOT. Prospective studies are required to define the role of HBOT in extensive burns.
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