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de Lesquen H, Paris R, Lacheze S, de la Villeon B, Menini W, Lamblin A, Vacher A, Balandraud P, Pasquier P, Avaro JP. Training for a mass casualty incident: Conception, development, and implementation of a crew-resource management course for forward surgical teams. J Trauma Acute Care Surg 2024; 97:S19-S23. [PMID: 38745350 DOI: 10.1097/ta.0000000000004380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
BACKGROUND Since 2021, the predeployment training of French FSTs has included a simulation-based curriculum consisting of organizational and human factors. The purpose of this article is to describe the development of a crew-resource management (CRM) training course dedicated for the forward surgical teams (FSTs) of the French Military Health Service. METHODS The approach was based on three steps: (1) establishment of a conceptual framework of FSTs deployment; (2) development of an aircrew-like CRM training combining lectures, laboratory exercises, and situational training exercises to consider four fundamental "nontechnical" (cognitive and social) skills for effective and safe combat casualty care: (a) leadership, (b) decision-making, (c) coordination, and (d) situational awareness; (3) Implementation of teamwork evaluation tools. RESULTS A multidisciplinary team designed a conceptual framework for FST preparedness, 24 French FSTs completed a high-quality training that takes into account both technical and nontechnical skills to maintain quality of combat care during mass-casualty incidents, FSTs' CRM skills were assessed using an audio/video recording of a simulated mass-casualty incident.
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Affiliation(s)
- Henri de Lesquen
- From the Department of Thoracic and Vascular Surgery (H.d.L., J.-P.A.), Department of Anesthesiology and Intensive Care (W.M.), Sainte Anne Military Hospital, Toulon; Department of Anesthesiology and Intensive Care (R.P., A.L.), Laveran Military Teaching Hospital, Marseille; Département Recherche Expertise Formation Aéromédicale (S.L., A.V.), French Armed Forces Biomedical Research Institute, Brétigny sur Orge; Department of Digestive and Endocrine Surgery (B.d.l.V.), Laveran Military Teaching Hospital, Marseille; French Military Medical Academy (A.L., P.B., P.P., J.-P.A.), École du Val-de-Grâce, Paris; Department of Anesthesiology and Intensive Care (P.P.), Percy Military Teaching Hospital, Clamart; and French Special Operations Forces Medical Component Command (P.P.), Villacoublay, France
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Igra NM, Schmulevich D, Geng Z, Guzman J, Biddinger PD, Gates JD, Spinella PC, Yazer MH, Cannon JW. Optimizing Mass Casualty Triage: Using Discrete Event Simulation to Minimize Time to Resuscitation. J Am Coll Surg 2024; 238:41-53. [PMID: 37870239 DOI: 10.1097/xcs.0000000000000894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
BACKGROUND Urban areas in the US are increasingly focused on mass casualty incident (MCI) response. We simulated prehospital triage scenarios and hypothesized that using hospital-based blood product inventories for on-scene triage decisions would minimize time to treatment. STUDY DESIGN Discrete event simulations modeled MCI casualty injury and patient flow after a simulated blast event in Boston, MA. Casualties were divided into moderate (Injury Severity Score 9 to 15) and severe (Injury Severity Score >15) based on injury patterns. Blood product inventories were collected from all hospitals (n = 6). The primary endpoint was the proportion of casualties managed with 1:1:1 balanced resuscitation in a target timeframe (moderate, 3.5 U red blood cells in 6 hours; severe, 10 U red blood cells in 1 hour). Three triage scenarios were compared, including unimpeded casualty movement to proximate hospitals (Nearest), equal distribution among hospitals (Equal), and blood product inventory-based triage (Supply-Guided). RESULTS Simulated MCIs generated a mean ± SD of 302 ± 7 casualties, including 57 ± 2 moderate and 15 ± 2 severe casualties. Nearest triage resulted in significantly fewer overall casualties treated in the target time (55% vs Equal 86% vs Supply-Guided 91%, p < 0.001). These differences were principally due to fewer moderate casualties treated, but there was no difference among strategies for severe casualties. CONCLUSIONS In this simulation study comparing different triage strategies, including one based on actual blood product inventories, nearest hospital triage was inferior to equal distribution or a Supply-Guided strategy. Disaster response leaders in US urban areas should consider modeling different MCI scenarios and casualty numbers to determine optimal triage strategies for their area given hospital numbers and blood product availability.
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Affiliation(s)
- Noah M Igra
- From the Department of Surgery, Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Igra, Geng, Cannon)
- School of Medicine, Tel Aviv University, Tel Aviv, Israel (Igra, Yazer)
| | | | - Zhi Geng
- From the Department of Surgery, Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Igra, Geng, Cannon)
| | - Jessica Guzman
- Department of Surgery, University of California Davis Medical Center, Sacramento, CA (Guzman)
| | - Paul D Biddinger
- Center for Disaster Medicine, Massachusetts General Hospital, Boston, MA (Biddinger)
| | | | - Philip C Spinella
- Departments of Surgery (Spinella), University of Pittsburgh Medical Center, Pittsburgh, PA
- Critical Care Medicine (Spinella), University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Mark H Yazer
- School of Medicine, Tel Aviv University, Tel Aviv, Israel (Igra, Yazer)
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA (Yazer)
| | - Jeremy W Cannon
- From the Department of Surgery, Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Igra, Geng, Cannon)
- Department of Surgery, Uniformed Services University F Edward Hébert School of Medicine, Bethesda, MD (Cannon)
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Cannon JW, Igra NM, Borge PD, Cap AP, Devine D, Doughty H, Geng Z, Guzman JF, Ness PM, Jenkins DH, Rajbhandary S, Schmulevich D, Stubbs JR, Wiebe DJ, Yazer MH, Spinella PC. U.S. cities will not meet blood product resuscitation standards during major mass casualty incidents: Results of a THOR-AABB working party prospective analysis. Transfusion 2022; 62 Suppl 1:S12-S21. [PMID: 35730720 DOI: 10.1111/trf.16960] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/27/2022] [Accepted: 02/01/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Mass casualty incidents (MCIs) create an immediate surge in blood product demand. We hypothesize local inventories in major U.S. cities would not meet this demand. STUDY DESIGN AND METHODS A simulated blast in a large crowd estimated casualty numbers. Ideal resuscitation was defined as equal amounts of red blood cells (RBCs), plasma, platelets, and cryoprecipitate. Inventory was prospectively collected from six major U.S. cities at six time points between January and July 2019. City-wide blood inventories were classified as READY (>1 U/injured survivor), DEFICIENT (<10 U/severely injured survivor), or RISK (between READY and DEFICIENT), before and after resupply from local distribution centers (DC), and features of DEFICIENT cities were identified. RESULTS The simulated blast resulted in 2218 injured survivors including 95 with severe injuries. Balanced resuscitation would require between 950 and 2218 units each RBC, plasma, platelets and cryoprecipitate. Inventories in 88 hospitals/health systems and 10 DCs were assessed. Of 36 city-wide surveys, RISK inventories included RBCs (n = 16; 44%), plasma (n = 24; 67%), platelets (n = 6; 17%), and cryoprecipitate (n = 22; 61%) while DEFICIENT inventories included platelets (n = 30; 83%) and cryoprecipitate (n = 12; 33%). Resupply shifted most RBC and plasma inventories to READY, but some platelet and cryoprecipitate inventories remained at RISK (n = 24; 67% and n = 12; 33%, respectively) or even DEFICIENT (n = 11; 31% and n = 6; 17%, respectively). Cities with DEFICIENT inventories were smaller (p <.001) with fewer blood products per trauma bed (p <.001). DISCUSSION In this simulated blast event, blood product demand exceeded local supply in some major U.S. cities. Options for closing this gap should be explored to optimize resuscitation during MCIs.
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Affiliation(s)
- Jeremy W Cannon
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Surgery, Uniformed Services University F. Edward Hébert School of Medicine, Bethesda, Maryland, USA
| | - Noah M Igra
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Sackler School of Medicine at Tel Aviv University, Tel Aviv, Israel
| | - P Dayand Borge
- Biomedical Services, American Red Cross, Philadelphia, Pennsylvania, USA
| | - Andrew P Cap
- U.S. Army Institute of Surgical Research, Joint Base San Antonio-FT Sam, Houston, Texas, USA
| | - Dana Devine
- Canadian Blood Services, Vancouver, British Columbia, Canada
| | - Heidi Doughty
- NIHR Surgical Reconstruction and Microbiology Research Centre, Institute of Translational Medicine, Birmingham, UK
| | - Zhi Geng
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jessica F Guzman
- Department of Surgery, University of California Davis Medical Center, Sacramento, California, USA
| | - Paul M Ness
- Department of Pathology, Division of Transfusion Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Donald H Jenkins
- Department of Surgery, Division of Trauma and Emergency Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | | | - Daniela Schmulevich
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Douglas J Wiebe
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Penn Injury Science Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark H Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Philip C Spinella
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Spagnolello O, Gatti S, Esmati S, Shahir MAA, Portella G. Kabul airport suicide attack: report of a mass casualty. Eur J Trauma Emerg Surg 2022; 48:2687-2688. [PMID: 35178581 DOI: 10.1007/s00068-022-01898-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/30/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Ornella Spagnolello
- EMERGENCY NGO Kabul Hospital, EMERGENCY Ong ONLUS, Kabul, Afghanistan. .,Department of Public Health and Infectious Diseases, University of Rome "La Sapienza", Rome, Italy.
| | - Sofia Gatti
- EMERGENCY NGO Kabul Hospital, EMERGENCY Ong ONLUS, Kabul, Afghanistan
| | - Shekiba Esmati
- EMERGENCY NGO Kabul Hospital, EMERGENCY Ong ONLUS, Kabul, Afghanistan
| | | | - Gina Portella
- EMERGENCY NGO Kabul Hospital, EMERGENCY Ong ONLUS, Kabul, Afghanistan
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DeVita T, Brett-Major D, Katz R. How are healthcare provider systems preparing for health emergency situations? WORLD MEDICAL & HEALTH POLICY 2021; 14:102-120. [PMID: 34226853 PMCID: PMC8242524 DOI: 10.1002/wmh3.436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 12/19/2020] [Accepted: 01/14/2021] [Indexed: 11/12/2022]
Abstract
Natural disasters, disease outbreaks, famine, and human conflict have strained communities everywhere over the course of human existence. However, modern changes in climate, human mobility, and other factors have increased the global community's vulnerability to widespread emergencies. We are in the midst of a disruptive health event, with the COVID-19 pandemic testing our health provider systems globally. This study presents a qualitative analysis of published literature, obtained systematically, to examine approaches health providers are taking to prepare for and respond to mass casualty incidents around the globe. The research reveals emerging trends in the weaknesses of systems' disaster responses while highlighting proposed solutions, so that others may better prepare for future disasters. Additionally, the research examines gaps in the literature, to foster more targeted and actionable contributions to the literature.
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Affiliation(s)
- Timothy DeVita
- Department of Internal Medicine Yale University School of Medicine New Haven Connecticut USA
| | - David Brett-Major
- Department of Epidemiology, College of Public Health University of Nebraska Medical Center Omaha Nebraska USA
| | - Rebecca Katz
- Center for Global Health Science and Security Georgetown University School of Medicine Washington District of Columbia USA
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6
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Ramsey G. Blood transfusions in mass casualty events: recent trends. Vox Sang 2020; 115:358-366. [PMID: 32253763 DOI: 10.1111/vox.12916] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/20/2020] [Accepted: 03/10/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVES The US AABB disaster task force recommends estimating 3 RBC units per admission (UPA) for mass casualty events (MCEs). In a previous analysis, median MCE UPA were 2·7 RBCs, 1·2 plasmas and 0·27 platelet doses (Vox Sang 2017; 112:648). Additional recent data were sought from the current era of balanced massive transfusion protocols (bMTPs). MATERIALS AND METHODS Publications in English from 1980 to 2020 were reviewed for MCEs using ≥50 RBCs/event and with numbers of admissions available. MCE reports were stratified by era and event-wide or trauma-centre source. The bMTP era included all MCEs since 2010 plus a 2008 bMTP military report. STATISTICS Mann-Whitney test. RESULTS Thirty-two MCEs met analysis criteria. Event-wide reports used medians [interquartile ranges] of 1·8 [1·2-3·9] RBC, 0·6 [0·3-0·9] plasma and 0·14 [0·06-0·26] platelet-dose UPA. Trauma centres transfused 3·4 [2·7-6·3] RBC, 2·4 [1·3-4·1] plasma and 0·41 [0·34-0·50] platelet-dose UPA, all P < 0·05 vs event-wide. Same-event median post-day-1 transfusions were 50% of day-1 use for RBC, 28% for plasma and 16% for platelets. Compared to prior years, the median plasma/RBC transfusion ratio rose from 0·28 to 0·67 in the bMTP era (P < 0·01). In recent mass shootings, trauma centres transfused up to 42 platelets (range 0·45-0·57 UPA) on day 1. CONCLUSION Based on available mass casualty data, we recommend planning for 3 RBC, 1 plasma and one-fourth platelet-dose units per admission for blood centres (event-wide), and 6, 4 and one-half UPA, respectively, for trauma centres, which have seen rising plasma usage and large mass-shooting platelet needs.
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Affiliation(s)
- Glenn Ramsey
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA.,Blood Bank, Department of Pathology, Northwestern Memorial Hospital, Chicago, Illinois, USA
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Caramello V, Camerini O, Ricceri F, Ottone P, Mascaro G, Chianese R, Bodas M, Bierens J, Della Corte F. Blood bank preparedness for mass casualty incidents and disasters: a pilot study in the Piedmont region, Italy. Vox Sang 2019; 114:247-255. [PMID: 30861146 DOI: 10.1111/vox.12761] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 01/16/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND OBJECTIVES Blood is a critical resource for responding to mass casualty incidents (MCI). The main framework for transfusion preparedness is the American Association of Blood Bank (AABB) Disaster Operation Handbook. A disaster preparedness plan for co-ordinated blood supply was issued in Italy in 2016. AIM To assess the level of preparedness of the Transfusion Centers (TS) in the Piedmont region, to evaluate the applicability of AABB checklist and to evaluate the application of the Italian plan. MATERIALS AND METHODS We surveyed all the Regional Transfusion Centers (TS) using the AABB checklist, addressing 74 priority action items grouped according to 16 preparedness domains. The Italian 2016 plan has been considered the regulatory cut-off and hospitals were stratified based on the type and the TS workload. A principal component analysis (PCA) was conducted to summarize the variance among centres. RESULTS Twenty-one out of 25 TS agreed to participate. Eighty-one % were at high and 18% were at medium level of preparedness. All but two centres were above the cut-off determined by the Italian law. A significant better preparedness was found in medium size hospitals compared to bigger and smaller hospitals. Other than that, the different TS showed a quite homogeneous distribution of preparedness variance. CONCLUSIONS This study demonstrated a good level of preparedness in the Piemonte TS, above the Italian law requirements in the majority of TS. The AABB checklist could be used to highlight gaps and needs in the regional TS networks in case of emergency crisis.
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Affiliation(s)
- Valeria Caramello
- Emergency Department, San Luigi Gonzaga University Hospital, Turin, Italy
| | - Odetta Camerini
- Transfusion Medicine and Immunoemathology Service, San Luigi Gonzaga University Hospital, Turin, Italy
| | - Fulvio Ricceri
- Department of Biological and Clinical Sciences, University of Turin, Turin, Italy.,Unit of Epidemiology, Regional Health Service ASL TO3, Turin, Italy
| | - Piero Ottone
- Transfusion Medicine and Immunoemathology Service, San Luigi Gonzaga University Hospital, Turin, Italy
| | - Gennaro Mascaro
- Transfusion Medicine and Immunoemathology Service, Maggiore della Carità University Hospital, Novara, Italy
| | - Rosa Chianese
- Piedmont Regional Coordination Center of Transfusion Medicine Network, Transfusion Medicine and Immunoemathology Service ASL TO4, Turin, Italy
| | - Moran Bodas
- CRIMEDIM - Research Center in Emergency and Disaster Medicine, UPO - Università del Piemonte Orientale, Novara, Italy
| | - Joost Bierens
- Research Group Emergency and Disaster Medicine, Faculty of Medicine & Pharmacy, Vrije Universiteit Brussels, Brussels, Belgium
| | - Francesco Della Corte
- CRIMEDIM - Research Center in Emergency and Disaster Medicine, UPO - Università del Piemonte Orientale, Novara, Italy
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Schauer SG, Naylor JF, Oliver JJ, Maddry JK, April MD. An analysis of casualties presenting to military emergency departments in Iraq and Afghanistan. Am J Emerg Med 2018; 37:94-99. [PMID: 29753547 DOI: 10.1016/j.ajem.2018.04.068] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 04/26/2018] [Accepted: 04/30/2018] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND During the past 17 years of conflict the deployed US military health care system has found new and innovative ways to reduce combat mortality down to the lowest case fatality rate in US history. There is currently a data dearth of emergency department (ED) care delivered in this setting. We seek to describe ED interventions in this setting. METHODS We used a series of ED procedure codes to identify subjects within the Department of Defense Trauma Registry from January 2007 to August 2016. RESULTS During this time, 28,222 met inclusion criteria. The median age of causalities in this dataset was 25 years and most (96.9%) were male, US military (41.3%), and part of Operation Enduring Freedom (66.9%). The majority survived to hospital discharge (95.5%). Most subjects sustained injuries by explosives (55.3%) and gunshot wound (GSW). The majority of subjects had an injury severity score that was considered minor (74.1%), while the preponderance of critically injured casualties sustained injuries by explosive (0.7%). Based on AIS, the most frequently seriously injured body region was the extremities (23.9%). The bulk of administered blood products were packed red blood cells (PRBC, 26.4%). Endotracheal intubation was the most commonly performed critical procedure (11.9%). X-ray (79.9%) was the most frequently performed imaging study. CONCLUSIONS US military personnel comprised the largest proportion of combat casualties and most were injured by explosive. Within this dataset, ED providers most frequently performed endotracheal intubation, administered blood products, and obtained diagnostic imaging studies.
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Affiliation(s)
- Steven G Schauer
- US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, United States; 59th Medical Wing, JBSA Lackland, TX, United States; Brooke Army Medical Center, JBSA Fort Sam Houston, TX, United States.
| | - Jason F Naylor
- Madigan Army Medical Center, Joint Base Lewis McChord, Washington, United States
| | - Joshua J Oliver
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX, United States
| | - Joseph K Maddry
- 59th Medical Wing, JBSA Lackland, TX, United States; Brooke Army Medical Center, JBSA Fort Sam Houston, TX, United States
| | - Michael D April
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX, United States
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Kuckelman J, Derickson M, Long WB, Martin MJ. MASCAL Management from Baghdad to Boston: Top Ten Lessons Learned from Modern Military and Civilian MASCAL Events. CURRENT TRAUMA REPORTS 2018. [DOI: 10.1007/s40719-018-0128-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Ravi SJ. Strengthening Health Systems Through International Blood Product Sharing Agreements. Health Secur 2017; 15:110-117. [PMID: 28192051 DOI: 10.1089/hs.2016.0039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Blood products are critical to the success of both routine healthcare delivery and emergency response efforts. Ensuring the safety and availability of blood products presents nations with considerable collection, screening, and distribution challenges that are often exacerbated by public health crises, particularly mass-casualty events involving traumatic injuries. However, recent outbreaks of Ebola and Zika virus disease have also illustrated the importance of securing blood product supplies during ongoing infectious disease emergencies. The United States and other nations should consider enhancing existing mechanisms for sharing medical countermeasures by creating formal agreements for sharing blood products during public health emergencies.
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11
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Ramsey G. Blood component transfusions in mass casualty events. Vox Sang 2017; 112:648-659. [PMID: 28891209 DOI: 10.1111/vox.12564] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 07/06/2017] [Accepted: 07/10/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Planning transfusion needs in mass casualty events (MCE) is critical for disaster preparedness. Published data on blood component usage were analysed to seek correlative factors and usage rates. MATERIALS AND METHODS English-language medical publications since 1980 were searched for MCEs with numbers of patient admissions and transfused RBCs. Reports were excluded from natural disasters or with total RBC use <50 units. Statistical analysis employed Mann-Whitney U-tests and Spearman's rank correlations. RESULTS In 24 reports, the average units per admission were 3·06 RBCs, 2·13 plasmas and 0·37 platelet doses. Five RBCs per admission would have sufficed for 87% of events. Transfusion needs involving bombings correlated with admissions (P ≤ 0·03). In the formula (massive-transfusion patients in MCE) times X = (total units for all MCE patients), the average X was 35 for RBCs (correlation P = 0·01), 17 for plasma (P = 0·10) and five for platelet doses (P = 0·06). From 67% to 84% of all components used were given in the first 24 h (event medians). CONCLUSIONS Blood component use in MCEs correlated with numbers of patients admitted or receiving massive transfusion. More current data are needed to better reflect emerging trauma care practices and refine predictive models of transfusion needs.
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Affiliation(s)
- G Ramsey
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Pathology, Northwestern Memorial Hospital, Chicago, IL, USA.,Blood Bank, Northwestern Memorial Hospital, Chicago, IL, USA
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12
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Managing the surge in demand for blood following mass casualty events: Early automatic restocking may preserve red cell supply. J Trauma Acute Care Surg 2017; 81:50-7. [PMID: 27120326 DOI: 10.1097/ta.0000000000001101] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Traumatic hemorrhage is a leading preventable cause of mortality following mass casualty events (MCEs). Improving outcomes requires adequate in-hospital provision of high-volume red blood cell (RBC) transfusions. This study investigated strategies for optimizing RBC provision to casualties in MCEs using simulation modeling. METHODS A computerized simulation model of a UK major trauma center (TC) transfusion system was developed. The model used input data from past MCEs and civilian and military trauma registries. We simulated the effect of varying on-shelf RBC stock hold and the timing of externally restocking RBC supplies on TC treatment capacity across increasing loads of priority one (P1) and two (P2) casualties from an event. RESULTS Thirty-five thousand simulations were performed. A casualty load of 20 P1s and P2s under standard TC RBC stock conditions left 35% (95% confidence interval, 32-38%) of P1s and 7% (4-10%) of P2s inadequately treated for hemorrhage. Additionally, exhaustion of type O emergency RBC stocks (a surrogate for reaching surge capacity) occurred in a median of 10 hours (IQR, 5 to >12 hours). Doubling casualty load increased this to 60% (57-63%) and 30% (26-34%), respectively, with capacity reached in 2 hours (1-3 hours). The model identified a minimum requirement of 12 U of on-shelf RBCs per P1/P2 casualty received to prevent surge capacity being reached. Restocking supplies in an MCE versus greater permanent on-shelf RBC stock holds was considered at increasing hourly intervals. T-test analysis showed no difference between stock hold versus supply restocking with regard to overall outcomes for MCEs up to 80 P1s and P2s in size (p < 0.05), provided the restock occurred within 6 hours. CONCLUSION Even limited-sized MCEs threaten to overwhelm TC transfusion systems. An early-automated push approach to restocking RBCs initiated by central suppliers can produce equivocal outcomes compared with holding excess stock permanently at TCs. LEVEL OF EVIDENCE Therapeutic/care management study, level IV.
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13
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Fatalities from Firearm-Related Injuries in Selected Governorates of Iraq, 2010-2013. Prehosp Disaster Med 2017; 32:548-555. [PMID: 28516826 DOI: 10.1017/s1049023x17006495] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND In Iraq, where Islamic State of Iraq and Syria (ISIS) and other groups have contributed to escalating violence in recent years, understanding the epidemiology of intentional firearm-related fatalities is essential for public health action. METHODS The Iraqi Ministry of Health (MoH; Baghdad, Iraq) compiles surveillance of fatal injuries in eight of Iraq's 18 governorates (Baghdad, Al-Anbar, Basrah, Erbil, Kerbala, Maysan, Ninevah, and Al-Sulaimaniya). Information is collected from coroner's reports and interviews with family members. Analysis was performed on intentional firearm-related injuries, excluding injuries from intentional self-harm or negligent discharges, that occurred during 2010-2013, a subset of all fatal injuries, and compared to previously published explosive-related fatalities. RESULTS Overall, the dataset included 7,985 firearm-related fatalities. Yearly fatalities were: 2010=1,706; 2011=1,642; 2012=1,662; and 2013=2,975. Among fatalities, 86.0% were men and 13.7% women; 83.4% were adults and 6.2% children <18 years of age. Where age and sex were both known, men aged 20-39 years accounted for 56.3% of fatalities. Three "high-burden" governorates had the highest fatality rate per 100,000 population-Baghdad (12.9), Ninevah (17.0), and Al-Anbar (14.6)-accounting for 85.9% of fatalities recorded in the eight governorates. Most fatalities occurred in the street (56.3%), followed by workplace (12.2%), home (11.3%), and farm/countryside (8.4%). Comparing the ratio of firearm-related fatalities to explosives-related fatalities revealed an overall ratio of 2.8:1. The ratio in Baghdad more than doubled from 2.9 in 2010 to 6.1 in 2013; the highest ratios were seen outside the high-burden governorates. CONCLUSIONS Firearm-related fatalities remained relatively stable throughout 2010-2012, and almost doubled in 2013, correlating with increased ISIS activity. Three governorates contributed the majority of fatalities and experienced the highest fatality rates; these saw high levels of conflict. Firearm-related fatalities disproportionately affected younger men, who historically are over-represented as victims and perpetrators of violence. More than one-half of fatalities occurred in the street, indicating this as a common environment for conflict involving firearms. Firearms appear to account for more fatalities in Iraq than explosives and largely accounted for escalating violence in Baghdad during the study period. The high ratio observed outside the high-burden governorates is reflective of very low numbers of explosives-related fatalities; thus, violence in these governorates is likely non-conflict-related. These observations provide valuable public health information for targeted intervention to prevent violence. Nerlander MP , Leidman E , Hassan A , Sultan ASS , Hussain SJ , Browne LB , Bilukha OO . Fatalities from firearm-related injuries in selected governorates of Iraq, 2010-2013. Prehosp Disaster Med. 2017;32(5):548-555.
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Bordes J, Joubert C, Esnault P, Montcriol A, Nguyen C, Meaudre E, Dulou R, Dagain A. Coagulopathy and transfusion requirements in war related penetrating traumatic brain injury. A single centre study in a French role 3 medical treatment facility in Afghanistan. Injury 2017; 48:1047-1053. [PMID: 27938877 DOI: 10.1016/j.injury.2016.11.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 10/30/2016] [Accepted: 11/19/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Traumatic brain injury associated coagulopathy is frequent, either in isolated traumatic brain injury in civilian practice and in combat traumatic brain injury. In war zone, it is a matter of concern because head and neck are the second most frequent site of wartime casualty burden. Data focusing on transfusion requirements in patients with war related TBI coagulopathy are limited. MATERIALS AND METHODS A descriptive analysis was conducted of 77 penetrating traumatic brain injuries referred to a French role 3 medical treatment facility in Kabul, Afghanistan, deployed on the Kabul International Airport (KaIA), over a 30 months period. RESULTS On 77 patients, 23 died during the prehospital phase and were not included in the study. Severe traumatic brain injury represented 50% of patients. Explosions were the most common injury mechanism. Extracranial injuries were present in 72% of patients. Traumatic brain injury coagulopathy was diagnosed in 67% of patients at role 3 admission. Red blood cell units (RBCu) were transfused in 39 (72%) patients, French lyophilized plasma (FLYP) in 41 (76%), and fresh whole blood (FWB) in 17 (31%). CONCLUSION The results of this study support previous observations of coagulopathy as a frequent complication of traumatic brain injury. The majority of patients with war related penetrating traumatic brain injury presented with extracranial lesions. Most of them required a high level of transfusion capacity.
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Affiliation(s)
- J Bordes
- Sainte Anne Military Teaching Hospital, Intensive Care Unit, Toulon, France.
| | - C Joubert
- Sainte Anne Military Teaching Hospital, Neurosurgery Unit, Toulon, France
| | - P Esnault
- Sainte Anne Military Teaching Hospital, Intensive Care Unit, Toulon, France
| | - A Montcriol
- Sainte Anne Military Teaching Hospital, Intensive Care Unit, Toulon, France
| | - C Nguyen
- Sainte Anne Military Teaching Hospital, Intensive Care Unit, Toulon, France
| | - E Meaudre
- Sainte Anne Military Teaching Hospital, Intensive Care Unit, Toulon, France; French Military Health Service Academy, Ecole du Val-de-Grâce, Paris, France
| | - R Dulou
- French Military Health Service Academy, Ecole du Val-de-Grâce, Paris, France; Val-de-Grâce Military Teaching Hospital, Neurosurgery Unit, Paris, France
| | - A Dagain
- Sainte Anne Military Teaching Hospital, Neurosurgery Unit, Toulon, France; French Military Health Service Academy, Ecole du Val-de-Grâce, Paris, France
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Eastridge BJ. Injuries to the Abdomen from Explosion. CURRENT TRAUMA REPORTS 2017. [DOI: 10.1007/s40719-017-0079-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Tresson P, Touma J, Gaudric J, Pellenc Q, Le Roux M, Pierret C, Kobeiter H, Julia P, Goeau-Brissonniere O, Desgranges P, Koskas F, Castier Y. Management of Vascular Trauma during the Paris Terrorist Attack of November 13, 2015. Ann Vasc Surg 2017; 40:44-49. [PMID: 28161564 DOI: 10.1016/j.avsg.2016.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 09/11/2016] [Accepted: 09/19/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND On November 13, 2015, Paris and Saint-Denis were the targets of terrorist attacks. The Public Hospitals of Paris Organization and the Percy Armed Forces Instruction Hospitals were mobilized to face the mass casualty situation. The objective of this study is to analyze the management of the victims presenting with a nonthoracic vascular trauma (NTVT). METHODS All the data relating to the victims of NTVT who required a specific vascular open or endovascular treatment were analyzed retrospectively. A 6-month follow-up was obtained for all the patients. RESULTS Among the 351 wounded, 20 (5.7%) patients had an NTVT and were dispatched in 8 hospitals (11 men of average age 32). NTVTs were gunshots in 17 cases (85%) or due to a handmade bomb in 3 cases (15%). Twelve patients (60%) received cardiopulmonary resuscitation during prehospital care. NTVT affected the limbs (14 cases, 70%) and the abdomen or the small pelvis (6 cases, 30%). All the patients were operated in emergency. Arterial lesions were treated with greater saphenous vein bypasses, by ligation, and/or embolization. Eleven venous lesions were treated by direct repair or ligation. Associated lesions requiring a specific treatment were present in 19 patients (95%) and were primarily osseous, nervous, and abdomino-pelvic. Severe postoperative complications were observed in 9 patients (45%). Fourteen patients (70%) required blood transfusion (6.4 U of packed red blood cells on average, range 0-48). There were no deaths or amputation and all vascular reconstructions were patent at 6 months. CONCLUSIONS The effectiveness of the prehospital emergency services and a multisite and multidisciplinary management made it possible to obtain satisfactory results for NTVT casualties. All the departments of vascular surgery must be prepared to receive many wounded victims in the event of terrorist attacks.
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Affiliation(s)
- Philippe Tresson
- Service de Chirurgie Vasculaire, Hôpital de la Pitié-Salpêtrière, AP-HP, Faculté de Médecine Pierre et Marie Curie, Université Paris 6, Paris, France
| | - Joseph Touma
- Service de Chirurgie Vasculaire, Hôpital Henri-Mondor, AP-HP, UPEC, Créteil, France
| | - Julien Gaudric
- Service de Chirurgie Vasculaire, Hôpital de la Pitié-Salpêtrière, AP-HP, Faculté de Médecine Pierre et Marie Curie, Université Paris 6, Paris, France
| | - Quentin Pellenc
- Service de Chirurgie Vasculaire et Thoracique, Hôpital Bichat, AP-HP, Faculté de Médecine Denis Diderot, Université Paris 7, Paris, France
| | - Marielle Le Roux
- Service de Chirurgie Thoracique et Vasculaire, Hôpital Tenon, AP-HP, Faculté de Médecine Pierre et Marie Curie, Université Paris 6, Paris, France
| | - Charles Pierret
- Service de Chirurgie Vasculaire, Hôpital d'Instruction des Armées de Percy, Clamart, France
| | - Hicham Kobeiter
- Service de Radiologie, Hôpital Henri-Mondor, AP-HP, UPEC, Créteil, France
| | - Pierre Julia
- Service de Chirurgie Vasculaire, Hôpital Européen Georges-Pompidou, AP-HP, Faculté de Médecine Paris Descartes, Université Paris 5, Paris, France
| | - Olivier Goeau-Brissonniere
- Service de Chirurgie Vasculaire, Hôpital Ambroise-Paré, AP-HP, Boulogne-Billancourt, Université de Versailles Saint Quentin en Yvelines, Versailles, France
| | - Pascal Desgranges
- Service de Chirurgie Vasculaire, Hôpital Henri-Mondor, AP-HP, UPEC, Créteil, France
| | - Fabien Koskas
- Service de Chirurgie Vasculaire, Hôpital de la Pitié-Salpêtrière, AP-HP, Faculté de Médecine Pierre et Marie Curie, Université Paris 6, Paris, France
| | - Yves Castier
- Service de Chirurgie Vasculaire et Thoracique, Hôpital Bichat, AP-HP, Faculté de Médecine Denis Diderot, Université Paris 7, Paris, France.
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Klimo P, Ragel BT, Jones GM, McCafferty R. Severe Pediatric Head Injury During the Iraq and Afghanistan Conflicts. Neurosurgery 2015; 77:1-7; discussion 7. [DOI: 10.1227/neu.0000000000000743] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
AbstractBACKGROUND:Much has been written about injuries sustained by US and coalition soldiers during the Global War on Terrorism campaigns. However, injuries to civilians, including children, have been less well documented.OBJECTIVE:To describe the epidemiologic features and outcomes associated with isolated severe head injury in children during Operations Enduring Freedom and Iraqi Freedom (OEF and OIF).METHODS:A retrospective review of children (<18 years old) in the Joint Theater Trauma Registry with isolated head injury (defined as an Abbreviated Injury Score Severity Code >3) and treated at a US combat support hospital in Iraq or Afghanistan (2004–2012). The primary outcome was in-hospital mortality.RESULTS:We identified 647 children with severe isolated head injuries: 337 from OEF, 268 from OIF, and 42 nontheater specific. Most were boys (76%; median age = 8 years). Penetrating injuries were most common (60.6%). Overall, 330 (51%) children underwent a craniotomy/craniectomy; 156 (24.1%) succumbed to their injuries. Admission Glasgow Coma Score was predictive of survival among the entire cohort and each of the individual conflicts. Male sex also significantly increased the odds of survival for the entire group and OEF, but not for OIF. Closed-head injury improved the predictive ability of our model but did not reach statistical significance as an independent factor.CONCLUSION:This is the largest study of combat-related isolated head injuries in children. Admission Glasgow Coma Score and male sex were found to be predictive of survival. Assets to comprehensively care for the pediatric patient should be established early in future conflicts.
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Affiliation(s)
- Paul Klimo
- Semmes-Murphey Neurologic & Spine Institute, Memphis, Tennessee
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Brian T. Ragel
- Department of Neurosurgery, Mercy Hospital and Clinic, Springfield, Missouri
| | - G. Morgan Jones
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
- Department of Clinical Pharmacy, University of Tennessee Health Sciences Center, Memphis, Tennessee
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Glasgow SM, Allard S, Rackham R, Doughty H. Going for gold: blood planning for the London 2012 Olympic Games. Transfus Med 2014; 24:145-53. [PMID: 24750387 DOI: 10.1111/tme.12116] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 02/04/2014] [Accepted: 02/20/2014] [Indexed: 11/29/2022]
Abstract
The Olympics is one of the largest sporting events in the world. Major events may be complicated by disruption of normal activity and major incidents. Health care and transfusion planners should be prepared for both. Previously, transfusion contingency planning has focused on seasonal blood shortages and pandemic influenzas. This article is the first published account of transfusion contingency planning for a major event. We describe the issues encountered and the lessons identified during transfusion planning for the London 2012 Olympics. Planning was started 18 months in advance and was led by a project team reporting to the Executive. Planning was based on three periods of Gamestime. The requirements were planned with key stakeholders using normal processes enhanced by service developments. Demand planning was based on literature review together with computer modelling. The aim was blood-stock sufficiency complimented by a high readiness donor panel to minimise waste. Plans were widely communicated and table-top exercised. Full transfusion services were maintained during both Games with all demands met. The new service improvements and high readiness donors worked well. Emergency command and control have been upgraded. Red cell concentrate (RCC) stock aged but wastage was not significantly increased. The key to success was: early planning, stakeholder engagement, service developments, integration of transfusion service planning within the wider health care community and conduct within an assurance framework.
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Affiliation(s)
- S M Glasgow
- Trauma Sciences, Blizard Institute, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK
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Réanimation initiale sur le champ de bataille: principaux éléments de prise en charge selon le service de santé des armées français. MEDECINE INTENSIVE REANIMATION 2014. [DOI: 10.1007/s13546-013-0824-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bala M, Kaufman T, Keidar A, Zelig O, Zamir G, Mudhi-Orenshat S, Bdolah-Abram T, Rivkind AI, Almogy G. Defining the need for blood and blood products transfusion following suicide bombing attacks on a civilian population: a level I single-centre experience. Injury 2014; 45:50-5. [PMID: 23217982 DOI: 10.1016/j.injury.2012.11.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Revised: 10/14/2012] [Accepted: 11/09/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Knowledge of patterns of blood use in the care of mass casualty settings is important for preparedness of medical centre resources and for maximising survival when blood supplies are limited. Our objectives were to review of our experience with the use of blood products and define the utilisation of blood transfusion following suicide bombing attacks. PATIENTS AND METHODS We conducted a retrospective analysis of blood and blood product transfusion following civilian bombing attacks at a level I trauma centre in Jerusalem, Israel from 2000 to 2005. The study group consisted of 137 patients who were admitted following 17 suicide bombing attacks which were carried out in Jerusalem during the 5-year period. Demographic data, number of units of blood and blood products transfused and the need for massive transfusions were recorded and analyzed. RESULTS Fifty-three patients received blood transfusions (38.7%). There were 33 males (62.2%) with a median ISS of 13 (range 4-25). These 53 patients received 524 PRBC, 42 WB, and 449 FFP. The mean number of PRBC transfused/admitted patient was 3.82 units (range 0-59). Thirty patients (21.9%) received 236 PRBC (45% of total PRBC) at the first 2h. The ratio of ordered to transfused blood was 946:524. The FFP:PRBC ratio for all transfused patients was 1:1.17. The number of PRBC transfused per attack correlated with the number of patients admitted per attack. The most commonly transfused blood type was A (52.3%). Only 18 units of uncrossed-matched blood were transfused (3.3% of total). 14 patients (10.2%) received massive transfusions. These patients received 399 PRBC (76.1% of total units transfused) and the average number of PRBC transfused was 28.5/patient (10-59). CONCLUSIONS More than 1/3 of casualties admitted following civilian bombing attacks received transfusions, most in the first 2h. Large-scale attacks will require more blood and blood products than small-scale attacks. Twice the number of PRBC ordered than transfused reflects a known trend for over-triage during the initial assessment following bombing attacks. One tenth of patients received massive transfusion.
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Affiliation(s)
- Miklosh Bala
- Department of General Surgery and Trauma Unit, Hadassah-Hebrew University Medical Centre, Israel
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A comprehensive review of blood product use in civilian mass casualty events. J Trauma Acute Care Surg 2013; 75:468-74. [DOI: 10.1097/ta.0b013e318298efb9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Esnault P, Cungi PJ, Romanat PE, D'Aranda E, Cotte J, Bordes J, Vichard A, Aguillon P, Sailliol A, Meaudre E. [Blood transfusion on battlefield. The Kabul hospital experience]. ACTA ACUST UNITED AC 2013; 32:670-5. [PMID: 23953835 DOI: 10.1016/j.annfar.2013.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 06/19/2013] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Blood transfusion is an aspect of medical care on the battlefield. French assets include: red blood cell units (RBCu), lyophilized plasma (PLYO), fresh whole blood (FWB) but neither fresh-frozen plasma (FFP) nor platelets. French transfusion strategy in military operations follows the evolution of knowledge and resources. We describe the characteristics of the transfusion at the military hospital in Kabul. PATIENTS AND METHODS Retrospective study of records of patients transfused between October 2010 to December 2011 conducted in Kabul from transfusion register. Variables studied were: patient characteristics, biology at admission, type and amount of transfusion products, evolution. RESULTS One hundred and twenty-six patients were transfused: 49 military (39%) which 22 French soldier (17%), most of time afghan (n=97; 77%), mean age at 24 years old (3-66). Two hundred and seventy-three RBCu from France were transfused and 350 unused were destroyed. Conditions leading to a transfusion were: 76 war wounds (60%), 21 trauma (17%) and 29 other (23%). In the first 24 hours, patients received in mean: two RBCu (0-12), one unit of FWB (0-18) and two PLYO (0-14). PLYO/RBCu ratio was 1/1.6. A massive transfusion (more than 10 RBCu) concerned 9% of patients. Twenty-seven percent of patients received FWB. We note 17 dead people (13.5%). CONCLUSION The use of the FWB and PLYO in substitution of FFP and platelets can provide cares of high quality in a logistically constrained context while controlling costs.
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Affiliation(s)
- P Esnault
- Département d'anesthésie-réanimation-urgences, HIA Sainte-Anne, boulevard de Sainte-Anne, 83000 Toulon, France.
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Navarro Suay R, Pérez Ferrer A, Jiménez Vizuete JM. [Control of bleeding in the military environment]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2012; 59:562-572. [PMID: 22854629 DOI: 10.1016/j.redar.2012.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 06/06/2012] [Indexed: 06/01/2023]
Abstract
One of the basics of military medicine is the control of haemorrhagic shock. Haemorrhage is the first cause of preventable death in combat, with the adequate control of bleeding being considered as fundamental to estimate the survival of the combatant as well as therapeutic support aimed at minimising blood loss being a challenge within military health logistics. The aim of this work is to review the medical and logistics advances in the treatment of bleeding in the military environment and combat during the latest conflicts, and to describe what is the current contribution of the Spanish Armed Forces and to profile future lines of investigation.
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Affiliation(s)
- R Navarro Suay
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Princesa, Madrid, España.
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Hirst H, Brinkman J, Beasley A, Crocker R, O'Sullivan J. The effects of blood pressure on rebleeding when using ExcelArrest™ in a porcine model of lethal femoral injury. J Emerg Trauma Shock 2011; 4:207-11. [PMID: 21769207 PMCID: PMC3132360 DOI: 10.4103/0974-2700.82207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Accepted: 09/23/2010] [Indexed: 12/01/2022] Open
Abstract
Background: Uncontrolled hemorrhage is one of the leading causes of death in both combat and civilian trauma. This study was designed to compare the arterial blood pressures at which rebleeding occurred when a hemostatic agent, ExcelArrest™, was used compared with a standard pressure dressing. Materials and Methods: This study was a prospective, experimental, and mixed research design. Swine were assigned to one of two groups: ExcelArrest™ (n=5) or a control consisting of standard pressure dressings (n=5). Investigators generated a complex groin injury. The femoral artery and vein were transected and allowed to bleed for 60 s in each pig. After 60 s, ExcelArrest™ was poured into the wound. The control group underwent the same procedures, but without treatment with the hemostatic agent. After 5 min of direct pressure, a standard pressure dressing was applied. After 30 min, dressings were removed and the systolic blood pressure (SBP) was increased incrementally using intravenous phenylephrine until rebleeding occurred. Statistical Analysis: A multivariate ANOVA and a least significant difference were used to analyze the data. Results: ExcelArrest™ was more effective in preventing rebleeding compared to a standard pressure dressing (P<0.05). The means and standard deviations in mmHg for SBP and mean arterial pressure (MAP) for rebleeding were as follows: ExcelArrest™ (SBP=206.4, SD±11.6; MAP=171.4, SD±12.5); for the control group (SBP=89.40±3.58, MAP=58.60±12.86). Conclusions: ExcelArrest™ was more effective in preventing rebleeding compared to the standard dressing with elevated blood pressures. There may be protective benefits in using this hemostatic agent against elevated blood pressures provided by ExcelArrest™.
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Affiliation(s)
- Hayong Hirst
- William Beaumont Army Medical Center, Ft Bliss, El Paso, TX, USA
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Pasquier P, de Rudnicki S, Donat N, Auroy Y, Merat S. Type et épidémiologie des blessures de guerre, à propos de deux conflits actuels : Irak et Afghanistan. ACTA ACUST UNITED AC 2011; 30:819-27. [DOI: 10.1016/j.annfar.2011.05.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Accepted: 05/31/2011] [Indexed: 11/30/2022]
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Klimo P, Ragel BT, Scott WH, McCafferty R. Pediatric neurosurgery during Operation Enduring Freedom. J Neurosurg Pediatr 2010; 6:107-14. [PMID: 20672929 DOI: 10.3171/2010.3.peds109] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Operation Enduring Freedom (OEF) is the current US military conflict against terrorist elements in Afghanistan. Deepening US involvement in this conflict and increasing coalition casualties prompted the establishment of continuous neurosurgical assets at Craig Joint Theater Hospital (CJTH) at Bagram Airfield, Afghanistan, in September 2007. As part of the military's medical mission, children with battlefield-related injuries and, on a selective case-by-case basis, non-war-related pathological conditions are treated at CJTH. METHODS A prospectively maintained record was created in which all rotating neurosurgeons at CJTH recorded their personal procedures. From this record, the authors were able to extract all cases involving patients 18 years of age or younger. Variables recorded included: age, sex, and category of patient (for example, local national, enemy combatant), date, indication and description of the neurosurgical procedure, mechanism of injury, and in-hospital morbidity and mortality data. RESULTS From September 2007 to October 2009, 296 neurosurgical procedures were performed at CJTH. Fifty-seven (19%) were performed in 43 pediatric patients (16 girls and 27 boys) with an average age of 7.5 years (range 11 days-18 years). Thirty-one of the 57 procedures (54%) were for battlefield-related trauma and 26 for humanitarian reasons (46%). The vast majority of cases were cranial (49/57, 86%) compared with spinal (7/54, 13%), with one peripheral nerve case. Craniotomies or craniectomies for penetrating brain injuries were the most common procedures. There were 5 complications (11.6%) and 4 in-hospital deaths (9.3%). CONCLUSIONS As in previous military conflicts, children are the unfortunate victims of the current Afghanistan campaign. Extremely limited pediatric neurosurgical service and care is rendered under challenging conditions and Air Force neurosurgeons provide valuable, life-saving pediatric treatment for both war-related injuries and humanitarian needs. As the conflict in Afghanistan continues, military neurosurgeons will continue to care for injured children to the best of their abilities.
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Affiliation(s)
- Paul Klimo
- 88th Medical Group, Wright-Patterson Air Force Base, Ohio 45433, USA.
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