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Erdemir AG, Yurttutan N, Onur MR, İdilman İS, Öztürk MH, Ertürk ŞM, Çevikol C, Akpınar E. Radiological management and challenges of the twin earthquakes of February 6th. Emerg Radiol 2023; 30:659-666. [PMID: 37535144 DOI: 10.1007/s10140-023-02162-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/28/2023] [Indexed: 08/04/2023]
Abstract
Two major earthquakes measuring 7.8 and 7.7 on the Richter scale struck Turkey and Northern Syria on February 6, claiming more than 50,000 lives. In such an unprecedented disaster, radiologists were confronted with very critical tasks of stepping out of the routine reporting process, performing radiological triage, managing acute adverse events, and optimizing imaging protocols. In our experience, radiologists can take three different positions in such disasters: (1) in the scene of the disaster, (2) serving in teleradiology, and (3) working in tertiary hospital for transported patients. With this article, we aimed to describe the challenges radiologists face on the three main fronts and how we manage these challenges.
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Affiliation(s)
- Ahmet Gürkan Erdemir
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Nursel Yurttutan
- Department of Radiology, Faculty of Medicine, Kahramanmaraş University, Kahramanmaraş, Turkey
| | - Mehmet Ruhi Onur
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Mehmet Halil Öztürk
- Department of Radiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Şükrü Mehmet Ertürk
- Department of Radiology, Faculty of Medicine, İstanbul University, Istanbul, Turkey
| | - Can Çevikol
- Department of Radiology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Erhan Akpınar
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Hou C, Hafeez S, Okun J, Chaudhry H, Dym RJ. "Learning From Disaster: What Past Events Can Teach Radiology Departments about Planning for a Mass Casualty Incident". Curr Probl Diagn Radiol 2023; 52:418-424. [PMID: 37268454 DOI: 10.1067/j.cpradiol.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 04/27/2023] [Accepted: 05/08/2023] [Indexed: 06/04/2023]
Abstract
The increased frequency of mass shootings, terror attacks, and natural disasters in recent years have presented challenges to provision of quality medical care in both short and long-term stressful situations. While emergency departments and trauma surgeons are usually the face of the response to mass casualty incidents (MCI), other departments such as radiology are often active participants in caring for these patients but may not be as well prepared. In this article, we review nine papers describing the experiences of various radiology departments with specific MCIs and the lessons they learned from those experiences. By analysis of common themes raised in these papers, we hope to enable departments to incorporate these lessons into their disaster plans to enhance their preparedness for such events.
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Affiliation(s)
- Cheryl Hou
- Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ
| | - Sonia Hafeez
- Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ
| | - Jared Okun
- Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ
| | - Humaira Chaudhry
- Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ
| | - Robert Joshua Dym
- Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ.
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3
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Gibney BT, Roberts JM, D'Ortenzio RM, Sheikh AM, Nicolaou S, Roberge EA, O'Neill SB. Preventing and Mitigating Radiology System Failures: A Guide to Disaster Planning. Radiographics 2021; 41:2111-2126. [PMID: 34723695 DOI: 10.1148/rg.2021210083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Disaster planning is a core facet of modern health care practice. Owing to complex infrastructure requirements, radiology departments are vulnerable to system failures that may occur in isolation or during a disaster event when the urgency for and volume of imaging examinations increases. Planning for systems failures helps ensure continuity of service provision and patient care during an adverse event. Hazards to which a radiology department is vulnerable can be identified by applying a systematic approach with recognized tools such as the Hazard, Risk, and Vulnerability Analysis. Potential critical weaknesses within the department are highlighted by the Failure Mode and Effects Analysis tool. Recognizing the potential latent conditions and active failures that may impact systems allows implementation of strategies to prevent failure or to build resilience and mitigate the effects if they happen. Inherent system resilience to an adverse event can be estimated, and the ability of a department to operate during a disaster and the subsequent recovery can be predicted. The main systems at risk in a radiology department are staff, structure, stuff (supplies and/or equipment), and software, although individual issues and solutions within these are department specific. When medical imaging or examination interpretation needs cannot be met in the radiology department, the use of portable imaging modalities and teleradiology can augment the disaster response. All phases of disaster response planning should consider both sustaining operations and the transition back to normal function. Online supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article. Work of the U.S. Government published under an exclusive license with the RSNA.
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Affiliation(s)
- Brian T Gibney
- From the Department of Radiology, Vancouver General Hospital, 899 W 12th Ave, Vancouver, BC, Canada V5Z 1L5 (B.T.G., J.M.R., R.M.D., A.M.S., S.N., S.B.O.); Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada (R.M.D.); and Department of Radiology, Madigan Army Medical Center, Tacoma, Wash, and the Uniformed Services University of the Health Sciences, Bethesda, Md (E.A.R.)
| | - James M Roberts
- From the Department of Radiology, Vancouver General Hospital, 899 W 12th Ave, Vancouver, BC, Canada V5Z 1L5 (B.T.G., J.M.R., R.M.D., A.M.S., S.N., S.B.O.); Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada (R.M.D.); and Department of Radiology, Madigan Army Medical Center, Tacoma, Wash, and the Uniformed Services University of the Health Sciences, Bethesda, Md (E.A.R.)
| | - Robert M D'Ortenzio
- From the Department of Radiology, Vancouver General Hospital, 899 W 12th Ave, Vancouver, BC, Canada V5Z 1L5 (B.T.G., J.M.R., R.M.D., A.M.S., S.N., S.B.O.); Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada (R.M.D.); and Department of Radiology, Madigan Army Medical Center, Tacoma, Wash, and the Uniformed Services University of the Health Sciences, Bethesda, Md (E.A.R.)
| | - Adnan M Sheikh
- From the Department of Radiology, Vancouver General Hospital, 899 W 12th Ave, Vancouver, BC, Canada V5Z 1L5 (B.T.G., J.M.R., R.M.D., A.M.S., S.N., S.B.O.); Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada (R.M.D.); and Department of Radiology, Madigan Army Medical Center, Tacoma, Wash, and the Uniformed Services University of the Health Sciences, Bethesda, Md (E.A.R.)
| | - Savvas Nicolaou
- From the Department of Radiology, Vancouver General Hospital, 899 W 12th Ave, Vancouver, BC, Canada V5Z 1L5 (B.T.G., J.M.R., R.M.D., A.M.S., S.N., S.B.O.); Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada (R.M.D.); and Department of Radiology, Madigan Army Medical Center, Tacoma, Wash, and the Uniformed Services University of the Health Sciences, Bethesda, Md (E.A.R.)
| | - Eric A Roberge
- From the Department of Radiology, Vancouver General Hospital, 899 W 12th Ave, Vancouver, BC, Canada V5Z 1L5 (B.T.G., J.M.R., R.M.D., A.M.S., S.N., S.B.O.); Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada (R.M.D.); and Department of Radiology, Madigan Army Medical Center, Tacoma, Wash, and the Uniformed Services University of the Health Sciences, Bethesda, Md (E.A.R.)
| | - Siobhán B O'Neill
- From the Department of Radiology, Vancouver General Hospital, 899 W 12th Ave, Vancouver, BC, Canada V5Z 1L5 (B.T.G., J.M.R., R.M.D., A.M.S., S.N., S.B.O.); Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada (R.M.D.); and Department of Radiology, Madigan Army Medical Center, Tacoma, Wash, and the Uniformed Services University of the Health Sciences, Bethesda, Md (E.A.R.)
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Carrington MA, Ranse J, Hammad K. The impact of disasters on emergency department resources: review against the Sendai framework for disaster risk reduction 2015-2030. Australas Emerg Care 2020; 24:55-60. [PMID: 33032978 DOI: 10.1016/j.auec.2020.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/03/2020] [Accepted: 09/14/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Emergency departments (EDs) are often first to feel the intra-hospital effects of disasters. Compromised care standards during disasters eventuate from increased demands on health resources; the facilities, supplies, equipment and manpower imperative for a functioning healthcare facility. Emergency departments must understand the effect of disasters on their health resources. This paper examines the impact on resources within the ED as a result of a disaster and provides a review against the United Nations Office for Disaster Risk Reduction's Sendai Framework for Disaster Risk Reduction 2015-2030 priorities. METHOD An integrative literature review design was utilised. Articles were extracted from databases and search engines. The Preferred Reporting Items of Systematic reviews and Meta-Analysis Guidelines for systematic literature reviews were used. RESULTS Seven papers met inclusion criteria. Disaster consumable stocking was used to mitigate disaster risk and improve resilience. Logistical challenges were exacerbated by poor building design. Ineffective human resource management, communications failure, insufficient ED space, diminished equipment and supplies and unreliable emergency power sources were described. CONCLUSIONS Disaster planning and preparedness strategies can address health resource deficits, increasing ED resilience. Further retrospective case studies are required to greater understand the effects of disasters on ED health resources.
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Affiliation(s)
- Mercedes A Carrington
- Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia.
| | - Jamie Ranse
- Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Karen Hammad
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia; Torrens Resilience Institute, Australia
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Nasir MU, Chandy PE, Roberts J, O'Neill SB. A Guide to Mass Casualty Incidents for Radiology Residents: Strategies, Ethics, Directions. Curr Probl Diagn Radiol 2020; 50:555-559. [PMID: 32951950 PMCID: PMC7448733 DOI: 10.1067/j.cpradiol.2020.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/11/2020] [Accepted: 08/21/2020] [Indexed: 11/25/2022]
Abstract
Mass casualty incidents, by nature of their scale and unpredictability, can rapidly overwhelm health infrastructure. Preparation is the key to managing these crises with the lowest risk to emergency and health personnel, while providing maximal life saving measures. We present an overview of the multitiered planning that should go into forming a well set out emergency response plan and one that is capable of being adapted to a wide range of mass casualty scenarios. We highlight the ethical implications that a healthcare team faces while making challenging decisions rapidly in a high-pressure environment. Radiology trainees should be aware of the response systems in place at their institutions and the role that is expected of them in mass casualty incidents.
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Affiliation(s)
- Muhammad Umer Nasir
- Department of Emergency and Trauma Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada; Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Poornima Elizabeth Chandy
- Department of Emergency and Trauma Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada; Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - James Roberts
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Siobhán B O'Neill
- Department of Emergency and Trauma Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada; Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
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Grossman VA. Catastrophe in Radiology: Considerations Beyond Common Emergencies. JOURNAL OF RADIOLOGY NURSING 2020; 39:336-346. [PMID: 32406394 PMCID: PMC7218374 DOI: 10.1016/j.jradnu.2020.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Disasters often occur without warning and have the potential to affect large numbers of people. Those in the radiology environment experience unique effects on them, their equipment, and their ability to provide quality patient care. Lessons can be learned by reviewing events and their impact on imaging departments around the world. Radiology departments need to be actively involved in the disaster planning and the management of disasters when they occur. Common themes emerge regardless of the type of disaster, and these themes should be included in all planning.
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Affiliation(s)
- Valerie Aarne Grossman
- Highland Hospital, University of Rochester, Nurse Manager of Medical Imaging, Rochester, NY
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O'Neill SB, Gibney B, O'Keeffe ME, Barrett S, Louis L. Mass Casualty Imaging-Policy, Planning, and Radiology Response to Mass Casualty Incidents. Can Assoc Radiol J 2020; 71:388-395. [PMID: 32174156 DOI: 10.1177/0846537120908073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A mass casualty incident (MCI) is an event that generates more patients at one time than locally available resources can manage using routine procedures. By their nature, many of these incidents have no prior notice but result in large numbers of casualties with injuries that range in severity. They can happen anywhere and at any time and regional hospitals and health-care providers have to mount a response quickly and effectively to save as many lives as possible. Radiologists must go from passenger to pilot when it comes to MCI planning. When involved at the hospital-wide planning stage, they can offer valuable expertise on how radiology can improve triage accuracy and at what cost in terms of time and resources and thereby contribute a pragmatic understanding of radiology's role and value during MCIs. By taking ownership of MCI planning in their own departments, radiologists can ensure that the radiology department can respond quickly and effectively to unforeseen emergencies. Well-designed radiology protocols will save lives in an MCI setting.
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Affiliation(s)
- Siobhán B O'Neill
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Brian Gibney
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Michael E O'Keeffe
- Department of Emergency Radiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sarah Barrett
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Luck Louis
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada
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Assessment of RAdiopaque Patient IDentification Stickers (RAPIDS) for patient-scan correlation in a mass casualty incident. Emerg Radiol 2020; 27:293-301. [DOI: 10.1007/s10140-020-01761-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/11/2020] [Indexed: 10/24/2022]
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Accuracy of Focused Assessment with Sonography for Trauma (FAST) in Disaster Settings: A Meta-Analysis and Systematic Review. Disaster Med Public Health Prep 2019; 13:1059-1064. [DOI: 10.1017/dmp.2019.23] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTFocused assessment with sonography for trauma (FAST) has been incorporated into the initial evaluation of trauma for decades. It is an important screening tool in the detection of intra-abdominal fluid. The objective of this study was to perform a systematic review of the use and accuracy of FAST as an imaging tool for blunt abdominal trauma in disaster/mass casualty settings. A systematic review of literature was conducted using key words and search terms. Two independent reviewers screened abstracts to determine inclusion using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS). For studies passing QUADAS, a meta-analysis was performed calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). FAST results were compared with the gold standard, which was a combination of CT scan results, operative findings, and medical records of the clinical course. Initial database screening resulted in 133 articles, of which 21 were selected for QUADAS evaluation. Five studies passed QUADAS and were selected in the final meta-analysis, with a total of 4263 patients. The sensitivity of FAST was 92.1% (87.8–95.6), specificity 98.7% (96.0–99.9), PPV 90.7% (70.0–98.0), and NPV 98.8% (98.1–99.5) for the detection of intra-abdominal injury. In our meta-analysis, FAST was both sensitive and specific in the evaluation of trauma in the disaster setting.
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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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Gharahbaghian L, Anderson KL, Lobo V, Huang RW, Poffenberger CM, Nguyen PD. Point-of-Care Ultrasound in Austere Environments. Emerg Med Clin North Am 2017; 35:409-441. [DOI: 10.1016/j.emc.2016.12.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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