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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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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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Kugathasan T, Mothersill C. Radiobiological and social considerations following a radiological terrorist attack; mechanisms, detection and mitigation: review of new research developments. Int J Radiat Biol 2021; 98:855-864. [PMID: 34644238 DOI: 10.1080/09553002.2021.1988180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE This review focuses on recent research in understanding the different aspects of what society should expect from a radiological attack. Although some scenarios of a radiologic event can be impossible to be prepared for, the effort put toward educating and better preparing for these types of events can help minimize some of the issues. The different areas discussed in this review include radioisotopes of concern, detection of radiation dose, biological effects of ionizing radiation exposures, low dose effects, targeted and non-targeted effects (NTE), psychological effects, mitigations, with a brief mention of other considerations such as medical preparedness, communication, policy implications and ethical issues. This review also discusses solutions to rectify the issues faced at hand that may come up in the event of a radiologic terrorist attack. CONCLUSIONS A review of recent work in the area shows that a multi-layered and interdisciplinary approach is needed to prepare for a radiological terrorist attack. As well as medical preparedness, the approach needs to include sociological and psychological planning as well as an understanding of ethical issues. Since the likely 'dirty bomb' scenarios may involve low dose exposures to high numbers of people, a much better theoretical and practical understanding of low dose radiobiology and the development of robust low dose exposure biomarkers is needed as part of an integrated plan.
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Affiliation(s)
- Tanya Kugathasan
- Department of Physics and Astronomy, McMaster University, Hamilton, Canada
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Davies J, Johnson R, Kashef E, Khan M, Dick E. How to deliver an effective primary survey report for the trauma CT: A radiological and surgical perspective. TRAUMA-ENGLAND 2021. [DOI: 10.1177/1460408621995144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Whole body contrast-enhanced multidetector CT (WB-CE MDCT) is integral to the assessment of the severely injured patient with stable haemodynamic parameters or in those who respond to resuscitation with blood products. WB-CE MDCT is able to identify the number and severity of injuries sustained by the patient and enable time critical intervention. In this narrative review article we discuss how communication within the trauma team, including the radiologists and appropriate clinicians is crucial in optimizing the effectiveness of WB-CE MDCT. We review the time critical imaging findings and their clinical relevance, which should be included in a succinct CT primary survey report. We also discuss the process through which the effectiveness of the trauma report may be maximised and how non technical factors including teamwork may be optimised to facilitate decision making in this high pressure environment.
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Affiliation(s)
- Joseph Davies
- Maidstone & Tunbridge Wells NHS Trust, Maidstone, UK
| | - Rowena Johnson
- Nuffield Orthopaedic Centre, Oxford NHS Foundation Trust, Oxford, UK
| | - Elika Kashef
- St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Mansoor Khan
- Digestive Diseases Department, Brighton and Sussex University Hospitals, Brighton, UK
| | - Elizabeth Dick
- St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK
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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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