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Moore AJL, McCrory B, Corcoran A, Guckian N, Bergin S, McCloskey C, Bricknell M, Kelly J. Defence Engagement (Health) between the UK and Ireland since the Good Friday Agreement in 1998. BMJ Mil Health 2024:e002657. [PMID: 38782492 DOI: 10.1136/military-2023-002657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/23/2024] [Indexed: 05/25/2024]
Abstract
This paper describes the range of Defence Engagement (Health) (DE(H)) activities between Northern Ireland and Ireland following the Good Friday Agreement in April 1998. Although the Agreement made provision for cross-border cooperation in health, the Omagh bombing of August 1998 energised the discussion to provide greater co-ordination of future responses to mass casualty events. The paper describes these DE(H) activities at the Strategic, Operational and Tactical levels to show the integration across these levels and between the agencies of both governments. The paper shows how a DE(H) programme can have a successful strategic effect by finding topics of mutual interest that can bring together two countries in order to provide an effective health and social care provision. This paper forms part of a special issue of BMJ Military Health dedicated to Defence Engagement (.
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Affiliation(s)
- A J L Moore
- Faculty for Medical Global Health Engagement, Defence Medical Services, Lichfield, UK
| | - B McCrory
- CAWT, Western Health and Social Services Board, Belfast, UK
| | - A Corcoran
- Irish Defence Forces Medical Corps, DFHQ, St Bricin's Military Hospital, Government of Ireland, Dublin, Ireland
| | - N Guckian
- Cooperation and Working Together, Londonderry, Derry/Londonderry, UK
| | - S Bergin
- Cooperation and Working Together, Londonderry, Derry/Londonderry, UK
| | - C McCloskey
- Cooperation and Working Together, Londonderry, Derry/Londonderry, UK
| | - M Bricknell
- Conflict and Health Research Group, King's College London-Strand Campus, London, UK
| | - J Kelly
- Faculty of Health Sciences, University of Hull, Hull, UK
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Hansen PM, Mikkelsen S, Rehn M. Communication in Sudden-Onset Major Incidents: Patterns and Challenges-Scoping Review. Disaster Med Public Health Prep 2023; 17:e482. [PMID: 37681689 DOI: 10.1017/dmp.2023.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
OBJECTIVE To identify and describe patterns and challenges in communication in sudden-onset major incidents. METHODS Systematic scoping review according to Joanna Briggs Institute and PRISMA-ScR guidelines. Data sources included Cochrane Library, EMBASE, PubMed/MEDLINE, Scopus, SweMed+, Web of Science, and Google Scholar. Non-indexed literature was searched as well. The included literature went through data extraction and quality appraisal as per pre-registered protocol. RESULTS The scoping review comprised 32 papers from different sources. Communication breakdown was reported in 25 (78.1%) of the included papers. Inter-authority communication challenges were reported in 18 (56.3%) of the papers. System overload and incompatibility was described in 9 papers (28.1%). Study design was clearly described in 30 papers (93.8%). CONCLUSIONS The pattern in major incident communication is reflected by frequent breakdowns with potential and actual consequences for patient survival and outcome. The challenges in communication are predominantly inter-authority communication, system overload and incompatibility, and insufficient pre-incident planning and guidelines.
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Affiliation(s)
- Peter Martin Hansen
- The Mobile Emergency Care Unit, Department of Anesthesiology and Intensive Care, Odense University Hospital Svendborg, Svendborg, Denmark
- Danish Air Ambulance, Aarhus N, Denmark
- The Prehospital Research Unit, Region of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Søren Mikkelsen
- The Mobile Emergency Care Unit, Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
- The Prehospital Research Unit, Region of Southern Denmark, Odense University Hospital, Odense, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Marius Rehn
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Research and Development, Norwegian Air Ambulance Foundation, Oslo, Norway
- Air Ambulance Department, Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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De Cauwer H, Barten D, Willems M, Van der Mieren G, Somville F. Communication failure in the prehospital response to major terrorist attacks: lessons learned and future directions. Eur J Trauma Emerg Surg 2023; 49:1741-1750. [PMID: 36214838 DOI: 10.1007/s00068-022-02131-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 10/01/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Communication is key in efficient disaster management. However, in many major incidents, prehospital communication failure led to insufficient upscaling, safety concerns for the emergency responders, logistical problems and inefficient disaster management. METHODS A review of medical reports and news articles of mass-casualty terrorist attacks was performed using PubMed-archived and (non-)governmental reports. The terrorist attacks in Tokyo 1995, Oklahoma 1995, Omagh 1998, New York 2001, Myyr-manni 2002, Istanbul 2003, Madrid 2004, London 2005, Oslo/Utøya 2011, Boston 2013, Paris 2015, Berlin 2016, Brussels 2016, Wuerzburg 2016, Manchester 2017, London 2017 were included. RESULTS In all mass-casualty terrorist attacks, communication failure was reported. Some failures had significant impact on casualty numbers. Outdated communication equipment, overwhelmed communication services, failure due to damaged infrastructure by the terrorist attack itself, and lack of training were the major issues. Communication failures were most commonly observed in both attacks between 1995-2009 and 2011-2017. DISCUSSION Communication failure was reported in all mass-casualty terrorist incidents. In several cases, communication between the different responding actors was poor or non-existing. Malfunctioning of (outdated) telecommunication services, inadequate training in the use of communication devices, unfortunate damage of telecommunication network infrastructure were also worrisome. CONCLUSION Despite reports of lessons learned in previous EMS responses, communication failures were still reported in most recent terrorist attacks. Governments should provide sufficient resources to equip hospitals, emergency departments, and ambulance services with (back-up) communication systems and invest in training. A European registration system is warranted. We provide proposals for improvement.
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Affiliation(s)
- Harald De Cauwer
- Department of Neurology, Ziekenhuis Geel, Geel, Belgium.
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.
| | - Dennis Barten
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, The Netherlands
| | - Melvin Willems
- Department of Emergency Medicine, Hospital Hasselt, Hasselt, Belgium
- Department of Emergency Medicine, Ziekenhuis Geel, Geel, Belgium
- Faculty of medicine, University of Leuven, Leuven, Belgium
| | | | - Francis Somville
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- Department of Emergency Medicine, Ziekenhuis Geel, Geel, Belgium
- Faculty of medicine, University of Leuven, Leuven, Belgium
- CREEC (Center for research and education in Emergency Care), Universiteit Leuven, Leuven, Belgium
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Abstract
Epidemiological aspects of explosion-related deaths in a civilian setting may bring comprehensive knowledge that is important for prevention efforts. This Swedish national study aimed to describe the extent of such deaths, circumstances and fatal injuries. Data, including all explosion-related deaths in Sweden from 2000 through 2018, were retrieved from the register of the National Board of Forensic Medicine. Among all 87 cases found, accidental deaths accounted for 62%, suicides for 21%, homicides for 7% and undetermined manner of death for the remaining 10% of cases. Most victims died on site. Adult males dominated in the study material, but explosions also killed four children. Explosives were most commonly involved in occupational blast deaths, suicides and homicides, followed by flammable gases and fluids. The incidence showed a significant decrease since the 1980s, based on the incidence rate from this study and a previous Swedish study (1979-1984). As already rare occurrences, blast-related deaths are challenging to prevent. Prevention efforts are needed to restrict the availability of explosives and focus on lowering the occupational risk for injury. In addition, child deaths must not be neglected. A vision of no fatalities is an appropriate goal for acting against explosion-related deaths in a civilian setting.
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Affiliation(s)
- Mensura Junuzovic
- Mensura Junuzovic, Department of Community
Medicine and Rehabilitation, Forensic Medicine, Umeå University, SE-907 12 Umeå, Sweden.
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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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Kuza CM, McIsaac JH. Emergency Preparedness and Mass Casualty Considerations for Anesthesiologists. Adv Anesth 2018; 36:39-66. [PMID: 30414641 PMCID: PMC7127691 DOI: 10.1016/j.aan.2018.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Catherine M Kuza
- Department of Anesthesiology, Division of Critical Care, Keck School of Medicine of USC, 1520 San Pablo Street, Suite 3451, Los Angeles, CA 90033, USA.
| | - Joseph H McIsaac
- Department of Biomedical Engineering, University of Connecticut (UConn) Medical Center, 263 Farmington Avenue, Farmington, CT 06032, USA
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Helicopter emergency medical services in major incident management: A national Norwegian cross-sectional survey. PLoS One 2017; 12:e0171436. [PMID: 28192440 PMCID: PMC5305240 DOI: 10.1371/journal.pone.0171436] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 01/20/2017] [Indexed: 11/20/2022] Open
Abstract
Objective Helicopter Emergency Medical Services (HEMS) aim to bring a highly specialised crew to the scene of major incidents for triage, treatment and transport. We aim to describe experiences made by HEMS in Norway in the management of major incidents. Design Doctors, rescue paramedics and pilots working in Norwegian HEMS and Search and Rescue Helicopters (SAR) January 1st 2015 were invited to a cross-sectional study on experiences, preparedness and training in major incident management. Results We identified a total of 329 Norwegian crewmembers of which 229 (70%) responded; doctors 101/150, (67%), rescue paramedics 64/78 (82%), pilots 64/101, (63%). HEMS and SAR crewmembers had experience from a median of 2 (interquartile range 0–6) major incidents. Road traffic incidents were the most frequent mechanism and blunt trauma the dominating injury. HEMS mainly contributed with triage, treatment and transport. Communication with other emergency services prior to arrival was described as bad, but good to excellent when cooperating on scene. The respondents called for more interdisciplinary exercises. Conclusion HEMS and SAR crewmembers have limited exposure to major incident management. Interdisciplinary training on frequent scenarios with focus on cooperation and communication is called for.
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Johnsen AS, Fattah S, Sollid SJM, Rehn M. Utilisation of helicopter emergency medical services in the early medical response to major incidents: a systematic literature review. BMJ Open 2016; 6:e010307. [PMID: 26861938 PMCID: PMC4762099 DOI: 10.1136/bmjopen-2015-010307] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/18/2015] [Accepted: 01/14/2016] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE This systematic review identifies, describes and appraises the literature describing the utilisation of helicopter emergency medical services (HEMS) in the early medical response to major incidents. SETTING Early prehospital phase of a major incident. DESIGN Systematic literature review performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Web of Science, PsycINFO, Scopus, Cinahl, Bibsys Ask, Norart, Svemed and UpToDate were searched using phrases that combined HEMS and 'major incidents' to identify when and how HEMS was utilised. The identified studies were subjected to data extraction and appraisal. RESULTS The database search identified 4948 articles. Based on the title and abstract, the full text of 96 articles was obtained; of these, 37 articles were included in the review, and an additional five were identified by searching the reference lists of the 37 articles. HEMS was used to transport medical and rescue personnel to the incident and to transport patients to the hospital, especially when the infrastructure was damaged. Insufficient air traffic control, weather conditions, inadequate landing sites and failing communication were described as challenging in some incidents. CONCLUSIONS HEMS was used mainly for patient treatment and to transport patients, personnel and equipment in the early medical management of major incidents, but the optimal utilisation of this specialised resource remains unclear. This review identified operational areas with improvement potential. A lack of systematic indexing, heterogeneous data reporting and weak methodological design, complicated the identification and comparison of incidents, and more systematic reporting is needed. TRIAL REGISTRATION NUMBER CRD42013004473.
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Affiliation(s)
- Anne Siri Johnsen
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
- Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
- Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway
| | - Sabina Fattah
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
- Anaesthesia and Critical Care Research Group, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - Stephen J M Sollid
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
- Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Marius Rehn
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
- Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
- London's Air Ambulance, Royal London Hospital, Barts Health Trust, London, UK
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Exploring the concept of a team approach to wound care: Managing wounds as a team. J Wound Care 2014; 23 Suppl 5b:S1-S38. [DOI: 10.12968/jowc.2014.23.sup5b.s1] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Waage S, Poole JC, Thorgersen EB. Rural hospital mass casualty response to a terrorist shooting spree. Br J Surg 2013; 100:1198-204. [PMID: 23842835 DOI: 10.1002/bjs.9203] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Civilian mass casualty incidents may occur infrequently and suddenly, and are caused by accidents, natural disasters or human terrorist incidents. Most reports deal with trauma centre management in large cities, and data from small local hospitals are scarce. A rural hospital response to a mass casualty incident caused by a terrorist shooting spree was evaluated. METHODS An observational study was undertaken to evaluate the triage, diagnosis and management of all casualties received from the Utøya youth camp in Norway on 22 July 2011 by a local hospital, using data from the hospital's electronic records. Descriptive data are presented for patient demographics, injuries and patient flow. RESULTS The shooting on Utøya youth camp left 69 people dead and 60 wounded. A rural hospital (Ringerike Hospital) triaged 35 patients, of whom 18 were admitted. During the main surge, the hospital triaged and treated 22 patients within 1 h, of whom 13 fulfilled the criteria for activating the hospital trauma team, including five with critical injuries (defined as an Injury Severity Score above 15). Ten computed tomography scans, two focused assessment with sonography for trauma (FAST) scans and 25 conventional X-rays were performed. During the first 24 h, ten surgical procedures were performed and four chest drains inserted. No patient died. CONCLUSION Critical deviation from the major incident plan was needed, and future need for revision is deemed necessary based on the experience. Communication systems and the organization of radiological services proved to be most vulnerable.
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Affiliation(s)
- S Waage
- Department of Surgery, Vestre Viken HE Ringerike Hospital, Hønefoss, Norway.
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Cohen D, Sevdalis N, Patel V, Taylor M, Lee H, Vokes M, Heys M, Taylor D, Batrick N, Darzi A. Tactical and operational response to major incidents: feasibility and reliability of skills assessment using novel virtual environments. Resuscitation 2013; 84:992-8. [PMID: 23357703 DOI: 10.1016/j.resuscitation.2012.12.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 12/01/2012] [Accepted: 12/12/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To determine feasibility and reliability of skills assessment in a multi-agency, triple-site major incident response exercise carried out in a virtual world environment. METHODS Skills assessment was carried out across three scenarios. The pre-hospital scenario required paramedics to triage and treat casualties at the site of an explosion. Technical skills assessment forms were developed using training syllabus competencies and national guidelines identified by pre-hospital response experts. Non-technical skills were assessed using a seven-point scale previously developed for use by pre-hospital paramedics. The two in-hospital scenarios, focusing on a trauma team leader and a silver/clinical major incident co-ordinator, utilised the validated Trauma-NOTECHS scale to assess five domains of performance. Technical competencies were assessed using an ATLS-style competency scale for the trauma scenario. For the silver scenario, the assessment document was developed using competencies described from a similar role description in a real-life hospital major incident plan. The technical and non-technical performance of all participants was assessed live by two experts in each of the three scenarios and inter-assessor reliability was computed. Participants also self-assessed their performance using identical proformas immediately after the scenarios were completed. Self and expert assessments were correlated (assessment cross-validation). RESULTS Twenty-three participants underwent all scenarios and assessments. Performance assessments were feasible for both experts as well as the participants. Non-technical performance was generally scored higher than technical performance. Very good inter-rater reliability was obtained between expert raters across all scenarios and both technical and non-technical aspects of performance (reliability range 0.59-0.90, Ps<0.01). Significant positive correlations were found between self and expert assessment in technical skills across all three scenarios (correlation range 0.52-0.84, Ps<0.05), although no such correlations were observed in non-technical skills. CONCLUSIONS This study establishes feasibility and reliability of virtual environment technical and non-technical skills assessment in major incident scenarios for the first time. The development for further scenarios and validated assessment scales will enable major incident planners to utilise virtual technologies for improved major incident preparation and training.
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Affiliation(s)
- Daniel Cohen
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
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Abstract
The immediate patterns of injury from explosions are well documented, from both military and civil experience. However, few studies have focused on less immediately apparent health consequences and latent effects of explosions in survivors, emergency responders and the surrounding community. This review aimed to analyze the risks to health following an explosion in a civil setting. A comprehensive review of the open literature was conducted, and data on 10 relevant military, civilian and industrial events were collected. Events were selected according to availability of published studies and involvement of large numbers of people injured. In addition, structured interviews with experts in the field were conducted, and existing national guidelines reviewed. The review revealed significant and potentially long-term health implications affecting various body systems and psychological well-being following exposure to an explosion. An awareness of the short- and long-term health effects of explosions is essential in screening for blast injuries, and identifying latent pathologies that could otherwise be overlooked in stressful situations with other visually distracting injuries and, often, mass casualties. Such knowledge would guide responsible medical staff in implementing early appropriate interventions to reduce the burden of long-term sequelae. Effective planning and response strategies would ensure accessibility of appropriate health care resources and evidence-based information in the aftermath of an explosion.
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Mitchell CJ, Kernohan WG, Higginson R. Are emergency care nurses prepared for chemical, biological, radiological, nuclear or explosive incidents? Int Emerg Nurs 2012; 20:151-61. [DOI: 10.1016/j.ienj.2011.10.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 09/24/2011] [Accepted: 10/04/2011] [Indexed: 10/15/2022]
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Mohammed AB, Mann HA, Nawabi DH, Goodier DW, Ang SC. Impact of London's Terrorist Attacks on a Major Trauma Center in London. Prehosp Disaster Med 2012; 21:340-4. [PMID: 17297905 DOI: 10.1017/s1049023x00003988] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractDuring the morning rush hour on Thursday, 07 July 2005, a series of four bombs exploded, affecting London's public transport system.These terrorist attacks killed 52 people and injured >700.A majorincident was declared, and the Royal London Hospital (RLH) was a primary receiving hospital.A total of 194 patients presented to the RLH.Twenty-seven patients required admission. A total of 11 amputations were performed on eight patients. One patient died intra-operatively.Another patient died on Day 6 due to complications related to a head injury.Coordination is vital to the implementation of the hospital's Major Incident Plan in such an emergency. Subsequent internal reviews of the response of the RLH on 07 July 2005 highlighted problems with communication and documentation, as well as the need for extra staffing.These areas should be improved for the management of future major incidents.
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Affiliation(s)
- Aso B Mohammed
- Senior House Officer, Trauma and Orthopedics, Royal London Hospital, London, UK.
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Cohen DC, Sevdalis N, Patel V, Taylor D, Batrick N, Darzi AW. Major incident preparation for acute hospitals: current state-of-the-art, training needs analysis, and the role of novel virtual worlds simulation technologies. J Emerg Med 2012; 43:1029-37. [PMID: 22726663 DOI: 10.1016/j.jemermed.2012.03.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 02/10/2012] [Accepted: 03/20/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND There is growing evidence that health systems in developed countries are poorly prepared to deal with major incidents. STUDY OBJECTIVES This study aimed to determine the skills required for successful major incident response, the factors that contribute to a successful major incident exercise, and whether there is a role for using novel simulation training (virtual worlds) in preparing for major incidents. METHODS This was a qualitative semi-structured interview study. Fourteen health care staff with experience of major incident planning and training in the United Kingdom were recruited. Interviews were content-analyzed to identify emergent themes. RESULTS The aims and benefits of current exercises were categorized into three major themes: Organizational, Interpersonal, and Cognitive. Participants felt that the main objective of current exercises is to see how a major incident plan is implemented, rather than training individual staff. Communications was the most frequently commented-on area requiring improvement. Participants felt that lack of constructive feedback reduced the effectiveness of the exercises. All participants commented that virtual worlds technology could be successfully utilized for training. The creation of an immersive environment, increased training opportunity, and improved participant feedback were thought to be amongst the greatest benefits. CONCLUSION There are clear deficiencies with current major incident preparation. Utilizing virtual worlds technology as an adjunct to existing exercises could improve training and response in the future.
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Affiliation(s)
- Daniel C Cohen
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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Cohen D, Sevdalis N, Taylor D, Kerr K, Heys M, Willett K, Batrick N, Darzi A. Emergency preparedness in the 21st century: training and preparation modules in virtual environments. Resuscitation 2012; 84:78-84. [PMID: 22659598 DOI: 10.1016/j.resuscitation.2012.05.014] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 05/10/2012] [Accepted: 05/16/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the feasibility of evidence-based design and use of low-cost virtual world environments for preparation and training in multi-agency, multi-site, major incident response. METHODS A prospective cohort feasibility study was carried out. One pre-hospital, and two in-hospital major incident scenarios, were created in an accessible virtual world environment. 23 pre-hospital and hospital-based clinicians each took part in one of three linked major incident scenarios: a pre-hospital bomb blast site, focusing on the roles of the team leader and triage person; a blast casualty in a resuscitation room, focusing on the role of the trauma team leader; a hospital command and control scenario focusing on the role of the clinical major incident co-ordinator/silver commander. Participants supplied both quantitative and qualitative feedback. RESULTS Using a systematic, evidence-based approach, three scenarios were successfully developed and tested using low-cost virtual worlds (Second Life and OpenSimulator). All scenarios were run to completion. 95% of participants expressed a desire to use virtual environments for future training and preparation. Pre-hospital responders felt that the immersive virtual environment enabled training in surroundings that would be inaccessible in real-life. CONCLUSIONS The feasibility and face/content validity of using low-cost virtual worlds for multi-agency major incident simulation has been established. Major incident planners and trainers should explore utilising this technology as an adjunct to existing methodologies. Future work will involve development of robust assessment metrics.
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Affiliation(s)
- Daniel Cohen
- Division of Surgery, Department of Surgery and Cancer, St. Mary's Campus, Imperial College London, Praed Street, London W2 1NY, United Kingdom.
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Bosch X. Beyond 9/11: health consequences of the terror attacks outside the USA. Intern Emerg Med 2012; 7:159-61. [PMID: 22161294 DOI: 10.1007/s11739-011-0748-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 11/28/2011] [Indexed: 10/14/2022]
Affiliation(s)
- Xavier Bosch
- Department of Internal Medicine, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain.
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Horner CWM, Crighton E, Dziewulski P. 30 years of burn disasters within the UK: guidance for UK emergency preparedness. Burns 2011; 38:578-84. [PMID: 22142983 DOI: 10.1016/j.burns.2011.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 10/22/2011] [Accepted: 10/24/2011] [Indexed: 10/14/2022]
Abstract
AIM To review casualty profiles of major UK burn disasters over the last 30 years in order to provide guidance to aid burn and emergency service planning and provision so as to improve emergency preparedness for future national disasters. METHODS A review of published literature was undertaken for disasters within the UK that had occurred between 1980 and 2009. Those producing 10 or more casualties with at least one sustaining cutaneous burns injuries were included. Frequency and extent of burns were recorded and analysed. RESULTS In total 37 disasters were included in this study, their frequency of occurrence falling over the 30 years reviewed. Burns tended to make up a small proportion of all casualties and were often relatively small in size with only 3 disasters having more than 5 patients with >10% burns. DISCUSSION This paper can help guide appropriate staffing and bed capacity planning for regional burns units and provide realistic figures to guide scenarios for national emergency training exercises. Due to the infrequent nature of major disasters, Critical Care, Trauma Care and Burn Care Networks will all need to be closely integrated and their implementation rehearsed so as to ensure optimal response to a major national disaster.
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Affiliation(s)
- C W M Horner
- The Burns Service, St Andrews Centre for Plastic Surgery and Burns, Chelmsford, Essex CM1 7ET, UK.
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Analysis of responses of radiology personnel to a simulated mass casualty incident after the implementation of an automated alarm system in hospital emergency planning. Emerg Radiol 2010; 18:119-26. [PMID: 21120569 DOI: 10.1007/s10140-010-0922-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Accepted: 11/16/2010] [Indexed: 10/18/2022]
Abstract
The purpose of this study was to evaluate the response to an automated alarm system of a radiology department during a mass casualty incident simulation. An automated alarm system provided by an external telecommunications provider handling up to 480 ISDN lines was used at a level I trauma center. During the exercise, accessibility, availability, and estimated time of arrival (ETA) of the called in staff were recorded. Descriptive methods were used for the statistical analysis. Of the 49 employees, 29 (59%) were accessible, of which 23 (79%) persons declared to be available to come to the department. The ETA was at an average 29 min (SD ±23). Radiologists and residents reported an ETA to their workplace almost two times shorter compared with technicians (19 ± 16 and 22 ± 16 vs. 40 ± 27 min, p > 0.05). Additional staff reserve is crucial for handling mass casualty incidents. An automated alarm procedure might be helpful. However, the real availability of the employees could not be exactly determined because of unpredictable parameters. But our results allow estimation of the manpower reserve and calculation of maximum radiology service capacities.
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Virtual Worlds and Modeling and Simulation Information Security in an Emergency Management Environment. Prehosp Disaster Med 2010. [DOI: 10.1017/s1049023x00022809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Clinical review: the role of the intensive care physician in mass casualty incidents: planning, organisation, and leadership. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2008; 12:214. [PMID: 18492221 PMCID: PMC2481436 DOI: 10.1186/cc6876] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
There is a long-standing, broad assumption that hospitals will ably receive and efficiently provide comprehensive care to victims following a mass casualty event. Unfortunately, the majority of medical major incident plans are insufficiently focused on strategies and procedures that extend beyond the pre-hospital and early-hospital phases of care. Recent events underscore two important lessons: (a) the role of intensive care specialists extends well beyond the intensive care unit during such events, and (b) non-intensive care hospital personnel must have the ability to provide basic critical care. The bombing of the London transport network, while highlighting some good practices in our major incident planning, also exposed weaknesses already described by others. Whilst this paper uses the events of the 7 July 2005 as its point of reference, the lessons learned and the changes incorporated in our planning have generic applications to mass casualty events. In the UK, the Department of Health convened an expert symposium in June 2007 to identify lessons learned from 7 July 2005 and disseminate them for the benefit of the wider medical community. The experiences of clinicians from critical care units in London made a large contribution to this process and are discussed in this paper.
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