A study on the disaster medical response during the Mauna Ocean Resort gymnasium collapse

A Scoping Review of the Essential Components of Emergency Medical Response Systems for Mass Casualty Incidents

OBJECTIVE

Emergency medical (EM) response systems require extensive coordination, particularly during mass casualty incidents (MCIs). The recognition of preparedness gaps and contextual priorities to MCI response capacity in low- and middle-income countries (LMICs) can be better understood through the components of EM reponse systems. This study aims to delineate essential components and provide a framework for effective emergency medical response to MCIs.

METHODS

A scoping review was conducted using 4 databases. Title and abstract screening was followed by full-text review. Thematic analysis was conducted to identify themes pertaining to the essential components and integration of EM response systems.

RESULTS

Of 20,456 screened citations, 181 articles were included in the analysis. Seven major and 40 sub-themes emerged from the content analysis as the essential components and supportive elements of MCI medical response. The essential components of MCI response were integrated into a framework demonstrating interrelated connections between essential and supportive elements.

CONCLUSIONS

Definitions of essential components of EM response to MCIs vary considerably. Most literature pertaining to MCI response originates from high income countries with far fewer reports from LMICs. Integration of essential components is needed in different geopolitical and economic contexts to ensure an effective MCI emergency medical response.

Measure of Utilizing Space Database Information for Improvement of Efficient Disaster Management (Focusing on Nuclear Power Plant Accidents)

The damage caused by disasters is increasing worldwide, with hundreds of thousands of deaths due to the occurrence of complex large-scale disasters such as the 2010 Haiti earthquake and the 2004 Indian tsunami. South Korea has also experienced human casualties and damage to property caused by large-scale disasters in the past 10 years. Accordingly, a disaster-appropriate response measure is needed. Thus, we conducted this study to present a measure of utilizing spatial database and image information to improve the efficiency of disaster management that is operated based on the country’s existing national disaster management system. We present an efficient disaster response measure that differs from the existing collection-, reporting-, and propagation-oriented operating methods of disaster information through the use of spatial database and image-based information that can be combined with mandatory information with regard to nuclear power plant accidents. Thus, this study contributes to deriving a system that could collect and provide information rapidly at the time of disaster by defining the attribute and spatial information required at the time of disaster during nuclear power plant accidents and by deriving available systems and providing institutions.

Analysis of Disaster Medical Response: The Sejong Hospital Fire

This paper provides a field report on a fire that broke out on January 26, 2018 at Sejong Hospital in Miryang, South Korea, engendering the establishment of a committee to investigate the hospital fire response. This field report analyzes the disaster medical response. The official records of the disaster response from each institution were examined. On-site surveys were conducted through interviews with government officials and other health care workers regarding communication during the disaster response without using a separate questionnaire. All medical records were abstracted from hospital charts. There were 192 casualties: 47 victims died, seven were seriously injured, and 121 suffered minor injuries. Emergency Medical Services (EMS) arrived three minutes after the fire started, while news of the fire reached the National Emergency Medicine Operation Center based in Seoul in 12 minutes. The first disaster medical assistance team (DMAT) was dispatched 63 minutes after the National Emergency Medicine Operation Center was notified. The disaster response was generally conducted in accordance with disaster medical support manuals; however, these response manuals need to be improved. Close cooperation among various institutions, including nearby community public health centers, hospitals, fire departments, and DMATs, is necessary. The response manuals should be revised for back-up institutions, as the relevant information is currently incomplete.

Effect of the Strategic Thinking, Problem Solving Skills, and Grit on the Disaster Triage Ability of Emergency Room Nurses

In this descriptive study, we aimed to identify factors related to emergency room nurses’ disaster triage ability. A total of 166 nurses who worked for emergency departments of general hospitals completed a structured questionnaire consisting of the Disaster Triage Ability Scale (DTAS), the Strategic Thinking Scale (STS), the Problem-Solving Inventory (PSI), and the Original Grit Scale (Grit-O). The data were analyzed using SPSS/WIN 25.0 by means of descriptive statistics, t-test, one-way ANOVA, the Scheffé post hoc test, Pearson’s correlation coefficients, and stepwise multiple regression. Participants’ DTAS averaged 14.03 ± 4.28 (Range 0–20) and showed a statistically significant difference according to their experience of triage education (t = 2.26, p = 0.022) as a disaster triage-related attribute. There were significant correlations among DTAS and confidence in the PSI (r = 0.30, p < 0.001), the approach-avoidance style in the PSI (r = −0.28, p < 0.001), and futurism in the STS (r = 0.19, p = 0.019). The strongest predictor was confidence in the PSI; in addition, 14.1% of the DTAS was explained by confidence in the PSI, approach-avoidance in the PSI, and futurism in the STS. Emergency room nurses who received triage education showed a higher level of the DTAS and their DTAS could be explained by problem-solving skills and strategic thinking. Therefore, it is necessary to develop and implement triage education programs integrated with stress management to improve the approach-avoidance style to ensure better problem-solving skills and to utilize various training methods to enhance confidence to improve problem-solving skills and futurism as part of strategic thinking.

Surge Capacity and Mass Casualty Incidents Preparedness of Emergency Departments in a Metropolitan City: a Regional Survey Study

BACKGROUND

Emergency departments (EDs) generally receive many casualties in disaster or mass casualty incidents (MCI). Some studies have conceptually suggested the surge capacity that ED should have; however, only few studies have investigated measurable numbers in one community. This study investigated the surge capacity of the specific number of accommodatable patients and overall preparedness at EDs in a metropolitan city.

METHODS

This cross-sectional study officially surveyed surge capacity and disaster preparedness for all regional and local emergency medical centers (EMC) in Seoul with the Seoul Metropolitan Government's public health division. This study developed survey items on space, staff, stuff, and systems, which are essential elements of surge capacity. The number of patients acceptable for each ED was investigated by triage level in ordinary and crisis situations. Multivariate linear regression analysis was performed on hospital resource variables related to surge capacity.

RESULTS

In the second half of 2018, a survey was conducted targeting 31 EMC directors in Seoul. It was found that all regional and local EMCs in Seoul can accommodate 848 emergency patients and 537 non-emergency patients in crisis conditions. In ordinary situations, one EMC could accommodate an average of 1.3 patients with Korean Triage and Acuity Scale (KTAS) level 1, 3.1 patients with KTAS level 2, and 5.7 patients with KTAS level 3. In situations of crisis, this number increased to 3.4, 7.8, and 16.2, respectively. There are significant differences in surge capacity between ordinary and crisis conditions. The difference in surge capacity between regional and local EMC was not significant. In both ordinary and crisis conditions, only the total number of hospital beds were significantly associated with surge capacity.

CONCLUSION

If the hospital's emergency transport system is ideally accomplished, patients arising from average MCI can be accommodated in Seoul. However, in a huge disaster, it may be challenging to handle the current surge capacity. More detailed follow-up studies are needed to prepare a surge capacity protocol in the community.

Can helmet decrease mortality of craniocerebral trauma patients in a motorcycle accident?: A propensity score matching

A helmet is critical for preventing head injuries during motorcycle accidents. However, South Korean motorcyclists have a lower prevalence of wearing a helmet, compared to developed countries. Therefore, we aimed to evaluate whether helmet wearing was associated with the clinical outcomes in Korean motorcycle accidents. Data were obtained from the Emergency Department-based Injury In-depth Surveillance database 2011-2015. We considered the patients had experienced a motorcycle accident and were only diagnosed with a craniocerebral trauma (CCT). The primary outcome was mortality and the secondary outcomes were the severity and hospitalization duration. The patients were separated whether they were wearing a helmet and the outcomes were compared using multivariate logistic regression after propensity score matching (PSM). Among 1,254,250 patients in the database, 2,549 patients were included. After PSM, 1,016 patients in each group were matched. The univariate analyses revealed that helmet wearing was associated with lesser severity (P < 0.001) and shorter hospitalization (P < 0.001). The regression analysis revealed that mortality was also lower in a helmet-wearing group (odds ratio: 0.34, 95% confidence interval: 0.21-0.56). In conclusion, wearing a helmet may reduce the mortality from a CCT after a motorcycle accident and associated with lesser severity and shorter hospitalization.

Assessment of the disaster medical response system through an investigation of a 43-vehicle mass collision on Jung-ang expressway

PURPOSE

It was considered the challenges of the actual response and the potential for improvement, including the activities of the disaster response system, national emergency medical center, and the regional base hospital for the treatment of multiple traffic accident victims. The purpose of this study was to analyze the accident management system through real investigating the multiple collision over 10 vehicles with mass casualty events as a disaster situation.

METHODS

This study was retrospective study to analyze the disaster event with multiple collision traffic accident on the expressway in Korea. We visited five medical centers for eight days since the accident occurred and interviewed the injured patients in this accident to examine the health status and medical records. After that, we visited the sixteen car-repair shops in four cities for real investigate about damaged vehicles. According to the arrangement of the accident situation for the accident vehicles through real-world investigation, we reproduced all parts of the accident scene, which were real-world investigated, by the accident situation sketch program. The collected data were summarized by Collision Deformation Classification (CDC) codes, and the medical records of the occupants were assessed using the Injury Severity Score (ISS).

RESULTS

The cause of the accident was snow freezing of the road. The information about 72 injured patients on 31 damaged vehicles was collected by phone, visit, and actual accident investigation. Of the 72 patients who were examined, 4 were severely injured and 68 were mildly injured. The accident occurred in the order of Sedan 13 (41.9%), SUV 11 (35.5%), Truck 4 (12.9%), Van 2 (6.5%) and Bus 1 (3.2%). The median value of the age [lower quartile and upper quartile] was 43 [34.5-52] years old and the patients included 25 drivers, 11 passengers, 7 back seat passengers, and 29 bus passengers.

CONCLUSION

The primary cause of this mass collision accident was road surface freezing, but the more serious secondary cause was a driver's inability to avoid the accident scene after the first collision. The severely injured occupants were occurred on the roads outside and inside the vehicle. In the event of a disaster, various teams from the police team, firefighting team, DMAT, EMS, road management team are gathered, and communication and command system between each team is important in order to identify and solve the disaster situation. To do this, it is important to develop manuals and prepare for training through repeated simulations.

Changes to the Korean Disaster Medical Assistance System After Numerous Multi-casualty Incidents in 2014 and 2015

Objective

A number of multiple-casualty incidents during 2014 and 2015 brought changes to Korea’s disaster medical assistance system. We report these changes here.

Methods

Reports about these incidents, revisions to laws, and the government’s revised medical disaster response guidelines were reviewed.

Results

The number of DMAT (Disaster Medical Assistance Team) staff members was reduced to 4 from 8, and the mobilization method changed. An emergency response manual was created that contains the main content of the DMAT, and there is now a DMAT training program to educate staff. The government created and launched a national 24-hour Disaster Emergency Medical Service Situation Room, and instead of the traditional wireless communications, mobile instant smart phone messaging has been added as a new means of communication. The number of disaster base hospitals has also been doubled.

Conclusion

Although there are still limitations that need to be remedied, the changes to the current emergency medical assistance system are expected to improve the system’s response capacity. (Disaster Med Public Health Preparedness. 2017;11:526–530)