Logistic Red Flags in Mass-Casualty Incidents and Disasters: A Problem-Based Approach

BACKGROUND

Mass-casualty incidents (MCIs) and disasters are characterized by a high heterogeneity of effects and may pose important logistic challenges that could hamper the emergency rescue operations.The main objective of this study was to establish the most frequent logistic challenges (red flags) observed in a series of Italian disasters with a problem-based approach and to verify if the 80-20 rule of the Pareto principle is respected.

METHODS

A series of 138 major events from 1944 through 2020 with a Disaster Severity Score (DSS) ≥ four and five or more victims were analyzed for the presence of twelve pre-determined red flags.A Pareto graph was built considering the most frequently observed red flags, and eventual correlations between the number of red flags and the components of the DSS were investigated.

RESULTS

Eight out of twelve red flags covered 80% of the events, therefore not respecting the 80-20 rule; the number of red flags showed a low positive correlation with most of the components of the DSS score. The Pareto analysis showed that potential hazards, casualty nest area > 2.5km2, number of victims over 50, evacuation noria over 20km, number of nests > five, need for extrication, complex access to victims, and complex nest development were the most frequently observed red flags.

CONCLUSIONS

Logistic problems observed in MCIs and disaster scenarios do not follow the 80-20 Pareto rule; this demands for careful and early evaluation of different logistic red flags to appropriately tailor the rescue response.

Hospital Disaster Preparedness in Italy: a preliminary study utilizing the World Health Organization Hospital Emergency Response Evaluation Toolkit

BACKGROUND

Natural and human-initiated disasters are occurring with greater devastating consequences and increased frequency. During these events, hospitals have the burden to care for acutely ill and injured patients. The aim of this study was to evaluate the level of disaster preparedness of Italian hospitals.

METHODS

Site visits were conducted from January, 2014 to December, 2014. The hospital emergency response checklist, developed by the WHO, was used as an evaluation toolkit. It consists of 92 items classified as 9 key components, such as command and control, triage, and critical services. The status of each component was determined by consensus of 3 independent evaluators.

RESULTS

The study selected 15 hospitals from different areas in Italy. Out of the 15 hospitals, 12 were considered to be at insufficients level of preparedness, only 3 were considered to have an effective level of preparedness. The average preparedness of all components were lower than the optimal level suggested by the WHO checklist.

CONCLUSIONS

The study revealed that a large majority of Italian hospitals evaluated are not well prepared to manage potential disasters. Also, all important elements of hospital preparedness, such as the command system, surge capacity, and safety, were insufficiently implemented. Nationwide standards, guidelines and procedures are required to improve hospital disaster preparedness in Italy.