Mass Casualty Incident Management Preparedness: A Survey of the American College of Surgeons Committee on Trauma

Mass casualty incidents (MCIs) are events resulting in more injured patients than hospital systems can handle with standard protocols. Several studies have assessed hospital preparedness during MCIs. However, physicians and trauma surgeons need to be familiar with their hospital's MCI Plan. The purpose of this survey was to assess hospitals' and trauma surgeon's preparedness for MCIs. Online surveys were e-mailed to members of the American College of Surgeons committee on Trauma Ad Hoc Committee on Disaster and Mass Casualty Management before the March 2012 meeting. Eighty surveys were analyzed (of 258). About 76 per cent were American College of Surgeons Level I trauma centers, 18 per cent were Level II trauma centers. Fifty-seven per cent of Level I and 21 per cent of Level II trauma centers had experienced an MCI. A total of 98 per cent of respondents thought it was likely their hospital would see a future MCI. Severe weather storm was the most likely event (95%), followed by public transportation incident (86%), then explosion (85%). About 83 per cent of hospitals had mechanisms to request additional physician/surgeons, and 80 per cent reported plans for operative triage. The majority of trauma surgeons felt prepared for an MCI and believed an event was likely to occur in the future. The survey was limited by the highly select group of respondents and future surveys will be necessary.

Scientific framework for research on disaster and mass casualty incident in Korea: building consensus using Delphi method

We aimed to determine the scientific framework for research on disaster and mass casualty incident (MCI) in Korea, especially Korean terminology, feasible definition, and epidemiologic indices. The two staged policy Delphi method was performed by instructors of National Disaster Life Support (NDLS®) with the constructed questionnaire containing items based on the literature review. The first-stage survey was conducted by 11 experts through two rounds of survey for making issue and option. The second-stage survey was conducted by 35 experts for making a generalized group based consensus. Experts were selected among instructors of National Disaster Life Support Course. Through two staged Delphi survey experts made consensus: 1) the Korean terminology "jaenan" with "disaster" and "dajung-sonsang-sago" with "MCI"; 2) the feasible definition of "disaster" as the events that have an effect on one or more municipal local government area (city-county-district) or results in ≥ 10 of death or ≥ 50 injured victims; 3) the feasible definition of MCI as the events that result in ≥ 6 casualties including death; 4) essential 31 epidemiologic indices. Experts could determine the scientific framework in Korea for research on disaster medicine, considering the distinct characteristics of Korea and current research trends.

Passenger behavior in trains during emergency situations

INTRODUCTION

This research presents a methodology for analyzing the behavior of people (passengers and crew) involved in emergency situations on passenger trains.

METHODS

This methodological tool centers around a qualitative character study coming from Focus Groups (FG) and in-depth interviews to extract the determinant variables on passenger and crew behavior when faced with certain emergency situations on trains.

RESULTS

This research has led to the creation of a classification of possible behaviors associated to each type of incident and dependent on certain variables. The qualitative study was used as the basis for modeling stated preference data using logit type discrete choice models to characterize and quantify the behavior. The most important results show that the determinant variables on passenger behavior correspond to the type of emergency suffered (its degree of seriousness), the type of passenger, the reasons for the journey (demands of time), the information received during the incident, the relationship between crew and passengers, the duration of the incident and the conditions (temperature control, availability of water, occupancy of the train), the distance to the destination station, and finally, the outside weather conditions. This research was carried out using the Spanish railway network as its reference, although it is applicable to any geographical area.

IMPACT ON INDUSTRY

The results show that the information variable should be considered in the development of future research and that the evidences of this research can be used to develop behavioral models for modeling railway passenger evacuations.

[Combat sick and wounded casualty: classification, notions and problems]

The nowdays all possible damages and diseases by the staff during a war, are systematized in a special classification of combat damages and diseases, which is based on effect of main damage factors of weapon. Analyzing existent classification and determination "sanitarium casualty", it should be pointed out that they were formed more than 50 years ago, and they have gone out of date. Theirs significs is projected not adequately in practice of medical supply. Therefore determinations of sanitarium casualty, used in practice and in documentation, are not full and not always clearly explain about which casualty is talking. Moreover, several authors (frequently it is functionary of hospital) faultily or by reason of not-understanding write and talk about sanitarium casualty, meaning wounded and ill persons, admitted to hospital and being treated there.

Differentiating mass disasters. The barzullah classification

BACKGROUND

To assess the pattern of mass casualty incidents managed at our hospital over the last eight years, and evolve a differentiating classification based on this pattern. A combination of retrospective and prospective assessment was made.

MATERIAL AND METHODS

All patients receiving injuries in mass casualty incidents and managed at our hospital. Patients with an injury severity score above 9. Management of injuries as per the trauma management protocol. Classification based on the data collected during the study and application of this classification to the subsequent mass casualty incidents to allow comparison between similar incidents in different settings.

RESULTS

A classification system that mainly differentiates mass casualty incidents on the hospital basis, the criteria being: the time interval between the first information to first reception, and the percentage of admission above the maximum normal intake.

CONCLUSIONS

The Barzullah classification system is the first attempt at developing a hospital based differentiation in mass casualty incidents. It provides a valid and easy method of comparing such incidents between hospitals and perhaps a basis for developing protocol for mass disaster management.