IT-Supported Management of Mass Casualty Incidents: The e-Triage Project

Voice, analogue mobile radio, and paper have been successfully used for decades for coordination of emergencies and disasters, but although being simple and robust this approach cannot keep pace with today’s requirements any more. Emerging and established digital communication standards open the door to new applications and services, but the expected benefit needs to be carefully evaluated against robustness, interoperability, and user-friendliness. This paper describes a framework for IT-supported management of mass casualty incidents, which is currently under implementation and study. The four pillars of the concept are handheld devices for use both in daily rescue operations and in disasters, autonomous satellite-based communication infrastructure, a distributed database concept for maximal availability, and psychological acceptance research

Wearable proximity sensors for monitoring a mass casualty incident exercise: a feasibility study

Over the past several decades, naturally occurring and man-made mass casualty incidents (MCI) have increased in frequency and number, worldwide. To test the impact of such event on medical resources, simulations can provide a safe, controlled setting while replicating the chaotic environment typical of an actual disaster. A standardised method to collect and analyse data from mass casualty exercises is needed, in order to assess preparedness and performance of the healthcare staff involved. We report on the use of wearable proximity sensors to measure proximity events during a MCI simulation. We investigated the interactions between medical staff and patients, to evaluate the time dedicated by the medical staff with respect to the severity of the injury of the victims depending on the roles. We estimated the presence of the patients in the different spaces of the field hospital, in order to study the patients' flow. Data were obtained and collected through the deployment of wearable proximity sensors during a mass casualty incident functional exercise. The scenario included two areas: the accident site and the Advanced Medical Post (AMP), and the exercise lasted 3 hours. A total of 238 participants simulating medical staff and victims were involved. Each participant wore a proximity sensor and 30 fixed devices were placed in the field hospital. The contact networks show a heterogeneous distribution of the cumulative time spent in proximity by participants. We obtained contact matrices based on cumulative time spent in proximity between victims and the rescuers. Our results showed that the time spent in proximity by the healthcare teams with the victims is related to the severity of the patient's injury. The analysis of patients' flow showed that the presence of patients in the rooms of the hospital is consistent with triage code and diagnosis, and no obvious bottlenecks were found

Oslo government district bombing and Utøya island shooting July 22, 2011: The immediate prehospital emergency medical service response

<p>Abstract</p> <p>Background</p> <p>On July 22, 2011, a single perpetrator killed 77 people in a car bomb attack and a shooting spree incident in Norway. This article describes the emergency medical service (EMS) response elicited by the two incidents.</p> <p>Methods</p> <p>A retrospective and observational study was conducted based on data from the EMS systems involved and the public domain. The study was approved by the Data Protection Official and was defined as a quality improvement project.</p> <p>Results</p> <p>We describe the timeline and logistics of the EMS response, focusing on alarm, dispatch, initial response, triage and evacuation. The scenes in the Oslo government district and at Utøya island are described separately.</p> <p>Conclusions</p> <p>Many EMS units were activated and effectively used despite the occurrence of two geographically separate incidents within a short time frame. Important lessons were learned regarding triage and evacuation, patient flow and communication, the use of and need for emergency equipment and the coordination of helicopter EMS.</p

Considerations in Mass Casualty and Disaster Management

[Extract] Disasters have increased in frequency over the past century. A number of high profile disasters have also dominated news headlines in the past decade raising the media and community awareness, of disasters. This has been across the full spectrum of disasters and as illustrated in Table 1 has included terrorist bombings, hurricanes, earthquakes, tsunamis and floods

Review of current practices in recording road traffic incident data: with specific reference to spatial analysis and road policing policy

Road safety involves three major components: the road system, the human factor and the vehicle element. These three elements are inter-linked through geo-referenced traffic events and provide the basis for road safety analyses and attempts to reduce the number of road traffic incidents and improve road safety. Although numbers of deaths and serious injuries are back to approximately the 1950s levels when there were many fewer vehicles on the road, there are still over 100 fatalities or serious injuries every day, and this is a considerable waste of human capital. It is widely acknowledged that the location perspective is the most suitable methodology by which to analyse different traffic events, where by in this paper, I will concentrating on the relationship between road traffic incidents and traffic policing. Other methods include studying road and vehicle engineering and these will be discussed later. It is worth noting here that there is some division within the literature concerning the definitions of ‘accident’ and ‘incident’. In this paper I will use ‘incident’ because it is important to acknowledge a vast majority of ‘road accidents’ are in fact crimes. However I will use the term ‘accident’ where it is referred to in the literature or relevant reports. It is important to mention here that a road traffic accident can be defined as ‘the product of an unwelcome interaction between two or more moving objects, or a fixed and moving object’ (Whitelegg 1986). Road safety and road incident reduction relates to many other fields of activity including education, driver training, publicity campaigns, police enforcement, road traffic policing, the court system, the National Health Service and Vehicle engineering. Although the subject of using GIS to analyse road traffic incidents has not received much academic attention, it lies in the field of crime mapping which is becoming increasingly important. It is clear that studies have been attempted to analyse road traffic incidents using GIS are increasingly sophisticated in terms of hypotheses and statistical technique (for example see Austin, Tight and Kirby 1997). However it is also clear that there is considerable blurring of boundaries and the analysis of road accidents sits uncomfortably in crime mapping. This is due to four main reasons: - Road traffic incidents are associated with road engineering, which is concerned with generic solutions while road traffic analysis is about sensitivity to particular contexts. - Not all road traffic incidents are crimes - It is not just the police who have an interest in reducing road traffic incidents, other partners include local authorities, hospitals and vehicle manufacturers - The management of road traffic incidents is not just confined to the police GIS has been used for over thirty years however it has only been recently been used in the field of transportation. The field of transportation has come to embrace Geographical Information Systems as a keytechnology to support its research and operational need. The acronym GIS-T is often employed to refer to the application and adaptation of GIS to research, planning and management in transportation. GIS-T covers a broad arena of disciplines of which road traffic incident detection is just one theme. Others include in vehicle navigation systems. Initially it was only used to ask simple accident enquiries such as depicting the relative incidence of accidents in wet weather or when there is no street lighting, or to flag high absolute or relative incidences of accidents (see Anderson 2002). Recently however there has been increased acknowledgement that there is a requirement to go beyond these simple questions and to extend the analyses. It has been widely claimed by academics and the police alike that knowing where road accidents occur must lead to better road policing, in order to ensure that road policing becomes better integrated with other policing activities. This paper will be used to explore issues surrounding the analysis of road traffic accidents and how GIS analysts, police and policy makers can achieve a better understanding of road traffic incidents and how to reduce them. For the purpose of this study I will be trying to achieve a broader overview of the aspects concerning road accident analysis with a strong emphasis on data quality and accuracy with concern to GIS analysis. Data quality and accuracy are seen as playing a pivotal role in the road traffic management agenda because they assist the police and Local Authorities as to the specific location whereby management can be undertaken. Part one will consider the introduction to road incidents and their relationship with geography and spatial analysis and how this were initially applied to locating ‘hotspots’ and the more recent theory of ‘accident migration’. Part two will address current data issues of the UK collection procedure. This section will pay particular reference to geo-referencing and the implication of data quality on the procedure of analysing road incidents using GIS. Part three addresses issues surrounding the spatial analysis of road traffic incidents, including some techniques such as spatial autocorrelation, time-space geography and the modifiable area unit problem. Finally part four looks at the role of effective road traffic policing and how this can be achieved due to better understanding of the theory and issues arising from analysing road traffic incidents. It will also look at the diffusion and use of GIS within the police and local authorities

Burn mass casualty incidents in Europe: A European response plan within the European Union Civil Protection Mechanism

Background: Burn care is centralized in highly specialized burn centers in Europe. These centers are of limited capacity and may be overwhelmed by a sudden surge in case of a burn mass casualty incident. Prior incidents in Europe and abroad have sustained high standards of care through well-orchestrated responses to share the burden of care in several burn centers. A burn mass casualty incident in Romania in 2015 sparked an initiative to strengthen the existing EU mechanisms. This paper aims to provide insight into developing a response plan for burn mass casualties within the EU Civil Protection Mechanism. Methods: The European Burns Association drafted medical guidelines for burn mass casualty incidents based on a literature review and an in-depth analysis of the Romanian incident. An online questionnaire surveyed European burn centers and EU States for burn mass casualty preparedness. Results: The Romanian burn mass casualty in 2015 highlighted the lack of a burn-specific mechanism, leading to the late onset of international transfers. In Europe, 71% of respondents had existing mass casualty response plans, though only 35% reported having a burn-specific plan. A burns response plan for burn mass casualties was developed and adopted as a Commission staff working document in preparation for further implementation. The plan builds on the existing Union Civil Protection Mechanism framework and the standards of the WHO Emergency Medical Teams initiative to provide 1) burn assessment teams for specialized in-hospital triage of patients, 2) specialized burn care across European burn centers, and 3) medevac capacities from participating states. Conclusion: The European burn mass casualty response plan could enable the delivery of high-level burn care in the face of an overwhelming incident in an affected European country. Further steps for integration and implementation of the plan within the Union Civil Protection Mechanism framework are needed.publishedVersio

Review of On-Scene Management of Mass-Casualty Attacks

Background: The scene of a mass-casualty attack (MCA) entails a crime scene, a hazardous space, and a great number of people needing medical assistance. Public transportation has been the target of such attacks and involves a high probability of generating mass casualties. The review aimed to investigate challenges for on-scene responses to MCAs and suggestions made to counter these challenges, with special attention given to attacks on public transportation and associated terminals. Methods: Articles were found through PubMed and Scopus, “relevant articles” as defined by the databases, and a manual search of references. Inclusion criteria were that the article referred to attack(s) and/or a public transportation-related incident and issues concerning formal on-scene response. An appraisal of the articles’ scientific quality was conducted based on an evidence hierarchy model developed for the study. Results: One hundred and five articles were reviewed. Challenges for command and coordination on scene included establishing leadership, inter-agency collaboration, multiple incident sites, and logistics. Safety issues entailed knowledge and use of personal protective equipment, risk awareness and expectations, cordons, dynamic risk assessment, defensive versus offensive approaches, and joining forces. Communication concerns were equipment shortfalls, dialoguing, and providing information. Assessment problems were scene layout and interpreting environmental indicators as well as understanding setting-driven needs for specialist skills and resources. Triage and treatment difficulties included differing triage systems, directing casualties, uncommon injuries, field hospitals, level of care, providing psychological and pediatric care. Transportation hardships included scene access, distance to hospitals, and distribution of casualties. Conclusion: Commonly encountered challenges during unintentional incidents were added to during MCAs, implying specific issues for safety, assessment, triage, and treatment, which require training. Effectively increasing readiness for MCAs likely entail struggles to overcome fragmentation between the emergency services and the broader crisis management system as well as enabling critical and prestige-less, context-based assessments of needed preparatory efforts

Review of On-Scene Management of Mass-Casualty Attacks

Background: The scene of a mass-casualty attack (MCA) entails a crime scene, a hazardous space, and a great number of people needing medical assistance. Public transportation has been the target of such attacks and involves a high probability of generating mass casualties. The review aimed to investigate challenges for on-scene responses to MCAs and suggestions made to counter these challenges, with special attention given to attacks on public transportation and associated terminals. Methods: Articles were found through PubMed and Scopus, "relevant articles" as defined by the databases, and a manual search of references. Inclusion criteria were that the article referred to attack(s) and/or a public transportation-related incident and issues concerning formal on-scene response. An appraisal of the articles' scientific quality was conducted based on an evidence hierarchy model developed for the study. Results: One hundred and five articles were reviewed. Challenges for command and coordination on scene included establishing leadership, inter-agency collaboration, multiple incident sites, and logistics. Safety issues entailed knowledge and use of personal protective equipment, risk awareness and expectations, cordons, dynamic risk assessment, defensive versus offensive approaches, and joining forces. Communication concerns were equipment shortfalls, dialoguing, and providing information. Assessment problems were scene layout and interpreting environmental indicators as well as understanding setting-driven needs for specialist skills and resources. Triage and treatment difficulties included differing triage systems, directing casualties, uncommon injuries, field hospitals, level of care, providing psychological and pediatric care. Transportation hardships included scene access, distance to hospitals, and distribution of casualties. Conclusion: Commonly encountered challenges during unintentional incidents were added to during MCAs, implying specific issues for safety, assessment, triage, and treatment, which require training. Effectively increasing readiness for MCAs likely entail struggles to overcome fragmentation between the emergency services and the broader crisis management system as well as enabling critical and prestige-less, context-based assessments of needed preparatory efforts