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

Variations in ED Visits During Hurricane Irma in Florida and Potential Cost Savings Using Telehealth

Background: Periods of natural disasters like hurricanes can lead to traumas, worsening of existing medical conditions, travel restrictions, or healthcare systems’ inability to provide critical and timely care. A promising approach is telehealth use to provide care to remote patients in shelters or their homes. However, there is a need to better understand evacuees’ behavior and ED use during such events. Methods: We conducted a retrospective study using 2017 archival billing data in Florida during Hurricane Irma. The NYU ED algorithm was used to classify visits into emergent and non-emergent categories. Comparison groups included counties under mandatory evacuations and those with extended power outages. Comparison timelines were defined as pre-, post-, and hurricane quarters. Results: Hurricane evacuations caused more individuals to seek emergent and non-emergent care outside of their home counties during the hurricane quarter. Extended power outages caused an increase in in-county emergent and non-emergent visits after the hurricane. Telehealth could have potentially led to over $296 M in cost savings during the hurricane quarter. Discussion: Telehealth investments can be extended to meet the needs of a disaster-affected population. The availability of a robust telehealth infrastructure, appropriate planning and resource allocation, and supporting policies and regulation can make the continuity of care possible

Training of Crisis Mappers and Map Production from Multi-sensor Data: Vernazza Case Study (Cinque Terre National Park, Italy)

This aim of paper is to presents the development of a multidisciplinary project carried out by the cooperation between Politecnico di Torino and ITHACA (Information Technology for Humanitarian Assistance, Cooperation and Action). The goal of the project was the training in geospatial data acquiring and processing for students attending Architecture and Engineering Courses, in order to start up a team of "volunteer mappers". Indeed, the project is aimed to document the environmental and built heritage subject to disaster; the purpose is to improve the capabilities of the actors involved in the activities connected in geospatial data collection, integration and sharing. The proposed area for testing the training activities is the Cinque Terre National Park, registered in the World Heritage List since 1997. The area was affected by flood on the 25th of October 2011. According to other international experiences, the group is expected to be active after emergencies in order to upgrade maps, using data acquired by typical geomatic methods and techniques such as terrestrial and aerial Lidar, close-range and aerial photogrammetry, topographic and GNSS instruments etc.; or by non conventional systems and instruments such us UAV, mobile mapping etc. The ultimate goal is to implement a WebGIS platform to share all the data collected with local authorities and the Civil Protectio

Indoor Localization for Fire Safety : A brief overview of fundamentals, needs and requirements and applications

An indoor localization system for positioning evacuating people can be anticipated to increase the chances of a safe evacuation and effective rescue intervention in case of a tunnel fire. Such a system may utilize prevalent wireless technologies, e.g., Bluetooth, RFID and Wi-Fi, which today are used to survey incoming and outgoing traffic to a certain space or location, to estimate group sizes and to measure the duration of visits during normal operation of buildings. Examples also exist of where the same wireless technologies are used for safety purposes, for example to assess real-time location, tracking and monitoring of vehicles, personnel and equipment in mining environments. However, they are relatively few, and typically rely on a high degree of control over the people that are to be tracked, and their association with (connection to) the localization system used for the tracking. In this report, the results of a brief overview of the literature within the field of indoor localization in general, and the application of indoor localization systems within the field of particularly fire safety, is summarized. This information forms the underlying basis for the planning and execution of a future field study, in which an indoor Wi-Fi localization system will be tested and evaluated in terms of if, and if so how, it can be used to position evacuating people in tunnels. Whereas such a system allows digital footprints to be collected within a wireless network infrastructure (also already existing ones), questions remains to be answered regarding aspects such as precision and accuracy, and furthermore, how these aspects are affected by other independent variables. In the end of this report, examples of research questions deemed necessary to answer in order to enable a sound evaluation of the system is presented. These need to be addressed in the future planning of the above-mentioned field study

Localization, Visualization And Evacuation Guidance System In Emergency Situations

Urban search and rescue is needed for a variety of emergencies or disasters, including tornadoes, floods, dam failures, technological accidents, and terrorist activities. The efficiency to save people is becoming very important. With the development of the technology, people are trying to find a better way to help people get out of the dangerous places as soon as possible. DIORAMA system has been proposed to help with this problem and turns out very successful on improving efficiency during emergency situation. However, the current DIORAMA system is not perfect for all scenarios, for example, there are some outdoor environments do not support GPS service. Also, the RFID reader is very heavy for responders to carry and the indoor environment is not applicable for DIORAMA system. Besides, there are lack of forensic visualization toolkits that are able to help the incident commander analyze the responders’ behavior and efficiency. In this project, we propose a Localization, Visualization and Evacuation Guidance System in Emergency Situations. The functionalities in this system include localization in outdoor environments using BLE. Besides, for outdoor environments, some forensic visualization toolkit that can help the responder analyze the responders’ behavior with the capability of visualization and representation of data clearly as well as replay the task, detect anomalies and visualize the anomalies clearly is also provided in improving the efficiency and organization in the future task. In addition, the system also includes an indoor localization, navigation guidance and visualization system that provides guidance for people to exit a dangerous building as soon as possible. This system is able to localize the position of evacuees, and construct the exit path that helps reduce the escape time as well as provide a navigation guidance that is able to guide the user to the exit. In addition, an analyst simulation application is provided to simulate the evacuees in a building and evaluate the evacuation time for evacuees given specific path generation algorithm