Challenge Patient Dispatching in Mass Casualty Incidents

Efficient management of mass casualty incidents is complex, since regular emergency medical services struc-tures have to be switched to a temporary “disaster mode” involving additional operational and tactical struc-tures. Most of the relevant decisions have to be taken on-site in a provisional and chaotic environment. Data gathering about affected persons is one side of the coin; the other side is on-site patient dispatching requiring information exchange with the regular emergency call center and destination hospitals. In this paper we extend a previous conference contribution about the research project e-Triage to the aspect of patient data and on-site patient dispatching. Our considerations reflect the situation in Germany, which deserves from our point of view substantial harmonization

Data-driven System Design in Service Operations

The service industry has become an increasingly important component in the world's economy. Simultaneously, the data collected from service systems has grown rapidly in both size and complexity due to the rapid spread of information technology, providing new opportunities and challenges for operations management researchers. This dissertation aims to explore methodologies to extract information from data and provide powerful insights to guide the design of service delivery systems. To do this, we analyze three applications in the retail, healthcare, and IT service industries. In the first application, we conduct an empirical study to analyze how waiting in queue in the context of a retail store affects customers' purchasing behavior. The methodology combines a novel dataset collected via video recognition technology with traditional point-of-sales data. We find that waiting in queue has a nonlinear impact on purchase incidence and that customers appear to focus mostly on the length of the queue, without adjusting enough for the speed at which the line moves. We also find that customers' sensitivity to waiting is heterogeneous and negatively correlated with price sensitivity. These findings have important implications for queueing system design and pricing management under congestion. The second application focuses on disaster planning in healthcare. According to a U.S. government mandate, in a catastrophic event, the New York City metropolitan areas need to be capable of caring for 400 burn-injured patients during a catastrophe, which far exceeds the current burn bed capacity. We develop a new system for prioritizing patients for transfer to burn beds as they become available and demonstrate its superiority over several other triage methods. Based on data from previous burn catastrophes, we study the feasibility of being able to admit the required number of patients to burn beds within the critical three-to-five-day time frame. We find that this is unlikely and that the ability to do so is highly dependent on the type of event and the demographics of the patient population. This work has implications for how disaster plans in other metropolitan areas should be developed. In the third application, we study workers' productivity in a global IT service delivery system, where service requests from possibly globally distributed customers are managed centrally and served by agents. Based on a novel dataset which tracks the detailed time intervals an agent spends on all business related activities, we develop a methodology to study the variation of productivity over time motivated by econometric tools from survival analysis. This approach can be used to identify different mechanisms by which workload affects productivity. The findings provide important insights for the design of the workload allocation policies which account for agents' workload management behavior

Triage Systems in Mass Casualty Incidents and Disasters: A Review Study with A Worldwide Approach

BACKGROUND: Injuries caused by emergencies and accidents are increasing in the world. To prioritise patients to provide them with proper services and to optimally use the resources and facilities of the medical centres during accidents, the use of triage systems, which are one of the key principles of accident management, seems essential. AIM: This study is an attempt to identify available triage systems and compare the differences and similarities of the standards of these systems during emergencies and disasters through a review study. METHODS: This study was conducted through a review of the triage systems used in emergencies and disasters throughout the world. Accordingly, all articles published between 1990 and 2018 in both English and Persian journals were searched based on several keywords including Triage, Disaster, Mass Casualty Incidents, in the Medlib, Scopus, Web of Science, Pubmed, Cochrane Library, Science Direct, Google scholar, Irandoc, Magiran, Iranmedex, and SID databases in isolation and in combination using both and/ or conjunctions. RESULTS: Based on the search done in these databases, twenty different systems were identified in the primary adult triage field including START, Homebush triage Standard, Sieve, Care Flight, STM, Military, CESIRA Protocol, MASS, Revers, CBRN Triage, Burn Triage, META Triage, Mass Gathering Triage, SwiFT Triage, MPTT, TEWS Triage, Medical Triage, SALT, mSTART and ASAV. There were two primary triage systems including Jump START and PTT for children, and also two secondary triage systems encompassing SAVE and Sort identified in this respect. ESI and CRAMS were two other cases distinguished for hospital triage systems. CONCLUSION: There are divergent triage systems in the world, but there is no general and universal agreement on how patients and injured people should be triaged. Accordingly, these systems may be designed based on such criteria as vital signs, patient's major problems, or the resources and facilities needed to respond to patients’ needs. To date, no triage system has been known as superior, specifically about the patients’ clinical outcomes, improvement of the scene management or allocation of the resources compared to other systems. Thus, it is recommended that different countries such as Iran design their triage model for emergencies and disasters by their native conditions, resources and relief forces

Anaesthesia for trauma patients

No Abstract

Rad/Nuc EMS Response Roundtable, 8/19-20/2010

The Radiation Studies Branch (RSB) of the Centers for Disease Control and Prevention\u2019s (CDC) National Center for Environmental Health (NCEH) convened a meeting August 19\u201320, 2010, in Atlanta, Georgia. The meeting, a roundtable of Emergency Management Services (EMS) experts, was held at the Westin Atlanta Perimeter North Hotel. Attachment 1 lists those attending.The meeting\u2019s goals, described by RSB Chief Dr. Charles Miller, were 1) to discuss the extent of the EMS community\u2019s preparedness for a mass casualty radiation incident, what it may need, and how CDC could help, and 2) to explore other questions that should be posed and addressed. The input from this and other similar meetings will contribute to the development of new or updated training aids and educational materials.Publication date from document properties.cdc-ems-radiation-roundtable-report-508.pd

Delivering trauma and rehabilitation interventions to women and children in conflict settings: A systematic review

Background: In recent years, more than 120 million people each year have needed urgent humanitarian assistance and protection. Armed conflict has profoundly negative consequences in communities. Destruction of civilian infrastructure impacts access to basic health services and complicates widespread emergency responses. The number of conflicts occurring is increasing, lasting longer and affecting more people today than a decade ago. The number of children living in conflict zones has been steadily increasing since the year 2000, increasing the need for health services and resources. This review systematically synthesised the indexed and grey literature reporting on the delivery of trauma and rehabilitation interventions for conflict-affected populations.Methods: A systematic search of literature published from 1 January 1990 to 31 March 2018 was conducted across several databases. Eligible publications reported on women and children in low and middle-income countries. Included publications provided information on the delivery of interventions for trauma, sustained injuries or rehabilitation in conflict-affected populations.Results: A total of 81 publications met the inclusion criteria, and were included in our review. Nearly all of the included publications were observational in nature, employing retrospective chart reviews of surgical procedures delivered in a hospital setting to conflict-affected individuals. The majority of publications reported injuries due to explosive devices and remnants of war. Injuries requiring orthopaedic/reconstructive surgeries were the most commonly reported interventions. Barriers to health services centred on the distance and availability from the site of injury to health facilities.Conclusions: Traumatic injuries require an array of medical and surgical interventions, and their effective treatment largely depends on prompt and timely management and referral, with appropriate rehabilitation services and post-treatment follow-up. Further work to evaluate intervention delivery in this domain is needed, particularly among children given their specialised needs, and in different population displacement contexts

How Violent Attacks Are Changing The Demands of Mass Casualty Incidents: A Review of The Challenges Associated with Intentional Mass Casualty Incidents

The article record as published may be found at https://www.hsaj.org/articles/16880Antagonistically induced mass casualty incidents (MCI) introduce unique conditions that are rarely addressed in current MCI policies. Many of today’s MCIs are intentional acts of violence, such as mass shootings, improvised explosions, mass stabbings, vehicle rammings, and other similar assault tactics.Sponsored the U. S. Department of Homeland Security’s National Preparedness Directorate, FEMA, CHDS is part of the Naval Postgraduate School (NPS)

Emergencies and Public Health Crisis Management- Current Perspectives on Risks and Multiagency Collaboration

The successful management of emergencies and public health crises depends on adequate measures being implemented at all levels of the emergency chain of action, from policy makers to the general population. It starts with appropriate risk assessment, prevention, and mitigation and continues to prehospital and hospital care, recovery, and evaluation. All levels of action require well-thought out emergency management plans and routines based on established command and control, identified safety issues, functional communication, well-documented triage and treatment policies, and available logistics. All these characteristics are capabilities that should be developed and trained, particularly when diverse agencies are involved. In addition to institutional responses, a robust, community-based disaster response system can effectively mitigate and respond to all emergencies. A well-balanced response is largely dependent on local resources and regional responding agencies that all too often train and operate within “silos”, with an absence of interagency cooperation. The importance of this book issue is its commitment to all parts of emergency and public health crisis management from a multiagency perspective. It aims to discuss lessons learned and emerging risks, introduce new ideas about flexible surge capacity, and show the way it can practice multiagency collaboration