Prioritized Criteria for Casualty Distribution following Trauma-related Mass Incidents; a Modified Delphi Study

Introduction: In the aftermath of mass casualty incidents (MCIs), many decisions need to be made in a fast and influential manner in a high pressure environment to distribute the limited resources among the numerous demands. This study was planned to rank the criteria influencing distribution of casualties following trauma-related MCI. Methods: This study utilized a modified Delphi methodology, concentrating on extracted criteria attained from preceding systematic literature reviews. The 114 extracted criteria were classified into eight sections including space, staff, equipment, system and structures, triage, treatment, transport, and uncategorized criteria and were imported into an online survey tool. In the first round, experts were asked to rank each criterion on a five-point Likert scale. The second round incorporated feedbacks from the first round, stating percent and median scores from the panel as a whole. Experts were then called upon to reassess their initial opinions regarding uncertain remarks from the first round, and once again prioritize the presented criteria. Results: Fifty-seven criteria were regarded as relevant to the following sections: space: 70% (7/10); staff: 44% (4/9); system / structure: 80% (4/5); equipment: 39.1% (9/23); treatment; 66.7% (6/9); triage: 73.7% (14/19); transport: 38.7% (12/31) and other sections: 12.5% (1/8). The first round achieved nearly 98% (n=48) response rate. Of the 114 criteria given to the experts, 68 (almost 60%) were approved. The highest percentage of approval belonged to the system and structures sections (4/5=80%). The response rate for the second round was about 86% (n=42). A consensus could be reached about nearly 84% (57) of the 68 criteria presented to experts. Conclusion: "Casualty Level of Triage on the Scene" and "Number of Available Ambulances" were the two criteria that obtained the highest level of consensus. On the other hand, "gender of casualty", "Number of Non-Medical staff in each Hospital" and "Desire to transport family members together" got lowest level of consensus. This sorted list could be used as a catalogue for developing a decision support system or tool for distribution of victims following mass casualty incidents. KEYWORDS:Mass casualty incidents; decision making; supply and distribution; wounds and injurie

Criteria and models for the distribution of casualties in trauma-related mass casualty incidents: a systematic literature review protocol

Abstract Background One of the most critical practices in mass casualty incident management is vacating the victims from scene of the incident and transporting them to proper healthcare facilities. Decision on distribution of casualties needs to be taken on pre-developed policies and structured decision support mechanisms. While many studies tried to present models for the distribution of casualties, no systematic review has yet been conducted to evaluate the existing models on casualty distribution following mass casualty incidents. A systematic review is therefore needed to examine the existing models of patient distribution and to provide a summary of the models. This systematic review protocol is aimed to examine the existing models and extracting rules and principles of mass casualty distribution. Methods This study will comprehensively investigate existing papers with search phrases and terms including “mass casualty incident”, distribution, evacuation, and Mesh terms directly corresponding to search phrases. No limitations on the type of studies, date of publication, or language of the relevant documents will be imposed. PubMed, Web of Science, Scopus, and Google Scholar will be searched to access the relevant documents. Included papers will be critically appraised by two independent reviewers. The data including incidents type, scene characteristics, patient features, pre-hospital resources, and hospital resources will be categorized. Subgroup analysis will be conducted when possible. Discussion To the best of our knowledge, no study has yet addressed the effects and interaction of contributing factors on the decision-making processes for casualty’s distribution. This is the first study that comprehensively assesses and critically appraises the current models of casualty distribution. This study will provide evidences about models and criteria for casualty distribution following mass casualty incidents. Systematic review registration PROSPERO Registration Number: CRD4201604911

Additional file 1: of Criteria and models for the distribution of casualties in trauma-related mass casualty incidents: a systematic literature review protocol

PRISMA-P Checklist, Filename: PRISMA-P + checklist. (DOCX 397 kb