The document discusses mass casualty incidents (MCIs) and lessons learned from past events. It defines MCIs and different levels based on severity. The philosophy of care shifts from individuals to the greatest number in MCIs. Past events like Gallant Eagle and Beirut demonstrated the importance of coordination, triage, and evacuation. The Tokyo sarin gas attack showed limitations of emergency responders and need for improved communication and cooperation between agencies.
The document discusses the Early Warning Score (EWS) system, which is a simple scoring method used to rapidly identify clinically deteriorating patients based on 5 physiological parameters. Studies have shown that implementing an EWS protocol can effectively reduce mortality and morbidity for deteriorating patients as well as prevent ICU admissions. The EWS allows for early detection of patients who need urgent medical review and intervention to avoid further physiological deterioration.
Triage is the process of sorting patients based on the urgency of their condition to provide the right care to the right patient at the right time. It involves initially assessing patients at arrival to identify those needing immediate care, determine the appropriate treatment area, and avoid congestion. The goals are to treat the most severely injured first while maximizing survival in a mass casualty event. Triage categories range from resuscitation to non-urgent to ensure critical patients receive rapid medical attention. Reassessment is important as a patient's condition may deteriorate while waiting.
This document provides information about disaster management in hospitals. It begins with an introduction to disaster management, defining key terms like disaster, management, and disaster management. It then discusses the phases of disaster management and outlines disaster action plans, management plans, and relevant acts. It also covers hospital disaster plans and committees. The document discusses various types of disasters and provides examples of recent hospital disasters in India. It emphasizes the importance of disaster preparedness and provides guidelines for various emergency responses, including to fires and floods.
This document provides an overview of incident reporting in a healthcare facility. It defines an incident and the main types: near misses, adverse events, and sentinel events. Near misses have the potential to cause harm but do not, while adverse events do cause unintended harm. Sentinel events result in major loss of function or death. The presentation outlines how and when to report each type of incident and the importance of reporting near misses to prevent future harm. It also describes the root cause analysis process used to determine why failures occurred and how to submit an accurate and thorough incident report.
the emergency assessment to be done carefully and immediately .the emergency nurse have quick review and deliver the health carein the quality manner in all the fields of health care as medical,surgical, paediatric ,and obstertics .
The document discusses the Early Warning Score (EWS) system, which is a simple scoring method used to rapidly identify clinically deteriorating patients based on 5 physiological parameters. Studies have shown that implementing an EWS protocol can effectively reduce mortality and morbidity for deteriorating patients as well as prevent ICU admissions. The EWS allows for early detection of patients who need urgent medical review and intervention to avoid further physiological deterioration.
Triage is the process of sorting patients based on the urgency of their condition to provide the right care to the right patient at the right time. It involves initially assessing patients at arrival to identify those needing immediate care, determine the appropriate treatment area, and avoid congestion. The goals are to treat the most severely injured first while maximizing survival in a mass casualty event. Triage categories range from resuscitation to non-urgent to ensure critical patients receive rapid medical attention. Reassessment is important as a patient's condition may deteriorate while waiting.
This document provides information about disaster management in hospitals. It begins with an introduction to disaster management, defining key terms like disaster, management, and disaster management. It then discusses the phases of disaster management and outlines disaster action plans, management plans, and relevant acts. It also covers hospital disaster plans and committees. The document discusses various types of disasters and provides examples of recent hospital disasters in India. It emphasizes the importance of disaster preparedness and provides guidelines for various emergency responses, including to fires and floods.
This document provides an overview of incident reporting in a healthcare facility. It defines an incident and the main types: near misses, adverse events, and sentinel events. Near misses have the potential to cause harm but do not, while adverse events do cause unintended harm. Sentinel events result in major loss of function or death. The presentation outlines how and when to report each type of incident and the importance of reporting near misses to prevent future harm. It also describes the root cause analysis process used to determine why failures occurred and how to submit an accurate and thorough incident report.
the emergency assessment to be done carefully and immediately .the emergency nurse have quick review and deliver the health carein the quality manner in all the fields of health care as medical,surgical, paediatric ,and obstertics .
1) The document discusses key terms and concepts related to emergency and disaster nursing including triage, trauma, emergency management, BLS, ACLS, defibrillation, disasters, and mass casualty incidents.
2) It describes the scope of practice of emergency nurses which includes specialized education and training to assess and prioritize care of acutely ill patients, support families, supervise staff, and provide care in a fast-paced environment.
3) Issues in emergency nursing are discussed such as the diversity of conditions, legal concerns, and providing holistic care in a high-stress environment where serious illness and death are common.
Hello ,
Disaster management is a vast topic which cant be cover in one ppt so i have taken one particular topic which is on Triage in disaster Management . I am trying to elaborate the topics by putting few pictures , if anyone have any problem with understand the ppt ,I have mentioned the reference guide . They can check it .
Thnks
KIRTTI
Disaster plans in hospitals and health care centersDr. Samir Sawli
Emergencies and disasters can happen at any moment – and, they usually occur without warning. When an emergency strikes, the safety of patients and staff will depend on the existing preparedness of Departments and their staff.
Hospital and Department Disaster Response Plans are developed and written to provide fundamental support and direction to all concerned staff.
These plans are an essential building block of the Hospital’s response to a crisis.
They are part of every Department’s basic health and safety responsibilities; as well as operational continuity and planning
Triage is the process of sorting patients based on the urgency of their condition to provide the right care to the patients who need it most. It involves an initial assessment of patients upon arrival to identify life-threatening issues and prioritize patients into categories based on need. The document outlines the goals and categories of triage in both emergency and disaster situations, with categories ranked from resuscitation to non-urgent based on the threat to life, limb, or function. It also describes the key components of triage including an initial across-the-room assessment and ongoing re-assessments to adjust patient priority as needs change.
This document discusses different types of patient transfers within and between hospitals and outlines guidelines for safe transfers. It identifies that transfers, especially of critically ill patients, can pose risks. Adverse events during transfers have been reported in 6-70% of cases, including changes in vital signs, unplanned extubation, and cardiac arrest (rates as high as 8%). Risks are greater for sicker patients and urgent transfers. Factors like communication, equipment, monitoring, and planning are important to consider. The document provides tables outlining reported adverse events and mishaps during transfers. It emphasizes the need for guidelines addressing who, what, when, where, why and how questions before any patient transfer.
The document outlines protocols for responding to cardiopulmonary arrests, known as Code Blues. It describes initiating Basic Life Support, Advanced Cardiac Life Support, or Pediatric Advanced Life Support depending on the patient. It provides details on activating emergency codes, assembling code teams, performing immediate interventions like CPR and defibrillation, notifying physicians, and transferring patients to the emergency department. Crash carts and equipment are also discussed, including obtaining replacement carts and charging used items.
CARDIOPULMONARY RESUSCITATION- BLS & ACLS-2020 AHA UPDATEAryaDasmahapatra
This document provides information about cardiopulmonary resuscitation (CPR) and the basic life support (BLS) and advanced cardiac life support (ACLS) protocols. It begins with definitions of CPR and its purposes to support life through circulation and prevent brain damage from lack of oxygen. The history of developments in CPR techniques from chest compressions to defibrillation are outlined. Adult and pediatric BLS protocols are described, including assessing responsiveness, calling for help, performing high-quality chest compressions, opening the airway, rescue breathing, and using an automated external defibrillator. Differences in CPR for adults, children and infants are also summarized.
This document provides information on emergency care and triage. It discusses the principles of emergency care which include providing care without delay and using triage to prioritize patients. Triage involves sorting patients into categories of emergent, urgent, and non-urgent based on the seriousness of their conditions. The document then describes the triage process in more detail, including the different color codes used to categorize patients and the criteria for each category. It also discusses the roles of triage team members and how to set up an effective triage system.
Emergency is the gateway to the hospital, patients with pain and agony, relative emotionally charged enter the emergency department at any hour of the day or night, expecting immediate treatment and solace.
Triage originated during World War I to prioritize treatment of wounded soldiers. It involves sorting patients into three categories based on need for immediate care. The goal of triage is to rapidly identify life-threatening conditions and determine the most appropriate treatment area, while decreasing congestion and providing ongoing assessment. The triage nurse greets patients, performs brief assessments, documents findings, assigns priority levels, and communicates with treatment staff. Triage is a dynamic process that involves reassessing patients, as conditions can improve or deteriorate during the wait for care.
The document provides information on various emergency codes used in hospitals. It defines codes for cardiac arrest (Code Blue), external disasters (Code Yellow), child abductions (Code Pink), physical assaults (Code Purple), bomb threats or internal disasters (Code Black), fires (Code Red), and evacuations (Code Orange). For each code, it describes how and when to activate the code, the objectives, and procedures for responding. For example, for Code Blue it notes to start life support, have the code blue team arrive within 5 minutes, and lists the code blue team members. The codes provide a way to quickly convey emergencies to staff while preventing panic.
Introduction to advanced prehospital careBen Lesold
This document provides an overview of the roles and responsibilities of an Advanced EMT-Critical Care Technician (AEMT-CC). It discusses key topics including the EMS system, education and certification requirements, medical direction, documentation, and quality assurance. The primary responsibilities of an AEMT-CC are preparation, response, patient assessment, treatment, documentation, and ensuring the patient's appropriate disposition. Medical direction and adherence to protocols are essential to ensure consistent, high-quality patient care.
1. The trauma protocol outlines the assessment and management of critically injured patients according to ATLS guidelines, with a focus on the ABCs - airway, breathing, circulation, disability and exposure.
2. Interventions include securing the airway with bag-valve-mask ventilation or intubation, assessing breathing with pulse oximetry and chest x-rays, supporting circulation with IV access and fluid boluses, evaluating neurologic status via GCS, and conducting a full secondary survey and spinal precautions.
3. Additional tests such as FAST scan, pelvic films and head/neck CTs help guide management, which may involve mechanical ventilation, chest tube insertion, blood transfusion, pelvic binding, wound
This document discusses mass casualty management and disaster preparedness for hospitals. It provides data on road traffic accidents in Nepal and describes key aspects of managing mass casualty incidents, including establishing triage, conducting primary and secondary surveys, and activating disaster plans. The main points are:
1) Triage is crucial to prioritize patients and direct them to the appropriate level of care. The START method is described.
2) During primary survey, life threats like airway, breathing, and circulation are addressed within 2-5 minutes.
3) Secondary survey thoroughly examines all body systems to identify minor injuries.
4) Hospitals must have clear disaster plans, adequate staff and supplies, and policies to handle surges
1. The document discusses advanced cardiac life support (ACLS) guidelines for treating cardiac arrest. It outlines the chain of survival and emphasizes high-quality CPR, defibrillation, airway management, monitoring during CPR, and drug therapy.
2. Key ACLS interventions include chest compressions, rescue breathing, defibrillation, and vasopressor administration to treat cardiac rhythms like ventricular fibrillation.
3. The document also reviews special considerations for cardiac arrest associated with pregnancy and post-cardiac arrest care.
This document provides information on basic life support (BLS) procedures for adults. It discusses that cardiac arrests are a major health issue, but that bystander CPR and early defibrillation can significantly increase survival rates. The key steps of BLS are described as CAB: assessing the airway, checking breathing, and performing chest compressions. 30 chest compressions should be provided initially before giving 2 rescue breaths. Foreign body airway obstruction is also addressed, with descriptions of back blows and abdominal thrusts to relieve mild to severe obstructions. Defibrillation is the final link in the chain of survival.
This document provides information on triage systems and procedures. It defines triage as sorting patients based on treatment priority. The START and JumpSTART triage systems categorize patients as red/immediate, yellow/delayed, green/minor, or black/deceased based on their respiration, pulse, and mental status. It outlines how to rapidly assess and tag patients in a mass casualty event using these criteria in 3 sentences or less per patient to maximize survivability. The document recommends clearing walking patients first and prioritizing life-saving interventions for immediate patients before movement or additional treatment.
This document outlines a hospital's mass casualty and hazardous chemical exposure plan. It discusses lessons learned from past events and key considerations for responding to a mass casualty incident. The plan details activating different response stages depending on the scale of the event and allocating roles and supplies. Triage, documentation, decontamination and expanding capacity to other hospital areas are addressed. The emergency operations centre coordinates the overall response and the hospital communicates regularly with them during an incident.
This document describes a training program on in-hospital disaster response and rescue for medical students. The program consisted of 16 hours of lectures and practical lessons across 4 modules: medical, psychological/social, technical, and peer-education. An evaluation found that participating students showed significantly greater improvements in attitudes and knowledge compared to a control group. The program organizers later formed an association and mobile app called MobileEmergency to help coordinate emergency responses in large hospitals. The app aims to inform staff, locate people, and support rescue efforts during disasters.
1) The document discusses key terms and concepts related to emergency and disaster nursing including triage, trauma, emergency management, BLS, ACLS, defibrillation, disasters, and mass casualty incidents.
2) It describes the scope of practice of emergency nurses which includes specialized education and training to assess and prioritize care of acutely ill patients, support families, supervise staff, and provide care in a fast-paced environment.
3) Issues in emergency nursing are discussed such as the diversity of conditions, legal concerns, and providing holistic care in a high-stress environment where serious illness and death are common.
Hello ,
Disaster management is a vast topic which cant be cover in one ppt so i have taken one particular topic which is on Triage in disaster Management . I am trying to elaborate the topics by putting few pictures , if anyone have any problem with understand the ppt ,I have mentioned the reference guide . They can check it .
Thnks
KIRTTI
Disaster plans in hospitals and health care centersDr. Samir Sawli
Emergencies and disasters can happen at any moment – and, they usually occur without warning. When an emergency strikes, the safety of patients and staff will depend on the existing preparedness of Departments and their staff.
Hospital and Department Disaster Response Plans are developed and written to provide fundamental support and direction to all concerned staff.
These plans are an essential building block of the Hospital’s response to a crisis.
They are part of every Department’s basic health and safety responsibilities; as well as operational continuity and planning
Triage is the process of sorting patients based on the urgency of their condition to provide the right care to the patients who need it most. It involves an initial assessment of patients upon arrival to identify life-threatening issues and prioritize patients into categories based on need. The document outlines the goals and categories of triage in both emergency and disaster situations, with categories ranked from resuscitation to non-urgent based on the threat to life, limb, or function. It also describes the key components of triage including an initial across-the-room assessment and ongoing re-assessments to adjust patient priority as needs change.
This document discusses different types of patient transfers within and between hospitals and outlines guidelines for safe transfers. It identifies that transfers, especially of critically ill patients, can pose risks. Adverse events during transfers have been reported in 6-70% of cases, including changes in vital signs, unplanned extubation, and cardiac arrest (rates as high as 8%). Risks are greater for sicker patients and urgent transfers. Factors like communication, equipment, monitoring, and planning are important to consider. The document provides tables outlining reported adverse events and mishaps during transfers. It emphasizes the need for guidelines addressing who, what, when, where, why and how questions before any patient transfer.
The document outlines protocols for responding to cardiopulmonary arrests, known as Code Blues. It describes initiating Basic Life Support, Advanced Cardiac Life Support, or Pediatric Advanced Life Support depending on the patient. It provides details on activating emergency codes, assembling code teams, performing immediate interventions like CPR and defibrillation, notifying physicians, and transferring patients to the emergency department. Crash carts and equipment are also discussed, including obtaining replacement carts and charging used items.
CARDIOPULMONARY RESUSCITATION- BLS & ACLS-2020 AHA UPDATEAryaDasmahapatra
This document provides information about cardiopulmonary resuscitation (CPR) and the basic life support (BLS) and advanced cardiac life support (ACLS) protocols. It begins with definitions of CPR and its purposes to support life through circulation and prevent brain damage from lack of oxygen. The history of developments in CPR techniques from chest compressions to defibrillation are outlined. Adult and pediatric BLS protocols are described, including assessing responsiveness, calling for help, performing high-quality chest compressions, opening the airway, rescue breathing, and using an automated external defibrillator. Differences in CPR for adults, children and infants are also summarized.
This document provides information on emergency care and triage. It discusses the principles of emergency care which include providing care without delay and using triage to prioritize patients. Triage involves sorting patients into categories of emergent, urgent, and non-urgent based on the seriousness of their conditions. The document then describes the triage process in more detail, including the different color codes used to categorize patients and the criteria for each category. It also discusses the roles of triage team members and how to set up an effective triage system.
Emergency is the gateway to the hospital, patients with pain and agony, relative emotionally charged enter the emergency department at any hour of the day or night, expecting immediate treatment and solace.
Triage originated during World War I to prioritize treatment of wounded soldiers. It involves sorting patients into three categories based on need for immediate care. The goal of triage is to rapidly identify life-threatening conditions and determine the most appropriate treatment area, while decreasing congestion and providing ongoing assessment. The triage nurse greets patients, performs brief assessments, documents findings, assigns priority levels, and communicates with treatment staff. Triage is a dynamic process that involves reassessing patients, as conditions can improve or deteriorate during the wait for care.
The document provides information on various emergency codes used in hospitals. It defines codes for cardiac arrest (Code Blue), external disasters (Code Yellow), child abductions (Code Pink), physical assaults (Code Purple), bomb threats or internal disasters (Code Black), fires (Code Red), and evacuations (Code Orange). For each code, it describes how and when to activate the code, the objectives, and procedures for responding. For example, for Code Blue it notes to start life support, have the code blue team arrive within 5 minutes, and lists the code blue team members. The codes provide a way to quickly convey emergencies to staff while preventing panic.
Introduction to advanced prehospital careBen Lesold
This document provides an overview of the roles and responsibilities of an Advanced EMT-Critical Care Technician (AEMT-CC). It discusses key topics including the EMS system, education and certification requirements, medical direction, documentation, and quality assurance. The primary responsibilities of an AEMT-CC are preparation, response, patient assessment, treatment, documentation, and ensuring the patient's appropriate disposition. Medical direction and adherence to protocols are essential to ensure consistent, high-quality patient care.
1. The trauma protocol outlines the assessment and management of critically injured patients according to ATLS guidelines, with a focus on the ABCs - airway, breathing, circulation, disability and exposure.
2. Interventions include securing the airway with bag-valve-mask ventilation or intubation, assessing breathing with pulse oximetry and chest x-rays, supporting circulation with IV access and fluid boluses, evaluating neurologic status via GCS, and conducting a full secondary survey and spinal precautions.
3. Additional tests such as FAST scan, pelvic films and head/neck CTs help guide management, which may involve mechanical ventilation, chest tube insertion, blood transfusion, pelvic binding, wound
This document discusses mass casualty management and disaster preparedness for hospitals. It provides data on road traffic accidents in Nepal and describes key aspects of managing mass casualty incidents, including establishing triage, conducting primary and secondary surveys, and activating disaster plans. The main points are:
1) Triage is crucial to prioritize patients and direct them to the appropriate level of care. The START method is described.
2) During primary survey, life threats like airway, breathing, and circulation are addressed within 2-5 minutes.
3) Secondary survey thoroughly examines all body systems to identify minor injuries.
4) Hospitals must have clear disaster plans, adequate staff and supplies, and policies to handle surges
1. The document discusses advanced cardiac life support (ACLS) guidelines for treating cardiac arrest. It outlines the chain of survival and emphasizes high-quality CPR, defibrillation, airway management, monitoring during CPR, and drug therapy.
2. Key ACLS interventions include chest compressions, rescue breathing, defibrillation, and vasopressor administration to treat cardiac rhythms like ventricular fibrillation.
3. The document also reviews special considerations for cardiac arrest associated with pregnancy and post-cardiac arrest care.
This document provides information on basic life support (BLS) procedures for adults. It discusses that cardiac arrests are a major health issue, but that bystander CPR and early defibrillation can significantly increase survival rates. The key steps of BLS are described as CAB: assessing the airway, checking breathing, and performing chest compressions. 30 chest compressions should be provided initially before giving 2 rescue breaths. Foreign body airway obstruction is also addressed, with descriptions of back blows and abdominal thrusts to relieve mild to severe obstructions. Defibrillation is the final link in the chain of survival.
This document provides information on triage systems and procedures. It defines triage as sorting patients based on treatment priority. The START and JumpSTART triage systems categorize patients as red/immediate, yellow/delayed, green/minor, or black/deceased based on their respiration, pulse, and mental status. It outlines how to rapidly assess and tag patients in a mass casualty event using these criteria in 3 sentences or less per patient to maximize survivability. The document recommends clearing walking patients first and prioritizing life-saving interventions for immediate patients before movement or additional treatment.
This document outlines a hospital's mass casualty and hazardous chemical exposure plan. It discusses lessons learned from past events and key considerations for responding to a mass casualty incident. The plan details activating different response stages depending on the scale of the event and allocating roles and supplies. Triage, documentation, decontamination and expanding capacity to other hospital areas are addressed. The emergency operations centre coordinates the overall response and the hospital communicates regularly with them during an incident.
This document describes a training program on in-hospital disaster response and rescue for medical students. The program consisted of 16 hours of lectures and practical lessons across 4 modules: medical, psychological/social, technical, and peer-education. An evaluation found that participating students showed significantly greater improvements in attitudes and knowledge compared to a control group. The program organizers later formed an association and mobile app called MobileEmergency to help coordinate emergency responses in large hospitals. The app aims to inform staff, locate people, and support rescue efforts during disasters.
The document discusses mass casualty incident (MCI) training conducted by the Salt Lake Valley Fire/Training Alliance. It provides an overview of large-scale MCI drills held in Utah in 2013 that simulated recent mass shootings and involved multiple emergency response agencies. Lessons learned from previous drills are also reviewed, including strengths like excellent inter-agency coordination and opportunities for improvement such as standardizing triage systems. The training emphasizes the importance of establishing a clear incident command structure and having resources like MCI response bags available to facilitate rapid deployment of an incident management system. Ongoing joint training is stressed as critical to ensuring an effective multi-agency response.
Mass casualty and hazardous substances 2014chricres
This document outlines procedures for a mass casualty hazardous substances incident at a hospital. It describes locking down the hospital, declaring a mass casualty event, activating the mass casualty plan by calling in additional staff, and setting up an incident command structure. It also provides guidelines for patient decontamination and flow through hot, warm, and cold zones, as well as staff protection and hospital operations during the response. The goal is to treat patients while preventing spread of contamination within the hospital.
A mass casualty incident is defined as an event which generates more patients at one time than locally available resources can manage using routine procedures. It requires exceptional emergency arrangements and additional or extraordinary assistance.
1. Mass casualty management involves treating a large number of injured people from a disaster in a short period of time. It requires advance planning and coordination between medical personnel, facilities, and community groups.
2. A mass casualty situation exceeds normal capabilities, so modifications are needed in triage, transportation, treatment approaches, and more to optimize survival rates. The goal is to reduce immediate mortality and morbidity through efficient triage, transport, and focusing resources on life-saving care.
3. Successful management requires flexible disaster plans that can be rapidly implemented through clear communication and teamwork between all involved parties according to their assigned roles.
Blast lung injury (BLI) is caused by the blast wave from high explosive detonations damaging the lungs. BLI can cause respiratory difficulty and hypoxia without obvious chest injuries. It is diagnosed clinically and may show a characteristic "butterfly" pattern on chest x-rays. Management of BLI involves supplemental oxygen, treatment of hemopneumothorax if present, and careful fluid management to avoid volume overload similar to pulmonary contusion. Outcomes of BLI can vary but many patients have normal exams and lung function after one year.
The Timeline of Lifesaving Interventions | Stacy Shackelford at TBS23scanFOAM
The document summarizes evidence from military trauma registries on where the most lives could be saved by improving combat casualty care. It finds that over 1,000 potentially preventable deaths from bleeding alone occurred pre-hospital or within the first hour of injury. Getting whole blood transfusion at the point of injury or within minutes can significantly improve survival rates. For casualties requiring surgery, delays over an hour from injury to reaching a surgical team are associated with lower survival. Mass casualty response must be scaled based on available resources and the recognition that time is a key triage tool, with lifesaving interventions only effective within the first few hours.
The document summarizes the concept of the "Golden Hour" in trauma care and reviews literature to support and refute its importance. The "Golden Hour" refers to the hour following injury being critical for treatment to prevent further damage and maximize survival chances. While its origin is attributed to Dr. R. Adams Cowley, several studies found little evidence supporting a strict one hour timeframe. Later studies indicate factors like injury severity score and response times under 5 minutes improved outcomes more than the specific "Golden Hour". Faster transport during this period may also increase risks to patients and emergency workers due to greater chances of accidents. In conclusion, rapid treatment remains important but the literature shows survival is dependent on multiple clinical factors rather than only time to definitive
The document summarizes research on cardiac arrest outcomes and proposes a new initiative called First Aid Corps to improve survival rates. It finds that bystander CPR and early defibrillation are critical to survival but rates are low. First Aid Corps would use GPS and mobile technologies to rapidly notify volunteers to perform CPR and use AEDs, aiming to increase survival rates from 3.3% to 60%. Cost-effectiveness analyses suggest this approach could save more lives at a lower cost per life saved compared to traditional emergency response systems.
This study analyzed 191 medical emergency calls from an Asian international airline over 12 months to determine the types of in-flight medical issues. The most common were gastrointestinal problems (35.6%), vasovagal syncope (14.6%), and chest pain/palpitations (9.4%). Most issues were treated symptomatically with oxygen and rest. A recommendation to divert the flight occurred in 6 cases involving serious conditions such as heart issues or seizures. The availability of medical professionals on flights was low, with a doctor present in only 14% of cases.
This document outlines a surgical services disaster response plan for the University of Pittsburgh School of Medicine. It discusses setting up an incident command structure, modifying care to a "greatest good for the greatest number" approach, and key lessons from past disasters like establishing experienced trauma surgeons in triage and carefully managing resources. The plan covers activating response teams, setting up alternative care areas, and modifying documentation to focus on critically injured patients during a mass casualty incident.
Oral the need for guidelines for common disabling conditions in natural disas...gosneyjr
The document discusses guidelines for rehabilitation of common disabling conditions in natural disasters. It outlines the International Society of Physical and Rehabilitation Medicine's (ISPRM) Rehabilitation Disaster Relief Subcommittee's (RDRC) approach to developing such guidelines. The RDRC aims to provide guidelines for conditions like spinal cord injury, traumatic brain injury, amputations, fractures, burns and more. It details a multi-phase plan to search for existing guidelines, identify gaps, and task experts to develop new guidelines as needed.
This briefing from the Air Force Medical Service is directly applicable to civilian and military communities who need to be prepared for managing medical trauma scenarios. This presentation focuses on integrated trauma management systems.
This document discusses mechanical ventilation strategies during disasters. It describes different types of disasters including natural disasters like fires, floods and earthquakes, as well as man-made disasters like explosions and pandemics. It emphasizes the need to plan for limited resources during disasters by considering restrictions on staff, facilities, equipment and supplies. The document also stresses the importance of fair allocation of scarce critical care resources through organized triage teams and sequential organ failure assessments. Specific strategies are provided for managing blast lung injuries from explosions and addressing ventilation needs during an infectious pandemic.
1) A bomb attack in Brussels in 2016 killed 32 people and injured 300 through the use of acetone/peroxide explosive devices in the airport and a train station.
2) Blast injuries are classified as primary (caused directly by the blast wave), secondary (caused by flying debris and shrapnel), tertiary (caused by victim being thrown by the blast), or quaternary (all other injuries).
3) While myths exist about blast injuries overwhelming hospitals and causing many amputations, in reality penetrating injuries from flying debris are most common in survivors and usually do not require extensive surgery. Management follows conventional trauma principles.
The document summarizes research on traumatic brain injuries (TBIs), including their pathophysiology, treatment, and prevention. It discusses the Defense and Veterans Brain Injury Center (DVBIC) and its role in conducting TBI research and clinical care. It also outlines the mechanisms, types, symptoms, and natural history of TBIs, as well as treatments focused on education, rehabilitation, and medication management. While studies on pharmacologic treatments were limited, guidelines were established for using methylphenidate for attention deficits and beta-blockers for aggression reduction post-TBI.
The document discusses strategies for managing sedation in neuro-ICU patients, including:
1) Titrating sedative and analgesic medications to keep patients calm, alert, and free of pain while being lightly sedated.
2) Using scales like the SAS and RASS to regularly assess sedation levels.
3) Preventing and identifying delirium using tools like the CAM-ICU, given its high prevalence in ICUs and association with poor outcomes.
4) Considering patient factors and medications when choosing a sedation regimen to balance safety, efficacy and risk of delirium.
The document discusses various scoring systems used to assess trauma severity and predict patient outcomes. It describes several commonly used scoring systems including:
1. The Abbreviated Injury Scale (AIS) which grades injuries from 1-6 based on severity.
2. The Injury Severity Score (ISS) which uses the AIS to allocate injuries to body regions and provides an overall score.
3. The Glasgow Coma Scale (GCS) which grades impairment of consciousness from 3-15.
4. The Trauma Score and Revised Trauma Score which assess physiological parameters to aid triage of patients.
5. The CRAMS scale which measures 5 components to triage patients needing
Pre hospital care of acutely injured patient by mohd taofiq et al.taofiq yinka
This document summarizes a presentation on pre-hospital management of acutely injured patients. It provides historical background on the development of emergency medical services. It also discusses epidemiology of trauma, the organization of trauma systems, concepts of pre-hospital care, the Nigerian experience, and recommendations. A study in Nigeria found that pre-hospital care was inadequate, with few patients receiving care and many experiencing delays in transport. It recommends establishing trauma centers and developing national pre-hospital care guidelines to improve trauma outcomes in Nigeria.
This document summarizes a study on the presentation and management of thoracic trauma patients at a tertiary care hospital in Pakistan. The study included 143 patients with thoracic trauma seen over a one year period. It found that most patients were male (83%) between the ages of 21-50 years. The majority of injuries were due to blunt trauma (87.4%) from road traffic accidents (72%), with rib fractures being the most common chest injury (74% of patients). Tube thoracostomy was the most common intervention (45% of patients). The mortality rate was 11.88%. The study concludes that thoracic trauma is an important cause of hospitalization and mortality in younger populations in Pakistan, with road traffic
Rapid response systems (RRSs) have become a routine part of the way patients are managed in general wards of acute care hospitals. They have been adopted by national health and safety organisations in North America, Canada, the United Kingdom and Australia and are increasingly being used in other parts of the world.
Studies have almost universally shown significant reductions in outcome indicators such as mortality (up to one third) and cardiac arrest rates (up to 50%). However the validity of these outcomes is questionable as most of these studies are single-centre, before-and-after studies conducted by one or two clinical champions in Rapid Response.
This presentation reveals that the implementation of an Intensivist led Rapid Response Team in an Australian quaternary hospital did not demonstrate such dramatic results. In fact, after one year of service the standardised mortality ratio and the in-hospital cardiac arrest rate remained similar.
The presentation explores some of the operational impacts of a RRS including the replacement of critical thinking with reliance on protocols and the progressive super-specialisation of medical teams. Despite these impacts and relatively static patient outcome data, the service has rapidly become an integral part of the hospital.
Barriers between Intensive Care and ward staff have broken down and quality outcome results have consistently shown ward nurses and doctors feel better prepared, educated and supported in managing clinical deterioration. These surprising results raise the question; should we place more value in quality outcomes?
Reflections on the musc ortho haiti experience (final)Kathleen Ellis
The document summarizes the MUSC Ortho Haiti Experience following the 2010 earthquake in Haiti. Over several missions, teams of orthopedic surgeons, nurses, and other medical professionals provided relief efforts at Hospital Lumiere including performing numerous surgeries such as amputations, external and internal fixations, and wound care. The document outlines the damage to infrastructure, acute and long term orthopedic needs, lessons learned from each mission, and suggestions for improving future disaster relief responses.
The Shocking Truth About Cops And DefibrillationDavid Hiltz
This document summarizes the results of a survey of law enforcement agencies in Massachusetts regarding their use of automated external defibrillators (AEDs). The key findings were that over 90% of responding agencies had AEDs, with the most common reasons being to respond quickly to medical emergencies and save lives. While most agencies encountered no issues, financial costs and union negotiations were sometimes obstacles. The majority of officers had not used AEDs but about 20% reported saves when they did use them. Overall attitudes towards AED programs were very positive.
The Advanced Trauma Life Support (ATLS) system was created in the United States in 1976 after an orthopedic surgeon crashed his plane and found the emergency care for his critically injured children to be inadequate. ATLS provides a standardized approach to assessing and treating trauma patients, including maintaining the airway, breathing, and circulation during the primary survey to address life-threatening issues first before conducting a full secondary survey. Over 50 countries now provide the ATLS course to physicians to improve trauma care worldwide.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
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Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
38. Bibliography Doyle, CJ. Mass Casualty Incidents, Integration with Prehospital Care. Emergency Medicine Cliics of North America. 1990; 8: 163-175. Timboe HL. Mass Casualty Situation: Gallant Eagle 82 Airborne Operations: A Case Report. Military Medicine. 1988; 153: 198-202. Frykberg ER, et al. Diaster in Beirut: An Application of Mass Casualty Principles. Military Medicine. 1987; 152: 563-566. Lorin HG, et al. The Bhopal Tradgedy-What has Swedish Disaster Medicine Planning Learned from it? The Jouranl of Emergency Medicine. 1986; 4: 311-316. Walsh DP, et al. The effectiveness of the Advanced Trauma Life Support System in a Mass Casualty Situation by Non-trauma Experienced Physicians: Grenada 1983. The Journal of Emergency Medicine. 1989; 7: 175-180. Mulligan ME, et al. Radiographic Evaluation of Mass Casualty Victims: Lessons from the Gander, Newfoundland, Accident. Radiology 1988; 168: 229-233. Satava RM, et al. A Mass Casualty While in Garrison during Operation Desert Storm. Military Medicine. 1992; 157: 299-300. Towne LE. China Eastern MD-11 Mass Casualty-Expect the Unexpected: A Case Report. Aviation, Space, and Environmental Medicine. 1995; 66 (10): 998-1000.
39. Bibliography Shalev AY. Editorial: The Role of Mental Health Professionals in Mass Casualty Events. Israeli Journal of Psychiatry Related Sciences. 1994; 31(4): 243-245. Rozin RR, et al. Integration of Military Unit and Civilian Hospital during Mass Casualty Situation: Experience during the 1982 Lebanon War. Military Medicine. 1986; 151: 580-582. Durham TW, et al. The Psychological Impact of Disaster on Rescue Personnel. Annals of Emergency Medicine. 1985; 14: 664-668. Phillips WJ, et al. Anesthesia during a Mass Casualty Disaster: The Army’s Experience at Fort Bragg, North Carolina, March 23, 1994. Military Medicine. 1997; 162: 371-373. Abraham RB, et al. Problematic Intubation in Soldiers: Are there Predisposing Factors? Military Medicine. 2000; 165: 111-113. Leibovici D, et al. Prehospital Cricothyroidotomy by Physicians. American Journal Emergency Medicine. 1997; 15: 91-93. Okumura T, et al. The Tokyo Subway Sarin Attack: Diaster Management, Part 1: Community Emergency Response. Academic Emergency Medicine. 1998; 5(6): 613-617. Okumura T, et al. The Tokyo Subway Sarin Attack: Diaster Management, Part 2: Hospital Response. Academic Emergency Medicine. 1998; 5(6): 618-624. Okumura T, et al. The Tokyo Subway Sarin Attack: Diaster Management, Part 3: National and International Responses. Academic Emergency Medicine. 1998; 5(6): 615-628.
Editor's Notes
This discussion has two major points1st.... Mass Casualty Incidents (MCIs) are reviewed.This portion is not very specific for anesthesia providers.2nd.... The anesthesia support of these incidents is examined through a discussion of my own experience.(MCIs can severely impact the local capability to provide health care in different ways.)
LEVEL 1 – How triage is performed, what treatment is performed,and how transport is conducted all may be altered in aLevel 1 MCI, however local EMS and health care facilities are able to adequately diagnose and treat thecasualties.LEVEL 2 – Significant casualty numbers required the pooling of resources and aid obtained from other are facilities to properly care for the casualties.LEVEL 3 – A medical disaster requiring help from state and federalagencies. Here in the US the governor must getinvolved and declare an emergency.An MCI refers to a simple incidentA medical disaster is distinctly different (referring to a larger scope in respect to geography & the number of victims).
Medical care provided in the shadow of a disaster is altered when compared to care give otherwise. The extent to which a situation may impact the type and timing of care provided is of course situation dependent. The senior medical officer should consider all factors when deciding upon treatment modifications. The emphasis is shifted away from the individual to the group. Triage should be based on the disaster principle of doing the greatest good for the greatest number of patients.The expectant category of patient care essentially highlights the tough choices that must be made without a great amount of time for reflection during an emergency.In some cases patients requiring CPR may not be afforded resuscitative efforts.Acceptable surgical endpoints might change, eg colostomy versus reanastomosis.
Airway assessment, establishment of breathing and restoration of circulation are immediate priorities in all potentially viable patients.The ability to identify which patients are viable and which are not required a skilled and experienced physician. Obviously, the most skilled should be the main triage officer at the receiving area in the hospital.Triage – triage – triageRe-evaluations must be made at each step of evacuation.A patient’s status may change such that a casualty relegated to the minimal care area becomes an immediate surgical case. All members of the team should be aware of changing patient status, whether this is due to undiagnosed injuries or malignant progression of initially minor wounds.
Many of the communication plans and mutual aid agreements should be made in the cool calm light of day without situational pressures. These plans should be written down and practiced.Communications includes contacting assigned personnel to return to their place of work and participate in the incident. It includes medical personnel at the scene communicating to the facility receiving casualties. The facility commander may need to request help from outside agencies and coordinate this mutual aid. Other communication includes coordination of internal resources as well as coordination of patient care efforts from the ER/triage area/ICUs/ORs/delayed and minimal care areas.Communication also includes the necessary debriefing.“While effective communication is recognized as an essential element of successful MCI and disaster care, communication difficulties are many. The most common problems encountered during medical disaster response.”
Simply stated US hospitals must comply with this part of JCAHO to receive accreditation.
The following are some MCIs reported in the English literature. They are presented in order by date. I have focused on those with military relevance for obvious reasons.The Israeli’s have a wealth of information published which reflects their peculiar circumstance in the Middle East. One resource that is worth looking at is Rozin RR “Integration of military unit and civilian hospital during mass casualty situation: Experience during the 1982 Lebanon War” Mil Med 1986; 151:580. In this article Rozin outline’s the steps taken to unite a military surgical hospital with a community hospital for a specific mission.
Peacetime Operation1780 jumpers into 5 DZs at NTC. Airborne Standard Operating Procedures followed for DZ safety/medical support.93rd Evac 60 beds, 10-30 miles from DZs. Weed ACH 25 beds.Injuries encountered secondary to high winds on the DZ: odontoid fracture, severe and minor head injuries, femur fractures, multiple extremity fractures, femoral artery laceration, basilar skull fracture, surgical abdomens, other.Ongoing field training was sustained by judicious evacuation back to Ft Bragg. This is only one of at least 3 mass casualty incidents that I know of where ongoing operations were able to be maintained by evacuation of stabilized casualties.“A mass casualty situation can be defined as any situation in which the number of patients produced in a relatively short period of time significantly exceeds the capability of the local medical support system to evaluate and treat the patients on a timely basis.”“Greatest good for the greatest number.”
Coordinated plan with referral hospitals in Southern California.93rd Evac planned and practiced mass casualty situations. Communications were set as part of operation, however maximum use of helicopter evacuation could have been made ifa central coordinator of these assets were designated (each DZ had control of pre-positioned asset).PA’s....Dust Off joined efforts at most needed location coordinating with Ft Irwin MEDEVAC. Referrals were made to Loma Linda, March AFB, and Long Beach, VA. 93rd took over nearby tentage to expand to 135 beds. Minor injuries not x-rayed until initial wave done. Accountability....Anesthesia support not outlined in these reports thus far.One operation was performed at 93rd EVAC.
US Marines stationed at Lebanon airport as part of the Multinational Force over seeing PLO evacuation from Beirut.IN A DISASTERYOU MAY BE THE CASUALTY.Medical Officers from other ships setup Bn Aid on site... Sniper fire (the disaster might not be over)Plan – LPH-2 USS Iwo Jima with 19 man surgical team augmentation (Gen surg, ortho, anesthesiologist, anesthetist) practiced integrated disaster protocol. LPH-2 – 2 ORs, 2 ICU beds, 7 beds expandable to 100. Hanger deck for triage.
The plan was thought through and practiced.This is a key point of all mass casualty incidents, and the principles of dealing with them.A recorder accompanied the triage/treatment officer at each site. Evacuation was a key component to sustained operations, therefore evacuation was planned and went well. (A very crucial aspect of this shipboard level of medical services was the lack of depth, or the ability to render definitive, comprehensive care to a larger number of wounded.) A British hospital 45 minutes away didn’t receive casualties until 4 hours had passed. Reflecting less than optimal coordination of the operation.The wisdom of the deployment of a surgical team to this are of operations was validated.The important of accurate record keeping cannot be over emphasized.-- location of all survivors-- assure optimum Rx and continuity of case-- facilitates the important task of retrospective assessment and critique for future improvement
Here we see a mass casualty incident not caused by accident or single incident but rather the arrangement established for wartime footing. (The planned mass casualty incident.)In this report the authors point to the fact that the majority of the patients assessed (primary survey) and triaged received care from physicians who had only completed internship and ATLS training (Combat Casualty Care Course) and everything went well. This contradicts conventional wisdom which supports using a senior medical officer for triage.USS Guam is an LPH 9 (Landing Platform Helicopter) ship. The team began accepting wounded from combat on Grenada. Initial triage staffing included a general surgeon assigned as part of the surgical team. When OR cases compelled him the GMO’s were left to do the primary survey and the remainder of the triage.The opposing argument could well be made that the general surgeon culled out the most urgent cases and left the remainder to personnel with less than optimal training, thereby exercising the greatest good for the greatest number principle of MCIs.
This display diagrams the layout of an LPH medical section.I would like to point out the expansion into the hanger deck and toward the stern of the ship. This is an excellent example of planned patient flow and flexibility of the medical planners to use the space available.What is not obvious on this two-dimensional depiction are the stairwells leading form the primary survey area and the secondary survey and main treatment area. These are typically narrow ‘gangways’ or ladders found on a ship.
Casualty Treatment Statistics are presented here.Note the unstable angina and the postpartum hemorrhage cases. Also, note the battle fatigue casualty. All manner of injuries and illnesses will be seen in a mid-intensity battlefield condition.16 casualties received 38 major surgical interventions: 2 head & neck, 2 thoracic, 15 abdominal, 1 urological, and 18 orthopedic. Missile wounds accounted for the majority of the casualties.The authors of this study conclude “3 PGY-1 trained physicians with no prior trauma experience triaged, resuscitated and stabilized the bulk of 76 casualties received over a 96 hour period according to ATLS protocol. In response to the primary survey, there were 13 lifesaving procedures carried out on 8 patients. There was no loss of life among the treated casualties.”The surgical team concept worked out in other arenas and employed here was successful. Specifically, the anesthesiologist and anesthetist present on the team point to our roles in mass casualty incidents.
Here we have a Level 3 MCI, a true disaster.The 2 hospitals in the area typically have 200 and 760 bed capacity, 40,000 patients present themselves for treatment.“Initially, everything was chaotic. Thousandsof patients flooded into the hospital.”Now in the review of this incident available to me no mention is made of the role of anesthesia providers in this situation however an inference from the details of the injuries sheds some light on the topic.Mehtylisocyanate (MIC) is an irritant which is twice as dense as air. On this particular day a temperature inversion contained and concentrated the gas leaking from the local Union Carbide plant. Respiratory tract findings included bronchoconstriction, upper airway irritation with choking symptoms, pulmonary edema, pneumothorax, subcutaneous and mediastinal emphysema, bronchopleural fistulae, and secondary infections.I think the anesthesia providers had more than their hands full for quite some time.“In chemical mass disasters like the one in Bhopal, all patients can not be brought into the hospitals.”“In Sweden, disaster medicine planning has recently been extended to include accidents with toxic substances... Closer cooperation with military planning would probably also be of great value.\"
I present this incident to complete the picture of possible events. Mass Casualty Incidents (MCIs) can happen anywhere and at anytime. The extent of its impact is situation dependent. This was by definition a Level 3 MCI requiring state and federal support. I think its is important for anesthesia personnel to understand that in mass casualty incidents there are many concerns. This incident points to the needs of the family members to be able to have closure with their loved one’s loss, and the role that radiologists and pathologists have in that regard. This occurred prior to the wide use of DNA for positive identification of remains.
An aside!Also, this reminds all of us that there are psychological implications of MCIs not only on the victims and their families, but also on the medical caregivers involved. There is a body of literature that points to the real need for those involved in any MCI to have the ability to review their experience with the group and with competent psychiatric/psychologic practitioners. For those interested I refer you to Shalev “The role of mental health professionals in mass casualty events” in Israeli Journal of Psychiatry Related Science 1994; 31:243.This brief report makes the point that MCIs can happen anywhere anytime, especially when American troops have been issued live ammunition.The evacuation hospitals in the Army are deployed in rear echelons, and do not doctrinally care for acute battlefield casualties. The rear echelon hospitals accept those stabilized patients from the forward hospitals and perform more definitive operations prior to evacuating them. They rarely treat acute combat casualties. Additionally, the casualties from this minor incident show up on the doorstep in the middle of a mass cal exercise!!!Additionally, take the time after the fact to document your experience in medicine for others to learn from.
This MCI will be reviewed in a bit more detail, as personal experience is a great teacher. To review this incident I will examine what the anesthesia personnel did in the middle of the maelstrom surrounding Womack Army Hospital on 23 Mar 93.Fortunately, the incident occurred on a weekday just before change of shift...so there were twice as many people on hand as is normally required for routine operations. A call had come in to the ER and relayed to the hospital commander that a plane had crashed at Pope Air Force Base (adjacent to Ft Bagg) and that casualties were being brought to the hospital.Our planned worst case scenario became a reality. This scenario (aircraft collision) served as one of the mass casualty plans practice at Ft Bagg. The debris that was an Air Force jet became a fire ball that tore through 500 paratroopers readying themselves at “Green Ramp” to jump out of the C141 that had just burst into flames when the F-14 crashed into it.
There are very few clinical pictures of the events that followed this crash. The following slides should give a sense of the destructive force and an inkling of its effect.One of the principles of MCIs was a sabotaged. The hospital’s medical photographer had started to capture the essence of this tragedy; the chief administrator of the hospital told her to stop taking pictures and help out in other ways. Every physician I know involved in this incident later asked this person if she had any good pictures for inclusion in lectures such as this. The best teaching tool is a good record. When your in the middle of one of these be sure to get all the data collected for future reference and critique, you will be glad you did!!
The casualties were as follows:Killed at the scene------------9Died en route-------------------2 (1 was declared in the triage area)Admitted to Womack-------55Transferred to local and regional burn center-----------------13Treated and released------15TOTAL 130
Some intubations were performed outside in the initial triage area and some were conducted just prior to helicopter evacuation. All facial burn victims had their endotracheal tubes secured with gauze wrapped around the neck and tied in a bow anticipating edema formation and the need to re-secure the tube at a different depth once edema had encroached on the previous secure point.MCI principal remain flexibleand adapt to the situation at hand.
Medical providers at the site were 91Bs (field medics) they used some of the equipment that they normally pack to jump—bandages and IVs. They knew the priority would be to evacuate to the hospital (1.5 miles).Ambulances were not used initially. Anything with wheels was used initially; cargo trucks, HUMVEEs, and personal vehicles.Local EMS did arrive and ambulances from the hospital were sent to the site to complete initial triage and evacuation. EMS from the region was also involved in transfer of patients to the Medical Center downtown. MEDEVAC was used to evacuate some severely burned patients to the Burn Unit at Raliegh/Durham.There were many “walking wounded” mostly with burns on the hands and upper extremities as these individuals were literally patting out the flames on themselves or their buddies.
A primary principle of operations for MCIs is remain flexible to the situational demands.Our hospital plan did not call for anesthesia support in the ER. I returned to the ER with a team of anesthesia personnel prepared to manage airways and intubate patients as well as help in initial resuscitation. The three of us began work and did not stop for some time. I reviewed each case and made mental note of how many cases went to the OR. Twenty intubations were required in the ER initially.
According to our plan routine OR cases were cancelled and the ongoing surgeries completed in a rapid fashion. I was on call and placed a colleague in charge of organizing the OR initially. The plan called for all anesthesia personnel to be recalled and for the oral surgeons to join our crew to assist in operating room management. The mass cal plan called for anesthesia providers to station themselves in the OR and ICU are for duties. I proceeded to the ER and was presented with an awesome sight of bodies pouring in the front door. I had assessed the situation enough to understand that airway management was going to be our priority in the ER/triage area (the front of the hospital). I quickly returned to the OR; informed my associates that this was no drill and to completely clear the ORs of everything that they could QUICKLY.
While operations began in the main OR (completion amputation of a traumatic lower extremity wound was the first patient bought to the OR) the “Intubation team” continued work in the ER. As indicated some patients were expeditiously evacuated after initial resuscitation in the triage area to downtown and to the regional burn center. Each of these patients was in respiratory distress on initial survey and was induced and intubated. 20 intubations doesn’t sound like much standing here, but as I recall the 3 teams I took to the ER at 1435 hours were busy for the better part of an hour. As everyone can envision based on trips to the ICUs and to the wards during response to “Code” situations the health care providers outside the OR really have no understanding of the timing and the terminology anesthesia providers use especially during the fast-paced induction/intubation sequence. The rounds to evaluate patients began at quick pace. Almost as soon as one patient was intubated a second presented in some form of respiratory distress. The pharmacy provided outstanding support by consulting with us. I informed them that members of the intubation team would need lidocaine, succinylcholine and morphine in the ER. Medical supply also followed us around with endotracheal tubes and stylets. This support was quickly agreed upon and implemented to fit the situation.Again... flexibility in keeping with the plan and training was the key to success in this incident.
In their study of IDF soldiers 8% had anatomical features that predispose to troublesome intubation. The most prevalent factors were protruding teeth and a receding mandible.Although rare, patients whose appearance is normal may quite unexpectedly be difficult to intubate.The laryngeal mask airway should be introduced to the armamentarium of the combat physician.
Within a very short period of time all ORs were empty and ready with two providers available for each room anticipating labor intensive case management. Assessment was brief and to the point, some of the first patients to arrive in the OR had been induced and intubated in the ER. Monitoring of some patients was particularly challenging, as there was little intact skin available for the placement of EKG leads. Arterial monitoring was quickly established in most patients. CVP/SG monitoring was also established in those cases in which fluid management was obviously going to be challenging intra operatively as well as post-operatively.A limited resource in terms of intra-operative management was type specific blood.PRBCs—90, Platelets—21 units, FFP—19, cryoprecipitate—27 units. The majority of this was transfused intraop within the first 24 hours.As can be inferred these patients required very little anesthesia and quite a bit of resuscitation.OR cases for the 24 hour period38 procedures were performed on 16 patients13 procedures were undertaken in the ICUs on 13 patients(primarily fasciotomies)
As soon as the limit/extent of the incident is established “next day” considerations should be planned. At Ft Bagg this included canceling all scheduled operations. The busy labor and delivery deck could not discontinue operations...as a matter of fact a caesarian section was performed late in the day/early evening for failure to progress. (Some daily “routine” medical care could not wait for the mass casualty incident to end.) This point cannot be under sold... in addition to the primary incident more mundane medical emergencies continue to occur at the normal rate and at the most inopportune moments.When the extent of our incident could be seen we began sending some people home to unwind and rest ensuring that we would have fresh personnel available for the continuing operation. Anesthesia personnel must remain vigilant during their duties to provide safe and effective anesthetic care in the operating rooms. To ensure this capability the “day after” excess personnel were dismissed as appropriate.The need for secondary operations... faciotomies/debridements was obvious. We set out to prepare for this eventuality.
The fact that we at Womack had planned and practiced the mass casualty drill was evident on 23 Mar 93. The timing was fortuitous – having twice the normal number of health care providers available at the beginning of the emergency was just luck.We remained flexible and changed aspects of the plan as the needs arose. Intubation teams in the ER, airway rounds, positioning an anesthesiologist in the recovery room for the better part of the incidents, all these things enabled our team to best support the delivery of health care in this emergency.Communication should have been better; between the ER, the triage and airway team and the OR. I found myself or one of the airway management team performing messenger duty between the ER, hospital commander and the OR on several occasions... the phone lines were overwhelmed. I alluded to the lack of pictorial documentation. I wish I and other practitioners had the ability to show you some of the scenes from the ER, OR, and ICUs.We did something within the first week after the incident that at the beginning I didn’t think was necessary. A group meeting of all anesthesia providers with a psychologist.......
Shemya Island is in the Alaskan Aleutian chain. It is approximately 350 miles from ADAK (which is the nearest inhabited island.Dr Towne seems to have done the best she could with minimal assistance and technical capability. Principally, I like this report for its timelines (published two years after the event) and her ability to examine her own experience. One major point was she wished she had tasked administrative assistants to stay at her side throughout the ordeal. A recorder for each individual patient, one for overall numbers, and a runner.“The numbers were obviously important because they were being used to obtain the appropriate numbers of medical personnel supplies, and aircraft; but as the lone physician, some delegation of the number crunching would have freed me up to perform more patient care.”
Sarin is colorless, odorless, volatile and highly lethal organophosphate. Inhibition of cholinesterase produces acetylcholine overdose with symptoms of muscarinic and nicotinic hyperactivity and central nervous system toxicity. Sarin can be absorbed through any body surface. Vaporized sarin is mainly absorbed through the respiratory tract and conjunctivae.
The first problem identified in the review of the EMS response was the limited out-of-hospital care imposed by EMT practice restrictions. Their conclusion was to have more physician involvement in the out-of-hospital treatment either thru great communications capability or with physical presence.
Communications is the most often cited problem during MCI practice and real scenarios. Our country is not the only one with turf battles and inadequate cross-communications.Their conclusion“Integration and cooperation of concerned organizations should be established through disaster drills.”
Recognition of the magnitude of the problem by the command structure is imperative to activate the disaster plan as early as possible. At St Luke’s International hospital the President and VP assessed the situation personally and adjusted the operational mode within an hour of the first patient arriving. Adequate staff from internal and external resource pools were mobilized. Despite structural inadequacies at the hospital a method of triage and crowd control was eventually enforced. Their conclusion was “Hospital disaster planning must include guidance of mass casualties, an emergency staff call-up system, and an efficient emergency medical chart system.”Initial storage of 2-pyridine aldoxime chloride (2-PAM) and atropine sulfate in this facility were 100 amps of 2-PAM and 1,030 amps of atropine. They used 1,700 amps of 2-PAM and 2,800 amps of atropine.
The Japanese Defense Forces are proscribed from acting without the Prime Ministers authorization. They are under close civilian control and scrutiny. Their MCI plans were appropriately geared toward response to earthquakes, hurricanes and tsunamis. Local government retains autonomy even during disasters. They must request central government (JSDF) intervention. Their conclusion “Such a concentration of authority (that had been possible and the norm prior to WW II in Japan) may compromise democracy, but in the case of large-scale disasters, a concentration of authority would be valuable. The development of a legal basis for the concentration of authority during major disasters is greatly needed in Japan.”This last quote is a terrific example of a national level after action review.
In summary there are many items to keep in mind when faced with a mass cal situation, be prepared and be flexible.