Quality management tool for mass casualty emergency responses and disasters

Introduction: Quality Management (QM) principles generally have not been applied to multi-casualty and disaster situations. Quality management dincorporates quality assurance (QA) and quality improvement (QI) supported by a management information system (MIS), Since responders to disasters and multi-casuality incidents generally operate on standing orders and/or protocols the character of the responses lends itself to quality management methods. Objectives: 1) to format disaster medical records as data colletion instruments 2) to develop appropriate tools that are easy to use for rapid assessments 3) to develop a mechanism for determibnation of causes of injuries and 4) to develop methods to a)track patients b) document response and recovery and c)document the circumstances assocated. Results: Testing indicated that the check-lists are completed in less than one minute, and produce objective data per patient each functional area evaluated . In one instance, data were compiled for 38 patients from one bus accident in less than 10 minutes. The same data were reproduced without variation, in the same amount of time by three different providers of varied professional backgrounds (AU)

The EMS response to the Oklahoma city bombing

This is a descriptive of the Emergency medical Services response to a bombing of a United States federal Building in Oklahoma City, Oklahoma on 19 april 1995. The explosion emanated from a rented truck parked in the front of the building. The force of the explosion destroyed three of the four support columns in the from of the building and resulted in a pancaking effect of the upper floors onto the lower floors. There were distinct phases of the medical response: 1)Immediately available local EMS ambulances and staff; 2) Additional ambulances staffed by recalled off-duty personnel; 3) mutual-aid ambulances and personnel from the surrounding communities. There were 361 persons in the building at the time of the explosion, 163 of these perished. Within the first hourof the explosion 139 patients were transported to area hospitals. The scene became flooded with volunteers who, although their intention were to provide help and to those injured created a substancial logistical problem for incident Command Several other lessons were learned. 1) telephone lines and cells became overloaded, but the Hospital Emergency Administrative Radio system was operational only in three of the 15 hospitals 2) Volunteer personnel should have responded to the hospitals and not to the scene and 3) Training was an essential for the success of such a response. Thus, the success of this operation was a functions of the intense training, practice and coordination between multiple agencies (AU)