COVID-19 the showdown for mass casualty preparedness and management: the Cassandra Syndrome.

Since December 2019, the world is potentially facing one of the most difficult infectious situations of the last decades. COVID-19 epidemic warrants consideration as a mass casualty incident (MCI) of the highest nature. An optimal MCI/disaster management should consider all four phases of the so-called disaster cycle: mitigation, planning, response, and recovery. COVID-19 outbreak has demonstrated the worldwide unpreparedness to face a global MCI.This present paper thus represents a call for action to solicitate governments and the Global Community to actively start effective plans to promote and improve MCI management preparedness in general, and with an obvious current focus on COVID-19.

Tornado Disaster Casualties Admitted to a County Hospital in the Jiangsu Province of China.

OBJECTIVE: We analyzed characteristics of tornado-related injuries and medical impact on a county-level hospital in China in June 23, 2016. The objective of this study was to describe and analyze local government rescue responses following the tornado. METHODS: County hospital medical records of 288 tornado-related injury patients were collected. Descriptive analyses to study injury characteristics and associated risk factors were performed. RESULTS: Of the studied population, 84% of the wounded were older than 45 years. Only 30 (10.4%) people were sent to the hospital for treatment within 3 hours following the disaster. Heavy objects or collapsing houses accounted for 191 (66.3%) of the documented injuries. The proportion of people with resulting brain injuries was 46.2% of the entire injured population, and the incidence of lower extremity injuries was 27.8%. A total of 89.6% of the wounded had skin and soft tissue injuries. Multiple injuries were found in 129 (44.8%) people and 156 had a single injury (54.2%), and 3 cases with acute stress disorder were admitted to the hospital. CONCLUSIONS: Preparation plans, including tornado warnings, prevention, and rescue, are a basic requirement for the mitigation of tornado-related injuries. Protection awareness of tornado disasters is also critical to ensure injury prevention.

Use of Dimensional Analysis in the X-, Y-, and Z-Axis to Predict Occurrence of Injury in Human Stampede.

BACKGROUND: Human stampedes (HS) may result in mass casualty incidents (MCI) that arise due to complex interactions between individuals, collective crowd, and space, which have yet to be described from a physics perspective. HS events were analyzed using basic physics principles to better understand the dynamic kinetic variables that give rise to HS. METHODS: A literature review was performed of medical and nonmedical sourced databases, Library of Congress databases, and online sources for the term human stampedes resulting in 25,123 references. Filters were applied to exclude nonhuman events. Retrieved references were reviewed for a predefined list of physics terms. Data collection involved recording frequency of each phrase and physics principle to give the final proportions of each predefined principle used a single-entry method for each of the 105 event reports analyzed. Data analysis was performed using the R statistics packages "tidyverse", "psych", "lubridate", and "Hmisc" with descriptive statistics used to describe the frequency of each observed variable. RESULTS: Of the 105 reports of HS resulting in injury or death reviewed, the following frequency of terms were found: density change in a limited capacity, 45%; XY-axis motion failure, 100%; loss of proxemics, 100%; deceleration with average velocity of zero, 90%; Z-axis displacement pathology (falls), 92%; associated structure with nozzle effect, 93%; and matched fluid dynamic of high pressure stagnation of mass gathering, 100%. CONCLUSIONS: Description or reference to principles of physics was seen in differing frequency in 105 reports. These include XY-axis motion failure of deceleration that leads to loss of human to human proxemics, and high stagnation pressure resulting in the Z-axis displacement effect (falls) causing injury and death. Real-time video-analysis monitoring of high capacity events or those with known nozzle effects for loss of proxemics and Z-axis displacement pathology offers the opportunity to prevent mortality from human stampedes.

Presence of undertriage and overtriage in simple triage and rapid treatment.

OBJECTIVE: We evaluated the use of the Simple Triage and Rapid Treatment (START) method by Emergency Medical Services (EMS) and hypothesized that EMS can categorize patients using the START algorithm accurately. DESIGN: Retrospective Chart Review. SETTING: Inner-city Tertiary-Care Institutional Emergency Department (ED). PARTICIPANTS: Patients ≥ 18 years transported by EMS with a START color of Red, Yellow, or Green during the state triage tag exercise, October 9-15, 2011. INTERVENTIONS: EMS assigned each patient a START triage tag. Chart review of the electronic EMS run sheets was performed by investigators to determine a START color. MAIN OUTCOME MEASURES: START triage colors were re-categorized as Red = 1, Yellow = 2, and Green = 3. The difference between the investigators' color and EMS color were coded as: 0 for agreement in triage, -1 for undertriage by one category, -2 for undertriage by two categories, 1 for overtriage by one category, 2 for overtriage by two categories. RESULTS: Of 224 participants, START triage colors were: Red = 7.1 percent, Yellow = 19.2 percent, Green = 73.7 percent. The mean difference in triage categories was 0.228 (95% CI: 0.114-0.311, p<.001). 71.0 percent of patients were triaged to the same category, 5.8 percent undertriaged by one category, 0 percent undertriaged by two categories, 17.9 percent overtriaged by one category, and 5.4 percent overtriaged by two categories. CONCLUSION: EMS was more likely to overtriage using START. All patients who were overtriaged by two categories were ambulatory at the scene, which implies other findings not in START may affect triage.

Mass Casualty Incident Management Preparedness: A Survey of the American College of Surgeons Committee on Trauma.

Mass casualty incidents (MCIs) are events resulting in more injured patients than hospital systems can handle with standard protocols. Several studies have assessed hospital preparedness during MCIs. However, physicians and trauma surgeons need to be familiar with their hospital's MCI Plan. The purpose of this survey was to assess hospitals' and trauma surgeon's preparedness for MCIs. Online surveys were e-mailed to members of the American College of Surgeons committee on Trauma Ad Hoc Committee on Disaster and Mass Casualty Management before the March 2012 meeting. Eighty surveys were analyzed (of 258). About 76 per cent were American College of Surgeons Level I trauma centers, 18 per cent were Level II trauma centers. Fifty-seven per cent of Level I and 21 per cent of Level II trauma centers had experienced an MCI. A total of 98 per cent of respondents thought it was likely their hospital would see a future MCI. Severe weather storm was the most likely event (95%), followed by public transportation incident (86%), then explosion (85%). About 83 per cent of hospitals had mechanisms to request additional physician/surgeons, and 80 per cent reported plans for operative triage. The majority of trauma surgeons felt prepared for an MCI and believed an event was likely to occur in the future. The survey was limited by the highly select group of respondents and future surveys will be necessary.

Scientific framework for research on disaster and mass casualty incident in Korea: building consensus using Delphi method.

We aimed to determine the scientific framework for research on disaster and mass casualty incident (MCI) in Korea, especially Korean terminology, feasible definition, and epidemiologic indices. The two staged policy Delphi method was performed by instructors of National Disaster Life Support (NDLS®) with the constructed questionnaire containing items based on the literature review. The first-stage survey was conducted by 11 experts through two rounds of survey for making issue and option. The second-stage survey was conducted by 35 experts for making a generalized group based consensus. Experts were selected among instructors of National Disaster Life Support Course. Through two staged Delphi survey experts made consensus: 1) the Korean terminology "jaenan" with "disaster" and "dajung-sonsang-sago" with "MCI"; 2) the feasible definition of "disaster" as the events that have an effect on one or more municipal local government area (city-county-district) or results in ≥ 10 of death or ≥ 50 injured victims; 3) the feasible definition of MCI as the events that result in ≥ 6 casualties including death; 4) essential 31 epidemiologic indices. Experts could determine the scientific framework in Korea for research on disaster medicine, considering the distinct characteristics of Korea and current research trends.

Passenger behavior in trains during emergency situations.

INTRODUCTION: This research presents a methodology for analyzing the behavior of people (passengers and crew) involved in emergency situations on passenger trains. METHODS: This methodological tool centers around a qualitative character study coming from Focus Groups (FG) and in-depth interviews to extract the determinant variables on passenger and crew behavior when faced with certain emergency situations on trains. RESULTS: This research has led to the creation of a classification of possible behaviors associated to each type of incident and dependent on certain variables. The qualitative study was used as the basis for modeling stated preference data using logit type discrete choice models to characterize and quantify the behavior. The most important results show that the determinant variables on passenger behavior correspond to the type of emergency suffered (its degree of seriousness), the type of passenger, the reasons for the journey (demands of time), the information received during the incident, the relationship between crew and passengers, the duration of the incident and the conditions (temperature control, availability of water, occupancy of the train), the distance to the destination station, and finally, the outside weather conditions. This research was carried out using the Spanish railway network as its reference, although it is applicable to any geographical area. IMPACT ON INDUSTRY: The results show that the information variable should be considered in the development of future research and that the evidences of this research can be used to develop behavioral models for modeling railway passenger evacuations.

Results of in-hospital triage in 17 mass casualty trainings: underestimation of life-threatening injuries and need for re-triage.

BACKGROUND: In-hospital triage is the key factor for successful management of an overwhelming number of patients in lack of treatment capacity. The main goal of in-hospital triage is to identify casualties with life-threatening injuries and to allocate immediate medical aid. For the first time, we evaluate the quality of in-hospital triage in the German capital Berlin. METHODS: In this prospective observational study of 17 unheralded external mass casualty trainings for Berlin disaster hospitals in 2010/2011, we analyzed the in-hospital triage of 601 rouged casualty actors. Evaluation was performed by structured external survey and interview of the casualty actors after the disaster training. In 93 percent (n = 558), complete data were available and suitable for statistical analysis. RESULTS: The primary triage category was allocated correctly to 61 percent (n = 338) of the simulated injury severity. The following measurements were performed: anamnesis in 77 percent, physical examination 71 percent, blood pressure in 68 percent, heart rate in 61 percent, and oxygen saturation in 25 percent. Additive radiological diagnostics were used: 38 percent X-ray, 16 percent computer tomography, and 7 percent ultrasound. On an average, 1.6 ± 1.2 diagnostic tools were used to allocate injury severity to rouged casualties. Of all the rouged casualties, 24 percent overtriage and 16 percent undertriage were observed. Overtriage was significantly infrequent in level I trauma centers (p = 0.03). Of the patients with life-threatening injuries, 18 percent was undertriaged. Of the 62 percent with secondary right allocation to triage category, re-triage was only used in 4 percent. CONCLUSION: The accuracy of in-hospital triage is low (61 percent). Predominately, the problem of overtriage (24 percent) due to insufficient triage training in contrast to undertriage (16 percent) occurs. The diagnostic triage adjuncts, ultrasound and re-triage, should be routinely used to lower the rate of undetected life threat in mass casualty incidents. Furthermore, a standardized training program and triage algorithm for in-hospital triage should be established.

[Combat sick and wounded casualty: classification, notions and problems].

The nowdays all possible damages and diseases by the staff during a war, are systematized in a special classification of combat damages and diseases, which is based on effect of main damage factors of weapon. Analyzing existent classification and determination "sanitarium casualty", it should be pointed out that they were formed more than 50 years ago, and they have gone out of date. Theirs significs is projected not adequately in practice of medical supply. Therefore determinations of sanitarium casualty, used in practice and in documentation, are not full and not always clearly explain about which casualty is talking. Moreover, several authors (frequently it is functionary of hospital) faultily or by reason of not-understanding write and talk about sanitarium casualty, meaning wounded and ill persons, admitted to hospital and being treated there.

Medical consequences of suicide bombing mass casualty incidents: the impact of explosion setting on injury patterns.

BACKGROUND: The increase in the incidence of suicide bombings on urban civilian populations in the recent years necessitates a better understanding of the related epidemiology in order to improve the outcome of future casualties. OBJECTIVE: To characterise the epidemiology of mass casualty incidents following suicide explosions in relation to the surrounding settings. METHODS: This study presents an analysis of the immediate medical consequences of 12 consecutive multiple casualty incidents (MCI's). Both pre-hospital and in-hospital data was assessed for each event including EMS evacuation times, types of injuries, body regions involved, Emergency Department (ED) triage, ED interventions and surgical procedures performed. RESULTS: The average arrival time of the first ambulance to the scene was 6.8+/-2.3 min. The first "urgent" patient was evacuated in average of 7.6+/-5.3 min later, while the last "urgent" patient was evacuated 27.8+/-7.9 min after the explosion. Explosions that occurred in buses had the worst rates of overall mortality (21.2%). However, those who survived closed space explosions suffered from the highest number of severe and moderate (ISS>8) injuries (22.9%). Casualties in this group underwent the largest number of both Emergency Room and Surgical interventions. Of the three settings, open space explosions resulted in the largest numbers of casualties with the smallest percentage of severe injuries or death. CONCLUSIONS: MCIs resulting from suicide explosions can be classified according to the setting of the event since each group was found to have distinct epidemiological characteristics.

Differentiating mass disasters. The barzullah classification.

BACKGROUND: To assess the pattern of mass casualty incidents managed at our hospital over the last eight years, and evolve a differentiating classification based on this pattern. A combination of retrospective and prospective assessment was made. MATERIAL AND METHODS: All patients receiving injuries in mass casualty incidents and managed at our hospital. Patients with an injury severity score above 9. Management of injuries as per the trauma management protocol. Classification based on the data collected during the study and application of this classification to the subsequent mass casualty incidents to allow comparison between similar incidents in different settings. RESULTS: A classification system that mainly differentiates mass casualty incidents on the hospital basis, the criteria being: the time interval between the first information to first reception, and the percentage of admission above the maximum normal intake. CONCLUSIONS: The Barzullah classification system is the first attempt at developing a hospital based differentiation in mass casualty incidents. It provides a valid and easy method of comparing such incidents between hospitals and perhaps a basis for developing protocol for mass disaster management.