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1.
Br J Anaesth ; 128(2): e168-e179, 2022 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-34749991

RESUMEN

BACKGROUND: Reports published directly after terrorist mass casualty incidents frequently fail to capture difficulties that may have been encountered. An anonymised consensus-based platform may enable discussion and collaboration on the challenges faced. Our aim was to identify where to focus improvement for future responses. METHODS: We conducted a mixed methods study by email of clinicians' experiences of leading during terrorist mass casualty incidents. An initial survey identified features that worked well, or failed to, during terrorist mass casualty incidents plus ongoing challenges and changes that were implemented as a result. A follow-up, quantitative survey measured agreement between responses within each of the themes using a Likert scale. RESULTS: Thirty-three participants responded from 22 hospitals that had received casualties from a terrorist incident, representing 17 cities in low-middle, middle and high income countries. The first survey identified themes of sufficient (sometimes abundant) human resource, although coordination of staff was a challenge. Difficulties highlighted were communication, security, and management of blast injuries. The most frequently implemented changes were education on specific injuries, revising future plans and preparatory exercises. Persisting challenges were lack of time allocated to training and psychological well-being. The follow-up survey recorded highest agreement amongst correspondents on the need for re-triage at hospital (90% agreement), coordination roles (85% agreement), flexibility (100% agreement), and large-scale exercises (95% agreement). CONCLUSION: This survey collates international experience gained from clinicians managing terrorist mass casualty incidents. The organisation of human response, rather than consumption of physical supplies, emerged as the main finding. NHSH Clinical Effectiveness Unit project registration number: 2020/21-036.


Asunto(s)
Traumatismos por Explosión/terapia , Atención a la Salud/organización & administración , Incidentes con Víctimas en Masa , Terrorismo , Atención a la Salud/estadística & datos numéricos , Países Desarrollados , Países en Desarrollo , Planificación en Desastres/métodos , Encuestas de Atención de la Salud , Hospitales/estadística & datos numéricos , Humanos , Triaje/métodos
2.
Air Med J ; 35(1): 28-32, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-26856657

RESUMEN

OBJECTIVE: Prehospital rapid sequence intubation (RSI) of critically ill trauma patients is a high-risk procedure that may be associated with an increased rate of severe complications such as failed intubation, failure of oxygenation, hypoxia, hypotension, or need for surgical airway. The objective of this study was to describe the factors associated with difficult intubation in prehospital RSI as defined by more than a single look at laryngoscopy to achieve tracheal intubation. METHODS: This is an observational study using prospectively collected data. RESULTS: Four hundred forty-three RSIs were performed. Paramedics were the initial laryngoscopist in 290 (65.5%). First-look laryngoscopy resulted in successful tracheal intubation (TI) in 372 (84.0%) (95% confidence interval, 80.3%-87.1%). Intubation was achieved on second look at laryngoscopy in 58 (13.1%). "First-pass" TI was achieved in 394 (88.9%). Overall, successful TI was achieved in 438 (98.9%) (95% confidence interval, 97.4%-99.5%). Complications occurred in 116 (26.2%), with desaturation the commonest in 77 (17.4%). CONCLUSION: Factors associated with more than 1 look at laryngoscopy before TI included paramedic laryngoscopist and the presence of at least 1 of the following indicators: blood/vomitus in the airway, limited mouth opening, and limited neck movement. Trauma to face/neck, obese body habitus, C-spine precautions, cricoid pressure, midline stabilization, and intubation on the ground did not influence the level of difficulty encountered.


Asunto(s)
Ambulancias Aéreas , Técnicos Medios en Salud , Servicios Médicos de Urgencia , Hipotensión/epidemiología , Hipoxia/epidemiología , Intubación Intratraqueal/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Traqueotomía/estadística & datos numéricos , Adulto , Australia/epidemiología , Femenino , Humanos , Laringoscopía , Masculino , Estudios Prospectivos , Insuficiencia del Tratamiento
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