Excess mortality reduction given a "reduce patient mortality at all costs" scenario for mass burn casualties.

OBJECTIVE: The aim of this study was to estimate the effect on medical resource use and mortality of full financial support from the government for treatment costs after a mass burn casualty event in Taiwan. METHODS: All patients with burn injuries from the event were included (n = 483). Each burn patient from this incident was matched to a separate burn patient identified from the National Health Insurance database. Medical care usage and mortality were compared between groups at 1-, 3-, 6-, 9-, and 12-month intervals. RESULTS: Regarding outpatient expenditure, burn patients from the mass casualty event had significantly higher levels of medical expenditure compared with their control counterparts at all intervals and levels of medical institution. For inpatient expenditure, patients from the mass casualty event only had higher expenditure for the first month, and excess procedures used by these patients mainly consisted of nonvital procedures such as rehabilitation training. The mortality rate was only slightly lower for this group of burn patients compared with their control counterparts. CONCLUSIONS: Full financial support by the government in terms of medical treatment may engender only marginal additional benefits in terms of mortality if burn treatment procedures are already well established in the country.

Operational and Financial Considerations of Using Drones for Medical Support of Mass Events in Poland.

OBJECTIVE: The implementation of drones in the medical security system requires a proper planning of the cooperation of different services, dividing the area into sectors, assessing potential risks, and other factors. This study refers to the cost analysis of using drones in the medical support of mass events. The aim of this research is to analyze the costs of unmanned aerial vehicle (UAV) implementation in the mass event medical support system. METHODS: The description includes purchase and maintenance costs of UAVs. The analysis also involves ways of raising funds for projects related to the UAV sector. Apart from the financial aspect, staff and drone operator training issues are the subjects of this analysis as well. RESULTS: This study is based on a specialist research involving drones and referring to reports on the current situation in Poland and in the world. CONCLUSIONS: The presented funds required for such projects and the way of raising these funds illustrate the range of the project and its requirements. (Disaster Med Public Health Preparedness. 2019;13:527-532).

Swift and Low-Cost Surge in Chemical Threat Response: Is It Possible? The Experience of a French Hospital.

In 2016 France hosted the European football championship. In a context of an increased terrorist threat, Chemical, Bacteriological, Radiological, Nuclear (CBRN) attacks were considered possible. Three days prior to the beginning of the event, the Health Authorities required that a medium sized hospital close to a major potential target, prepare a chemical decontamination centre. Despite a low level of preparedness, little external help, and very few extra resources, an efficient decontamination chain (all premises necessary for the management of contaminated victims: from the entrance gate to the post-decontamination dressing cabins) was set up in 15 days (12 days after the unrealistic deadline). Numerous practical measures allowed three persons in CBRN personal protective equipment (PPE) to manage the whole chain, providing a maximum flow of 24 persons/hour. Volunteers were trained in PPE dressing, undressing and in decontamination procedures. This experience, offers a novel paradigm in managing chemical decontamination, in terms of attitude, and with adaptations to overcome practical constraints. It demonstrates that it is possible to set up a decontamination chain rapidly at very low cost. This provides an attractive option for less advanced countries and in humanitarian contexts. Some additional refinements, enhancements may be considered to further improve results. (Disaster Med Public Health Preparedness. 2018;12:649-656).

Tympanic membrane perforation impact on severity of injury and resource use in victims of explosion.

PURPOSE: Though tympanic membrane perforation (TMP) is a marker of barotrauma, relation to severity of injury has been contested based on previous observations that following an explosion many victims with significant injuries do not suffer from TMP while many victims with TMP do not suffer from significant injuries. The objective of this study was to reassess the relationship of TMP to severity of injury and resource demand in patients treated in multiple casualty incidents following terrorist bombings treated in one medical center. METHODS: Retrospective review. RESULTS: Most of the patients with TMP were mildly injured. Nevertheless, TMP was more prevalent in patients with moderate and severe injuries, 53.3 % compared to 13.6 % in mildly injured patients (p = 0.0009). Patients with TMP suffered from more body areas injured (p < 0.0001). They more often needed surgery (30.6 vs. 5.5 %; p < 0.0001), ICU hospitalization (16.1 vs. 1.3 %; p < 0.0001) and secondary transfer to a level I trauma center (12.9 vs. 1.0 %; p < 0.0001). They were hospitalized longer (p < 0.0001). Fifty-three (12.6 %) patients included in this study were not examined by the ENT service. Most of those not examined were either moderately or severely injured. CONCLUSIONS: Patients with TMP were more severely injured and more often needed surgery, ICU hospitalization and need for transfer to a level I trauma center. The observation that all those who died in hospital and most of those who were unstable were not examined by the ENT services suggests that impact of TMP as an indicator of severity may be underestimated.

Cost Analysis of 48 Burn Patients in a Mass Casualty Explosion Treated at Chang Gung Memorial Hospital.

INTRODUCTION: Little is known about the costs of treating burn patients after a mass casualty event. A devastating Color Dust explosion that injured 499 patients occurred on June 27, 2015 in Taiwan. This study was performed to investigate the economic effects of treating burn patients at a single medical center after an explosion disaster. METHODS: A detailed retrospective analysis on 48 patient expense records at Chang Gung Memorial Hospital after the Color Dust explosion was performed. Data were collected during the acute treatment period between June 27, 2015 and September 30, 2015. The distribution of cost drivers for the entire patient cohort (n=48), patients with a percent total body surface area burn (%TBSA)≥50 (n=20), and those with %TBSA <50 (n=28) were analyzed. RESULTS: The total cost of 48 burn patients over the acute 3-month time period was $2,440,688, with a mean cost per patient of $50,848 ±36,438. Inpatient ward fees (30%), therapeutic treatment fees (22%), and medication fees (11%) were found to be the three highest cost drivers. The 20 patients with a %TBSA ≥50 consumed $1,559,300 (63.8%) of the total expenses, at an average cost of $77,965±34,226 per patient. The 28 patients with a %TBSA <50 consumed $881,387 (36.1%) of care expenses, at an average cost of $31,478±23,518 per patient. CONCLUSIONS: In response to this mass casualty event, inpatient ward fees represented the largest expense. Hospitals can reduce this fee by ensuring wound dressing and skin substitute materials are regionally stocked and accessible. Medication fees may be higher than expected when treating a mass burn cohort. In preparation for a future event, hospitals should anticipate patients with a %TBSA≥50 will contribute the majority of inpatient expenses.

The injury burden of the 2010 Haiti earthquake: a stratified cluster survey.

INTRODUCTION: On January 12, 2010, a 7.0 magnitude earthquake devastated metropolitan Port au Prince and surrounding areas and resulted in widespread injury, mortality and displacement. This study aimed to estimate the injury rate among the affected population and the resulting demand of emergency medical care in the aftermath of the earthquake. METHODS: In January 2011, a cross-sectional stratified cluster (60×20 household) survey of the earthquake-affected population in metropolitan Port au Prince was conducted to assess their well-being, unmet needs and perceptions of humanitarian assistance one year post-earthquake. Mixed effects simple and multiple logistic regressions were used to measure the total unadjusted and adjusted odds of injury. RESULTS: A total of 261 injuries were reported in the pre-earthquake population of 6489 individuals with reported injury status. The overall earthquake injury rate was estimated at 40.2 injuries/1000 (CI: 35.6-45.3). Individual characteristics such as age, gender, and education status were not significantly associated with risk of injury. Elevated injury rates were observed among households residing in camps at 46.7/1000 (CI: 39.7-54.5) as compared to those in neighbourhoods where the injury rate was 33.7/1000 (CI: 27.8-40.5) (p=0.018). Extrapolation of the survey injury rate to the affected population yields an estimated 124,577 earthquake injuries (range 110,048-140,033) which is substantially lower than the 300,000 reported injuries. CONCLUSIONS: Estimates of the injury burden in disasters in lower- and middle-income countries is essential for disaster preparedness and response planning in future natural disasters. Given the difficulties in reporting injuries in emergencies, including both challenges of aggregating information and lack of standardized definitions and inclusion/exclusion criteria for injuries that are not severe, ascertaining the injury burden of disasters will be a persistent challenge.

Effect of a mass casualty incident: clinical outcomes and hospital charges for casualty patients versus concurrent inpatients.

OBJECTIVES: A mass casualty incident (MCI) may strain a health care system beyond surge capacity, affecting patterns of care for casualties and other patients. Prior studies of MCIs have assessed clinical care for casualty patients, but have not examined outcomes or expenditures for noncasualty inpatients in the same time period. METHODS: This was a retrospective analysis of administrative hospital claims in a state where an MCI with over 200 casualties occurred; two hospitals that admitted casualties of >5% of their inpatient capacity were studied. The "surge period" was defined as 7 days after the MCI. Using diagnostic codes, patients admitted on the MCI day with diagnoses of burns or inhalation injury were included in the "MCI surge cohort." Patients admitted within a time frame of 7 days prior to 7 days after the MCI who were inpatients during the surge period were included in the "non-MCI surge cohort." The authors compared the MCI and non-MCI surge cohorts to a mutually exclusive reference cohort (all inpatients during 6 weeks prior to the MCI), regarding key outcomes of hospital length of stay (LOS) and hospital charges adjusted for age, sex, race/ethnicity, and severity of illness. RESULTS: Fifty-five patients met criteria for the MCI surge cohort, 1,369 for the non-MCI surge cohort, and 5,980 for the reference group. Compared with the reference group and adjusted for covariates, the mean (±SD) hospital LOS was 4.90 (±1.85) days longer for the MCI surge cohort (95% confidence interval [CI] = 1.67 to 8.84) and 1.34 (±0.16) days longer for the non-MCI surge cohort (95% CI = 1.00 to 1.65). The MCI cohort also had significantly longer mean hospital LOS than the non-MCI surge cohort (difference = 3.56 days; 95% CI = 0.36 to 7.36). Also adjusted for covariates, mean (±SD) total hospital charges for the MCI surge cohort were $22,349 (±$8,342) greater than for the reference group (95% CI = $8,182 to $39,485). Mean (±SD) charges for the non-MCI surge cohort were $4,028 (±$633) greater than for the reference group (95% CI = $2,792 to $5,196). The MCI cohort also had higher mean total charges than the non-MCI surge cohort (difference = $18,321; 95% CI = $4,488 to $34,980). CONCLUSIONS: When adjusted for severity of illness, casualty patients and noncasualty patients receiving concurrent hospital care have significantly longer LOS and higher charges than typical hospital patients at times unaffected by MCIs. Spillover effects from MCIs for noncasualty patients have not been previously described and have implications for clinical and hospital management in MCI and other high-surge circumstances.

German suffering in the Franco­German War, 1870/71.

Suffering during the Franco­Prussian War of 1870/71 has to be interpreted in the context of three developments: the willingness to alleviate wartime suffering, which had led to the foundation of the International Red Cross and the Geneva Convention a few years earlier, the industrialization of war, which had enormously increased the efficiency of the weaponry, and the nationalization of war. For many Germans, the outcome of the war justified the wartime suffering, which was often trivialized in the media. The small number of authors who saw the high casualty numbers and the pain of the victims as a warning about the consequences of modern warfare usually belonged to the anti-Prussian opposition. Nationalist euphoria in the face of victory and German unification drowned out such critics, whose patriotism was in doubt. Finally, the remembrance of the war during the Kaiserreich aimed largely at celebrating the triumph of the German army and the foundation of the national state. The glorification of the military was hardly compatible with a detailed description of the misery of the battlefield and the pain of war victims. In 1870/71 and in the subsequent decades, nationalism overwhelmed and eventually excluded a humanitarian narrative.