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1.
J Urban Health ; 101(3): 571-583, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38831155

RESUMEN

Mass shootings (incidents with four or more people shot in a single event, not including the shooter) are becoming more frequent in the United States, posing a significant threat to public health and safety in the country. In the current study, we intended to analyze the impact of state-level prevalence of gun ownership on mass shootings-both the frequency and severity of these events. We applied the negative binomial generalized linear mixed model to investigate the association between gun ownership rate, as measured by a proxy (i.e., the proportion of suicides committed with firearms to total suicides), and population-adjusted rates of mass shooting incidents and fatalities at the state level from 2013 to 2022. Gun ownership was found to be significantly associated with the rate of mass shooting fatalities. Specifically, our model indicated that for every 1-SD increase-that is, for every 12.5% increase-in gun ownership, the rate of mass shooting fatalities increased by 34% (p value < 0.001). However, no significant association was found between gun ownership and rate of mass shooting incidents. These findings suggest that restricting gun ownership (and therefore reducing availability to guns) may not decrease the number of mass shooting events, but it may save lives when these events occur.


Asunto(s)
Armas de Fuego , Incidentes con Víctimas en Masa , Propiedad , Suicidio , Humanos , Armas de Fuego/estadística & datos numéricos , Estados Unidos/epidemiología , Propiedad/estadística & datos numéricos , Incidentes con Víctimas en Masa/estadística & datos numéricos , Suicidio/estadística & datos numéricos , Heridas por Arma de Fuego/epidemiología , Heridas por Arma de Fuego/mortalidad , Eventos de Tiroteos Masivos
2.
Curr Psychiatry Rep ; 26(6): 304-311, 2024 06.
Artículo en Inglés | MEDLINE | ID: mdl-38639879

RESUMEN

PURPOSE OF REVIEW: There is widespread use of emergency preparedness drills in public K-12 schools across the US, but considerable variability exists in the types of protocols used and how these practices are conducted. This review examines research into both "lockdown drills" and "active shooter drills" as it relates to their impact on participants across different outcomes and evaluations of their procedural integrity. RECENT FINDINGS: A number of studies on lockdown drills yielded largely consistent findings about their impacts, whereas findings related to the effects of active shooter drills are less uniform. The research also demonstrated that lockdown drills, though not active shooter drills, can help participants build skill mastery to be able to successfully deploy the procedure. Differences in how drills impact participants and whether they cultivate skill mastery are largely attributable to the type of drill being conducted. This review suggests that employing clearly defined drill procedures incorporating best practices, coupled with instructional training, can help schools prepare for emergencies without creating trauma for participants.


Asunto(s)
Defensa Civil , Incidentes con Víctimas en Masa , Instituciones Académicas , Humanos , Defensa Civil/métodos , Planificación en Desastres/métodos , Planificación en Desastres/organización & administración , Heridas por Arma de Fuego/prevención & control , Violencia con Armas/prevención & control , Eventos de Tiroteos Masivos
3.
Anesth Analg ; 138(4): 893-903, 2024 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-38109852

RESUMEN

Disasters, both natural and man-made, continue to increase. In Spring 2023, a 3-hour workshop on mass casualty incidents was conducted at the Society for Pediatric Anesthesia-American Academy of Pediatrics Annual conference. The workshop used multiple instructional strategies to maximize knowledge transfer and learner engagement including minididactic sessions, problem-based learning discussions in 3 tabletop exercises, and 2 30-minute disaster scenarios with actors in a simulated hospital environment. Three themes became evident: (1) disasters will continue to impact hospitals and preparation is imperative, (2) anesthesiologists are extensively and comprehensively trained and their value is often underestimated as mass casualty incident responders, and (3) a need exists for longitudinal disaster preparedness education and training over the course of a career. In this special article, we have sought to further define the problem and evidence, the capacity of anesthesiologists as leaders in disaster preparedness, and the rationale for preparation with current best practices to guide how best to move forward.


Asunto(s)
Planificación en Desastres , Incidentes con Víctimas en Masa , Niño , Humanos , Anestesiólogos , Escolaridad , Hospitales
4.
Annu Rev Clin Psychol ; 20(1): 125-148, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38346290

RESUMEN

This in-depth review delves into the multifaceted realm of mass shootings and explores their epidemiology from a psychological perspective. The article presents a comprehensive examination of the prevalence, perpetrator and victim profiles, motives, and contributing factors associated with mass shootings. By investigating the intricate relationship between masculinity, domestic violence, military service, social media, fame-seeking, suicidal ideation, mental illness, and firearms, this article sheds light on the multifaceted nature of mass shootings. Moreover, it discusses the importance of implementing effective prevention strategies to address this growing public health concern. The findings from this review serve as a valuable resource for researchers, practitioners, policy makers, and the community at large, facilitating a deeper understanding of mass shootings and fostering the development of evidence-based solutions to prevent these tragic incidents.


Asunto(s)
Incidentes con Víctimas en Masa , Humanos , Estados Unidos/epidemiología , Incidentes con Víctimas en Masa/estadística & datos numéricos , Heridas por Arma de Fuego/epidemiología , Armas de Fuego/estadística & datos numéricos , Trastornos Mentales/epidemiología , Víctimas de Crimen/estadística & datos numéricos , Eventos de Tiroteos Masivos
5.
Am J Emerg Med ; 75: 72-78, 2024 01.
Artículo en Inglés | MEDLINE | ID: mdl-37967485

RESUMEN

AIM: The objective of our research is to evaluate and compare the performance of ChatGPT, Google Bard, and medical students in performing START triage during mass casualty situations. METHOD: We conducted a cross-sectional analysis to compare ChatGPT, Google Bard, and medical students in mass casualty incident (MCI) triage using the Simple Triage And Rapid Treatment (START) method. A validated questionnaire with 15 diverse MCI scenarios was used to assess triage accuracy and content analysis in four categories: "Walking wounded," "Respiration," "Perfusion," and "Mental Status." Statistical analysis compared the results. RESULT: Google Bard demonstrated a notably higher accuracy of 60%, while ChatGPT achieved an accuracy of 26.67% (p = 0.002). Comparatively, medical students performed at an accuracy rate of 64.3% in a previous study. However, there was no significant difference observed between Google Bard and medical students (p = 0.211). Qualitative content analysis of 'walking-wounded', 'respiration', 'perfusion', and 'mental status' indicated that Google Bard outperformed ChatGPT. CONCLUSION: Google Bard was found to be superior to ChatGPT in correctly performing mass casualty incident triage. Google Bard achieved an accuracy of 60%, while chatGPT only achieved an accuracy of 26.67%. This difference was statistically significant (p = 0.002).


Asunto(s)
Incidentes con Víctimas en Masa , Triaje , Humanos , Triaje/métodos , Estudios Transversales , Motor de Búsqueda , Simulación por Computador
6.
BMC Health Serv Res ; 24(1): 745, 2024 Jun 18.
Artículo en Inglés | MEDLINE | ID: mdl-38890678

RESUMEN

INTRODUCTION: Medical First Responders (MFRs) in the emergency department SUMMA 112 are tasked with handling the initial management of Mass Casualty Incidents (MCI) and building response capabilities. Training plays a crucial role in preparing these responders for effective disaster management. Yet, evaluating the impact of such training poses challenges since true competency can only be proven amid a major event. As a substitute gauge for training effectiveness, self-efficacy has been suggested. OBJECTIVE: The purpose of this study is to employ a pre- and post-test assessment of changes in perceived self-efficacy among MFRs following an intervention focused on the initial management of MCI. It also aimed to evaluate a self-efficacy instrument for its validity and reliability in this type of training. METHOD: In this study, we used a pretest (time 1 = T1) - post-test (time 2 = T2) design to evaluate how self-efficacy changed after a training intervention with 201 MFRs in initial MCI management. ANOVA within-subjects and between subjects analyses were used. RESULTS: The findings reveal a noteworthy change in self-efficacy before and after training among the 201 participants. This suggests that the training intervention positively affected participants' perceived capabilities to handle complex situations like MCI. CONCLUSION: The results allow us to recommend a training program with theory components together with practical workshops and live, large-scale simulation exercises for the training of medical first responders in MCI, as it significantly increases their perception of the level of self-efficacy for developing competencies associated with disaster response.


Asunto(s)
Socorristas , Incidentes con Víctimas en Masa , Autoeficacia , Humanos , Masculino , Femenino , Socorristas/psicología , Socorristas/educación , Adulto , Planificación en Desastres , Persona de Mediana Edad , Encuestas y Cuestionarios
7.
Public Health ; 232: 93-99, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38759473

RESUMEN

OBJECTIVES: Mass violence incidents (MVIs) involving firearms, commonly referred to as "mass shootings" have become increasingly frequent in the United States. These shootings often result in immediate casualties and have far-reaching psychological impacts on survivors, witnesses, and the broader community. This study aimed to assess the prevalence and risk factors of depression within affected communities. STUDY DESIGN: Population-based cross-sectional study. METHODS: Data were collected from six communities affected by MVIs involving firearms that occurred between 2015 and 2020. Participants were randomly selected through address-based sampling, and depression was assessed using Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) diagnostic-level major depressive episode (MDE). RESULTS: Overall, the MDE prevalence was 17·2% since the MVI, 15·4% in the past year, and 8·2% in the past month. Significant risk factors for MDE since MVIs include high exposure to the incident (adjusted relative risk [aRR] = 1·32, 95% confidence interval [CI]: 19-1·60), being aged 18-29 years (aRR = 2·52, 95% CI: 1·61-3·95), being a woman (aRR = 1·58, 95% CI: 1·27-1·96), having low social support (aRR = 1·80, 95% CI: 1·46-2·22), and experiencing past sexual or physical trauma (aRR = 2·20, 1·52-3·19). CONCLUSION: Our study reveals a high burden of depression within communities affected by MVIs involving firearm use. Persons with high exposure to the MVIs and certain demographic groups had greater risks for MDE. These findings highlight the long-term mental health burden in communities affected by MVIs and underscore the necessity of providing mental health services in its aftermath.


Asunto(s)
Incidentes con Víctimas en Masa , Humanos , Adulto , Femenino , Masculino , Factores de Riesgo , Prevalencia , Estudios Transversales , Adolescente , Estados Unidos/epidemiología , Adulto Joven , Persona de Mediana Edad , Incidentes con Víctimas en Masa/estadística & datos numéricos , Incidentes con Víctimas en Masa/psicología , Depresión/epidemiología , Armas de Fuego/estadística & datos numéricos , Anciano , Trastorno Depresivo Mayor/epidemiología , Encuestas y Cuestionarios , Eventos de Tiroteos Masivos
8.
Public Health ; 234: 132-142, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-39002283

RESUMEN

OBJECTIVES: Doctors and nurses suffer different mental health conditions following traumatic incidents. We systematically synthesized existing evidence on the prevalence of anxiety, depression, and post-traumatic stress disorder (PTSD) and their associated risk factors among doctors and nurses following mass casualty incidents (MCIs). STUDY DESIGN: Systematic review. METHODS: Seven databases were searched (2010-2022) with peer-reviewed articles in English using the predefined keywords. Two reviewers screened the titles, abstracts, and full texts using the eligibility criteria and extracted data independently. We used the National Institutes of Health Quality Assessment Tools (NIH-QAT) and the Critical Appraisal Skills Programme checklist (CASP) to measure the quality appraisal of the included studies. RESULTS: A total of 5170 articles were retrieved, and 2512 articles were assessed by title and abstract (53 were eligible for full-text review). Finally, we included 19 studies. Most were assessed as of fair quality with a considerable risk of bias. PTSD was the highest-reported mental health condition. Nurses reported higher mental conditions, particularly PTSD. Two sets of risk factors (personal and workplace) are associated with anxiety, depression, and PTSD were found. CONCLUSIONS: MCIs have a significant impact on the mental health outcomes of emergency health workers. Preventive measures should be designed considering the high-risk group, personal, and organizational risk factors of mental health outcomes.


Asunto(s)
Ansiedad , Depresión , Incidentes con Víctimas en Masa , Enfermeras y Enfermeros , Médicos , Trastornos por Estrés Postraumático , Humanos , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/psicología , Incidentes con Víctimas en Masa/psicología , Depresión/epidemiología , Ansiedad/epidemiología , Enfermeras y Enfermeros/psicología , Enfermeras y Enfermeros/estadística & datos numéricos , Médicos/psicología , Médicos/estadística & datos numéricos , Factores de Riesgo
9.
BMC Med Educ ; 24(1): 544, 2024 May 15.
Artículo en Inglés | MEDLINE | ID: mdl-38750542

RESUMEN

BACKGROUND: Clinical acumen represents only part of being adequately equipped to attend a major incident. The emotive sights, sounds and smells of these dynamic environments are all-encompassing experiences, and responders must also be armed with the emotional preparedness to perform their clinical or managerial duties effectively, as well as the mental resilience to facilitate professional continuance. Despite this, limited training and a sparsity of evidence exists to guide developments within this domain. Historically, major incident training has focused on clinical theory acquisition, but irrespective of how comprehensive the learning materials, they are of little consequence if tandem steps to cultivate mental resilience and emotional preparedness are absent. High-Fidelity Simulation (HFS) has a growing reputation as an effective means of bridging important gaps between theory and practice. This pilot study aimed to measure student's self-reported perception of their readiness to respond to a major incident following a large-scale HFS. METHODS: Quantitative data was obtained from a sample of 108 students undertaking paramedic science, physician associate studies and adult nursing degree programmes. A bespoke questionnaire was developed to measure self-reported clinical acumen, mental and emotional preparedness. RESULTS: 91% of students agreed the combination of theoretical training and HFS provided made them feel clinically prepared to attend a real major incident; 86% agreed this experience had developed their mental resilience and 90% agreed that they felt emotionally prepared to attend a major incident. CONCLUSION: Within this pilot study, the blend of theoretical training and HFS contributed to self-reported clinical acumen, mental and emotional preparation, in learners training to work in disaster environments or emergency medicine settings.


Asunto(s)
Incidentes con Víctimas en Masa , Resiliencia Psicológica , Humanos , Proyectos Piloto , Masculino , Femenino , Adulto , Emociones , Encuestas y Cuestionarios , Enseñanza Mediante Simulación de Alta Fidelidad , Adulto Joven , Competencia Clínica
10.
Emerg Med J ; 41(8): 495-499, 2024 Jul 22.
Artículo en Inglés | MEDLINE | ID: mdl-38811145

RESUMEN

Mass violence events, especially in healthcare settings, have devastating consequences and long-lasting effects on the victims and the community. The rate of violent events in Mexico, especially in hospital settings, has increased since 2006, but has become more evident in 2018. Guanajuato State, located in central Mexico, is among the states most affected by the wave of violence, especially active shooter events. The year 2019 had the highest number of incidents. Therefore, the Silver Code and the components of Safe Hospitals, in accordance with the Hartford consensus and PAHO guidelines, were implemented in the hospitals of the Institute of Public Health of the State of Guanajuato, with a focus on the actions of healthcare personnel to prevent collateral damage. Although subsequently there were still fatalities and injuries in the events involving active shooters in the hospitals, there were no casualties among healthcare personnel, according to data from the Institute of Public Health, Guanajuato State. This paper presents information from the data from General Directorate of Epidemiology to describe the hospital mass violence situation in the State of Guanajuato, Mexico and recounts the step taken to effectively manage and prevent these situations moving forward. Specific recommendations based on international consensus and our experience provided include increasing the level of security checks for people entering the hospital premises, training healthcare personnel on violence-related preparedness and improving management of active shooter events consistent with published evidence, to reduce the possibility of casualties.


Asunto(s)
Servicio de Urgencia en Hospital , Humanos , México/epidemiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Servicio de Urgencia en Hospital/organización & administración , Armas de Fuego/estadística & datos numéricos , Heridas por Arma de Fuego/epidemiología , Heridas por Arma de Fuego/mortalidad , Incidentes con Víctimas en Masa/estadística & datos numéricos , Violencia/estadística & datos numéricos , Violencia/prevención & control
11.
BMC Emerg Med ; 24(1): 127, 2024 Jul 24.
Artículo en Inglés | MEDLINE | ID: mdl-39048983

RESUMEN

BACKGROUND: Emergency medical services preparedness in mass casualty incidents is one of the most important concerns in emergency systems. A mass casualty incident is a sudden event with several injured individuals that overwhelms the local health care system. This study aimed to identify and validate the components of emergency medical services readiness in mass casualty incidents which ultimately led to designing a conceptual model. METHODS: This research was an explanatory mixed-method study conducted in five consecutive stages in Iran between November 2021 and September 2023. First, a systematic review was carried out to extract the components of emergency medical services preparedness in mass casualty incidents based on the PRISMA guideline. Second, a qualitative study was designed to explore the preparedness components through in-depth semi-structured interviews and analyzed using the content analysis approach. Third, the integration of the components extracted from the two stages of the systematic review and qualitative study was done by an expert panel. Fourth, the obtained components were validated using the Delphi technique. Two rounds were done in the Delphi phase. Finally, the conceptual model of emergency medical services preparedness in mass casualty incidents was designed by a panel of experts. RESULTS: 10 articles were included in the systematic review stage and sixteen main components were extracted and classified into four categories. In the second stage, thirteen components were extracted from the qualitative study and classified into five categories. Then, the components of the previous two phases were integrated into the panel of experts and 23 components were identified. After validation with the Delphi technique, 22 components were extracted. Lastly, the final components were examined by the panel of experts, and the conceptual schematic of the model was drawn. CONCLUSIONS: It is necessary to have an integrated framework and model of emergency medical service readiness in the planning and management of mass casualty incidents. The components and the final model of this research were obtained after the systematic scientific steps, which can be used as a scheme to improve emergency medical service preparedness in response to mass casualty incidents.


Asunto(s)
Técnica Delphi , Planificación en Desastres , Servicios Médicos de Urgencia , Incidentes con Víctimas en Masa , Investigación Cualitativa , Humanos , Servicios Médicos de Urgencia/organización & administración , Irán , Planificación en Desastres/organización & administración
12.
BMC Emerg Med ; 24(1): 175, 2024 Sep 27.
Artículo en Inglés | MEDLINE | ID: mdl-39333890

RESUMEN

BACKGROUND: Given the increasing frequency of disasters globally, it is critical that healthcare systems are prepared for these mass casualty events. The Saudi health system's preparedness for mass casualty incidents needs to be more robust, potentially due to limited disaster drills and inadequate standardized patient (SP) simulation training. This study aims to (i) assess the performance of front-line hospital staff in Saudi Arabia through a functional drill and (ii) evaluate the drill's effectiveness using SP and MAC-SIM cards, providing detailed insights into its design and execution. METHODS: A functional drill was conducted at a government hospital in Riyadh, Saudi Arabia, on December 19, 2022, using a cross-sectional approach with two phases. 141 healthcare receivers served as subjects, while 23 volunteers acted as SPs. The scenario simulated a building collapse to assess the emergency department (ED) response, interdepartmental communication, and surge capacity. Data were collected through direct observation of healthcare practitioners' interactions with the SPs, analysis of SP data, and participant feedback. Quantitative data were analyzed descriptively, while qualitative data were examined for patterns and themes related to simulation performance and effectiveness. RESULTS: The hospital receivers' performances demonstrated accurate triage categories. The ED team assessed most patients (67%) in less than 5 min. For patients requiring definitive care, such as intensive care unit, 95% spent less than 2.5 h in the ED. Most patients (65%) required 'other treatments'. Communication was efficient in the triage zone and the yellow treatment area. Participants' feedback on using MAC-SIM cards during the simulation was overwhelmingly positive with 82.61% reporting that MAC-SIM use helped them respond better. Experienced SPs (paramedics) with prior disaster knowledge and experience outperformed inexperienced SPs (nurses) in the functional exercise. CONCLUSION: This groundbreaking study is the first in the Arabic Gulf region to use SPs with MAC-SIM cards in functional drills. The findings highlight the potential of simulation exercises to improve hospital team knowledge and performance when responding to disasters. Multiple evaluation techniques can effectively identify participant strengths and weaknesses, informing future disaster improvement plans. This information is a valuable resource for Arabic and middle-income countries where disaster medicine is still developing.


Asunto(s)
Planificación en Desastres , Incidentes con Víctimas en Masa , Simulación de Paciente , Humanos , Arabia Saudita , Proyectos Piloto , Estudios Transversales , Planificación en Desastres/organización & administración , Masculino , Femenino , Servicio de Urgencia en Hospital/organización & administración , Adulto , Entrenamiento Simulado , Capacidad de Reacción
13.
BMC Emerg Med ; 24(1): 68, 2024 Apr 23.
Artículo en Inglés | MEDLINE | ID: mdl-38649853

RESUMEN

BACKGROUND: Road traffic accidents (RTAs) are predicted to become the world's seventh leading cause of death by 2030. Given the significant impact of RTAs on public health, effective hospital preparedness plays a pivotal role in managing and mitigating associated health and life-threatening issues. This study aims to meticulously evaluate the preparedness of selected hospitals in western Iran to handle road traffic accidents with mass casualties (RTAs-MC). METHODS: The study employed a descriptive-analytical approach, utilizing a reliable and valid questionnaire to measure hospitals' preparedness levels. Descriptive statistics (frequency distribution and mean) were utilized to provide an overview of the data, followed by analytical statistics (Spearman correlation test) to examine the relationship between hospital preparedness and its dimensions with the hospital profile. Data analysis, performed using SPSS software, categorized preparedness levels as weak, moderate, or high. RESULTS: The study found that hospitals in Kurdistan province had a favorable preparedness level (70.30) to respond to RTAs-MC. The cooperation and coordination domain had the highest preparedness level (98.75), while the human resource management (59.44) and training and exercise (54.00) domains had the lowest preparedness levels. The analysis revealed a significant relationship between hospital preparedness and hospital profile, including factors such as hospital specialty, number of beds, ambulances, staff, and specialized personnel, such as emergency medicine specialists. CONCLUSION: Enhancing preparedness for RTAs-MC necessitates developing response plans to improve hospital profile, considering the region's geographic and topographic features, utilizing past experiences and lessons learned, implementing of Hospital Incident Command System (HICS), providing medical infrastructure and equipment, establishing communication channels, promoting cooperation and coordination, and creating training and exercise programs.


Asunto(s)
Accidentes de Tránsito , Incidentes con Víctimas en Masa , Irán , Humanos , Estudios Transversales , Encuestas y Cuestionarios , Planificación en Desastres/organización & administración , Servicio de Urgencia en Hospital
14.
BMC Emerg Med ; 24(1): 47, 2024 Mar 21.
Artículo en Inglés | MEDLINE | ID: mdl-38515061

RESUMEN

BACKGROUND: Frontline hospitals near active hostilities face unique challenges in delivering emergency care amid threats to infrastructure and personnel safety. Existing literature focuses on individual aspects like mass casualty protocols or medical neutrality, with limited analysis of operating acute services directly under fire. OBJECTIVES: To describe the experience of a hospital situated meters from hostilities and analyze strategies implemented for triage, expanding surge capacity, and maintaining continuity of care during attacks with limited medical staff availability due to hazardous conditions. A focus will be placed on assessing how the hospital functioned and adapted care delivery models in the event of staffing limitations preventing all teams from arriving on site. METHODS: A retrospective case study was conducted of patient records from Barzilai University Medical Center at Ashkelon (BUMCA) Medical Center in Israel within the first 24 h after escalated conflict began on October 7, 2023. Data on 232 admissions were analyzed regarding demographics, treatment protocols, time to disposition, and mortality. Missile alert data correlated patient surges to attacks. Statistical and geospatial analyses were performed. RESULTS: Patients predominantly male soldiers exhibited blast/multisystem trauma. Patient surges at the hospital were found to be correlated with the detection of incoming missile attacks from Gaza within 60 min of launch. While 131 (56%) patients were discharged and 55 (24%) transferred within 24 h, probabilities of survival declined over time reflecting injury severity limitations. 31 deaths occurred from severe presentation. CONCLUSION: Insights gleaned provide a compelling case study on managing mass casualties at the true frontlines. By disseminating BUMCA's trauma response experience, strategies can strengthen frontline hospital protocols optimizing emergency care delivery during hazardous armed conflicts through dynamic surge capacity expansion, early intervention prioritization, and infrastructure/personnel protection measures informed by risks.


Asunto(s)
Traumatismos por Explosión , Planificación en Desastres , Servicios Médicos de Urgencia , Incidentes con Víctimas en Masa , Humanos , Masculino , Femenino , Estudios Retrospectivos , Triaje/métodos , Hospitales , Servicio de Urgencia en Hospital
15.
J Med Syst ; 48(1): 82, 2024 Sep 05.
Artículo en Inglés | MEDLINE | ID: mdl-39235718

RESUMEN

INTRODUCTION: Chemical mass casualty incidents (MCIs) pose a substantial threat to public health and safety, with the capacity to overwhelm healthcare infrastructure and create societal disorder. Computer simulation systems are becoming an established mechanism to validate these plans due to their versatility, cost-effectiveness and lower susceptibility to ethical problems. METHODS: We created a computer simulation model of an urban subway sarin attack analogous to the 1995 Tokyo sarin incident. We created and combined evacuation, dispersion and victim models with the SIMEDIS computer simulator. We analyzed the effect of several possible approaches such as evacuation policy ('Scoop and Run' vs. 'Stay and Play'), three strategies (on-site decontamination and stabilization, off-site decontamination and stabilization, and on-site stabilization with off-site decontamination), preliminary triage, victim distribution methods, transport supervision skill level, and the effect of search and rescue capacity. RESULTS: Only evacuation policy, strategy and preliminary triage show significant effects on mortality. The total average mortality ranges from 14.7 deaths in the combination of off-site decontamination and Scoop and Run policy with pretriage, to 24 in the combination of onsite decontamination with the Stay and Play and no pretriage. CONCLUSION: Our findings suggest that in a simulated urban chemical MCI, a Stay and Play approach with on-site decontamination will lead to worse outcomes than a Scoop and Run approach with hospital-based decontamination. Quick transport of victims in combination with on-site antidote administration has the potential to save the most lives, due to faster hospital arrival for definitive care.


Asunto(s)
Simulación por Computador , Planificación en Desastres , Incidentes con Víctimas en Masa , Triaje , Humanos , Planificación en Desastres/organización & administración , Triaje/organización & administración , Descontaminación/métodos , Sarín , Agentes Nerviosos
16.
Acta Chir Belg ; 124(5): 356-364, 2024 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-38284807

RESUMEN

BACKGROUND: Terrorist attacks have the potential to be mass casualty events, causing multiple injuries and deaths. High injury rate attacks will particularly place a high burden on emergency medical systems. This study aimed to assess if there is a difference between attacks with high injury rates and high fatality rates. METHODS: The top 100 terrorist events causing the highest number of fatalities versus the highest number of injuries were selected from the Global Terrorism Database. Analyses were performed on temporal factors, location, target type, attack and weapon type, and perpetrator type. RESULTS: The 9/11 attacks caused the highest number of both fatalities and injuries. With regards to injury rates, the sarin attacks in Tokyo, Japan ranked second. Events with high fatality rates were overrepresented in Sub-Saharan Africa, whereas events with high injury rates were predominant in the Middle East & North Africa. High fatality rates were most often associated with armed assaults and hostage takings. Bombings were responsible for the highest number of injuries. CBRN attacks were overrepresented in the top 100 injuries, and accounted for 11% of the incidents. CONCLUSION: High injury rate incidents place a heavy burden on the health care system as the number of injuries is nearly ten times as high as the number of injuries in high fatality rate incidents. Epidemiological analysis of high impact terrorist events may contribute to counter-terrorism preparedness, to an increased focus on dealing with CBRN-events, and thus to a proper medical response to future terrorist events.


Asunto(s)
Bases de Datos Factuales , Incidentes con Víctimas en Masa , Terrorismo , Humanos , Incidentes con Víctimas en Masa/estadística & datos numéricos , Heridas y Lesiones/mortalidad , Heridas y Lesiones/epidemiología , Salud Global
17.
Acta Chir Belg ; 124(5): 349-355, 2024 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-38265761

RESUMEN

OBJECTIVES: Belgium is not only prone to inland terrorism but also attracts terrorist factions aiming at various political, diplomatic, military, and/or religious targets. This study aimed to identify and characterize all documented terrorist attacks in Belgium reported to the Global Terrorism Database (GTD) over a period of 50 years. METHODS: The GTD was searched for all terrorist attacks in Belgium between 1970 and 2019. Analyses were performed on temporal factors, location, target type, attack and weapon type, attacker type, and number of casualties or hostages. RESULTS: In 50 years, 121 incidents accounted for 80 confirmed fatalities and 498 injured people. Bombings and explosions were the most frequently identified attack type (46.3%), followed by assassination (16.5%), infrastructure damage (15.7%) and armed or unarmed assaults (14.0%). Governmental and diplomatic institutions were the most frequent target (24.0%). For those perpetrators the GTD did have enough information we saw a timely change from far left and separatist dominating the early decades to Jihadi groups in the last decade, while anti-semitic factions were active in every decade. CONCLUSION: In contrast to other studies, this study did not show an increase over time. Left-wing perpetrators dominated the eighties. In 50 years of terrorist activity in Belgium, the health care system was spared. Devastating mass casualty attacks challenging the health care system are rare in Belgium.


Asunto(s)
Bases de Datos Factuales , Terrorismo , Bélgica/epidemiología , Terrorismo/estadística & datos numéricos , Humanos , Incidentes con Víctimas en Masa/estadística & datos numéricos
18.
Healthc Manage Forum ; 37(2): 52-55, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-37991433

RESUMEN

Including post-event support planning as part of crisis preparedness is necessary to meet the emotional and psychological needs of those most affected. This necessarily requires engagement with health and community organization leaders best positioned to provide immediate, short- and long-term post-event supports as part of the response planning for a crisis. Drawing on the findings of the Mass Casualty Commission, the public inquiry tasked with investigating Canada's worst mass shooting, the critical role of post-event supports is explored as a critical element of crisis preparedness.


Asunto(s)
Planificación en Desastres , Incidentes con Víctimas en Masa , Humanos , Eventos de Tiroteos Masivos
19.
Healthc Manage Forum ; 37(2): 86-89, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-37731265

RESUMEN

Mass casualty events can cause patient surges within healthcare facilities. These surges can be limited to hours or continue for days or weeks. As emergency departments are the front doors to the healthcare system, it is critical that they are prepared to accept patient surges. Focusing plans on optimizing space, staff, and supplies is critical to a successful response. Boarded or non-emergent patients must be diverted, discharged, and decanted from the emergency department to expand resuscitation space. If inadequate, non-clinical space may be required for patient care. Staff call-in lists should be maintained, and in-house berthing for staff during prolonged responses may be necessary. Further, identifying the spectrum of care, from conventional to crisis, is necessary to thrive during a disaster response: staff must understand that business as usual will not be compatible with austere disaster response before levels of care begin to decline.


Asunto(s)
Planificación en Desastres , Incidentes con Víctimas en Masa , Humanos , Capacidad de Reacción , Servicio de Urgencia en Hospital , Cuidados Críticos
20.
Sud Med Ekspert ; 67(4): 22-26, 2024.
Artículo en Ruso | MEDLINE | ID: mdl-39189490

RESUMEN

The article presents the main innovative methods used in forensic expert practice at the current stage, reveals the principle and algorithms of the developed software complex for registration and identification of the deceased. The proposed program automatically generates four documents, which reduces the time required for forensic expertise in the conditions of mass admission of deceased. The article's authors substantiate prospects of further application of computer technologies in forensic practice to improve organizational and methodological activities in emergencies with a large number of deceased.


Asunto(s)
Medicina Legal , Incidentes con Víctimas en Masa , Humanos , Medicina Legal/métodos , Programas Informáticos , Testimonio de Experto/métodos , Algoritmos , Urgencias Médicas
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