Emotional and psychological implications for healthcare professionals in disasters or mass casualties: A systematic review.

AIM: To synthesize and describe the emotional and psychological implications for healthcare professionals who provided care in a mass casualty incident or disaster. BACKGROUND: The experience of healthcare providers immersed in the actual uncertainty of an ongoing disaster is real, challenging, complex and strongly connected with emotions. Identifying these implications for healthcare professionals is essential for developing strategies to help these professionals deliver high-quality care. EVALUATION: A systematic review was conducted in PubMed, CINAHL, Scopus, Nursing & Allied Health Database and PsycINFO using published data until February 2021 and following the PRISMA guidelines. KEY ISSUES: Nineteen articles were included. Factors associated with negative psychological implications were identified and different strategies have been synthesized to prevent or reduce them when caring for the victims of a disaster. CONCLUSIONS: Feelings of sadness, helplessness, fear and blockage, among others, were identified as common reactions among nurses and other healthcare professionals dealing in mass casualties or disasters. These reactions may lead to post-traumatic disorder, turning professionals into hidden victims. IMPLICATIONS FOR NURSING MANAGEMENT: Organizations, senior charge nurses and other health service managers need to foster resilience and flexibility among their workforce to improve self-care during a disaster, as well as ensure policies to address a lack of emotional preparedness among their personnel. Some strategies to consider include cognitive behavioural therapy, psychoeducation or meditation.

Intentional mass-casualty incident simulation-based training: A qualitative study into nursing students' perceptions and experiences.

BACKGROUND: The number of intentional mass casualty incidents (IMCI) has increased in recent years, and hemorrhage control is one of the important life-saving techniques used in these events. OBJECTIVE: The objective of this study is to understand the perceptions and experiences of nursing students subjected to a simulated intentional mass-casualty incident after receiving a training action within their curriculum, focused on how to respond to active threats and bleeding control. DESIGN: A qualitative phenomenological study on nursing students (n = 74) enrolled in the Nursing Care for Critical Patients course, facing a simulated IMCI in November 2019. DATA SOURCES: A total of 7 focus groups were performed, containing 8 to 12 participants each. FINDINGS: Participants reported a feeling of vulnerability and fear of an IMCI occurrence. Based on this context, the participants reported not knowing how to react to this type of situation, which is why training activities such as this one is seen as a way of improving participants' self-protection and safety. Likewise, a simulated IMCI is considered useful for any citizen and as a training exercise for life-saving techniques, such as hemorrhage control. CONCLUSIONS: Training on the subject of hemorrhage control using a simulated IMCI setting could increase self-efficacy and self-control, as well as reducing feelings of fear and vulnerability. Such training intervention could be primary prevention measures of an IMCI as well as a sustainable way to train knowledge-transmitting instructors.

Tourniquets as a haemorrhage control measure in military and civilian care settings: An integrative review.

AIMS AND OBJECTIVES: The aim of review was to describe and synthesise the evidence on the use of tourniquets to control haemorrhages, summarising both civilian and military use. BACKGROUND: Trauma-related haemorrhage constitutes one of the most preventable deaths among injured patients, particularly in multi-casualty incidents and disasters. In this context, safe instruments such as tourniquets are essential to help healthcare professionals to minimise loss of life and maximise patient recovery. DESIGN AND METHODS: An integrative review was conducted in Medline, Nursing & Allied Health Premium, and Health & Medical Collection, using published data until March 2021 and following the PRISMA guidelines. RESULTS: A total of 25 articles were included. Evidence has been synthesised to understand the use of different types of tourniquets, environment of application, indication for their placement and potential complications associated with tourniquet placement. CONCLUSIONS: Commercial tourniquets such as Combat Application Tourniquet or Emergency Tourniquet models are a valuable and safe instrument for haemorrhage control in both military and civilian out-of-hospital care settings. Nurses, as part of emergency teams, and other professionals should be aware that there is a possibility of adverse complications, but they are directly proportional to the time of tourniquet placement and generally temporary. In addition, national and international guidelines ensure the need for all civilian emergency services to be equipped with these devices, as well as for the training of healthcare professionals and first responders in their use. RELEVANCE TO CLINICAL PRACTICE: Despite the lack of complications in the use of tourniquets in these cases, their use has been a matter of debate for decades. In this sense, this review yields up-to-date guidelines in the use of tourniquets, their recommendations and their significance among professionals to manage complicated situations.

Respuesta de los autores: Consenso Victoria I: otra perspectiva cara al futuro de los incidentes con múltiples víctimas intencionados / Author's reply: Another perspective on the management of multiple intentional-injury victims in the future: the Victory I Consensus

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A civilian tactical survival chain for incidents involving multiple intentionalinjury victims: the Victory I Consensus Report. / Consenso Victoria I: la cadena de supervivencia táctica civil ante incidentes de múltiples víctimas intencionados.

EN: International guidelines recommend adapting military health care protocols to emergencies involving multiple intentional-injury victims in civilian environments. Adaptations can reflect similarities in types of injuries or issues of provider safety and that arise in military and some civilian emergencies. Because more experience with such incidents has been gained in the United States, most of the literature on this topic discusses emergency medical systems that differ from the ones operating in the autonomous communities of Spain, where varying resources and procedures are mandated by local authorities charged with preparing for emergencies. However, common elements are present, offering a framework and principles to apply when drafting evidence-based plans for effective, efficient response to multiple-victim emergencies. We think that participants at each point in the chain of survival must have clear missions and understand the roles they play in the various zones that comprise the scene of an emergency. Therefore this consensus paper attempts to define the relevant principles and roles for participants at all levels, from occasional first responders up to staff at trauma referral centers.

ES: Son múltiples las recomendaciones internacionales que aconsejan adaptar modelos asistenciales del entorno militar a incidentes de múltiples víctimas intencionados (IMVI) ocurridos en el entorno civil, bien por el tipo de patrón lesional, bien por aspectos de seguridad y autoprotección. Debido a la experiencia en Norteamérica, donde este tipo de situaciones son más frecuentes, casi toda la bibliografía y referencias existentes no se corresponden con un modelo de sistemas de emergencias médicas como el que existe en las distintas comunidades autónomas españolas, con sus diferentes medios y procedimientos tal y como viene estipulado por sus competencias exclusivas en esta materia. No obstante, se han detectado una serie de elementos comunes que pueden servir de referencia para elaborar un plan de respuesta a los IMVI, basados en la evidencia y utilizando principios de actuación dirigidos a una acción eficaz y eficiente. Pensamos que cada actor de los eslabones de esta cadena asistencial debe tener clara su misión, su rol y su función en las diferentes zonas de la escena, y así se intentan definir en este documento de consenso, desde un primer interviniente ocasional hasta la asistencia definitiva en los centros de referencia para pacientes traumatizados.

Consenso Victoria I: la cadena de supervivencia táctica civil ante incidentes de múltiples víctimas intencionados / A civilian tactical survival chain for incidents involving multiple intentionalinjury victims: the Victory I Consensus Report

Son múltiples las recomendaciones internacionales que aconsejan adaptar modelos asistenciales del entorno militar a incidentes de múltiples víctimas intencionados (IMVI) ocurridos en el entorno civil, bien por el tipo de patrón lesional, bien por aspectos de seguridad y autoprotección. Debido a la experiencia en Norteamérica, donde este tipo de situaciones son más frecuentes, casi toda la bibliografía y referencias existentes no se corresponden con un modelo de sistemas de emergencias médicas como el que existe en las distintas comunidades autónomas españolas, con sus diferentes medios y procedimientos tal y como viene estipulado por sus competencias exclusivas en esta materia. No obstante, se han detectado una serie de elementos comunes que pueden servir de referencia para elaborar un plan de respuesta a los IMVI, basados en la evidencia y utilizando principios de actuación dirigidos a una acción eficaz y eficiente. Pensamos que cada actor de los eslabones de esta cadena asistencial debe tener clara su misión, su rol y su función en las diferentes zonas de la escena, y así se intentan definir en este documento de consenso, desde un primer interviniente ocasional hasta la asistencia definitiva en los centros de referencia para pacientes traumatizados

International guidelines recommend adapting military health care protocols to emergencies involving multiple intentional-injury victims in civilian environments. Adaptations can reflect similarities in types of injuries or issues of provider safety and that arise in military and some civilian emergencies. Because more experience with such incidents has been gained in the United States, most of the literature on this topic discusses emergency medical systems that differ from the ones operating in the autonomous communities of Spain, where varying resources and procedures are mandated by local authorities charged with preparing for emergencies. However, common elements are present, offering a framework and principles to apply when drafting evidence-based plans for effective, efficient response to multiple-victim emergencies. We think that participants at each point in the chain of survival must have clear missions and understand the roles they play in the various zones that comprise the scene of an emergency. Therefore this consensus paper attempts to define the relevant principles and roles for participants at all levels, from occasional first responders up to staff at trauma referral centers