Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-23T04:19:55.807Z Has data issue: false hasContentIssue false
  • English
  • Français

Mass Casualty Incident Management for Resource-Limited Settings: Lessons From Central Haiti

Published online by Cambridge University Press:  11 March 2021

Shada A. Rouhani Open the ORCID record for Shada A. Rouhani [Opens in a new window] ,
Linda Rimpel ,
Jean Jimmy Plantin ,
Christopher F. Calahan ,
Marc Julmisse ,
Marie Cassandre Edmond ,
Keegan A. Checkett  and
Regan H. Marsh
Shada A. Rouhani*
Affiliation:
Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA Partners In Health, Boston, Massachusetts, USA
Linda Rimpel
Affiliation:
Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
Jean Jimmy Plantin
Affiliation:
Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
Christopher F. Calahan
Affiliation:
Partners In Health, Boston, Massachusetts, USA Department of Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
Marc Julmisse
Affiliation:
Partners In Health, Boston, Massachusetts, USA Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
Marie Cassandre Edmond
Affiliation:
Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
Keegan A. Checkett
Affiliation:
Partners In Health, Boston, Massachusetts, USA Department of Emergency Medicine, University of Chicago, Chicago, Illinois, USA
Regan H. Marsh
Affiliation:
Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA Partners In Health, Boston, Massachusetts, USA
*
Corresponding author: Shada A. Rouhani, Email: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Mass casualty incidents (MCIs) have gained increasing attention in recent years due multiple high-profile events. MCI preparedness improves the outcomes of trauma victims, both in the hospital and prehospital settings. Yet most MCI protocols are designed for high-income countries, even though the burden of mass casualty incidents is greater in low-resource settings.

Results:

Hôpital Universitaire de Mirebalais (HUM), a 300-bed academic teaching hospital in central Haiti, developed MCI protocols in an iterative process after a large MCI in 2014. Frequent MCIs from road traffic collisions allowed protocol refinement over time. HUM’s protocols outline communication plans, triage, schematics for reorganization of the emergency department, clear delineation of human resources, patient identification systems, supply chain solutions, and security measures for MCIs. Given limited resources, protocol components are all low-cost or cost-neutral. Unique adaptations include the use of 1) social messaging for communication, 2) mass casualty carts for rapid deployment of supplies, and 3) stickers for patient identification, templated orders, and communication between providers.

Conclusion:

These low-cost solutions facilitate a systematic response to MCIs in a resource-limited environment and help providers focus on patient care. These interventions were well received by staff and are a potential model for other hospitals in similar settings.

Keywords

mass casualty incidentsemergency servicehospitalemergency medicinelow-income countryroad traffic collision
Type
Concepts in Disaster Medicine
Information
Disaster Medicine and Public Health Preparedness , Volume 16 , Issue 2 , April 2022 , pp. 770 - 776
Copyright
© 2021 Society for Disaster Medicine and Public Health, Inc.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

World Health Organization. Mass casualty management systems. Strategies and guidelines for building health sector capacity. Geneva: World Health Organization; 2007. https://www.who.int/hac/techguidance/tools/mcm_guidelines_en.pdf. Accessed October 29, 2019.Google Scholar
Cooke, T, Chesters, A, Grier, G. 34 A systematic literature review of the pre-hospital lessons identified following mass casualty deliberate bombing incidents. Emerg Med J. 2017;34:A884.CrossRefGoogle Scholar
Gates, JD, Arabian, S, Biddinger, P, et al. The initial response to the Boston marathon bombing: lessons learned to prepare for the next disaster. Ann Surg. 2014;260:960-966.CrossRefGoogle Scholar
Philippe, JM, Brahic, O, Carli, P, et al. French Ministry of Health’s response to Paris attacks of 13 November 2015. Crit Care. 2016;20:85.CrossRefGoogle ScholarPubMed
Aylwin, CJ, Konig, TC, Brennan, NW, et al. Reduction in critical mortality in urban mass casualty incidents: analysis of triage, surge, and resource use after the London bombings on July 7, 2005. Lancet. 2006;368:2219-2225.CrossRefGoogle ScholarPubMed
Adini, B, Bodas, M, Nilsson, H, et al. Policies for managing emergency medical services in mass casualty incidents. Injury. 2017;48:1878-1883.CrossRefGoogle ScholarPubMed
Shartar, SE, Moore, BL, Wood, LM. Developing a mass casualty surge capacity protocol for emergency medical services to use for patient distribution. South Med J. 2017;110:792-795.CrossRefGoogle ScholarPubMed
Perry, RW, Lindell, MK. Hospital planning for weapons of mass destruction incidents. J Postgrad Med. 2006;52:116-120.Google ScholarPubMed
Adini, B, Goldberg, A, Laor, D, et al. Assessing levels of hospital emergency preparedness. Prehosp Disaster Med. 2006;21:451-457.CrossRefGoogle ScholarPubMed
Sarhan, MD, Dahaba, AA, Marco, M, et al. Mass casualties in Tahrir Square at the climax of the Egyptian uprising: evidence of an emerging pattern of regime’s organized escalating violence during 10 hours on the night of January 28, 2011. Ann Surg. 2012;256:1093-1097.CrossRefGoogle ScholarPubMed
Halpern, P, Goldberg, SA, Keng, JG, et al. Principles of emergency department facility design for optimal management of mass-casualty incidents. Prehosp Disaster Med. 2012;27:204-212.CrossRefGoogle ScholarPubMed
Golabek-Goldman, M. Adequacy of US hospital security preparedness for mass casualty incidents: critical lessons from the Israeli experience. J Public Health Manag Pract. 2016;22:68-80.CrossRefGoogle ScholarPubMed
Bin Shalhoub, AA, Khan, AA, Alaska, YA. Evaluation of disaster preparedness for mass casualty incidents in private hospitals in Central Saudi Arabia. Saudi Med J. 2017;38:302-306.CrossRefGoogle ScholarPubMed
King, DR, Patel, MB, Feinstein, AJ, et al. Simulation training for a mass casualty incident: two-year experience at the Army Trauma Training Center. J Trauma. 2006;61:943-948.CrossRefGoogle ScholarPubMed
Vincent, DS, Berg, BW, Ikegami, K. Mass-Casualty triage training for international healthcare workers in the Asia-Pacific region using manikin-based simulations. Prehosp Disaster Med. 2009;24:206-213.CrossRefGoogle ScholarPubMed
Zafar, H, Jawad, A, Shamim, MS, et al. Terrorist bombings: medical response in a developing country. J Pak Med Assoc. 2011;61:561-566.Google ScholarPubMed
Odero, W, Garner, P, Zwi, A. Road traffic injuries in developing countries: a comprehensive review of epidemiological studies. Trop Med Int Health. 1997;2:445-460.CrossRefGoogle ScholarPubMed
Hyder, AA, Norton, R, Perez-Nunez, R, et al. The Road Traffic Injuries Research Network: a decade of research capacity strengthening in low- and middle-income countries. Health Res Policy Syst. 2016;14:14.CrossRefGoogle Scholar
Peden, MM. World report on road traffic injury prevention. Geneva: World Health Organization; 2004. https://www.who.int/violence_injury_prevention/publications/road_traffic/world_report/en/. Accessed October 29, 2019.Google Scholar
Samuel, JC, Akinkuotu, A, Villaveces, A, et al. Epidemiology of injuries at a tertiary care center in Malawi. World J Surg. 2009;33:1836-1841.CrossRefGoogle Scholar
Odero, W, Khayesi, M, Heda, PM. Road traffic injuries in Kenya: magnitude, causes and status of intervention. Inj Control Saf Promot. 2003;10:53-61.CrossRefGoogle ScholarPubMed
Mock, C, Quansah, R, Kobusingye, O, et al. Trauma care in Africa: the way forward. Afr J Trauma. 2014;3:3-10.CrossRefGoogle Scholar
Samuel, JC, Sankhulani, E, Qureshi, JS, et al. Under-Reporting of road traffic mortality in developing countries: application of a capture-recapture statistical model to refine mortality estimates. PLoS One. 2012;7:e31091.CrossRefGoogle ScholarPubMed
Umer, M, Sepah, YJ, Shahpurwala, MM, et al. Suicide bombings: process of care of mass casualties in the developing world. Disasters. 2009;33:809-821.CrossRefGoogle ScholarPubMed
Mould-Millman, NK, Sasser, SM, Wallis, LA. Prehospital research in sub-saharan Africa: establishing research tenets. Acad Emerg Med. 2013;20:1304-1309.CrossRefGoogle ScholarPubMed
Mould-Millman, NK, Dixon, JM, Sefa, N, et al. The State of Emergency Medical Services (EMS) systems in Africa. Prehosp Disaster Med. 2017;32:273-283.CrossRefGoogle ScholarPubMed
El Sayed, M, Chami, AF, Hitti, E. Developing a hospital disaster preparedness plan for mass casualty incidents: lessons learned from the downtown Beirut bombing. Disaster Med Public Health Prep. 2017;12(3):379-385.CrossRefGoogle ScholarPubMed
Ouma, PO, Maina, J, Thuranira, PN, et al. Access to emergency hospital care provided by the public sector in sub-Saharan Africa in 2015: a geocoded inventory and spatial analysis. Lancet Glob Health. 2018;6:e342-e350.CrossRefGoogle ScholarPubMed
Marsh, RH, Rouhani, SA. Gaps in physical access to emergency care in sub-Saharan Africa. Lancet Glob Health. 2018;6:e240-e241.CrossRefGoogle ScholarPubMed
Ozoilo, KN, Kidmas, AT, Nwadiaro, HC, et al. Management of the mass casualty from the 2001 Jos crisis. Niger J Clin Pract. 2014;17:436-441.CrossRefGoogle ScholarPubMed
Abdallah, S, Heinzen, R, Burnham, G. Immediate and long-term assistance following the bombing of the US Embassies in Kenya and Tanzania. Disasters. 2007;31:417-434.CrossRefGoogle ScholarPubMed
Marsh, RH, Rouhani, SA, Pierre, P, et al. Strengthening emergency care: experience in central Haiti. Lancet Glob Health. 2015;3(Suppl 2):S5-S7.CrossRefGoogle ScholarPubMed
Haiti Référence. Tragic accidents in Haiti: 2010. https://www.haiti-reference.com/pages/plan/geographie-et-tourisme/milieu-naturel/tragiques-accidents_2/. Accessed June 10, 2019.Google Scholar
Rouhani, SA, Marsh, RH, Rimpel, L, et al. Social messaging for global health: lessons from Haiti. J Glob Health. 2019;9:010308.CrossRefGoogle ScholarPubMed
Bloom, BA, Gibbons, RC. Trauma, Focused Assessment with Sonography for Trauma (FAST). Treasure Island: StatPearls; 2018. https://www.ncbi.nlm.nih.gov/books/NBK470479/. Accessed October 29, 2019.Google Scholar
Landman, A, Teich, JM, Pruitt, P, et al. The Boston Marathon bombings mass casualty incident: one emergency department’s information systems challenges and opportunities. Ann Emerg Med. 2015;66:51-59.CrossRefGoogle ScholarPubMed
Hammond, J. Mass casualty incidents: planning implications for trauma care. Scand J Surg. 2005;94:267-271.CrossRefGoogle ScholarPubMed
National Center for Injury Prevention and Control. In a Moment’s Notice: Surge Capacity for Terrorist Bombings. Challenges and Proposed Solutions. Centers for Disease Control and Prevention, 2007. American College of Surgeons Website. https://www.facs.org/~/media/files/quality%20programs/%20trauma/disaster/moments_notice.ashx/. Accessed October 29, 2019.Google Scholar
Chan, TC, Killeen, J, Griswold, W, et al. Information technology and emergency medical care during disasters. Acad Emerg Med. 2004;11:1229-1236.CrossRefGoogle ScholarPubMed
Tsai, LH, Huang, CH, Su, YC, et al. Comparison of prehospital triage and five-level triage system at the emergency department. Emerg Med J. 2017;34:720-725.CrossRefGoogle ScholarPubMed
Ozoilo, KN, Pam, IC, Yiltok, SJ, et al. Challenges of the management of mass casualty: lessons learned from the Jos crisis of 2001. World J Emerg Surg. 2013;8(1):44.CrossRefGoogle ScholarPubMed
Florida Department of Health. Hospital medical surge planning for mass casualty incidents. University of Rochester Medical Center Website. https://www.urmc.rochester.edu/medialibraries/urmcmedia/flrtc/documents/wny-hospital-medical-surge-planning-for-mass-casualty-incidents.pdf. Accessed June 16, 2019.Google Scholar