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Reconsidering Policy of Casualty Evacuation in a Remote Mass-Casualty Incident

Published online by Cambridge University Press:  15 November 2013

Bruria Adini ,
Robert Cohen ,
Elon Glassberg ,
Bella Azaria ,
Daniel Simon ,
Michael Stein ,
Yoram Klein  and
Kobi Peleg
Bruria Adini*
Affiliation:
Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Aviv, Israel
Robert Cohen
Affiliation:
Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Aviv, Israel
Elon Glassberg
Affiliation:
Medical Corps, Israel Defense Forces, Ramat Gan, Israel
Bella Azaria
Affiliation:
Home Front Command, Israel Defense Forces, Ramla, Israel
Daniel Simon
Affiliation:
Sheba Medical Center, Ramat Gan, Israel
Michael Stein
Affiliation:
Beilinson Medical Center, Petach Tikva, Israel
Yoram Klein
Affiliation:
Kaplan Medical Center, Rehovot, Israel
Kobi Peleg
Affiliation:
Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Aviv, Israel School of Public Health, Tel-Aviv University, Tel Aviv, Israel
*
Correspondence: Bruria Adini, PhD The Israel National Center for Trauma and Emergency Medicine Gertner Institute for Epidemiology and Health Policy Research Hatamar 16 Bat Chen, 40290 Israel E-mail [email protected]
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Abstract

Objectives

Inappropriate distribution of casualties in mass-casualty incidents (MCIs) may overwhelm hospitals. This study aimed to review the consequences of evacuating casualties from a bus accident to a single peripheral hospital and lessons learned regarding policy of casualty evacuation.

Methods

Medical records of all casualties relating to evacuation times, injury severity, diagnoses, treatments, resources utilized and outcomes were independently reviewed by two senior trauma surgeons. In addition, four senior trauma surgeons reviewed impact of treatment provided on patient outcomes. They reviewed the times for the primary and secondary evacuation, injury severity, diagnoses, surgical treatments, resources utilized, and the final outcomes of the patients at the point of discharge from the tertiary care hospital.

Results

Thirty-one survivors were transferred to the closest local hospital; four died en route to hospital or within 30 minutes of arrival. Twenty-seven casualties were evacuated by air from the local hospital within 2.5 to 6.15 hours to Level I and II hospitals. Undertriage of 15% and overtriage of seven percent were noted. Four casualties did not receive treatment that might have improved their condition at the local hospital.

Conclusions

In MCIs occurring in remote areas, policy makers should consider revising the current evacuation plan so that only immediate unstable casualties should be transferred to the closest primary hospital. On site Advanced Life Support (ALS) should be administered to non-severe casualties until they can be evacuated directly to tertiary care hospitals. First responders must be trained to provide ALS to non-severe casualties until evacuation resources are available.

AdiniB , CohenR , GlassbergE , AzariaB , SimonD , SteinM , KleinY , PelegK . Reconsidering Policy of Casualty Evacuation in a Remote Mass-Casualty Incident. Prehosp Disaster Med. 2013;28(6):1-5.

Keywords

Casualty evacuationmass-casualty incidentmotor vehicle accidentremote hospitals
Type
Case Report
Information
Prehospital and Disaster Medicine , Volume 29 , Issue 1 , February 2014 , pp. 91 - 95
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2013 

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References

1. Bloch, YH, Schwartz, D, Pinkert, M, et al. Distribution of casualties in a mass-casualty incident with three local hospitals in the periphery of a densely populated area: lessons learned from the medical management of a terrorist attack. Prehosp Disaster Med. 2007;22(3):186-192.Google Scholar
2. Sockeel, P, De Saint Roman, C, Massoure, MP, et al. The Main Gate Syndrome: a new format in mass-casualty victim “surge” management? J Chir (Paris). 2008;145(5):459-465.CrossRefGoogle ScholarPubMed
3. De Cebballos, G, Fuentes, TF, Diaz, PD, et al. Casualties treated at the closest hospital in the Madrid, March 11, terrorist bombings. Crit Care Med. 2005;33(1):S107-S112.CrossRefGoogle Scholar
4. Schwartz, D, Pinkert, M, Leiba, A, et al. Significance of a Level-2, “selective, secondary evacuation” hospital during a peripheral town terrorist attack. Prehosp Disaster Med. 2007;22(1):59-66.Google Scholar
5. Assa, A, Landau, DA, Barenboim, E, et al. Role of air-medical evacuation in mass-casualty incidents - a train collision experience. Prehosp Disaster Med. 2009;24(3):271-276.Google Scholar
6. Beninati, W, Meyer, MT, Carter, TE. The critical care air transport program. Crit Care Med. 2008;36(7):S370-S376.Google Scholar
7. Cordell, RF, Cooney, MS, Beijer, D. Audit of the effectiveness of command and control arrangements for medical evacuation of seriously ill or injured casualties in southern Afghanistan 2007. J R Army Med Corps. 2008;154(4):227-230.Google Scholar
8. Mason, PE, Eadie, JS, Holder, AD. Prospective Observational Study of United States (US) Air Force Critical Care Air Transport Team Operations in Iraq. J Emerg Med. 2011;41(1):8-13.Google Scholar
9. Auf der Heide, E. The importance of evidence-based disaster planning. Ann Emerg Med. 2006;47(1):34-49.Google Scholar
10. Hoejenbos, MJJ, McManus, J, Hodgetts, T. Is there one optimal medical treatment and evacuation chain for all situations: “Scoop and Run” or “Stay-and-Play”. Prehosp Disaster Med. 2008;23(4):s74-s78.Google Scholar
11. Gerhardt, RT, De Lorenzo, RA, Oliver, J, et al. Out-of-hospital combat casualty care in the current war in Iraq. Ann Emerg Med. 2009;53(2):169-174.Google Scholar
12. Frykberg, ER. Triage: principles and practice. Scand J Surg. 2005;94(4):272-278.Google Scholar
13. Peleg, K, Kellermann, AL. Enhancing Hospital Surge Capacity for Mass-Casualty Events. JAMA. 2009;302(5):565-567.Google Scholar
14. Lee, CH. Disaster and Mass-Casualty Triage. Virtual Mentor. 2010;12(6):466-470.Google ScholarPubMed
15. Matsuzaki, S, Fernando, S, Marasinghe, A. Decision Making Model Supporting Emergency Medical Care. Biometrics and Kansei Engineering. 2009:179-182.Google Scholar
16. Sharma, BR. Triage in trauma-care system: a forensic view. J Clinical Forensic Medicine. 2005;12(2):64-73.Google Scholar
17. Davis, T, Dinh, M, Roncal, S, et al. Prospective evaluation of a two-tiered trauma activation protocol in an Australian major trauma referral hospital. Injury. 2010;41(5):470-474.Google Scholar
18. Sullivent, EE, Paul, M, Wald, MM. Reduced mortality in injured adults transported by helicopter emergency medical services. Prehosp Emerg Care. 2011;15(3):295-302.CrossRefGoogle ScholarPubMed
19. Salomone, JP, Ustin, JS, McSwain, NE Jr, et al. Opinions of trauma practitioners regarding prehospital interventions for critically injured patients. J Trauma. 2005;58(3):509-515.CrossRefGoogle ScholarPubMed
20. Gerbeaux, P. Should emergency medical service rescuers be trained to practice endotracheal intubation? Crit Care Med. 2005;33(8):1718-1721.CrossRefGoogle ScholarPubMed