Clinical guidelines for responding to chemical, biological, radiological, nuclear and trauma/burn mass casualty incidents: Quick reference guides for emergency department staff

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The word 'DISASTER' may be used as a mnemonic for listing the critical elements of emergency response. The National Disaster Life Support Education Foundation's (NDLSEC) DISASTER paradigm emphasises out-of-hospital emergency response and includes the following elements: (1) detect; (2) incident command system; (3) security and safety; (4) assessment; (5) support; (6) triage and treatment; (7) evacuate; and (8) recovery. This paper describes how the DISASTER paradigm was used to create a series of clinical guidelines to assist the preparedness effort of hospitals for mitigating chemical, biological, radiological, nuclear incidents or explosive devices resulting in trauma/burn mass casualty incidents (MCIs) and their initial response to these events. Descriptive information was obtained from observations and records associated with this project. The information contributed by a group of subject matter experts in disaster medicine, at the Yale New Haven Health System Center for Emergency Preparedness and Disaster Response was used to author the clinical guidelines. Akin to the paradigm developed by the NDLSEC for conducting on-scene activities, the clinical guidelines use the letters in the word 'disaster' as a mnemonic for recalling the main elements required for mitigating MCIs in the hospital emergency department.

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... Safety and security must always be prioritized with any MCI, recognizing that some incidents, such as terror attacks or chemical hazards, require containment and pose a greater security threat than others. 13,32,34,37,39,47,54,59,62,75,[77][78][79][80][81][82][83][84][85][86][87][88][89][90][91][92] Moreover, security officials maintain the law and order at the scene and at the hospitals receiving injured patients, controlling access points, and restricting it to only authorized personnel, monitoring for suspicious activities, and preventing crowds from interfering with emergency operations. 13,32,34,39,40,47,49,59,62,73,81,87,[91][92][93][94] Deploying a safety officer to identify potential threats and implement appropriate safety procedures is essential in virtually all MCIs. ...
... 13,32,34,39,40,47,49,59,62,73,81,87,[91][92][93][94] Deploying a safety officer to identify potential threats and implement appropriate safety procedures is essential in virtually all MCIs. 13,36,39,47,56,75,81,93 In response to the safety and security challenges adopted in some settings is the introduction of Tactical medicine, in which outof-hospital care is provided by specially trained practitioners, many with military and/or law enforcement training, who operate in hostile environments. 33,81,87,[95][96][97] Human Resources MCI response depends upon adequate and appropriate personnel capacity. ...
... 57,62,91,134,154 Several different triage methodologies have been used and tested in disasters, such as the START, JumpSTART, SALT, or SORT algorithms, among others, which quickly prioritize victims and assist in casualty distribution and setting up treatment areas where patients can be separated into cohorts based on triage categories. 27,30,31,37,39,40,[45][46][47]52,53,55,60,62,69,75,82,91,99,[101][102][103]105,107,108,110,118,120,125,127,134,145,148,151,154,160,[166][167][168][169][170][171][172][173][174][175][176][177][178][179][180][181][182][183][184] However, triage is a dynamic process, and patients may need to be reevaluated and reassigned to a different category. 23,27,33,36,39,40,46,47,49,50,53,[60][61][62]64,66,67,82,91,95,96,[101][102][103]105,127,128,133,134,144,146,148,150,151,154,160,166,[168][169][170][171][172][173][174][176][177][178][179][180][181][182][183][184][185][186][187][188][189] In such instances, emphasis is placed upon directing scarce resources to those who have the best chance of survival. ...
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Objective: Emergency medical (EM) response systems require extensive coordination, particularly during mass casualty incidents (MCIs). The recognition of preparedness gaps and contextual priorities to MCI response capacity in low- and middle-income countries (LMICs) can be better understood through the components of EM reponse systems. This study aims to delineate essential components and provide a framework for effective emergency medical response to MCIs. Methods: A scoping review was conducted using 4 databases. Title and abstract screening was followed by full-text review. Thematic analysis was conducted to identify themes pertaining to the essential components and integration of EM response systems. Results: Of 20,456 screened citations, 181 articles were included in the analysis. Seven major and 40 sub-themes emerged from the content analysis as the essential components and supportive elements of MCI medical response. The essential components of MCI response were integrated into a framework demonstrating interrelated connections between essential and supportive elements. Conclusions: Definitions of essential components of EM response to MCIs vary considerably. Most literature pertaining to MCI response originates from high income countries with far fewer reports from LMICs. Integration of essential components is needed in different geopolitical and economic contexts to ensure an effective MCI emergency medical response.
... Triage of patients is a crucial component of managing an HCID mass casualty event to prevent overload and facilitate an effective management of resources [79]. The main objective of triage processes is to facilitate saving as many salvageable patients as possible by identifying those that will survive as a result of the administered medical attention who would otherwise not live [79,80]. Triage during HCID events focuses on sorting those severely and critically ill patients who require immediate medical intervention from other casualties whose treatment may be delayed or administered in alternative facilities [81]. ...
The clinical management of high consequence infectious diseases (HCID) poses an immense challenge, seen largely varying standards in terms of infection prevention control (IPC) as well as in quality of clinical care. This chapter gives an overview of possible treatment as well as IPC options. Lessons learned within the German Permanent Working Group of Competence and Treatment Centres for highly infectious, life-threatening diseases (STAKOB) are taken into account.KeywordsClinical managementHCIDSTAKOBIsolation
... Multiple Casualty Incident (MCI) is essentially any medical emergency with more than one patient, where the number of patients and the severity of their injuries do not exceed the capability of the facilities (Albanese et al., 2014;Murray and Goodfellow, 2002;Sammut et al., 2001). This term is used to trigger a change in handling patients and allocating resources to the most patients possible. ...
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This cross-sectional retrospective descriptive study was performed to determine the role of the emergency medicine in the management of thunderstorms associated asthma Multiple Casualty Incident (MCI) and to give an overview of affected patient characteristics. Eligible participants were all patients presented to the ED with acute bronchospasm, between 2nd-7th November, 2013. Not only available medical records of all patients were gathered and analyzed, retrospectively but also the effectiveness of the MCI plan designed by emergency medicine was reviewed. There was no gender priority in the studied population (201 male, 242 female). The majority of affected patients were aged between 20-40 (278 out of 443). Only 40 patients of all 443 were admitted (37 in the pulmonary ward and 3 in the ICU). No mortality in the ED was reported. Over 50% of patients had a positive history of asthma, allergies have been treated at least once for shortness of breath or asthma previously. Our findings illustrate that described respiratory illness MCI seems to have a benign course, since the majority of patients discharged home. Besides, the designed protocol for treatment of patients and managing the MCI were obviously effective.
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