The Santa Monica crash: An urban multicasualty event
Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-7054, USA.The American surgeon (Impact Factor: 0.82). 11/2004; 70(10):886-9.
Mass casualty events provide dramatic challenges for trauma centers and trauma systems. We analyzed the management of victims and assessed the response of the UCLA Healthcare System to the Santa Monica multicasualty event of July 16, 2003, when an elderly man drove his car through a crowded outdoor market and injured 73 people, 10 of whom died (eight at the scene). Of the victims, 26 were treated at UCLA (n = 15) and Santa Monica (n = 11) Medical Centers. Fourteen patients (54%) were female; average age was 41.9 years (range 7 months to 88 years). Fifteen patients were treated in the ER only, and 11 patients required admission. Of the latter, 10 (91%) had multisystem injuries, most commonly musculoskeletal, which occurred in nine patients (82%). Seven patients required immediate operations (orthopedic in six and a pericardial window in one). Three patients required delayed operations (orthopedic and plastic surgery). Most surgical and medical specialties were needed in consultation. Average LOH was 11.8 (range 2-23) days. Mean ISS was 21.2 (range 1-75). There were six complications (three early and three late) and one death from head injury. Seven patients (64%) required rehabilitation. We conclude that mass casualty victims have multisystem injuries of variable severity, which underscores the importance of trauma centers and trauma systems. The large trauma scene and particular need for orthopedic services were notable features of this event.
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ABSTRACT: Multiple casualty incidents (MCI) highlight discrepancies between patient needs and available resources. It is generally thought that heavy patient loads adversely affect trauma health care delivery. The purpose of this study was to identify the impact of multiple casualty situations on the clinical outcomes of injured patients. All severely injured trauma patients (Injury Severity Score [ISS] > or = 12) who presented during a 12-month period to a regional trauma center were retrospectively reviewed. MCIs were defined as treating and admitting three or more trauma patients within a maximum of 3 hours. This cohort was compared with all other patients who did not meet MCI criteria. Ten percent (88/861) of all trauma patients were treated in an MCI setting. Groups did not vary among sex, age, ISS, or mechanism of injury (p > 0.05). MCI patients displayed a greater length of hospital stay, time to first surgical procedure, time to emergency laparotomy, and time spent in the emergency room (p < 0.05). MCI and non-MCI patients did not differ in ICU length of stay, postadmission morbidity, or mortality (p > 0.05). The impact of a MCI on the quality of trauma care has not been previously defined. MCI events delay definitive care and prolong a patient's length of stay. This is particularly concerning in the emergency department where a trauma center's ability to treat MCI patients effectively via an increased surge capacity relies on swift patient triage and flow. We are now investigating these issues in other trauma centers.
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ABSTRACT: To describe the Los Angeles County trauma system response to disasters. Review of trauma system structure and multicasualty events. The Los Angeles County trauma system is made up of 13 level I and II trauma centers with defined catchment areas that serve 10 million people in 88 cites over 4,000 square miles and receive more than 20,000 trauma activations annually. There is an organized disaster plan, which is orchestrated through the Medical Alert Center that coordinates the distribution of casualties from the scene of a multicasualty event, with the most critically injured patients going to level I centers by air, severe injuries to level I and II centers by ground and air and less severe injuries to local community hospitals by ground. The plan has been used in several multicasualty events over the last 25 years, the most recent of which occurred 6 hours after this paper was presented. The system allows for all critically injured patients to be distributed to several trauma centers, so that all can be cared for in a timely fashion without overwhelming any one trauma center and without critically injured patients being taken to nontrauma centers where they cannot receive optimal care. The answer to disaster preparedness in our country is to develop this kind of trauma system in every state. Doing so will improve access of our population to excellent care on a daily basis and will provide a network of trauma centers that can be mobilized to most effectively care for victims of multicasualty events.
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ABSTRACT: Two train crash multicasualty incidents (MCI) occurred in 2005 and 2008 in Los Angeles. A postcrash analysis of the first MCI determined that most victims went to local community hospitals (CHs) with underutilization of trauma centers (TCs), resulting in changes to our disaster plan. To determine whether our trauma system MCI response improved, we analyzed the distribution of patients from the scene to TCs and CHs in the two MCIs. Data from the emergency medical services and TC records were interrogated to compare patients triage status, type of transport, and the destination in the 2008 MCI to the 2005 MCI. Clinical data from the 2008 MCI were tabulated to evaluate severity of injuries, need for immediate and delayed operation, need for intensive care unit, and need for specialty surgical services, and appropriate distribution of patients. In 2005, 14 (56%) of the 25 severely injured patients and 75 (71%) of the 106 total patients were transported to four CHs. In 2008, 53 (93%) of 57 of the severely injured patients were transported to TCs and only 34 (35%) of 98 of total patients were transported to nine CHs. In 2008, more TCs were used (8 vs. 5) and more patients were transported by air (34 vs. 2). In 2008, the most severely injured victims were transported to four level I TCs (median injury severity score, 16; range, 1-43; 10 emergent operations) and four level II TCs (median injury severity score, 10; range, 1-22; 4 emergent operations). Only 11 patients were admitted to CHs, and no operations were required. A trauma system performance improvement program allowed us to significantly improve our response to MCIs with improved utilization of TCs and improved distribution of victims according to injury severity and needs.
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