Mass casualty situations
Ian Greaves, Keith Porter, Chris Wright in Trauma Care Pre-Hospital Manual, 2018
A mass casualty incident is one where there are typically more people injured than there are resources immediately available to provide the necessary care. In this situation there is a need to determine priority for both treatment and evacuation from the scene; it is a resource-constrained environment. The prioritisation of casualties must be objective and reproducible, ideally based on evidence. The process must be dynamic; patients can deteriorate or improve after contact with the responding personnel, and it must be flexible to accommodate the capacity available to manage the load. The process should occur serially; at the incident scene, at entry to the casualty clearing station (CSS; front triage), at departure from the CCS (rear triage) and again on arrival at hospital.
CBRN and the Trauma Victim
Ian Greaves, Keith Porter, Jeff Garner in Trauma Care Manual, 2021
The mainstay of the treatment of ARS is: Supportive, including anti-emetics (ondansetron or granisetron), fluid replacement and continuing hydration until early enteral feeding is startedReplacement therapy, including platelets (early in the course of the syndrome) and (later) packed red cellsProphylactic antimicrobials, including antibiotics, antivirals and antifungalsStimulation therapy, using cytokines to stimulate bone marrow recoveryWith effective treatment, the median lethal dose for 50% of an exposed population at 60 days (LD50/60) can be increased from 3.5–4 Gy to 5–6 Gy. With intensive care and cytokine therapy, this can be further increased to 6–8 Gy. In the case of combined trauma, the threshold for cytokine therapy may be lowered. However, during a mass casualty incident, the triage and resource allocation for severe combined injury (radiation and conventional trauma) patients may be towards expectant management and palliation subject to national guidelines.
General Radiography in the Critical Care and Trauma Environment
Christopher M. Hayre, William A. S. Cox in General Radiography, 2020
A mass casualty incident (MCI) refers to any incident resulting in a higher number of casualties than reasonably expected. They may be of an intentionally violent nature, such as planned explosion or mass stabbing, or because of an incident such as a multivehicle road traffic collision, or such a collision involving a vehicle such as a bus leading to injuries to multiple people. It is important all radiographers are aware of their protocol for major incidents and mass casualty incidents, and these will often be found within the area of the department responsible for imaging for the ED. National guidance is also available from NHS England (2018).
Botulism Outbreak in a Regional Community Hospital: Lessons Learned in Transfer and Transport Considerations
Published in Prehospital Emergency Care, 2019
William Krebs, Terri Higgins, Martha Buckley, James J. Augustine, Bradley D. Raetzke, Howard A. Werman
A mass casualty incident (MCI) occurs when emergency medical service (EMS) resources, such as personnel and equipment, are overwhelmed by the number and severity of casualties. Botulinum toxin exposure from any source can lead to multiple victims, but outbreaks of botulism from food sources have a higher potential to reach large number of victims and cause an MCI (2). MCIs are major stressors on hospitals as they place high demand on emergency department (ED) resources and providers, surgical resources and often, intensive care assets; a botulism outbreak is unique in that it may require multiple critical care beds for extended periods of time, potentially overwhelming hospital resources and making distribution of victims to other facilities a priority (3). Because invasive ventilatory support is required, transport by critical care capable EMS providers is recommended.
Comparing the Accuracy of Mass Casualty Triage Systems in a Pediatric Population
Published in Prehospital Emergency Care, 2019
Robert W. Heffernan, E. Brooke Lerner, Courtney H. McKee, Lorin R. Browne, M. Riccardo Colella, J. Marc Liu, Richard B. Schwartz
A mass casualty incident (MCI) is any event where the need for medical resources exceeds those currently available. This broad definition means that an MCI can range from a motor vehicle crash with multiple victims to a larger scale natural disaster. To manage such an event, emergency medical services (EMS) providers are trained to employ a mass casualty triage system. These systems objectively prioritize patients’ need for medical treatment. The goal of mass casualty triage systems is to prioritize those needing emergency treatment to conserve limited medical resources so that the total mortality and morbidity arising from the incident are minimized. There are numerous triage systems available, but there remains limited scientific evidence to show that one system is better than another (1–3).
Halogen gas exposure: toxic effects on the parturient
Published in Toxicology Mechanisms and Methods, 2021
Dylan R. Addis, James A. Lambert, David A. Ford, Tamas Jilling, Sadis Matalon
The unpredictable nature of a small-scale or mass casualty incident necessitates that clinicians and researchers assess for threats to numerous unique and potentially vulnerable demographic groups including infants, children, elderly individuals, and pregnant women. At any given time pregnant women are estimated to account for 1–2% of the general population in the United States and up to 5% of women of reproductive age are pregnant or up to 6 weeks postpartum (Mosher et al. 2004; Jamieson et al. 2009; Centers for Disease Control and Prevention 2019). The Pandemic and All-Hazards Preparedness Reauthorization Act of 2013 (H.R. 307) identifies women within the peripartum period as a population with special clinical needs, recognizing the unique pathophysiological milieu as potentially increasing risk in the event of a natural or man-made disaster or pandemic (Centers for Disease Control and Prevention 2019). The normal maternal physiological adaptations to pregnancy that allow for fetal growth and development along with maternal hemostasis in the peripartum period have significant implications for cardiorespiratory function and consequently create a unique risk profile for exposure to cardiopulmonary toxins.
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