Hospital Emergency Response Teams. Triage for Optimal Disaster Response
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The percentage of patients transferred by the fire station and private ambulances was Fire station ambulances contributed more towards unbalanced patient transfer. Compared to the large hospitals with DMATs and level 1 trauma centers, which received delayed notification of the disaster Fig.
In the case of the closest 2 hospitals, there was more than 1 hour between disaster notification and patient arrival. This provided time to increase the number of available medical staff and secure additional space for treatment. Reinforcement of nursing resources was easily done because it coincided with the change of nursing shift.
Topic Collection: Hospital Patient Decontamination
Gyeongju regional hospitals also had about 2 hours of preparation time. Hospitals treating the patients were analyzed according to their capability of providing EMS. The 12 facilities comprised 1 regional emergency medical center designated by the Ministry of Health and Welfare, 3 local emergency medical centers designated by the governor of the province, 4 local emergency medical facilities designated by the mayor, and 4 registered emergency response institutions.
One of the hospitals that received the victims was located Locations of the hospitals are shown in Fig. Details regarding patient admission are presented in Table 4. Of the patients, were discharged after examination, 11 were hospitalized, and 18 were transferred to other hospitals. Most injuries involved the head Multiple wounds were recorded as duplicates. The investigations involved radiography More than 2 tests per patient were recorded as duplicates.
Treatment typically included analgesia and trauma care. Administration of analgesics was most common More than 2 treatments were recorded as duplicates. Surgery was performed in 3 out of patients. One patient underwent tendon and ligament subcutaneous adiabatic surgery under local anesthesia, 1 underwent a damage control surgery for major trauma, and 1 underwent osteoplastic craniotomy and cranioplasty. The exact cause of death of the 10 victims who died in the roof collapse could not be determined because autopsies were not performed.
Additionally, due to lack of records of the field rescue time for the deceased, judging the number of preventable deaths was impossible. Diagnoses of the deceased victims are summarized in Table 5. This was a mass casualty incident with at least casualties. Field triage and distribution of transportation at the site were not properly conducted. Although, these problems have been pointed out in the aftermath of multiple mass casualty incidents [ 3 , 5 , 8 ], the situation has not improved. As shown in Table 4 , about half of the patients were transported to the closest hospitals, which were poorly equipped to handle the injured.
The most severely injured patient was transported directly to a level 1 trauma center based on the judgment of the on-site DMAT personnel and not the fire department personnel. Two severely injured patients were misdiagnosed or undertreated by the first emergency department and proper diagnosis and surgery was performed after the patients were transferred to another regional level 1 trauma center. The biggest obstacle in the distribution of transport was a lack of patient transportation command by the field command post. Each ambulance had come from the nearest hospitals without knowing the overall transportation status, similar to the situation in previous mass casualty incidents [ 8 ].
To improve this situation, the fire department suggested reinforcement of the emergency medical personnel to the field command post for triage, and managed the transport of patients during the initial stage of the incident until the arrival of DMATs [ 14 ].
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The fire department and Ministry of Health and Welfare officials proposed that the DMATs or the public health center personnel should manage this role immediately at the scene in cooperation with the fire department personnel [ 14 , 15 ]. We propose further improvement plans. First, to improve the disaster medical response capacity of the paramedics of fire department, it is necessary to strengthen triage training [ 16 , 17 ].
Second, for rapid mobilization and strengthening the capability of DMATs, it is necessary to implement a hospital-based ambulance dispatch system [ 18 ]. Another major problem is the lack of cooperation between the fire department and medical staff at the scene. Especially, disputes regarding the location of advanced medical posts are usual [ 3 , 7 ], and were repeated in the latest disaster. The advanced medical post is a major element of the field disaster response system, and is legally required [ 19 ]. However, it continues to be ignored in mass casualty incidents. Implementation of joint training of the personnel of public health centers, hospitals, and fire stations was previously suggested [ 15 ].
In addition, we suggest organizing a consultative body comprising fire stations, public health centers, and hospitals for every region, and holding frequent meetings between them. Late dispatch of DMATs is another issue observed in previous disasters [ 5 - 8 ].
In previous cases, the propagation time of the situation was delayed; however, in this case, mobilization of the DMATs took 69 minutes because the decision regarding dispatch from the Ministry of Health and Welfare was delayed. To improve this situation, the Ministry of Health and Welfare delegated the authority of DMAT response decisions to the previously authorized officials of the permanent situation room inside the National Emergency Medical Center [ 14 ]. As a new means of communication, use of mobile instant messenger among disaster responders was the most salient point of this accident.
Previous studies reported that the community, government, and rescue teams shared the information regarding disaster planning, response, and recovery using various types of social media, such as Facebook and Twitter [ 20 ].
Efforts for development of a mobile social networking platform for disaster situations had been reported [ 21 ]. However, there are no reports involving total replacement of existing radio technology based wireless communication system with mobile instant messengers. Mobile messenger usage is disadvantageous because the time of transmitting information using text messages is slightly longer than that using voice transmission. However, it has several advantages; sharing visual information in the form of images and video clips is fast and missing information is less because the information remains in the chat window.
Since then, this new means of communication has been used in other mass casualty incidents, and has been used officially after the installation of a permanent situation room in the National Emergency Medical Center. Because the current instant messenger was developed for commercial purposes, development of a new platform that addresses hacking problems and has several functions for disaster situations is needed.
The largest limitation of this study is that the information was collected through interviews and relied on the memories of the interviewees. Hence, there could be some errors because of the 5-month lapse between the time of the disaster and interviews. In addition, the suggested improvement plans for the disaster medical response system were based on evaluation of only 1 mass casualty incident. Thanks to all institutional personnel who provided the materials and responded to the interviews while conducting this study.
Especially, thanks to the Ministry of Public Safety and Security, Gyeongju fire station, and the Gyeongju public health center actively supportive to this study, and the 11 hospitals who readily provided medical records in difficult conditions. Although published reports on previous disasters have pointed out the absence of initial field triage or insufficient hospital transport dispersion, no significant improvements have been made.
The Mauna Ocean Resort gymnasium collapsed on February 17, , at Field triage and distribution of transportation at the site were not properly conducted, like other previous disasters. However, this highlighted a need for public safety and practical preparation in the form of a disaster response system. No potential conflict of interest relevant to this article was reported. National Center for Biotechnology Information , U. Clin Exp Emerg Med. Published online Sep Author information Article notes Copyright and License information Disclaimer.
Abstract Objective To investigate and document the disaster medical response during the Gyeongju Mauna Ocean Resort gymnasium collapse on February 17, Methods Official records of each institution were verified to select the study population. Results One hundred fifty-five accident victims treated at 12 hospitals, mostly for minor wounds, were included in this study. Conclusion In the Gyeongju Mauna Ocean Resort gymnasium collapse, the initial triage and distribution of patients was inefficient and medical assistance arrived late. Keywords: Disasters, Mass casualty incidents, Medical assistance, Social networking.
Study design and data collection The disaster response of each institution was comprehensively examined using the official reports issued by the institution [ 11 , 12 ]. Table 1. Hospital investigation. Regions Hospitals No. Open in a separate window. EMS, emergency medical service. Table 2. Investigation summary as per the disaster response stages. DMAT, disaster medical assistance team. Statistical analysis Since all triage results could not be verified from the hospital records, the injury severity score ISS was used to evaluate the injury severity of the trauma patients.
Incident response by timelines. Awareness of the accident and response Almost immediately after the roof collapse, the situation room of the Gyeongbuk Regional Fire and Disaster Headquarters received the first report of the disaster. Field disaster medical activity Field disaster medical activities were initiated after the arrival of paramedics at the collapse site.
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Location of the hospitals that received the accident victims. Inpatient care in the hospital Compared to the large hospitals with DMATs and level 1 trauma centers, which received delayed notification of the disaster Fig. Table 4. Patient admission details from emergency medical institutes.
Emergency medical institute classification Hospitals Distance km a No. ER, emergency room. Table 5. Diagnoses of deceased victims. Number Hospital Diagnosis 1 Hospital A Lung contusion 2 Hospital A Skull deformity, chest contusion 3 Hospital A Multiple fractures of the ribs, hemothorax 4 Hospital A Multiple fractures of the ribs, hemothorax 5 Hospital A Multiple fractures of the ribs, hemothorax 6 Hospital I No data 7 Hospital E Traumatic asphyxia 8 Hospital F Death on arrival described in the medical record as head injury, right sided chest bruising, left sided lower chest bruising 9 Hospital A First and second lumbar fracture, dislocation 10 Hospital A Unknown, right lung congestion.
Acknowledgments Thanks to all institutional personnel who provided the materials and responded to the interviews while conducting this study. Capsule Summary What is already known Although published reports on previous disasters have pointed out the absence of initial field triage or insufficient hospital transport dispersion, no significant improvements have been made.
What is new in the current study The Mauna Ocean Resort gymnasium collapsed on February 17, , at Footnotes No potential conflict of interest relevant to this article was reported. Injuries and their complications after urban area fires: the dong-incheon live-hof restaurant fire. J Korean Soc Emerg Med. Analysis of victims of the fire that broke out at a beer bar in Inchon. Suggestion for maintaining coordinated disaster response: review of disaster response to the air China aircraft crash near Kimhae airport. Analysis of transportation of victims of the subway fire in Daegu.
An evaluation of the disaster medical system after an accident which occurred after a bus fell off the Incheon bridge. Disaster medical responses to the shelling of Yeonpyeong Island. Experiences of a disaster medical assistant team in the Chun-cheon landslide disaster. Experiences of disaster medical response system in a fire at Goyang bus terminal. Go SJ. Munhwailbo; Feb 19, [cited Jul 24]. Park GS. Gaps in disaster preparedness.
Ebook Hospital Emergency Response Teams Triage For Optimal Disaster Response 2010
KBS News; Feb 19, [cited Apr 15]. Gyeongju Fire Station. Report on emergency rescue activities: Mauna Ocean Resort gymnasium collapsing. Gyeongju: Gyeongju Fire Station; National Emergency Medical Center.
Report on disaster medical response of Gyeongju Mauna Ocean Resort gymnasium collapsing. Seoul: National Emergency Medical Center; Development and validation of the excess mortality ratio-adjusted injury severity score using the international classification of diseases 10th edition. Acad Emerg Med. Ministry of Public Safety and Security. Structure the healthcare facility Emergency Treatment Area to support medical operations in response a mass casualty incident. Establish a Hospital Emergency Response Team that meets all safety requirements, provides security to the hospital, and efficiently manages patients for processing into the hospital facility for follow-up treatment.
Compare decontamination methods and procedures.
Hospital Emergency Response Training for Mass Casualty Incidents - Center for Domestic Preparedness
Conduct operations in an Emergency Treatment Area while wearing appropriate personal protective equipment in response to a mass casualty incident involving contamination. Conduct an effective medical response to a mass casualty incident using the Hospital Emergency Response Team approach. It is recommended to have successfully completed operations-level CBRNE chemical, biological, radiological, nuclear and explosive or hazardous-materials training as specified in 29 CFR