Emergency imaging after a mass casualty incident: role of the radiology department during training for and activation of a disaster management plan

Abstract

In the setting of mass casualty incidents (MCIs), hospitals need to divert from normal routine to delivering the best possible care to the largest number of victims. This should be accomplished by activating an established hospital disaster management plan (DMP) known to all staff through prior training drills. Over the recent decades, imaging has increasingly been used to evaluate critically ill patients. It can also be used to increase the accuracy of triaging MCI victims, since overtriage (falsely higher triage category) and undertriage (falsely lower triage category) can severely impact resource availability and mortality rates, respectively. This article emphasizes the importance of including the radiology department in hospital preparations for a MCI and highlights factors expected to influence performance during hospital DMP activation including issues pertinent to effective simulation, such as establishing proper learning objectives. After-action reviews including performance evaluation and debriefing on issues are invaluable following simulation drills and DMP activation, in order to improve subsequent preparedness. Historically, most hospital DMPs have not adequately included radiology department operations, and they have not or to a little extent been integrated in the DMP activation simulation. This article aims to increase awareness of the need for radiology department engagement in order to increase radiology department preparedness for DMP activation after a MCI occurs.

Improving Imaging Care for Diverse, Marginalized, and Vulnerable Patient Populations

“…Following natural disasters, patients may delay care or have difficulty accessing health care facilities (31). Specific to the imaging environment, facilities within proximity to a natural disaster can expect a rapid influx of patients, many of whom will be in need of diagnostic imaging, and it may be helpful to include a radiologist as a member of the emergency response/ triage team to assist in increasing efficiency and throughput in the radiology department (32,33).…”

Refining the criteria for immediate total-body CT after severe trauma

“…Although these criteria are prone to interpretation differences, we would recommend adopting these criteria in iTBCT indication schemes. During mass casualty accidents, overruling the iTBCT indication scheme has to be considered [18,19]. Furthermore, there should be awareness for the increase of incidental findings by TBCT compared to the STWU during implementation or refining of iTBCT indication schemes [20,21].…”

Sonographer credentialing in extended focussed assessment by sonography in trauma (eFAST)

“…Assessment and management of multitrauma patients in MCIs is difficult, due to the complex patterns of injury and volume of patients. Imaging examinations including ultrasound, radiography, and computed tomography can be used to improve the accuracy of trauma triage . Ultrasound is an ideal imaging modality as it can be performed whilst other resuscitative care is undertaken in multiple environments, including prehospital, during transit, or in‐hospital.…”