Evaluation of a CT triage protocol for mass casualty incidents: results from two large-scale exercises

Abstract

The purpose of this study was to evaluate the feasibility, stability, and reproducibility of a dedicated CT protocol for the triage of patients in two separate large-scale exercises that simulated a mass casualty incident (MCI). In both exercises, a bomb explosion at the local soccer stadium that had caused about 100 casualties was simulated. Seven casualties who were rated "critical" by on-site field triage were admitted to the emergency department and underwent whole-body CT. The CT workflow was simulated with phantoms. The history of the casualties was matched to existing CT examinations that were used for evaluation of image reading under MCI conditions. The times needed for transfer and preparation of patients, examination, image reconstruction, total time in the CT examination room, image transfer to PACS, and image reading were recorded, and mean capacities were calculated and compared using the Mann-Whitney U test. We found no significant time differences in transfer and preparation of patients, duration of CT data acquisition, image reconstruction, total time in the CT room, and reading of the images. The calculated capacities per hour were 9.4 vs. 9.8 for examinations completed, and 8.2 vs. 7.2 for reports completed. In conclusion, CT triage is feasible and produced constant results with this dedicated and fast protocol.

Radiological mass casualty incident (MCI) workflow analysis: single-centre data of a mid-scale exercise

“…5,7 Particularly rare are publications concerning dedicated CT workflow in MCI handling. 6,24 In this context, a very realistic MCI simulation offered the possibility to analyse existing CT workflow with respect to process optimization, identification of bottlenecks and other limitations.…”

“…But even in centres with more than one scanner, the efficiency depends on a variety of parameters such as facility factors, number of CT staff, scanning time and protocol choice as well as on image reconstruction, processing, reading, reporting and distribution time. 6,24 The aim of study was to analyse and interpret radiological MCI workflow data.…”

Prätherapeutische Ablaufanalyse bei einem Massenanfall von Verletzten

“…Da die typischen Extremereignisse wie Naturkatastrophen, Bombenanschläge, Flugzeug-oder Zugunglücke von einer lokalen Betrachtung aus selten auftreten,isteseine Herausforderung,auf solche Situationen gut vorbereitet zu sein [1,28]. Leider gibt es im Gegensatz zur allgemeinen Polytraumaversorgung auch wenig Richtlinien, insbesondere im Hinblick auf den Workflow im Schockraum und in der Diagnostik [16,18,21,25,30]. Aus diesen Gründen und v. a. auch zur Berücksichtigung der lokal unterschiedlichen Gegebenheiten haben sich Simulationen durchgesetzt, um die Versorgung bei einem Massenanfall von Verletzten (MANV) zu trainieren, Schwachstellen zu identifizieren und die Versorgungsabläufe entsprechend individuell zu optimieren [27,30].…”

“…In der Literatur sind bislang zwei dedizierte CT-Protokolle für den MANVEinsatz angegeben, wobei sich beide auf die Generation von 4-Detektorzeilen-CT-Geräte beziehen [16,18] …”

Stellenwert der Multidetektor-CT bei Polytrauma

“…Der Thoraxscan wird als CTA um den Hals erweitert und bis auf Höhe des Circulus Willisii akquiriert, anschließend aber getrennt rekonstruiert [6,19,26,27,35,40]. Die hohe örtliche und zeitliche Auflösung führte zur Reduktion der Bewegungsartefakte und Generierung eines Volumendatensatzes mit isotropen Voxeln, die in multiplanaren Rekonstruktionen (MPR) zur Verfügung gestellt werden können.…”