Specificities of terrorist attacks: organisation of the in-hospital patient-flow and treatment strategies

Friemert, Benedikt; Achatz, Gerhard; Hoth, Patrick; Paffrath, Thomas; Franke, Axel; Bieler, Dan

doi:10.1007/s00068-020-01390-5

Cited by 21 publications

(20 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In general, the mass casualty triage response is completed at two key time points: (1) at the scene when EMS must determine which patients need urgent transfer to hospital; and (2) on hospital arrival, where assessment of haemodynamic status and the need for life-saving treatment in the context of emergency, critical care, and surgical treatment capacity is undertaken. 70,71 Triaging patients in the immediate aftermath of an MCI can be difficult. EMS may be operating in an unsafe environment, and with limited access to reliable information.…”

Section: Triagementioning

confidence: 99%

“…75 MCIs are generally considered to result in three 'waves' of patients arriving at hospitals. 70,76 The first wave differs most from the normal trauma patient scenario and largely comprises patients who can mobilise themselves to the nearest healthcare centre. These 'walking wounded' are rarely triaged as high priority, but by virtue of their mobility, overwhelm the nearest hospital to the incident.…”

Section: Triagementioning

confidence: 99%

See 1 more Smart Citation

Review of the requirements for effective mass casualty preparedness for trauma systems. A disaster waiting to happen?

Gabbe¹,

Veitch²,

Mather³

et al. 2022

British Journal of Anaesthesia

View full text Add to dashboard Cite

Mass casualty incidents (MCIs) are diverse, unpredictable, and increasing in frequency, but preparation is possible and necessary. The nature of MCIs requires a trauma response but also requires effective and tested disaster preparedness planning. From an international perspective, the aims of this narrative review are to describe the key components necessary for optimisation of trauma system preparedness for MCIs, whether trauma systems and centres meet these components and areas for improvement of trauma system response. Many of the principles necessary for response to MCIs are embedded in trauma system design and trauma centre function. These include robust communication networks, established triage systems, and capacity to secure centres from threats to safety and quality of care. However, evidence from the current literature indicates the need to strengthen trauma system preparedness for MCIs through greater trauma leader representation at all levels of disaster preparedness planning, enhanced training of staff and simulated disaster training, expanded surge capacity planning, improved staff management and support during the MCI and in the post-disaster recovery phase, clear provision for the treatment of paediatric patients in disaster plans, and diversified and pre-agreed systems for essential supplies and services continuity. Mass casualty preparedness is a complex, iterative process that requires an integrated, multidisciplinary, and tiered approach. Through effective preparedness planning, trauma systems should be well-placed to deliver an optimal response when faced with MCIs.

show abstract

Section: Triagementioning

confidence: 99%

Section: Triagementioning

confidence: 99%

Review of the requirements for effective mass casualty preparedness for trauma systems. A disaster waiting to happen?

Gabbe¹,

Veitch²,

Mather³

et al. 2022

British Journal of Anaesthesia

View full text Add to dashboard Cite

show abstract

“…Unlike a standard MASCAL, the arrival of patients in a TerrorMASCAL is dynamic, which makes it difficult to plan the first minutes and hours; thus, in this situation, hospitals benefit from recruiting personnel as quickly as possible [ 1 ]. The number of self-referrals who visit a hospital in a MASCAL situation who have not received prior (pre-) triage or first aid should not be underestimated.…”

Section: Discussionmentioning

confidence: 99%

“…During a terrorist attack mass casualty incident (TerrorMASCAL), compared to a “normal” MASCAL, there is a dynamic course that can extend over several hours. In addition, there is the possibility that casualties may occur at different locations, and critical infrastructures may also be affected [ 1 ]. Injury patterns primarily involve penetrating and perforating injuries, which can result in rapid blood loss.…”

Section: Introductionmentioning

confidence: 99%

Preparation of hospitals for mass casualty incidents in Bavaria, Germany: care capacities for penetrating injuries and explosions in TerrorMASCALs

Thies

Zech

Kohlmann

et al. 2021

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

Background In a terror attack mass casualty incident (TerrorMASCAL), compared to a “normal” MASCAL, there is a dynamic course that can extend over several hours. The injury patterns are penetrating and perforating injuries. This article addresses the provision of material and personnel for the care of special injuries of severely injured persons that may occur in the context of a TerrorMASCAL. Methods To answer the research question about the preparation of hospitals for the care of severely injured persons in a TerrorMASCAL, a survey of trauma surgery departments in Bavaria (Germany) was conducted using a questionnaire, which was prepared in three defined steps based on an expert consensus. The survey is divided into a general, neurosurgical, thoracic, vascular and trauma surgery section. In the specialized sections, the questions relate to the implementation of and material and personnel requirements for special interventions that are required, particularly for injury patterns following gunshot and explosion injuries, such as trepanation, thoracotomy and balloon occlusion of the aorta. Results In the general section, it was noted that only a few clinics have an automated system to notify off-duty staff. When evaluating the data from the neurosurgical section, the following could be established with regard to the performance of trepanation: the regional trauma centers do not perform trepanation but nevertheless have the required material and personnel available. A similar result was recorded for local trauma centers. In the thoracic surgery section, it could be determined that almost all trauma centers that do not perform thoracotomy have the required material available. This group of trauma centers also stated that they have staff who can perform thoracotomy independently. The retrograde endovascular aortic occlusion procedure is possible in 88% of supraregional, 64% of regional and 10% of local trauma centers. Pelvic clamps and external fixators are available at all trauma centers. Conclusion The results of the survey show potential for optimization both in the area of framework conditions and in the care of patients. Consistent and specific training measures, for example, could improve the nationwide performance of these special interventions. Likewise, it must be discussed whether the abovementioned special procedures should be reserved for higher-level trauma centers.

show abstract

“…After a mass casualty incident and especially after terrorist attacks, medical care is a challenge and tactical and strategic aspects must be considered. Friemert et al impressively illustrate these aspects in their contribution [1]. Terrorist attacks result in a highly dynamic and complex situation in which emergency forces on site-both prehospital and in-hospital-are exposed to a high level of danger, the influx of patients into hospitals is uncontrolled and possibly overwhelming, and capacities can quickly reach their limits.…”

mentioning

confidence: 99%

Terror preparedness as a service of general interest: the Terror and Disaster Surgical Care (TDSC®)-course

Achatz¹,

Bieler

Franke

et al. 2020

Eur J Trauma Emerg Surg

Self Cite

View full text Add to dashboard Cite

Specificities of terrorist attacks: organisation of the in-hospital patient-flow and treatment strategies

Cited by 21 publications

References 20 publications

Review of the requirements for effective mass casualty preparedness for trauma systems. A disaster waiting to happen?

Review of the requirements for effective mass casualty preparedness for trauma systems. A disaster waiting to happen?

Preparation of hospitals for mass casualty incidents in Bavaria, Germany: care capacities for penetrating injuries and explosions in TerrorMASCALs

Terror preparedness as a service of general interest: the Terror and Disaster Surgical Care (TDSC®)-course

Contact Info

Product

Resources

About