IntroductionMass-casualty incidents (MCIs) may involve only a few patients or may involve thousands. The injuries may range from burns to penetrating trauma to chemical or radiation exposures. The quantity and nature of injuries determine what healthcare resources will best minimize morbidity and mortality, and it is the task of the emergency medical services (EMS) to optimize resource utilization.Matching a victim's needs to the appropriate resources starts with field triage. Ideally, victims are transported to the most appropriate facilities. This destination selection must be based on the best assumption of a patient's needs, on the individual hospital's capabilities and capacities, and the system's available resources. 1-6 For the critically injured, trauma centers have been demonstrated to have better outcomes, and their utilization should be optimized. 7-10 Optimally, victim's needs must be balanced with avoiding overwhelming any particular facility. AbstractIntroduction: Management of mass-casualty incidents should optimize outcomes by appropriate prehospital care, and patient triage to the most capably facilities. The number of patients, the nature of injuries, transportation needs, distances, and hospital capabilities and availabilities are all factors to be considered. Patient maldistributions such as overwhelming individual facilities, or transport to facilities incapable of providing appropriate care should be avoided. This report is a critical view of the application of the START triage nomenclature in the prehospital arena following a train crash in Los Angeles County on 26 January 2005. Methods: A scheduled debriefing was held with the major fire and emergency medical services responders, Medical Alert Center staff, and hospitals to assess and review the response to the incident. Site visits were made to all of the hospitals involved. Follow-up questions were directed to emergency department staff that were on duty during the day of the incident. Results: The five Level-I Trauma Centers responded to the poll with the capacity to receive a total of 12 "Immediate" patients, 2.4 patients per center, the eight Level-II Trauma Centers responded with capacity to receive 17 "Immediate" patients, two patients per center, while the 25 closest community hospitals offered to accept 75 "Immediate" patients, three patients per hospital. These community hospitals were typically about one-half of the size of the trauma centers (average 287 beds versus 548, average 8.7 operating rooms versus 16.6). Twenty-six patients were transported to a community hospital >15 miles from the scene, while eight closer community hospitals did not receive any patients. Conclusions: The debriefing summary of this incident concluded that there were no consistently used criteria to decide ultimate destination for "Immediates", and that they were distributed about equally between community hospitals and trauma centers. Zoraster RM, Chidester C, Koenig W: Field triage and patient maldistribution in a mass-casualty incident. Prehosp Disa...
A trauma system performance improvement program allowed us to significantly improve our response to MCIs with improved utilization of TCs and improved distribution of victims according to injury severity and needs.
Most firefighter injuries and illnesses encountered during the Los Angeles Station Fire were minor. The prevalence of injuries observed should be taken into consideration in creation of protocols and mandatory equipment lists for fireline paramedics. Furthermore, advanced training for paramedics in the diagnosis and treatment of minor medical conditions may be useful.
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