An innovative emergency transportation scenario for mass casualty incident management

Abstract

The purpose of this research is to analyze and introduce a new emergency medical service (EMS) transportation scenario, Emergency Medical Regulation Center (EMRC), which is a temporary premise for treating moderate and minor casualties, in the 2015 Formosa Fun Color Dust Party explosion in Taiwan. In this mass casualty incident (MCI), although all emergency medical responses and care can be considered as a golden model in such an MCI, some EMS plans and strategies should be estimated impartially to understand the truth of the successful outcome. Factors like on-scene triage, apparent prehospital time (appPHT), inhospital time (IHT), and diversion rate were evaluated for the appropriateness of the EMS transportation plan in such cases. The patient diversion risk of inadequate EMS transportation to the first-arrival hospital is detected by the odds ratios (ORs). In this case, the effectiveness of the EMRC scenario is estimated by a decrease in appPHT. The average appPHTs (in minutes) of mild, moderate, and severe patients are 223.65, 198.37, and 274.55, while the IHT (in minutes) is 18384.25, 63021.14, and 83345.68, respectively. The ORs are: 0.4016 (95% Cl = 0.1032–1.5631), 0.1608 (95% Cl = 0.0743–0.3483), and 4.1343 (95% Cl = 2.3265–7.3468; P < .001), respectively. The appPHT has a 47.61% reduction by employing an EMRC model. Due to the relatively high appPHT, diversion rate, and OR value in severe patients, the EMS transportation plan is distinct from a prevalent response and develops adaptive weaknesses of MCIs in current disaster management. Application of the EMRC scenario reduces the appPHT and alleviates the surge pressure upon emergency departments in an MCI.

Factors Associated With Delayed Pre-Hospital Times During Trauma-Related Mass Casualty Incidents: A Systematic Review

“…Of the 6 observational studies, 4 papers were rated as moderate quality, 22,24,26,27 and 2 were deemed high quality. 23,25 For the case reports, 3 were deemed to be of moderate quality, 30,31,33 while 3 reports were graded as high quality (Table 4). 28,29,32…”

“…Most studies documented pre-hospital times of 2 hours or longer, 23,24,26,27,29–31 although PHTs were reported variably as means, medians, and sequences (per individual patient) (Table 3). Three studies focused on reporting the PHTs for individual patients who were of particular note (first and/ or last arrivals).…”

“…29 Similarly, there was no obvious relationship between PHTs and proportion of deaths (Figure 2, Table 3), although 3 studies failed to report mortality data. 22,24,31…”

“…25,26,31 In the Taiwan color-dust explosion, although triage was implemented effectively at the scene, EMS providers did not follow the triage decisions to prioritize severely injured for transportation to hospital. 31 As a result, the average pre-hospital time for severely injured patients was higher than for moderately injured patients (274.55 and 198.37 minutes, respectively). 31 Similarly, there was no distinction regarding transportation priorities for different patient classifications following a fire incident because the response units failed to initiate effective triage response.…”

“…29 Similarly, there was no obvious relationship between PHTs and proportion of deaths (Figure 2, Table 3), although 3 studies failed to report mortality data. 22,24,31 Factors associated with delayed pre-hospital time Difficult access to incident locations Inaccessibility to the incident site due to geographical location or obstruction was the main reason for patient triage and transportation delays in 3 studies. [28][29][30] The Columbia icefield bus rollover occurred in an extreme environment, and despite having access to aeromedical services and physicians in the field, the steep slopes challenged the response teams resulting in a prolonged PHT of more than 4 hours for the first critical patient (Figure 3).…”