Creation and Delphi-method Refinement of Pediatric Disaster Triage Simulations

Cicero, Mark X.; Brown, Linda; Overly, Frank; Yarzebski, Jorge; Meckler, Garth; Fuchs, Susan; Tomassoni, Anthony J.; Aghababian, Richard V.; Chung, Sarita; Garrett, Andrew L.; Fagbuyi, Daniel B.; Adelgais, Kathleen; Goldman, Ran D.; Parker, James; Auerbach, Marc; Riera, Antonio; Cone, David C.; Baum, Carl R.

doi:10.3109/10903127.2013.856505

Cited by 23 publications

(20 citation statements)

References 15 publications

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“…Superficial wounds with minimal visible bleeding may be overlying extensive internal damage and internal haemorrhage and the same is true for the reverse; severe surface injuries do not always indicate extensive damage of internal organs [10]. The inherent challenges with gunshot wound triage are exacerbated by the volume of patients that can be seen in a mass shooting and particular problems are associated with paediatric incidents [17]. Physiological triage utilises vital signs, can be done quickly and requires little experience.…”

Section: Resultsmentioning

confidence: 99%

Pre-hospital management of mass casualty civilian shootings: a systematic literature review

2016

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BackgroundMass casualty civilian shootings present an uncommon but recurring challenge to emergency services around the world and produce unique management demands. On the background of a rising threat of transnational terrorism worldwide, emergency response strategies are of critical importance. This study aims to systematically identify, describe and appraise the quality of indexed and non-indexed literature on the pre-hospital management of modern civilian mass shootings to guide future practice.MethodsSystematic literature searches of PubMed, Cochrane Database of Systematic Reviews and Scopus were conducted in conjunction with simple searches of non-indexed databases; Web of Science, OpenDOAR and Evidence Search. The searches were last carried out on 20 April 2016 and only identified those papers published after the 1 January 1980. Included documents had to contain descriptions, discussions or experiences of the pre-hospital management of civilian mass shootings.ResultsFrom the 494 identified manuscripts, 73 were selected on abstract and title and after full text reading 47 were selected for inclusion in analysis. The search yielded reports of 17 mass shooting events, the majority from the USA with additions from France, Norway, the UK and Kenya. Between 1994 and 2015 the shooting of 1649 people with 578 deaths at 17 separate events are described. Quality appraisal demonstrated considerable heterogeneity in reporting and revealed limited data on mass shootings globally.ConclusionKey themes were identified to improve future practice: tactical emergency medical support may harmonise inner cordon interventions, a need for inter-service education on effective haemorrhage control, the value of senior triage operators and the need for regular mass casualty incident simulation.

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Section: Resultsmentioning

confidence: 99%

Pre-hospital management of mass casualty civilian shootings: a systematic literature review

2016

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“…Implementation of in‐person simulations, integrating simulation content generated via the Delphi Method by subject matter experts (Cicero et al., ), may improve the EMS providers’ knowledge and skill level for appropriately triaging patients at the scene of a mass shooting (Cicero et al., ). In an effort to understand integrated responses by law enforcement officers and the EMS better, simulations of active shooter incidents were performed.…”

Section: Resultsmentioning

confidence: 99%

Rapid response to mass shootings

Reeping

Jacoby

Rajan

et al. 2019

Criminology & Public Policy

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Research Summary:We conducted a scoping review of literature indexed in the National Library of Medicine's journal citation database, MEDLINE, and Scopus to identify articles in which the rapid response of hospital staff, emergency medical services personnel, the police, and the public to mass shootings is covered. Sixty-five articles were included, and critical themes related to reducing the harm from a mass shooting were summarized.Policy Implications: According to our findings, when mass shootings occur in the United States, several evidenceinformed steps can be taken from the moment the first bullet is fired until the last injured individual is transported to the hospital to promote a rapid response that can reduce death and disability. Ten recommendations are made ranging from recognition of the need for rapid response and bystander training to triage and transport training of police and avoidance of over-response.

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“…The development of the simulations has been previously described. 20 The 3 simulations each included 10 patients with evaluation tools. The simulations were a multi-family house fire, a school shooting, and a school bus crash.…”

Section: Curriculummentioning

confidence: 99%

“…Table 1 shows the triage domains assessed for each patient and the simulation modality used to represent the patient. 20 Using a modified Delphi method, 18 subject matter experts from across North America assigned expected triage levels for each of the patients. Delphi experts determined 1 of 4 triage levels: RED Emergent), YELLOW (Delayed), GREEN (Ambulatory), and BLACK (Deceased).…”

Section: Curriculummentioning

confidence: 99%

“…Performances on the first simulation, before any educational interventions, were rated by using a checklist-based tool. 20 The timing of the simulation in this study is shown in the project flow diagram ( Figure 1). We chose to compare triage outcomes before any educational interventions to approximate real-world performance of the 3 PDT strategies.…”

Section: Evaluation Of Triage Performancementioning

confidence: 99%

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