Description of procedures performed on patients by emergency medical services during mass casualty incidents in the United States

Sayed, Mazen El; Tamim, Hani; Mann, N. Clay

doi:10.1016/j.ajem.2015.04.035

Cited by 21 publications

(16 citation statements)

References 11 publications

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“…However, new studies have been recently published in the United States [ 17 , 18 ] and Europe [ 19 ]. Clinical recommendations are usually based on previous research and case studies, but little research has been made in the field of MCI [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

An epidemiological approach to mass casualty incidents in the Principality of Asturias (Spain)

Delgado

Gómez

Álvarez

et al. 2016

Scand J Trauma Resusc Emerg Med

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BackgroundMass Casualty Incidents (MCI) have been rarely studied from epidemiological approaches. The objective of this study is to establish the epidemiological profile of MCI in the autonomous region of the Principality of Asturias (Spain) and analyse ambulance deployment and severity of patients.MethodsThis is a population-based prospective study run in 2014. Inclusion criteria for MCI is “every incident with four or more people affected that requires ambulance mobilisation”.ResultsThirty-nine MCI have been identified in Asturias in 2014. Thirty-one (79 %) were road traffic accidents, three (7.5 %) fires and five (12.8 %) other types. Twenty-one incidents (56.7 %) had four patients, and only three of them (8 %) had seven or more patients. An average of 2.41 ambulances per incident were deployed (standard error = 0.18). Most of the patients per incident were minor injured patients (mean = 4; standard error = 0.2), and 0,26 were severe patients (standard error = 0.08). There was a positive significant correlation (p < 0.01) between the total number of patients and the total number of ambulances deployed and between the total number of patients and Advanced Life Support (ALS) ambulances deployed (p < 0.001). The total number of non-ALS ambulances was not related with the total number of patients.DiscussionPopulation based research in MCI is essential to define MCI profile. Quantitative definition of MCI, adapted to resources, avoid selection bias and present a more accurate profile of MCI. As espected, road traffic accidents are the most frequent MCI in our region. This aspect is essential to plan training and response to MCI. Analysis of total response to MCI shows that for almost an hour, we should plan extra resources for daily emergencies. This data is an important issue to bear in mind when planning MCI response. The fact that most patients are classified as minor injured and more advanced life support units than needed are deployed shows that analysis of resources deployment and patient severity helps us to better plan future MCI response.ConclusionsRoad traffic accidents with minor injured patients are the most frequent MCI in our region. More advanced life support units than needed have been initially deployed, which might compromise response to daily emergencies during an MCI.

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Section: Discussionmentioning

confidence: 99%

An epidemiological approach to mass casualty incidents in the Principality of Asturias (Spain)

Delgado

Gómez

Álvarez

et al. 2016

Scand J Trauma Resusc Emerg Med

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“…Previous studies of MCIs have been limited to single incidents or single hospitals ( 7 ), or have only focused on prehospital care ( 1 2 8 ). Moreover, many researchers have demonstrated that the understanding of MCIs is often limited to individual incidents or local geographic regions ( 2 ).…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Emergency Medical Services-Assessed Mass Casualty Incidents according to Causes

et al. 2016

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To effectively mitigate and reduce the burden of mass casualty incidents (MCIs), preparedness measures should be based on MCIs’ epidemiological characteristics. This study aimed to describe the epidemiological characteristics and outcomes of emergency medical services (EMS)-assessed MCIs from multiple areas according to cause. Therefore, we extracted the records of all MCIs that involved ≥ 6 patients from an EMS database. All patients involved in EMS-assessed MCIs from six areas were eligible for this study, and their prehospital and hospital records were reviewed for a 1-year period. The EMS-assessed MCIs were categorized as being caused by fire accidents (FAs), road traffic accidents (RTAs), chemical and biological agents (CBs), and other mechanical causes (MECHs). A total of 362 EMS-assessed MCIs were identified, with a crude incidence rate of 0.6–5.0/100,000 population. Among these MCIs, 322 were caused by RTAs. The MCIs involved 2,578 patients, and 54.3% of these patients were women. We observed that the most common mechanism of injury varied according to MCI cause, and that a higher number of patients per incident was associated with a longer prehospital time. The highest hospital admission rate was observed for CBs (16 patients, 55.2%), and most patients in RTAs and MECHs experienced non-severe injuries. The total number of deaths was 32 (1.2%). An EMS-assessed MCI database was established using the EMS database and medical records review. Our findings indicate that RTA MCIs create a burden on EMS and emergency department resources, although CB MCIs create a burden on hospitals’ resources.

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“…[12] Participating States have different inclusion criteria and proportions of submitted EMS activations. [13,14] Each EMS record in NEMSIS corresponds to a unique activation submitted by a single responding vehicle. Thus, if multiple EMS vehicles respond to the same event, multiple records for the same event will reside in the national database.…”

Section: Methodsmentioning

confidence: 99%

Impact of prehospital mechanical ventilation

Sayed¹,

Tamim

Mailhac³

et al. 2019

Medicine

Self Cite

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Prehospital use of ventilators by emergency medical services (EMS) during 911 calls is increasing. This study described the impact of prehospital mechanical ventilation on prehospital time intervals and on mortality.This retrospective matched-cohort study used 4 consecutive public releases of the US National Emergency Medical Services Information System dataset (2011–2014). EMS activations with recorded ventilator use were randomly matched with activations without ventilator use (1 to 1) on age (range ± 2 years), gender, provider's primary impression, urbanicity, and level of service.A total of 5740 EMS activations were included (2870 patients per group). Patients in the ventilator group had a mean age of 69.1 (±17.3) years with 49.4% males, similar to the non-ventilator group. Activations were mostly in urban settings (83.8%) with an advanced life support level of care (94.5%). Respiratory distress (77.8%) and cardiac arrest (6.8%) were the most common provider's primary impressions. Continuous positive airway pressure was the most common mode of ventilation used (79.2%).Mortality was higher at hospital discharge (29.0% vs 21.1%, P = .01) but not at emergency department (ED) discharge (8.4% vs 7.4%, P = .19) with prehospital ventilator use. Both total on-scene time and total prehospital time intervals increased with reported ventilator use (4.10 minutes (95% confidence interval [CI]: 2.71–5.49) and 3.59 minutes (95% CI: 3.04–4.14), respectively).Ventilator use by EMS agencies in 911 calls in the US is associated with higher prehospital time intervals without observed impact on survival to ED discharge. More EMS outcome research is needed to provide evidence-based prehospital care guidelines and targeted resource utilization.

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Description of procedures performed on patients by emergency medical services during mass casualty incidents in the United States

Cited by 21 publications

References 11 publications

An epidemiological approach to mass casualty incidents in the Principality of Asturias (Spain)

An epidemiological approach to mass casualty incidents in the Principality of Asturias (Spain)

Epidemiology of Emergency Medical Services-Assessed Mass Casualty Incidents according to Causes

Impact of prehospital mechanical ventilation

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