Emergency Medical Response in Mass Casualty Tunnel Incidents—with Emphasis on Prehospital Care

Abstract

Responding to mass casualty incidents in a tunnel environment is problematic not least from a prehospital emergency medical services (EMS) perspective. The aim of this review was to 1) categorize preconditions for emergency response in tunnel environments based on Haddon's matrix and 2) identify specific EMS knowledge of providing prehospital care. Twenty eight articles, reports and book chapters were selected for further analysis. Firstly, sorting the data from each included article was done according to Haddon's matrix. The result covers human factors, technical factors, physical environmental factors and socioeconomic environmental factors all related to preconditions for emergency response. To describe the EMS's knowledge the data was also sorted according to command and safety, communication, assessment, and triage treatment and transport, also known as CSCATT. Few studies, especially of high quality, actually provide detailed information regarding emergency response to tunnel incidents and those that do, often have a main focus on management by the rescue service. While many incidents studied were caused by fires in tunnels, thus requiring rescue service in action, the subsequent EMS response issues that have taken place appear to have been given limited attention. To optimize the survival rates and health of the injured, as well as to provide a safe and effective work environment for the emergency services, there is a need to explore the event phase.

Development of the Aerial Remote Triage System: Result of a survey of international experts

“…Previous studies have used voice commands to interact with victims in a MCI [15,[25][26][27]. Holgerson et al [27] shown some strategies in order to overcome communication difficulties at the scene of a MCI, they include the reservation of priority lines in the mobile phone network and the use of loudspeakers to inform the crowds. A study by Jain et al [4], in simulated MCI scenarios, showed that victims were able to follow the directions given to them by the first responders through a loudspeaker incorporated in a drone.…”

“…Previous studies have used voice commands to interact with victims in a MCI [15, 25-27]. Holgerson et al [27] shown some strategies in order to overcome communication difficulties at the scene of a MCI, they include the reservation of priority lines in the mobile phone network and the use of loudspeakers to inform the crowds.…”

Development of the Aerial Remote Triage System using drones in mass casualty scenarios: A survey of international experts

“…Previous studies have used voice commands to communicate with injured people in a MCI [21,[29][30][31]. Holgerson et al [31] showed some strategies to overcome communication difficulties at the scene of a MCI, such as the reservation of priority lines in the cell phone network and the use of loudspeakers to inform the crowds.…”

“…Previous studies have used voice commands to communicate with injured people in a MCI [21,[29][30][31]. Holgerson et al [31] showed some strategies to overcome communication difficulties at the scene of a MCI, such as the reservation of priority lines in the cell phone network and the use of loudspeakers to inform the crowds. Jain et al [4] reported that, in simulated MCI scenarios, injured people were able to follow the instructions given by the first responders through a loudspeaker incorporated in a drone; also other study by Sanfridsson et al [32] found that bystanders perceived easier the interactions with the drone loudspeaker than with their own mobile phone in speakerphone mode.…”

Design and validation of a preparedness evaluation tool of pre-hospital emergency medical services for terrorist attacks: a mixed method study

“…The results of some studies showed that, unfortunately, the level of preparedness for dealing with these events is low and the medical emergency is less prepared to manage these events [ 14 ]. Studies by Annelie Holgersson et al [ 15 ] and Westman Anton et al [ 16 ] stated that differences in viewpoints on terrorism preparation and response among emergency responders were demonstrating the significance of empowering inter-organizational insights on safety culture, risk perception, and management practices, as well as understanding of the other organizations’ institutional logics and main tasks, in order to achieve an effective, collaborative response to terrorism-induced incidents.…”