Prehospital Response and Field Triage in Pediatric Mass Casualty Incidents: The Israeli Experience

Waisman, Yehezkel; Amir, Lisa; Mor, Meirav; Feigenberg, Zvi; Aharonson, Limor Daniel; Peleg, Kobi; Blumenfeld, Amir

doi:10.1016/j.cpem.2006.01.006

Cited by 16 publications

(9 citation statements)

References 11 publications

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“…In addition to EMS personnel worldwide being less experienced, in dealing with emergency management of critically ill children compared to adults, pediatric victims of terrorist attacks suffer injuries not usually seen in the age group [19]. Waisman et al [18] describe an experience-based development of a pediatric triage algorithm with changes to the performance of triage in children due to the difficulties and time-consuming practice, of obtaining measurements of vital signs and blood pressure in children, and due to different mechanisms of injury in children because of their physiological and anatomical characteristics.…”

Section: Caring For the Pediatric Casualtymentioning

confidence: 99%

“…Waisman et al [18] describe an experience-based development of a pediatric triage algorithm with changes to the performance of triage in children due to the difficulties and time-consuming practice, of obtaining measurements of vital signs and blood pressure in children, and due to different mechanisms of injury in children because of their physiological and anatomical characteristics. For further details please see original references [18,19]. Since children have unique characteristics and pediatric mass-casualty incidents are rare, prehospital personnel may have difficulties performing certain clinical procedures such as intubation or establishing an intravenous line.…”

Section: Caring For the Pediatric Casualtymentioning

confidence: 99%

“…The setting of modern urban terrorist bombings also means that civilian medical systems are confronted with patients arriving at the hospital alive who would likely have died of their injuries in previous conventional war settings [6]. Moreover, there is a difference in those at risk of injury in a military setting versus those in a civilian setting, where the civilian environment includes children and the elderly [16][17][18][19]. Antagonistic acts thus result in injuries that are not commonly encountered in the civilian environment and also augment the challenges of an unintentional mass-casualty incident by adding the factor of a hostile environment which together, demand other approaches by the responders on scene.…”

Section: Introductionmentioning

confidence: 99%

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Review of On-Scene Management of Mass-Casualty Attacks

Holgersson

2016

Journal of Human Security

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Background: The scene of a mass-casualty attack (MCA) entails a crime scene, a hazardous space and a great number of people needing medical assistance. Public transportation has been the target of such attacks and involves a high probability of generating mass casualties. The aim of the review was to investigate challenges for on-scene responses to MCAs and suggestions made to counter these challenges, with special attention given to attacks on public transportation and associated terminals. Methods: Articles were found through PubMed and Scopus, "relevant articles" as defined by the databases, and a manual search of references. Inclusion criteria were that the article referred to attack(s) and/or a public transportation-related incident and issues concerning formal on-scene response. An appraisal of the articles' scientific quality was conducted based on an evidence hierarchy model developed for the study. Results: One hundred and five articles were reviewed. Challenges for command and coordination on scene included establishing leadership, inter-agency collaboration, multiple incident sites, and logistics. Safety issues entailed knowledge and use of personal protective equipment, risk awareness and expectations, dynamic risk assessment, cordons, defensive versus offensive approaches, and joining forces. Communication concerns were equipment shortfalls, dialoguing and providing information. Assessment problems were scene layout and interpreting environmental indicators as well as understanding setting-driven needs for specialist skills and resources. Triage and treatment difficulties included differing triage systems, directing casualties, uncommon injuries, field hospitals, level of care and providing psychological and pediatric care. Transportation hardships included scene access, distance to hospitals, and distribution of casualties. Conclusion: Commonly encountered challenges during unintentional incidents were augmented during MCAs, implying specific issues for safety, assessment, triage, and treatment, which require training. Effectively increasing readiness for MCAs will likely entail struggles to overcome fragmentation between the emergency services and the broader crisis management system as well as enabling critical and prestige-less, context-based assessments, of needed preparatory efforts.

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Section: Caring For the Pediatric Casualtymentioning

confidence: 99%

Section: Caring For the Pediatric Casualtymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Review of On-Scene Management of Mass-Casualty Attacks

Holgersson

2016

Journal of Human Security

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“…48 However, as seen in the recent disasters, the number of casualties can exceed the number of transport options in an MCI. Therefore, a safe and protected area should be established away from the incident scene in order for definitive treatment can be initiated on disaster victims especially if transport is delayed.…”

Section: Treatment/decontaminationmentioning

confidence: 99%

Pediatric Prehospital Medicine in Mass Casualty Incidents

Lowe

2009

Journal of Trauma: Injury, Infection &Amp; Critical Care

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The prehospital provider is met with unique challenges when responding to a call and finding a pediatric aged patient that requires evaluation, treatment, and transfer to a medical facility. Many mass causality incidents secondary to natural disaster, man-made disasters, or acts of terrorisms have exposed the vulnerabilities of prehospital emergency medical services personnel in the evaluation, treatment, and transport of the pediatric population. Many lessons learned from past events have been published with agendas to incorporate the needs of the transport of pediatric patients. This article will review the issues and recommendations of the prehospital personnel's role with expectations that pediatric aged victims are rendered optimal care.

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“…13 Similar lessons have been learned and shared by other military organizations. 14 Until recently, it was unreasonable to expect the US military to configure medical assets for a primary humanitarian disaster missions first and combat and defense missions second. 15 With a renewed emphasis on homeland security and domestic response, it is conceivable future medical units may be designed with disaster response in mind.…”

Section: Editorial Commentsmentioning

confidence: 99%