The utility of point-of-care ultrasound in targeted automobile ramming mass casualty (TARMAC) attacks

Shokoohi, Hamid; Pourmand, Ali; Boniface, Keith; Allen, Rebecca; Petinaux, Bruno; Sarani, Babak; Phillips, James P.

doi:10.1016/j.ajem.2018.05.058

Cited by 9 publications

(9 citation statements)

References 24 publications

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“…In recent times, MCIs (and especially those of an intentional nature) have increased in incidence, creating a special interest in how to determine which patients have highest evacuation priority, as well as which hospital center is most appropriate for their pathology. 12 The PhEMS are implementing in their operating procedures systems that allow responders to discriminate the surgical time, such as point-of-care ultrasound (POCUS) 13,14 or point-of-care testing (POCT). [15][16][17][18] However, this equipment implies a significant economic effort and technically requires prior learning to ensure good diagnostic performance.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of National Early Warning Score 2 (NEWS2) in Prehospital Triage on In-Hospital Early Mortality: A Multi-Center Observational Prospective Cohort Study

Martin-Rodríguez

López-Izquierdo

Vegas

et al. 2019

Prehosp. Disaster med.

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Introduction:In cases of mass-casualty incidents (MCIs), triage represents a fundamental tool for the management of and assistance to the wounded, which helps discriminate not only the priority of attention, but also the priority of referral to the most suitable center.Hypothesis/Problem:The objective of this study was to evaluate the capacity of different prehospital triage systems based on physiological parameters (Shock Index [SI], Glasgow-Age-Pressure Score [GAP], Revised Trauma Score [RTS], and National Early Warning Score 2 [NEWS2]) to predict early mortality (within 48 hours) from the index event for use in MCIs.Methods:This was a longitudinal prospective observational multi-center study on patients who were attended by Advanced Life Support (ALS) units and transferred to the emergency department (ED) of their reference hospital. Collected were: demographic, physiological, and clinical variables; main diagnosis; and data on early mortality. The main outcome variable was mortality from any cause within 48 hours.Results:From April 1, 2018 through February 28, 2019, a total of 1,288 patients were included in this study. Of these, 262 (20.3%) participants required assistance for trauma and injuries by external agents. Early mortality within the first 48 hours due to any cause affected 69 patients (5.4%). The system with the best predictive capacity was the NEWS2 with an area under the curve (AUC) of 0.891 (95% CI, 0.84-0.94); a sensitivity of 79.7% (95% CI, 68.8-87.5); and a specificity of 84.5% (95% CI, 82.4-86.4) for a cut-off point of nine points, with a positive likelihood ratio of 5.14 (95% CI, 4.31-6.14) and a negative predictive value of 98.7% (95% CI, 97.8-99.2).Conclusion:Prehospital scores of the NEWS2 are easy to obtain and represent a reliable test, which make it an ideal system to help in the initial assessment of high-risk patients, and to determine their level of triage effectively and efficiently. The Prehospital Emergency Medical System (PhEMS) should evaluate the inclusion of the NEWS2 as a triage system, which is especially useful for the second triage (evacuation priority).

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Section: Introductionmentioning

confidence: 99%

Accuracy of National Early Warning Score 2 (NEWS2) in Prehospital Triage on In-Hospital Early Mortality: A Multi-Center Observational Prospective Cohort Study

Martin-Rodríguez

López-Izquierdo

Vegas

et al. 2019

Prehosp. Disaster med.

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“…The impacts result in high-power injuries which include blunt trauma to the central nervous system, and thoracoabdominal organs with crush injuries if the victims are run over. 10 A retrospective analysis of patient data following intentional vehicular assaults in Jerusalem, Israel from October 2008 to May 2016 found a higher severity of injury and mortality rate following these incidents compared with general pedestrian injury. 11 The study found that more patients arriving from intentional vehicular assaults were intubated and required a significantly higher number of surgical procedures.…”

Section: Discussionmentioning

confidence: 99%

“…Vehicle-based terrorism is unlike any other mass casualty scenario as it is a result of blunt, non-penetrating trauma. The impacts result in high-power injuries which include blunt trauma to the central nervous system, and thoracoabdominal organs with crush injuries if the victims are run over 10. A retrospective analysis of patient data following intentional vehicular assaults in Jerusalem, Israel from October 2008 to May 2016 found a higher severity of injury and mortality rate following these incidents compared with general pedestrian injury 11.…”

Section: Discussionmentioning

confidence: 99%

Democratization of terrorism: an analysis of vehicle-based terrorist events

Houser

2022

Trauma Surg Acute Care Open

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ObjectivesThe COVID-19 pandemic inspired social changes that promote outdoor activities including eating at restaurants, which may linger in a world hyperfocused on disease transmission prevention, increasing the vulnerabilities to vehicle-based terrorism. Vehicle ramming attacks started to transition from a relatively rare method of attack to one of the most lethal forms of terrorism in Western countries just prior to the emergence of SARS-CoV-2. This study aims to provide a historical analysis of the terrorism-based attacks using vehicles between 1970 and 2019.MethodsThis study uses the methodology suggested by Tin et al in which the Global Terrorism Database hosted by the National Consortium for the Study of Terrorism and Responses to Terrorism was searched retrospectively for data. Data was collected from the database using the internal search function for terror events between January 1, 1970 and December 31, 2019 which used a vehicle as a means of attack.ResultsThere were 257 recorded terror attacks that involved some type of vehicle between 1970 and 2019. The attacks resulted in 808 fatalities and 1715 injuries when excluding the September 11 attacks. 76 events occurred at the West Bank and Gaza Strip, 25 in the USA, 16 in Israel, and 14 in the UK. Of the 257 terror incidents, 71% (183) occurred within the last 6-year span of inquiry.ConclusionBy 2016, vehicle attacks were the most lethal form of attack comprising just over half of all terrorism-related deaths in that year. Large gatherings such as festivals, sporting events, and now outdoor seating at restaurants, leave a number of people highly vulnerable to a vehicle ramming attacks depending on established countermeasures. The increased prevalence of outdoor activities and gatherings in a post-COVID-19 world will further expose large numbers of people to the potential vulnerabilities of vehicle-based terrorism. The scale of the casualties from a vehicle-based terror attack can overwhelm traditional resources and strain the abilities of the healthcare sector. Counterterrorism and disaster medicine specialists are crucial players in educating first responders and emergency medicine providers, allowing them to adequately prepare for an evolving threat in a world devastated by COVID-19.Level of evidenceVI.

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“…Novel systems are under development which may simplify the approach to some high-threat incidents in the future, such as a point-of-care ultrasound (POCUS) triage tool proposal for categorization of victims from hostile vehicle attacks. 59 Continued research into innovative models and validation of existing ones will refine the triage process to make it more applicable and relevant for high-threat environments such as CCTAs.…”

Section: Life-saving Interventionsmentioning

confidence: 99%

Triage in Complex, Coordinated Terrorist Attacks

Pepper

Archer

Moloney

2019

Prehosp. Disaster med.

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Introduction:Terror attacks have increased in frequency, and tactics utilized have evolved. This creates significant challenges for first responders providing life-saving medical care in their immediate aftermath. The use of coordinated and multi-site attack modalities exacerbates these challenges. The use of triage is not well-validated in mass-casualty settings, and in the setting of intentional mass violence, new and innovative approaches are needed.Methods:Literature sourced from gray and peer-reviewed sources was used to perform a comparative analysis on the application of triage during the 2011 Oslo/Utoya Island (Norway), 2015 Paris (France), and 2015 San Bernardino (California USA) terrorist attacks. A thematic narrative identifies strengths and weaknesses of current triage systems in the setting of complex, coordinated terrorist attacks (CCTAs).Discussion:Triage systems were either not utilized, not available, or adapted and improvised to the tactical setting. The complexity of working with large numbers of patients, sensory deprived environments, high physiological stress, and dynamic threat profiles created significant barriers to the implementation of triage systems designed around flow charts, physiological variables, and the use of tags. Issues were identified around patient movement and “tactical triage.”Conclusion:Current triage tools are inadequate for use in insecure environments, such as the response to CCTAs. Further research and validation are required for novel approaches that simplify tactical triage and support its effective application. Simple solutions exist in tactical triage, patient movement, and tag use, and should be considered as part of an overall triage system.

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The utility of point-of-care ultrasound in targeted automobile ramming mass casualty (TARMAC) attacks

Cited by 9 publications

References 24 publications

Accuracy of National Early Warning Score 2 (NEWS2) in Prehospital Triage on In-Hospital Early Mortality: A Multi-Center Observational Prospective Cohort Study

Accuracy of National Early Warning Score 2 (NEWS2) in Prehospital Triage on In-Hospital Early Mortality: A Multi-Center Observational Prospective Cohort Study

Democratization of terrorism: an analysis of vehicle-based terrorist events

Triage in Complex, Coordinated Terrorist Attacks

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