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Intensive Care for Emergency Surgeons: Mass Casualties

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Intensive Care for Emergency Surgeons

Abstract

Disasters overwhelm human and material resources leaving a huge death toll behind. Healthcare systems struggle to manage and respond to major incidents with multiple casualties. Even highly specialized medical units like an ICU should plan far ahead and prepare accordingly in order to perform efficiently during a mass casualty incident. ICU response plan should focus on staff, stuff and space issues. During a major incident, both casualties and resources should be triaged, and level of treatment is adjusted accordingly. The dynamic environment and the stressful conditions of major incidents pose always a challenge. Effective ICU performance can be achieved through vigorous training and interdisciplinary cooperation. Disasters evolve through the years, and an ICU should always be prepared to accommodate terrorist victims, burn patients and CBRN casualties.

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References

  1. Tintinalli JE, Stapczynski JS, Ma OJ, Cline DM, Cydulka RK, Meckler GD. Chapter 6. Disaster preparedness and response. In: Tintinalli’s emergency medicine. 7th ed. New York: McGraw-Hill; 2011.

    Google Scholar 

  2. Shaluf IM. Disaster types. Disaster Prev Manag. 2007;16:704–17.

    Article  Google Scholar 

  3. Center for Research on the Epidemiology of Disasters (CRED), The United Nations Office for Disaster Risk Reduction (UNISDR). Poverty & Centers for Disease Control and Prevention. All-Hazards Preparedness Guide. 2016. https://www.cdc.gov/phpr/documents/ahpg_final_march_2013.pdf. Accessed 6 May 2018.

  4. Loganathan RS, Alva R, Karwa M, Kvetan V. Disaster medicine for the ICU physician. In: Fink MP, Abraham E, Vincent J-L, Kochanek P, editors. Textbook of critical care. Philadelphia: Elsevier Saunders; 2005. p. 2233–50.

    Google Scholar 

  5. Rubinson L, Nuzzo JB, Talmor DS, O’Toole T, Kramer BR, Inglesby TV. Augmentation of hospital critical care capacity after bioterrorist attacks or epidemics: recommendations of the Working Group on Emergency Mass Critical Care. Crit Care Med. 2005;33:2393–403.

    Article  Google Scholar 

  6. Cushman JG, Patcher HL, Beaton HL. Two New York City hospitals’ surgical response to the September 11, 2001, terrorist attack in New York City. J Trauma. 2003;54(1):147–54.

    Article  Google Scholar 

  7. Einav S, Aharonson-Daniel L, Weissman C, Freund HR, Peleg K, Israel Trauma Group. In-hospital resource utilization during multiple casualty events. Ann Surg. 2006;243(4):533–40.

    Article  Google Scholar 

  8. Burkle FM Jr. Mass casualty management of a largescale bioterrorist event: an epidemiological approach that shapes triage decisions. Emerg Med Clin North Am. 2002;20:409–36.

    Article  Google Scholar 

  9. Campbell D. War plan UK: the truth about civil defence in Britain. London: Burnett Books; 1982. p. 112–413.

    Google Scholar 

  10. Frykberg E. Disaster and mass casualty management: a commentary on the American College of Surgeons Position Statement. J Am Coll Surg. 2003;197:857–9.

    Article  Google Scholar 

  11. Ciraulo DL, Barie PS, Briggs SM, et al. An update on the surgeons scope and depth of practice to all hazards emergency response. J Trauma. 2006;60:1267–74.

    Article  Google Scholar 

  12. Christian MD, Devereaux AV, Dichter JR, Geiling JA, Rubinson L. Definitive care for the critically ill during a disaster: current capabilities and limitations from the Task Force for Mass Critical Care summit meeting, January 26-27, 2007. Chest. 2008;133:8–17.

    Article  Google Scholar 

  13. Carles M, Levraut J, Gonzalez JF, Valli F, Viudes G, Leplatois T, Bornard L, Galiano N, Massalou D, Delabrière F, Babe P, Levraut L, Amoretti ME, Favier C, Oualid H, Raucoules M. Mass casualty events and health organisation: terrorist attack in Nice. Lancet. 2016;388:2349–50.

    Article  Google Scholar 

  14. Einav S, Feigenberg Z, Weissman C, et al. Evacuation priorities in mass casualty terror-related events implications for contingency planning. Ann Surg. 2004;239:304–10.

    Article  Google Scholar 

  15. Rinnert KJ, Keyes DC. Hospital preparedness. In: Keyes DC, editor. Medical response to terrorism. Philadelphia: Lippincott Williams & Wilkins; 2005. p. 235–47.

    Google Scholar 

  16. Bovender JO Jr, Carey B. A week we don’t want to forget: lessons learned from Tulane. Front Health Serv Manag. 2006;23:3–12.

    Article  Google Scholar 

  17. Casani JAP, Romanosky AJ. Surge capacity. In: Ciottone G, editor. Disaster medicine. Philadelphia: Mosby Elsevier; 2006. p. 193–202.

    Chapter  Google Scholar 

  18. Hanfling D, Andress K. Chapter 49. Emergency department disaster planning and response. In: Emergency department management. New York: Mc Graw Hill; 2014.

    Google Scholar 

  19. Schultz CH, Mothershead JL, Field M. Bioterrorism preparedness. I: the emergency department and hospital. Emerg Med Clin North Am. 2002;20:437–55.

    Article  Google Scholar 

  20. Klein JS, Weigelt J. Disaster management. Surg Clin North Am. 1991;71:257–66.

    Article  CAS  Google Scholar 

  21. Frykberg ER, Tepas JJ III. Terrorist bombings. Ann Surg. 1998;208:569–76.

    Article  Google Scholar 

  22. Ewart GW, Marcus L, Gaba MM, Bradner RH, Medina JL, Chandler EB. The critical care medicine crisis: a call for federal action. Chest. 2004;125:1518–21.

    Article  Google Scholar 

  23. Eiseman B, Chandler JG. Military medical surge capacity in times of war and natural disaster. J Trauma. 2006;60:237–9.

    Article  Google Scholar 

  24. Mahoney EJ, Biffl WL, Cioffi WG. Analytic review: mass-casualty incidents: how does an ICU prepare? J Intensive Care Med. 2008;23:219.

    Article  Google Scholar 

  25. Gruber P, Gomersall C, Joynt G. Avian influenza (H5N1): implications for intensive care. Intensive Care Med. 2006;32:823–9.

    Article  Google Scholar 

  26. Hammond J, Brooks J. Review: the World Trade Center attack. helping the helpers: the role of critical incident stress management. Crit Care. 2001;5:315–7.

    Article  CAS  Google Scholar 

  27. Gomersall CD, Tai DY, Loo S, et al. Expanding ICU facilities in an epidemic: recommendations based on experience from the SARS epidemic in Hong Kong and Singapore. Intensive Care Med. 2006;32:1004–13.

    Article  Google Scholar 

  28. Mollica R, Cardozo BL, Osofsky HJ, Raphael B, Ager A, Salama P. Mental health in complex emergencies. Lancet. 2004;364:2058–67.

    Article  CAS  Google Scholar 

  29. Neyman G, Irvin CB. A single ventilator for multiple simulated patients to meet disaster surge. Acad Emerg Med. 2006;13:1246–9.

    Article  Google Scholar 

  30. Stroller JK, Stefanak M, Orens D, Burkhart J. The hospital oxygen supply: an “O2K” problem. Respir Care. 2000;45:300–5.

    Google Scholar 

  31. Hajat S, Kovats R, Lachowycz K. Heat-related and cold related deaths in England and Wales: who is at risk? Occup Environ Med. 2007;64:93–100.

    Article  CAS  Google Scholar 

  32. Rodriguez H, Aguirre BE. Hurricane Katrina and the healthcare infrastructure: a focus on disaster preparedness, response, and resiliency. Front Health Serv Manag. 2006;23:13–24.

    Article  Google Scholar 

  33. Tucker M, Eichold B, Lofgren JP, et al. Carbon monoxide poisonings after two major hurricanes—Alabama and Texas, August–October 2005. MMWR Morb Mortal Wkly Rep. 2006;55:236–9.

    Google Scholar 

  34. Lynn M, Gurr D, Memon A, Kaliff J. Management of conventional mass casualty incidents: ten commandments for hospital planning. J Burn Care Res. 2006;27:649–58.

    Article  Google Scholar 

  35. Peleg K, Rozenfeld M, Dolev E. Children and terror casualties receive preference in ICU admissions. Disaster Med Public Health Prep. 2012;6:14–9.

    Article  Google Scholar 

  36. Kanter RK. Strategies to improve pediatric disaster surge response: potential mortality reduction and tradeoffs. Crit Care Med. 2007;35:2837–42.

    Article  Google Scholar 

  37. Bohn D, Kanter RK, Burns J, Barfield WD, Kissoon N. Supplies and equipment for pediatric emergency mass critical care. Pediatr Crit Care Med. 2011;12(6 0):S120–7.

    Article  Google Scholar 

  38. Barillo DJ, Jordan MH, Jocz RJ, Nye D, Cancio LC, Holcomb JB. Tracking the daily availability of burn beds for national emergencies. J Burn Care Rehabil. 2005;26:174–82.

    Article  Google Scholar 

  39. Davis DP, Poste JC, Hicks T, Polk D, Rymer TE, Jacoby I. Hospital bed surge capacity in the event of a mass- casualty incident. Prehosp Disaster Med. 2005;20:169–76.

    Article  Google Scholar 

  40. Norcross ED, Elliott BM, Adams DB, Crawford FA. Impact of a major hurricane on surgical services in a university hospital. Am Surg. 1993;59:28–33.

    CAS  PubMed  Google Scholar 

  41. Rosenbaum RA, Benyo JS, O’Connor RE, et al. Use of a portable forced air system to convert existing hospital space into a mass casualty isolation area. Ann Emerg Med. 2004;44:628–34.

    Article  Google Scholar 

  42. Baber I, Rinker R. Direct patient care during an acute disaster: chasing the will-o’-the-wisp. Crit Care. 2006;10(1):206.

    Article  Google Scholar 

  43. Aschkenasy-Steuer G, Shamir M, Rivkind A, Mosheiff R, Shushan Y, Rosenthal G, Mintz Y, Weissman C, Sprung CL, Weiss YG. Clinical review: the Israeli experience: conventional terrorism and critical care. Crit Care. 2005;9(5):490–9.

    Article  Google Scholar 

  44. Shirley PJ, Mandersloot G. Clinical review: the role of the intensive care physician in mass casualty incidents: planning, organisation, and leadership. Crit Care. 2008;12:214.

    Article  Google Scholar 

  45. Frykberg ER. Principles of mass casualty management following terrorist disasters. Ann Surg. 2004;239:319–21.

    Article  Google Scholar 

  46. Nocera A, Garner A. An Australian mass casualty incident triage system for the future based upon triage mistakes of the past: the Homebush Triage Standard. Aust N Z J Surg. 1999;69:603–8.

    Article  CAS  Google Scholar 

  47. Frykberg ER. Medical management of disasters and mass casualties from terrorist bombings: how can we cope? J Trauma. 2002;53:201–12.

    Article  Google Scholar 

  48. Barfod C, Danker J, Forberg J, Lauritzen MLP. The distribution of triage categories and the impact of emergency symptoms and signs on the triage level. Scand J Trauma Resusc Emerg Med. 2010;18:34.

    Article  Google Scholar 

  49. Wise RA. Keeping patients safe when disaster strikes. Front Health Serv Manag. 2006;23:35–9.

    Article  Google Scholar 

  50. Cotter S. Treatment area considerations for mass casualty incidents. Emerg Med Serv. 2006;35:48–51.

    PubMed  Google Scholar 

  51. White DB, Katz MH, Luce JM, Lo B. Who should receive life support during a public health emergency? Using ethical principles to improve allocation of resources. Ann Intern Med. 2009;150:132–8.

    Article  Google Scholar 

  52. Pikoulis E, Delis S, Tsatsoulis P, Leppaniemi A, Derlopas K, Koukoulides G, Mantonakis S. Blunt injuries of the stomach. Eur J Surg. 1999;165:937–9.

    Article  CAS  Google Scholar 

  53. Velmahos GC, Demetriades D, Toutouzas KG, et al. Selective nonoperative management in 1,856 patients with abdominal gunshot wounds: should routine laparotomy still be the standard of care? Ann Surg. 2001;234:395–403.

    Article  CAS  Google Scholar 

  54. Bala M, Willner D, Keidar A, Rivkind AI, Bdolah-Abram T, Almogy G. Indicators of the need for ICU admission following suicide bombing attacks. Scand J Trauma Resusc Emerg Med. 2012;20:19.

    Article  Google Scholar 

  55. Burris D, Rhee P, Kaufmann C, Pikoulis E, Austin B, Eror A, DeBraux S, Guzzi L, Leppäniemi A. Controlled resuscitation for uncontrolled hemorrhagic shock. J Trauma. 1999;46(2):216–23.

    Article  CAS  Google Scholar 

  56. Leppäniemi A, Soltero R, Burris D, Pikoulis E, Waasdorp C, Ratigan J, Hufnagel H, Malcolm D. Fluid resuscitation in a model of uncontrolled hemorrhage: too much too early, or too little too late? J Surg Res. 1996;63:413–8.

    Article  Google Scholar 

  57. Hirshberg A, Holcomb JB, Mattox KL. Hospital trauma care in multiple-casualty incidents: a critical view. Ann Emerg Med. 2001;37:647–52.

    Article  CAS  Google Scholar 

  58. Redwood-Campbell LJ, Riddez L. Post-tsunami medical care: health problems encountered in the International Committee of the Red Cross Hospital in Banda Aceh, Indonesia. Prehosp Disaster Med. 2006;21:1–7.

    Article  Google Scholar 

  59. Frykberg E, Tepas JJ III, Alexander R. The 1983 Beirut Airport terrorist bombing. Injury patterns and implications for disaster management. Am Surg. 1989;55:134–41.

    CAS  PubMed  Google Scholar 

  60. Mackway-Jones K. Major incident medical management and support: the practical approach at the scene. 3rd ed. Hoboken: Blackwell Publishing Ltd; 2012.

    Google Scholar 

  61. Avidan V, Hersch M, Spira R, Einav S, Goldberg S, Schecter W. Civilian hospital response to a mass casualty event: the role of the intensive care unit. J Trauma. 2007;62(5):1234–9.

    Article  Google Scholar 

  62. Leibovici D, Gofrit ON, Stein M, Shapira SC, Noga Y, Heruti RJ, Shemer J. Blast injuries: bus versus open-air bombings--a comparative study of injuries in survivors of open-air versus confined-space explosions. J Trauma. 1996;41:1030–5.

    Article  CAS  Google Scholar 

  63. Lipsky AM, Klein Y, Givon A, Klein M, Hammond JS, Peleg K. Accuracy of initial critical care triage decisions in blast versus non-blast trauma. Disaster Med Public Health Prep. 2014;8:326–32.

    Article  Google Scholar 

  64. Kearns RD, Conlon KM, Valenta AL, Lord GC, Cairns CB, Holmes JH, Johnson DD, Matherly AF, Sawyer D, Skarote MB, Siler SM, Helminiak RC, Cairns BA. Disaster planning: the basics of creating a burn mass casualty disaster plan for a burn center. J Burn Care Res. 2014;35:1–13.

    Article  Google Scholar 

  65. O’Neill TB, Rawlins J, Rea S, Wood F. Complex chemical burns following a mass casualty chemical plant incident: how optimal planning and organisation can make a difference. Burns. 2012;38:713–8.

    Article  Google Scholar 

  66. Cone DC, Koenig KL. Mass casualty triage in the chemical, biological, radiological, or nuclear environment. Eur J Emerg Med. 2005;12:287–302.

    Article  Google Scholar 

  67. Levi L, Michaelson M, Admi H, Bregman D, Bar-Nahor R. National strategy for mass casualty situations and its effects on the hospital. Prehosp Disaster Med. 2002;17:12–6.

    Article  Google Scholar 

  68. Morens DM, Fauci AS. The 1918 influenza pandemic: insights for the 21st century. J Infect Dis. 2007;195:1018–28.

    Article  Google Scholar 

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Correspondence to Emmanouil A. Pikoulis .

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Pikoulis, E.A., Pikoulis, A.E., Kalogeropoulos, A.N. (2019). Intensive Care for Emergency Surgeons: Mass Casualties. In: Picetti, E., Pereira, B., Razek, T., Narayan, M., Kashuk, J. (eds) Intensive Care for Emergency Surgeons. Hot Topics in Acute Care Surgery and Trauma. Springer, Cham. https://doi.org/10.1007/978-3-030-11830-3_19

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