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Reconsidering Policy of Casualty Evacuation in a Remote Mass-Casualty Incident

Published online by Cambridge University Press:  15 November 2013

Bruria Adini ,
Robert Cohen ,
Elon Glassberg ,
Bella Azaria ,
Daniel Simon ,
Michael Stein ,
Yoram Klein  and
Kobi Peleg
Bruria Adini*
Affiliation:
Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Aviv, Israel
Robert Cohen
Affiliation:
Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Aviv, Israel
Elon Glassberg
Affiliation:
Medical Corps, Israel Defense Forces, Ramat Gan, Israel
Bella Azaria
Affiliation:
Home Front Command, Israel Defense Forces, Ramla, Israel
Daniel Simon
Affiliation:
Sheba Medical Center, Ramat Gan, Israel
Michael Stein
Affiliation:
Beilinson Medical Center, Petach Tikva, Israel
Yoram Klein
Affiliation:
Kaplan Medical Center, Rehovot, Israel
Kobi Peleg
Affiliation:
Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Aviv, Israel School of Public Health, Tel-Aviv University, Tel Aviv, Israel
*
Correspondence: Bruria Adini, PhD The Israel National Center for Trauma and Emergency Medicine Gertner Institute for Epidemiology and Health Policy Research Hatamar 16 Bat Chen, 40290 Israel E-mail adini@netvision.net.il
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Abstract

Objectives

Inappropriate distribution of casualties in mass-casualty incidents (MCIs) may overwhelm hospitals. This study aimed to review the consequences of evacuating casualties from a bus accident to a single peripheral hospital and lessons learned regarding policy of casualty evacuation.

Methods

Medical records of all casualties relating to evacuation times, injury severity, diagnoses, treatments, resources utilized and outcomes were independently reviewed by two senior trauma surgeons. In addition, four senior trauma surgeons reviewed impact of treatment provided on patient outcomes. They reviewed the times for the primary and secondary evacuation, injury severity, diagnoses, surgical treatments, resources utilized, and the final outcomes of the patients at the point of discharge from the tertiary care hospital.

Results

Thirty-one survivors were transferred to the closest local hospital; four died en route to hospital or within 30 minutes of arrival. Twenty-seven casualties were evacuated by air from the local hospital within 2.5 to 6.15 hours to Level I and II hospitals. Undertriage of 15% and overtriage of seven percent were noted. Four casualties did not receive treatment that might have improved their condition at the local hospital.

Conclusions

In MCIs occurring in remote areas, policy makers should consider revising the current evacuation plan so that only immediate unstable casualties should be transferred to the closest primary hospital. On site Advanced Life Support (ALS) should be administered to non-severe casualties until they can be evacuated directly to tertiary care hospitals. First responders must be trained to provide ALS to non-severe casualties until evacuation resources are available.

AdiniB , CohenR , GlassbergE , AzariaB , SimonD , SteinM , KleinY , PelegK . Reconsidering Policy of Casualty Evacuation in a Remote Mass-Casualty Incident. Prehosp Disaster Med. 2013;28(6):1-5.

Keywords

Casualty evacuationmass-casualty incidentmotor vehicle accidentremote hospitals
Type
Case Report
Information
Prehospital and Disaster Medicine , Volume 29 , Issue 1 , February 2014 , pp. 91 - 95
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2013 

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