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Who Should Worry for the “Worried Well”? Analysis of Mild Casualties Center Drills in Non-Conventional Scenarios

Published online by Cambridge University Press:  28 June 2012

Adi Leiba ,
Avi Goldberg ,
Ariel Hourvitz ,
Gali Weiss ,
Michal Peres ,
Ahuva Karskass ,
Dagan Schwartz ,
Yehezkel Levi  and
Yaron Bar-Dayan
Adi Leiba
Affiliation:
Israel Defense Forces Home Front Command, Medical Department, Israel
Avi Goldberg
Affiliation:
Israel Defense Forces Home Front Command, Medical Department, Israel
Ariel Hourvitz
Affiliation:
Israel Defense Forces Home Front Command, Medical Department, Israel
Gali Weiss
Affiliation:
Israel Defense Forces Home Front Command, Medical Department, Israel
Michal Peres
Affiliation:
Israel Defense Forces Home Front Command, Medical Department, Israel
Ahuva Karskass
Affiliation:
Israel Defense Forces Home Front Command, Medical Department, Israel
Dagan Schwartz
Affiliation:
Department of Emergency Medicine, Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel
Yehezkel Levi
Affiliation:
Surgeon General Headquarters, Israel Defense Forces Medical Corps, Israel
Yaron Bar-Dayan*
Affiliation:
Israel Defense Forces Home Front Command, Medical Department, Israel Department of Emergency Medicine, Meir Hospital and the Department of Disaster and Emergency Medicine, and the Department of Healthcare Management, and the Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel
*
Col. Dr. Y. Bar-Dayan, MD, MHA Neve Savion, 16 Dolev St., Or-Yehuda, ISRAEL E-mail: bardayan@netvision.net.il
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Abstract

Introduction:

A mass toxicological event (MTE) caused by an act of terrorism or an industrial incident can create large numbers of ambulatory casualties suffering from mild intoxication, acute stress reaction (ASR), and exacerbation of chronic diseases or iatrogenic insult (such as atropine overdose). The logistical and medical management of this population may present a challenge insuch a scenario. The aim of this article is to describe the concept of the Israeli Home Front Command (HFC) of a “Mild Casualties Center” (MCC) for a chemical scenario, and to analyze the results of two large-scale drills that have been used to evaluate this concept.

Methods:

Two large-scale drills were conducted. One MCC drill was located in a school building and the second MCC drill was located in a basketball stadium. These medical centers were staffed by physicians, nurses, and medics, both military (reservists) and civilian (community, non-hospital teams). Two hundred simulated patients entered the MCC during each of the drills, and drill observers assessed how these patients were managed for two hours.

Results:

Of the casualties, 28 were treated in the “medical treatment site”, 10 of which were relocated to a nearby hospital. Only four casualties were treated in the large “mental care site”, planned for a much higher burden of “worried well” patients. Documentation of patient data and medical care was sub-optimal.

Conclusion:

A MCC is a logistically suitable solution for the challenge of managing thousands of ambulatory casualties. The knowledge of the medical team must be bolstered, as most are unfamiliar with both nerve gas poisoning and with ASR. Mild casualties centers should not be located within hospitals and must be staffed by non-hospital, medical personnel to achieve the main task of allowing hospital teams to focus on providing medical care to the moderate and severe nerve gas casualties, without the extra burden of caring for thousands of mild casualties.

Keywords

acute stress reaction (ASR)drillsmass toxicological event (MTE)mental health caremild casualties center (MCC)triage
Type
Special Report
Information
Prehospital and Disaster Medicine , Volume 21 , Issue 6 , December 2006 , pp. 441 - 444
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2006

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References

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