Reconsidering policy of casualty evacuation in a remote mass-casualty incident

Bruria Adini, Robert Cohen, Elon Glassberg, Bella Azaria, Daniel Simon, Michael Stein, Yoram Klein, Kobi Peleg

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

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.

Original languageEnglish
Pages (from-to)91-95
Number of pages5
JournalPrehospital and Disaster Medicine
Volume29
Issue number1
DOIs
StatePublished - 1 Feb 2014
Externally publishedYes

Keywords

  • Casualty evacuation
  • mass-casualty incident
  • motor vehicle accident
  • remote hospitals

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency

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