Devastating effects of disasters and global crises on people increase the importance of humanitarian logistics studies for pre and post-disaster stages. Location planning of Temporary Medical ...Centers/field hospitals is one of the most important problems for disaster response. We aimed to determine the location and number of temporary medical centers in case of disasters by considering the locations of the existing hospitals, casualty classification (triage), capacities of medical centers and possibilities of damage to the roads and hospitals. Besides, we aimed to assign different casualty classes to these medical centers for emergency medical response by considering the distances between disaster areas and medical centers. For this purpose, a two-stage stochastic programming model was developed. The proposed model finds an optimal TMC location solution while minimizing the total setup cost of the TMCs and the expected total transportation cost by considering casualty types, demand, possibilities of damage to the roads and hospitals, and distance between the disaster areas and the medical centers. In the model, α-reliability constraints for the expected number of unassigned casualties were also used. Besides, the model was reformulated without triage, in order to understand the impact of casualty classification on the solution of the problem. We performed a real case study for the district of Kartal expected to be widely damaged in the possible Istanbul earthquake, and a sensitivity analysis was made. The analysis of the results offer some managerial insights associated with the number of temporary medical centers’ needed, their locations, and additional hospital capacity requirements.
•A two-stage stochastic programming model is proposed for location planning of Temporary Medical Centers.•Total setup cost of TMCs and expected total casualty transportation cost are minimized.•Triage, α-reliability constraints and probability of damage to the hospitals and roads are considered.•A case study was conducted for earthquake scenarios of Istanbul's Kartal district.•Triage helps prevent significant differences of unassigned casualty percentages among demand points.
Transfusion support during mass casualty events Doughty, Heidi; Green, Laura
British journal of anaesthesia : BJA,
February 2022, 2022-02-00, 20220201, Letnik:
128, Številka:
2
Journal Article
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Transfusion support is an essential element of modern emergency healthcare. Blood services together with hospital transfusion teams are required to prepare for, and respond to, mass casualty events ...as part of wider healthcare emergency planning. Preparedness is a constant collaborative process that actively identifies and manages potential risks, to prevent such events becoming a ‘disaster’. The aim of transfusion support during incidents is to provide sufficient and timely supply of blood components and diagnostic services, whilst maintaining support to other patients not involved in the event.
The deadliest mass shooting in modern United States history occurred on October 1, 2017, in Las Vegas, killing 58 and overwhelming hospitals with more than 600 injured. The scope of the tragedy ...offers insight into medical demands, which may help guide preparedness for future mass shooting incidents.
Retrospective, deidentified, health care institution-provided data from all hospitals and blood banks providing care to Las Vegas shooting victims were gathered. Study authors independently reviewed all data and cross-referenced it for verification. Main outcomes and measures include the number of victims requiring hospital and intensive care admission, the amount and types of blood components transfused during the first 24 hours, and the amount of blood donated to local blood banks following the Las Vegas mass shooting.
Two hundred twenty patients required hospital admission, 68 of them to critical care. Nearly 500 blood components were transfused during the first 24 hours in a red blood cell-to-plasma-to-platelet ratio of 1:0.54:0.81. Public citizens donated almost 800 units of blood immediately after the shooting; greater than 17% of this donated blood went unused.
The amount of blood components transfused per patient admitted was similar in magnitude to other mass casualty events, and available blood supply met patient demand. The public call for blood donors was not necessary to meet immediate demand and led to resource waste. Preparation for future mass shooting incidents should include training the community in hemorrhage control, encouraging routine blood donation, and avoiding public calls for blood donation unless approved by local blood suppliers.
Therapeutic study, level V.
The article examines Israel’s experience in managing the COVID-19 vaccination program beginning in December 2020. Utilizing principles of mass casualty event management, such as triaging, flow of ...casualty care, and flexibility (among others), we analyze Israel’s vaccination program. The successful Israeli experience was found to be based on timely coordinated and adaptive health system logistics and operations, as well as cooperative population behaviors.
The increasing frequency and intensity of climatic events and the number of infrastructures involved require standardization and multiplication of the evaluation of hospital evacuation plans. This ...article presents an automated simulation method dedicated to guiding experts in the development of a hospital selective evacuation plan.
A pragmatic adaptation of the 13 principles of the international guidelines by a local operational expert working group led to the implementation of a computer-assisted simulation model. An application for a public hospital at significant risk of flooding is provided.
The expert group classifies each patient to be transferred according to 3 priorities (P1 to P3), 3 age categories (adult, paediatric, neonatal), specific transfer equipment and team required, and type of reception unit in hospitals. Ten specific profiles for transport conditions or destination hospitals were considered. The model can be used either to evaluate the minimal number of evacuation means necessary to proceed with the evacuation in a few hour of all the patients who require evacuation (output) or alternatively, the number of patients out of delay considering the number of evacuation means available (constraint). The model can be adapted with real-time constraints or optimization strategies such as traffic conditions, convoys, ephemeral proximity units, and reinforcements.
The definition of the criteria that impact hospital intensive care unit evacuation, followed by the identification of these elements in the case of each hospital concerned, allows the construction of a homogeneous and transposable planning model and identifies the best evacuation strategies for each hospital.
During the COVID-19 pandemic surge in the hospitalization of critically ill patients and the global demand for mechanical ventilators, alternative strategies for device sharing were explored. We ...developed and assessed the performance of a system for shared ventilation that uses clinically available components to individualize tidal volumes under a variety of clinically relevant conditions. The feasibility of remote monitoring of ventilators was also assessed.
By using existing resources and off-the-shelf components, a ventilator-sharing system (VSS) that ventilates 2 patients simultaneously with a single device, and a ventilator monitoring system (VMS) that remotely monitors pulmonary mechanics were developed. The feasibility and effectiveness of VSS and VMS were evaluated in benchtop testing using 2 test lungs on a single ventilator, and then performance was assessed in translational swine models of normal and impaired lung function.
In benchtop testing, VSS and VMS delivered the set individualized parameters with minimal % errors in test lungs under pressure- and volume-regulated ventilation modes, suggesting the highest precision and accuracy. In animal studies, the VSS and VMS successfully delivered the individualized mechanical ventilation parameters within clinically acceptable limits. Further, we found no statistically significant difference between the target and measured values.
The VSS adequately ventilated 2 test lungs or animals with variable lung conditions. The VMS accurately displayed mechanical ventilation settings, parameters, and alarms. Both of these systems could be rapidly assembled for scaling up to ventilate several critically ill patients in a pandemic or mass casualty disaster situations by leveraging off-the-shelf and custom 3D printed components.
Hajj is a unique gathering with Mecca and Kaaba being spiritually important to many faiths across the globe, especially Muslims. This is because of the proclamation of the prophet's father, Ibrahaam, ...when he called all mankind to perform Hajj. That is why all Muslims on Earth feel that they have to visit Mecca and Kaaba on a specific date and time, and that is the reason this small location hosts one of the largest human gatherings in the world. Hajj is one of the five pillars of Islam that every financially and physically able Muslim must perform once in his/her lifetime. For 14 centuries countless millions of Muslim men and women from the four corners of the earth have undertaken pilgrimage to Mecca.
In conclusion this review article confirm that Hajj is oldest and largest mass gathering in all mankind and there is some issues influence the health response such as size of gathering. diversity of population, climate and health facilities around hajj site, also we discuss the infectious and non infectious related illness in hajj and their prevention methods.
To generate a Hospital Medical Surge Preparedness Index that can be used to evaluate hospitals across the United States in regard to their capacity to handle patient surges during mass casualty ...events. Data from the American Hospital Association’s annual survey, conducted from 2005 to 2014. Our sample comprised 6239 hospitals across all 50 states, with an annual average of 5769 admissions. An extensive review of the American Hospital Association survey was conducted and relevant variables applicable to hospital inpatient services were extracted. Subject matter experts then categorized these items according to the following subdomains of the “Science of Surge” construct: staff, supplies, space, and system. The variables within these categories were then analyzed through exploratory and confirmatory factor analyses, concluding with the evaluation of internal reliability. Based on the combined results, we generated individual (by hospital) scores for each of the four metrics and an overall score. The exploratory factor analysis indicated a clustering of variables consistent with the “Science of Surge” subdomains, and this finding was in agreement with the statistics generated through the confirmatory factor analysis. We also found high internal reliability coefficients, with Cronbach’s alpha values for all constructs exceeding 0.9. A novel Hospital Medical Surge Preparedness Index linked to hospital metrics has been developed to assess a health care facility’s capacity to manage patients from mass casualty events. This index could be used by hospitals and emergency management planners to assess a facility’s readiness to provide care during disasters.
Transfusion emergency preparedness is increasingly being recognized as an important element in the healthcare response to mass casualty events (MCE). Planning should be designed to support an ...integrated response between the blood services and hospitals. The lessons identified from the Manchester Arena bombing in 2017 and recent incidents in London have led to new guidance. Demand planning has been informed by the global experience of civilian MCEs and the changing trends in trauma care. Past evidence suggests that only a modest number of hospitalized patients following MCEs require transfusion. The mean blood use per patient admitted is consistently calculated at 2–3 red cell units. Most blood is used within the first 6 h. However, a small number of critically injured with multi‐trauma may require massive transfusion and ongoing support. Many blood services have reported meeting the initial overall demand for blood from stock. However, universal components may be in short supply. The demand can be managed by pre‐agreed substitutions. Early transfusion triage enables the best use of hospital laboratory and blood service support. Careful communication with donor communities is essential to manage a controlled replenishment of stocks. Future challenges for the transfusion community include the trend towards lower red cell stock holdings and the changing trends in weapon use and tactics. A standardized approach to transfusion data collection is required to support future planning. The transfusion community is encouraged to plan for MCEs, contribute to ‘after action reviews’ and work together for safe and sustainable transfusion support.
The purpose of this study was to develop a treatment for respiratory damage caused by exposure to toxic industrial chemicals (TICs), including mass casualty events, by aerosols of dexamethasone ...and/or N-acetyl cysteine formulated in targeted lipid-based particles. Good encapsulation, performance as slow-release drug depots, conservation of matter, and retention of biological activity were obtained for the three drug-carrier formulations, pre- and post-aerosolization. Weight changes over a 2week period were applied, deliberately, as a non-invasive clinical parameter. Control mice gained weight continuously, whereas a non-lethal 30minute exposure of mice to 300ppm Cl2 in air showed a two-trend response. Weight loss over the first two days, reversing thereafter to weight gain, but at a rate and level significantly slower and smaller than those of the control mice, indicating the chlorine damage was long-term. The weight changes of Cl2-exposed mice given the inhalational treatments also showed the two-trend response, but the weight gain rates and levels were similar to those of the control mice, reaching the weight-gain range of the control mice. Following this proof of concept, studies are now extended to include additional TICs, and biochemical markers of injury and recovery.
A. The experimental set-up. B. Impact of the liposomal inhalational treatment on chlorine-exposed mice at day 2 and day 4 from exposure and therapy. Display omitted
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