Hostname: page-component-77c89778f8-fv566 Total loading time: 0 Render date: 2024-07-20T10:12:27.875Z Has data issue: false hasContentIssue false

Factors Influencing the Prioritization of Injured Patients for Transfer to a Burn or Trauma Center Following a Mass Casualty Event

Published online by Cambridge University Press:  03 February 2020

Elizabeth A. Lancet
Affiliation:
FDNY
Wei Wei Zhang
Affiliation:
Columbia University Mailman School of Public Health
Patricia Roblin
Affiliation:
SUNY Downstate Medical Center
Bonnie Arquilla
Affiliation:
SUNY Downstate Medical Center
Rachel Zeig-Owens
Affiliation:
FDNY Montefiore Medical Center and Albert Einstein College of Medicine
Glenn Asaeda
Affiliation:
FDNY
Brad Kaufman
Affiliation:
FDNY
Nikolaos A. Alexandrou
Affiliation:
FDNY
James J. Gallagher
Affiliation:
Weill Cornell Medicine/New York Presbyterian
Michael L. Cooper
Affiliation:
Staten Island University Hospital
Timothy Styles
Affiliation:
NYC Department of Health and Mental Hygiene (DOHMH) Center for Disease Control and Prevention (CDC)
David J. Prezant
Affiliation:
FDNY Montefiore Medical Center and Albert Einstein College of Medicine
Celia Quinn*
Affiliation:
NYC Department of Health and Mental Hygiene (DOHMH) Center for Disease Control and Prevention (CDC)
*
Correspondence and reprint requests to Celia Quinn, 42-09 28th Street, 6th Floor, CN-119, Long Island City, NY 11101-4132 (e-mail: cquinnmd@health.nyc.gov).

Abstract

Objectives:

In New York City, a multi-disciplinary Mass Casualty Consultation team is proposed to support prioritization of patients for coordinated inter-facility transfer after a large-scale mass casualty event. This study examines factors that influence consultation team prioritization decisions.

Methods:

As part of a multi-hospital functional exercise, 2 teams prioritized the same set of 69 patient profiles. Prioritization decisions were compared between teams. Agreement between teams was assessed based on patient profile demographics and injury severity. An investigator interviewed team leaders to determine reasons for discordant transfer decisions.

Results:

The 2 teams differed significantly in the total number of transfers recommended (49 vs 36; P = 0.003). However, there was substantial agreement when recommending transfer to burn centers, with 85.5% agreement and inter-rater reliability of 0.67 (confidence interval: 0.49–0.85). There was better agreement for patients with a higher acuity of injuries. Based on interviews, the most common reason for discordance was insider knowledge of the local community hospital and its capabilities.

Conclusions:

A multi-disciplinary Mass Casualty Consultation team was able to rapidly prioritize patients for coordinated secondary transfer using limited clinical information. Training for consultation teams should emphasize guidelines for transfer based on existing services at sending and receiving hospitals, as knowledge of local community hospital capabilities influence physician decision-making.

Type
Original Research
Copyright
Copyright © 2020 Society for Disaster Medicine and Public Health, Inc.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

References

REFERENCES

Regional Emergency Medical Advisory Committee, New York City. “Prehospital Treatment Protocols General Operating Procedure”. V08012015c; August 1, 2015.Google Scholar
Leahy, NE, Yurt, RW, Lazar, EJ, et al. Burn disaster response planning in New York City: updated recommendations for best practices. J Burn Care Res. 2012;5:587-594.Google Scholar
Yurt, RW, Lazar, EJ, Leahy, NE, et al. Burn disaster response planning: an urban region’s approach. J Burn Care Res. 2008;29:158-165.Google ScholarPubMed
Osler, T, Glance, LG, Hosmer, DW. Simplified estimates of the probability of death after burn injuries: extending and updating the Baux score. J Trauma. 2010;68:690-697.Google ScholarPubMed
Dokter, J, Meijs, J, Oen, IM, et al. External validation of the revised Baux score for the prediction of mortality in patients with acute burn injury. J Trauma Acute Care Surg. 2014;76:840-845.CrossRefGoogle ScholarPubMed
Baker, SP, O’Neill, B, Haddon, W Jr, et al. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14:187-196.CrossRefGoogle ScholarPubMed
Viera, AJ, Garrett, JM. Understanding interobserver agreement: the kappa statistic. Fam Med. 2005;37:360-363.Google ScholarPubMed
Landis, JR, Koch, GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159-174.CrossRefGoogle ScholarPubMed
Kadri, SS, Miller, AC, Hohmann, S, et al. Risk factors for in-hospital mortality in smoke inhalation-associated acute lung injury: data from 68 United States hospitals. Chest. 2016;150:1260-1268.CrossRefGoogle ScholarPubMed