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Traditional strategies to determine hospital bed surge capacity have relied on cross-sectional hospital census data, which underestimate the true surge capacity in the event of a mass-casualtyincident.
Objective:
To determine hospital bed surge capacity for the County more accurately using physician and nurse manager assessments for the disposition of all in-patients at multiple facilities.
Methods:
Overnight- and day-shift nurse managers from each in-patient unit at four different hospitals were approached to make assessments for each patient as to their predicted disposition at 2, 24, and 72 hours post-event in the case of a mass-casualty incident, including transfer to a hypothetical, onsite nursing facility. Physicians at the two academic institutions also were approached for comparison. Age, gender, and admission diagnosis also were recorded for each patient.
Results:
A total of 1,741 assessments of 788 patients by 82 nurse managers aabnd 25 physicians from the four institutions were included. Nurse managers assessed approximately one-third of all patients as dischargeable at 24 hours and approximately one-half at 72 hours; one-quarter of the patients were assessed as being transferable to a hypothetical, on-site nursing facility at both time points. Physicians were more likely than werenurse managers to send patients to such a facility or discharge them, but less likely to transfer patients outof the intensive care unit (ICU). Inter-facility variability was explained by differences in the distribution of patient diagnoses.
Conclusions:
A large proportion of in-patients can be discharged within 24 and 72 hours in the event of a mass-casualty incident (MCI). Additional beds can be made available if an on-site nursing facility is made available. Both physicians and nurse managers should be included on the team that makes patient dispositions in the event of a MCI.
Since the 1995 Tokyo subway sarin attack, terrorist attacks involving weapons of mass destruction or other industrial chemicals present worldwide security and health concerns. On-scene medical triage and treatment in such events is crucial to save as many lives as possible and minimize the deleterious effects of the toxic agent involved. Since there are many chemicals that can be used as potential terrorist weapons, the medical challenge for the emergency medical services (EMS) is a combination of: (1) recognizing that a chemical terrorist attack (non-conventional) has occurred; and (2) identifying the toxic agent followed by proper antidotal treatment. The latter must be done as quickly as possible, preferably on-scene. The most valuable decision at this stage should be whether the agent is organophosphate (OP) or not OP, based on clinical findings observed by pre-trained, first responders. This decision is crucial, since only OP intoxication has readily available, rapidly acting, onscene, specific agents such as atropine and one of the oximes, preferably administered using autoinjectors. Due to the lack of a specific antidote, exposure to other agents (such as industrial chemicals, e.g., chlorine, bromide, or ammonia) should be treated on-scene symptomatically with non-specific measures, such as decontamination and supportive treatment. This paper proposes an algorithm as a cognitive framework for the medical teams on-scene. This algorithm should be part of the medical team's training for preparedness for chemical terrorist attacks, and the team should be trained to use it in drills. Implementing this path of thinking should improve the medical outcome of such an event.
The purpose of this study was to ascertain information about emergency medical technicians' (EMTs') attitudes towards their training, comfort, and roles when a patient dies on-scene.
Methods:
A sample of 136 EMTs (all levels) from 14 different states participated in a survey prior to completing a continuing education program. About 40% (n = 54) of the EMTs were attending a training program related to death based on the Emergency Death Education and Crisis Training Curriculum,1 while 60% (n = 82) were attending an EMT training program not related to death. Each participant answered questions about their attitudestowards a death on-scene using a five-point Likert scale. The EMTs were compared by level of training (EMT-B/EMT-I and EMT-P), and by type of educational program attended (death-related education and nondeath-related education).
Results:
Most (82%) participants reported that an EMT's actions impact the grief process of a bereaved family. About half (54%) reported that an EMT's role should include notifying the family of the death. However, three-quarters (76%) reported that they had not been trained adequately to make a death notification or help the family with their grief. Many (40%) felt uncomfortable making a death notification. Differences were present in EMTs enrolled in the death education courses as compared to those attending an educational program not related to death. Differences also were found in the levels of EMTs (EMT-B/EMT-I versus EMT-Paramedics).
Conclusion:
This study provides new insights about EMTs' attitudes towards death and the death-related training they receive.