Isabelle Imamedjian1, Nisreen Hamza M Maghraby2, Valérie Homier3. 1. Fellow Emergency Medicine, McGill University Health Center, Montreal, QC, Quebec, Canada. 2. Fellow Trauma & Disaster Management, McGill University, Montreal, Canada; Emergency Medicine Faculty Member, King Fahd University Teaching Hospital-Alkhobar, Saudi Arabia; Imam Abdulrahman Bin Faisal UniversiyDammam, Saudi Arabia (KSA). 3. Assistant Professor, Department of Medicine, McGill University, Quebec, Canada; Emergency Physician, McGill University Health Center, Quebec, Canada.
Abstract
OBJECTIVE: A hospital mass casualty simulation exercise testing feasibility of two city buses and a tent as a hybrid system for patient decontamination. DESIGN: Observational study of a single mass casualty simulation exercise involving patient decontamination SETTING: Held on May 26, 2016 at the Montreal General Hospital, a Level 1 Trauma center without a garage. PATIENTS, PARTICIPANTS: Twenty-one medical staff including nurses, doctors, and patient attendants, and 30 volunteer-simulated patients. INTERVENTIONS: The foregrounds of the hospital were cordoned off to create a single-entry point for the simulated patients that were identified as contaminated (C) by staff wearing personal protective equipment. Non-contaminated patients were directed to a separate hospital entrance. C patients were triaged in Bus 1 to determine priority for decontamination. Bus 2 served as a holding area for stable patients awaiting decontamination. Patients were decontaminated in appropriate tent sections (non-ambulatory, ambulatory male or female) and then directed to the emergency department. RESULTS: Direct observation and participant feedback suggested that buses may provide adequate shelter for C patients. However, buses had limited capacity for non-ambulatory patients, who were not easily transported inside. Furthermore, areas of improvement were identified in communication, staffing, equipment, and coordination of operations. CONCLUSIONS: The use of city buses as triage and waiting zones prior to decontamination appears feasible for centers without a garage and facing unpredictable weather conditions. Further simulations are required for fine-tuning and testing real-time unfolding of tasks, ideally during an unannounced exercise.
OBJECTIVE: A hospital mass casualty simulation exercise testing feasibility of two city buses and a tent as a hybrid system for patient decontamination. DESIGN: Observational study of a single mass casualty simulation exercise involving patient decontamination SETTING: Held on May 26, 2016 at the Montreal General Hospital, a Level 1 Trauma center without a garage. PATIENTS, PARTICIPANTS: Twenty-one medical staff including nurses, doctors, and patient attendants, and 30 volunteer-simulated patients. INTERVENTIONS: The foregrounds of the hospital were cordoned off to create a single-entry point for the simulated patients that were identified as contaminated (C) by staff wearing personal protective equipment. Non-contaminated patients were directed to a separate hospital entrance. C patients were triaged in Bus 1 to determine priority for decontamination. Bus 2 served as a holding area for stable patients awaiting decontamination. Patients were decontaminated in appropriate tent sections (non-ambulatory, ambulatory male or female) and then directed to the emergency department. RESULTS: Direct observation and participant feedback suggested that buses may provide adequate shelter for C patients. However, buses had limited capacity for non-ambulatory patients, who were not easily transported inside. Furthermore, areas of improvement were identified in communication, staffing, equipment, and coordination of operations. CONCLUSIONS: The use of city buses as triage and waiting zones prior to decontamination appears feasible for centers without a garage and facing unpredictable weather conditions. Further simulations are required for fine-tuning and testing real-time unfolding of tasks, ideally during an unannounced exercise.
Authors: Sara B Donevant; Erik R Svendsen; Jane V Richter; Abbas S Tavakoli; Jean B R Craig; Nicholas D Boltin; Homayoun Valafar; Salvatore Robert DiNardi; Joan M Culley Journal: J Am Med Inform Assoc Date: 2019-10-01 Impact factor: 4.497