Rosel Tallach1, Sharon Einav2, Karim Brohi3, Kirthi Abayajeewa4, Paer-Sellim Abback5, Chris Aylwin6, Nicola Batrick6, Mathieu Boutonnet7, Michael Cheatham8, Fabrice Cook9, Sonja Curac10, Stephanie Davidson11, Hilary Eason12, Nick Fiore13, Christine Gaarder14, Sanjeewa Garusinghe4, Eric Goralnick15, David Grimaldi10, Kritaya Kritayakirana16, Jacques Levraut17, Tobias Lindner18, Sven Märdian18, Ashley Padayachee19, Sabeena Qureshi6, Suneil Ramessur20, Mathieu Raux21, Amila Ratnayake22, Michael Römer18, Hobnojit Roy23, Eunice Tole24, Sheila Tose25, Fernando T Fuentes26, Tobias Gauss5. 1. Royal London Hospital, London, UK; Raigmore Hospital, Inverness, UK. Electronic address: rosel.tallach1@nhs.scot. 2. Shaare Zedek Medical Center, Jerusalem, Israel. 3. Royal London Hospital, London, UK. 4. National Hospital of Sri Lanka, Colombo, Sri Lanka. 5. Hôpital Beaujon, AP-HP, Clichy, France. 6. St Mary's Hospital, London, UK. 7. Hôpital Instructions des Armées Percy, Paris, France. 8. Orlando Regional Medical Center, Orlando, FL, USA. 9. Hôpital Mondor, AP-HP, Paris, France. 10. Erasme Hospital, Brussels, Belgium. 11. Sunrise Hospital and Medical Centre, Las Vegas, NV, USA. 12. Royal Manchester Children's Hospital, Manchester, UK. 13. Sunrise Children's Hospital, Las Vegas, NV, USA. 14. Oslo University Hospital, Oslo, Norway. 15. Brigham and Women's Hospital, Boston, MA, USA. 16. King Chulalongkorn Memorial Hospital, Bangkok, Thailand. 17. Centre Hospitalier Universitaire de Nice, France. 18. Charite Universitätsmedizin, Berlin, Germany. 19. Christchurch Hospital, Christchurch, New Zealand. 20. St Thomas' Hospital, London, UK. 21. Pitié-Salpétrière, AP-HP, Paris, France. 22. Military Hospital Narahenpita, Colombo, Sri Lanka. 23. BARC Hospital, Mumbai, India. 24. Aga Khan University Hospital, Nairobi, Kenya. 25. Salford Royal Foundation Trust Hospital, Manchester, UK. 26. Gregorio Marañón University General Hospital, Madrid, Spain.
Abstract
BACKGROUND: Reports published directly after terrorist mass casualty incidents frequently fail to capture difficulties that may have been encountered. An anonymised consensus-based platform may enable discussion and collaboration on the challenges faced. Our aim was to identify where to focus improvement for future responses. METHODS: We conducted a mixed methods study by email of clinicians' experiences of leading during terrorist mass casualty incidents. An initial survey identified features that worked well, or failed to, during terrorist mass casualty incidents plus ongoing challenges and changes that were implemented as a result. A follow-up, quantitative survey measured agreement between responses within each of the themes using a Likert scale. RESULTS: Thirty-three participants responded from 22 hospitals that had received casualties from a terrorist incident, representing 17 cities in low-middle, middle and high income countries. The first survey identified themes of sufficient (sometimes abundant) human resource, although coordination of staff was a challenge. Difficulties highlighted were communication, security, and management of blast injuries. The most frequently implemented changes were education on specific injuries, revising future plans and preparatory exercises. Persisting challenges were lack of time allocated to training and psychological well-being. The follow-up survey recorded highest agreement amongst correspondents on the need for re-triage at hospital (90% agreement), coordination roles (85% agreement), flexibility (100% agreement), and large-scale exercises (95% agreement). CONCLUSION: This survey collates international experience gained from clinicians managing terrorist mass casualty incidents. The organisation of human response, rather than consumption of physical supplies, emerged as the main finding. NHSH Clinical Effectiveness Unit project registration number: 2020/21-036. Crown
BACKGROUND: Reports published directly after terrorist mass casualty incidents frequently fail to capture difficulties that may have been encountered. An anonymised consensus-based platform may enable discussion and collaboration on the challenges faced. Our aim was to identify where to focus improvement for future responses. METHODS: We conducted a mixed methods study by email of clinicians' experiences of leading during terrorist mass casualty incidents. An initial survey identified features that worked well, or failed to, during terrorist mass casualty incidents plus ongoing challenges and changes that were implemented as a result. A follow-up, quantitative survey measured agreement between responses within each of the themes using a Likert scale. RESULTS: Thirty-three participants responded from 22 hospitals that had received casualties from a terrorist incident, representing 17 cities in low-middle, middle and high income countries. The first survey identified themes of sufficient (sometimes abundant) human resource, although coordination of staff was a challenge. Difficulties highlighted were communication, security, and management of blast injuries. The most frequently implemented changes were education on specific injuries, revising future plans and preparatory exercises. Persisting challenges were lack of time allocated to training and psychological well-being. The follow-up survey recorded highest agreement amongst correspondents on the need for re-triage at hospital (90% agreement), coordination roles (85% agreement), flexibility (100% agreement), and large-scale exercises (95% agreement). CONCLUSION: This survey collates international experience gained from clinicians managing terrorist mass casualty incidents. The organisation of human response, rather than consumption of physical supplies, emerged as the main finding. NHSH Clinical Effectiveness Unit project registration number: 2020/21-036. Crown