![]() ![]() Surge or crisis capacity was defined as a “systematic change into a system in which standards of care are significantly altered…”, prompting “…the institution to either get the right resources in, transfer the excess patients out, or look for additional relief.” The IOM workshop also discussed several legal issues including suspension of EMTALA and state licensing and credentialing requirements during MCI’s, allowing for reciprocity of out-of-state responders and healthcare providers as well as drafting of mutual medical aid agreements. 6 Participants defined standard terminology and metrics, discussed the state of the art in MCI management and offered strategies for the future. In 2009 the Institute of Medicine (IOM) sponsored a workshop on medical surge capacity. ![]() Key lessons learned are summarized in these points: While most trauma centers were already aware of the event via the media before Boston EMS radio contact, all sites reported difficulty with communication among their own staff members, reflecting shortcomings with their center’s MCI communication plan. Several first responders and healthcare providers were already staffing the marathon to render medical assistance and proved invaluable after the bombing in providing bleeding control with tourniquets and stabilizing victims prior to transport. A central EMS Command Center coordinated triage among area hospitals but law enforcement occasionally redirected ambulance traffic. Multiple transport mechanisms were used including ambulances, police vehicles and private automobiles. Field triage only tagged 50% of patients arriving at trauma centers and patients in extremis were unevenly distributed among the six area trauma centers, where one level 1 center received none of these patients. 5 Representing six area trauma centers that cared for the injured, the review credits the work of first responders and healthcare providers for the 100% survival rate for any patient that arrived at a trauma center. 4 Some of these patients were transferred to our institution only to succumb to the widely disseminated infection.Īn after-action review published by the Boston Trauma Center Chief ‘s Collaborative discusses key lessons learned from the 2013 Boston Marathon bombings’ MCI response, the scale of which had not been seen since the Cocoanut Grove fire. A component of delayed recognition of a rare fungal infection also contributed to late deaths. 3 They concluded that in addition to the intensity of the tornado and the large size of damage area, other contributing factors included ignoring the warning sirens or having less than 15 minutes to seek shelter, structural weakness in area homes and disproportionate damage to a hospital and area business where more people were gathered. ![]() In their review of the MCI, Bimal Paul and Mitchel Stimers collected data from first responders, survivors and the Federal Emergency Management Agency (FEMA) to determine reasons for the high fatality rate. It destroyed 7,000 homes, resulted in 162 fatalities and over 1,000 injured, and cost an estimated $3 billion in insured losses. since the beginning of recordkeeping in 1950 struck Joplin, Missouri. In 2011, the deadliest single tornado recorded in the U.S. It also emphasizes the mitigation of risk at the local level with preparation and coordination. 2 The document outlines core capabilities which include quick disaster response in the aftermath of an incident. 1 In 2015 the federal government updated its National Preparedness Goal, “A secure and resilient Nation with the capabilities required across the whole community to prevent, protect against, mitigate, respond to, and recover from the threats and hazards that pose the greatest risk”. Evolving areas for improvement include planning for catastrophic emergencies requiring drastic changes in infrastructure and response systems, and their ability to respond to unconventional mass casualty incidents (MCI) as measured by surge capacity. hospital preparedness highlighted considerable progress made in the area of healthcare coalitions contributing to collaboration and networking between all levels of providers from first responders to hospitals and public health agencies. 1 An interim 2007 progress report on the state of U.S. The Hospital Preparedness Program (HPP) was established after Septemto “enhance the ability of hospitals and healthcare systems to prepare for and respond to bioterror attacks…and other public health emergencies, including pandemic influenza and natural disasters”.
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