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A hospital mass casualty exercise using city buses and a tent as a hybrid system for patient decontamination

Isabelle Imamedjian. MDCM, CCFP, Nisreen Hamza M. Maghraby, MBBS, FRCPC (EM), MM, Valérie Homier, MD, FRCPC

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.


Keywords


decontamination, simulation, disaster preparedness, city buses as shelters

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References


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DOI: http://dx.doi.org/10.5055/ajdm.2017.0273

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