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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


Tintinalli J, Stapczynski J, Ma J, et al. : Emergency Medicine; A Comprehensive Study Guide. (8th ed.) New York: McGraw-Hill, 2016.

Emergency and Disaster Risk Management for Health. World Health Organization Web site. Available at http://www.who.int/hac/techguidance/preparedness/en/. Accessed August 29, 2016.

Committee on the Future of Emergency Care in the United States Health System. Future of Emergency Care: Hospital-based Emergency Care At the Breaking Point. Washington: National Academy of Sciences, 2007.

Online Organization Report - McGill University Health Center Statistics 2016. Available at https://muhc.ca/homepage/page/muhcglance. Accessed July 7, 2016.

Online Organization Report – Weather Averages. Available at http://www.worldweatheronline.com/montreal-weather-averages/quebec/ca.aspx. Accessed July 7, 2016.

Simple Triage and Rapid Treatment Web site. Available at http://www.start-triage.com/. Accessed August 29, 2016.

City Bus Characteristics. Société de Transports de Montréal Web site. Available at https://www.stm.info/en/press/press-releases/2009/the-stm-s-articulated-buses-are-here-. Accessed July 4, 2016.

City Bus Characteristics. Société de Transports de Montréal Web site. Available at http://www.stm.info/en/access/using-public-transitwheelchair. Accessed July 4, 2016.

Online Organization Report - McGill University Health Center Statistics 2016. Available at https://muhc.ca/mgh/dashboard. Accessed July 7, 2016.




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

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