Professional Documents
Culture Documents
Emergency Medicine and MCM
Emergency Medicine and MCM
and
Management of Mass Casualty
Karn Suttapanit, M.D., FTCEP
Department of Emergency medicine, Faculty of Medicine Ramathibodi Hospital
Resuscitation in Emergency care
• Airway management
• Shock assessment
Airway management
Advance
Airway assessment
and
Plan of Airway management
Basic
Airway assessment
Patient history
Physical examination
Non-invasive
- Ultrasound evaluation
Invasive
Risk treatment
Very low – low = Acceptance
Medium =Avoidance + Mitigation
High-Extremely high = Avoidance + Mitigation + Transfer
• Risk acceptance = ยอมรับได้
• Risk mitigation = มี แผนที่ ทำให้ควำมเสี่ยงนั้นมี ผลกระทบน้อยลง
Risk treatment • Risk Avoidance = หลีกเลี่ยงไม่ให้เกิด
• Risk transfer = กำรโอนถ่ำยควำมเสี่ยง
Preparedness
Parking point
2nd triage and treatment unit
1st triage
Fireman
Safety
START
Primary triage
Jump-START (1-8years)
SALT
SAVE
Secondary triage
SORT
SORT
• No Prolong Scene time
And depend on
Treatment • Number of Patients and severity
• Capacity and Capability
Treatment
• อยู่ใกล้จดุ ทำกำรรักษำให้มำกที่ สดุ เพื่ อทำให้กำรขนส่งเป็ นไปอย่ำงรวดเร็วและ
ปลอดภัย
• มี จดุ ทำงเข้ำ-ทำงออก ที่ สงั เกตได้งำ่ ยและปลอดภัย
• มี พื้นที่ จอดรถพยำบำล (ambulance parking point) แยกกับพื ้นที่
รับส่งผูบ้ ำดเจ็บ
Transport • มี เส้นทำงกำรเดินรถทำงเดี ยว
• เส้นทำงกำรนำส่งผูบ้ ำดเจ็บ ต้องไม่ตัดผ่ำนจุดเกิดเหตุ
• ไม่ทำให้โรงพยำบำลเกิด mass casualty แทน
Out Hospital MCI
• Goals
• Using Limit resource for more than one patient. (Less is More)
• Manage Resource (Call for help and resource)
• Don’t relocate the MCI or disaster
• To reduce or eliminate to the extent possible the loss of life and health , and
physical and psychological suffering , incurred as a consequence of MCI
triage
20 45 /
cap. refill 4 sec
20 8 /
cap. refill 4 sec
30 40 /
cap. refill 1 sec
40
45
20 / 130 /
45 20 /
100 /
40
5
/
12
35 / cap. refill 1 sec
triage
20 45 /
cap. refill 4 sec
20 8 /
cap. refill 4 sec
30 40 /
cap. refill 1 sec
40
45
20 / 130 /
45 20
100 /
40
5
12
35 / cap. refill 1 sec
Case Scenario
In Mass casualty incident from traffic accident, you were assigned role in the triage officer. 3 victims come to your area.
Victim Number 1 reveal SBP 70, GCS 3, RR 6 breath/min
Victim Number 2 reveal SBP 100, GCS 15, RR 12 breath/min
Victim Number 3 reveal SBP 100, GCS 14, RR 30 breath/min
• Manage following flow Planning and avoid over-
planning
• Surge capacity
Hospital • Hospital information center and media
management
Response • Logistic and Supply
• Psychological support
• Management and Identification of Dead Victims
• Flow planning
• Equipment
Hospital • Hospital and Emergency department zoning
Response • Alarm code
• Action card cover all member involve ICS
system
Hospital and Emergency department zoning
Action
Head of Red zone 1………………………
Treatment area 2………………………
3………………………
Must be done before MCI
• Staff
• Intensive care and Intermediate care
• OR
• Ward (monitor and oxygen supply)
Surge Capacity • Other space in hospital
• In MCI: In experience, the number of beds is rarely or never
the limiting factor – there is always space, there are often
extra supplies of beds, and patients can even sleep on the
floor on mattresses
Contact
Hospital
information
Set the press conference: answer
center question from public
and media
management Blood
component
Donation Water and
Food suuply
Update all times: Use and remain stock
Logistic • Equipment
• Drug and IV fluid
and • Food and water
Supply • Electrical and power supply
• A sense of safety
• A sense of self- and community efficacy
Psychological • Connectedness
support • Calming
• Hope
Management and Identification of Dead Victims
• Forensic
• Chain of custody
Hospital evacuation
• 96 h assessment – failures in critical areas
• Used to determine if a facility can provide safe patient care and
treatment for 96- hours (4 days) after an incident without assistance
from the community
• Communications
• Resources and assets
• Safety and security
• Staff responsibilities
• Utilities management
• Patient and clinical support activities
Patient evacuation
Seyedin H. Developing a hospital preparedness checklist to assess the ability to respond to the COVID -19 pandemic. East Mediterr Health J. 2021.
Thank you
for
attention