Original ResearchMajor Incident Patient Evacuation: Full-Scale Field Exercise Feasibility Study
Introduction
Prompt initiation of sophisticated major incident management improves patient outcome and optimizes resource expenditure.1 The evacuation of patients is the third initiative in the hierarchy of medical support at major incidents: triage, treatment, and transport.2 Casualty evacuation should be dynamic, because mode of transport, evacuation priority, and final destination will be influenced by triage and treatment decisions. To ensure optimal outcomes, patients should be transported as efficiently as possible from the scene to the hospital providing definitive care. To avoid unnecessary delay, treatment and packaging should be limited to that necessary for transport.2 Optimal care therefore relies on a well-organized transportation chain using field-friendly evacuation equipment to ensure transport of “the RIGHT PATIENT to the RIGHT PLACE at the RIGHT TIME.”
Major incidents are infrequent, overwhelming events with a heterogeneous nature that favors the “all-hazards” approach. Because rescue capacity varies between systems, an incident may be considered major by one emergency medical service (EMS) but not by another service.2 EMS systems are primarily designed to respond to the daily burden of injuries and can have delayed access to evacuation material for multiple casualties. Even when major incidents are flooded with resources, rescue workers struggle to coordinate and optimize patient evacuation.3, 4 Additionally, major incident management usually involves emergency workers from multiple rescue services. Standardizing the equipment for patient evacuation seems essential given the multitude of responders. Providing rescue workers with rapid access to a large quantity of standardized stretchers may improve patient transportation efficacy.
In the absence of a coherent and interoperable national civil system for major incident management, the Norwegian Air Ambulance Foundation developed and funded the Interdisciplinary Emergency Service Cooperation Course (TAS), a no-cost training course for all emergency services in Norway. The TAS program was established in 1998. By 2009, approximately 15,500 professionals had participated in one of more than 500 available courses. The TAS curriculum has gradually evolved, and the principles for disaster health education as proposed by World Association for Disaster and Emergency Medicine have been adapted progressively.5
Norway is sparsely populated, subarctic country with time-consuming, weather-dependent patient transport.6 Although large-scale incidents are infrequent in our region, such incidents demand advanced interdisciplinary cooperation of local EMS, fire fighters, police, rescue technicians, and air medical resources. In remote areas, single EMS units may handle multiple casualties for prolonged periods until interdisciplinary assistance arrives. In the absence of a standardized field-friendly approach to multiple casualty management, the Norwegian Air Ambulance Foundation developed “Optimal Patient Evacuation Norway” (OPEN). The OPEN concept has been incorporated as a module in the TAS courses. OPEN aims to save time, improve patient handling, prevent hypothermia, and simplify scene management. In this study, we assessed access to patient evacuation supplies among Norwegian EMS personnel participating in TAS courses. Furthermore, we assessed the feasibility of the OPEN concept for major incident patient evacuation in the extrication and triage phase of full-scale major incident field exercises.
Section snippets
TAS Course
From March to May 2010, we conducted four 2-day TAS courses in mixed urban/rural and coastal/inland municipalities. The courses were free of charge for the participants. The didactic program was piloted and refined through 43 TAS courses before the study. The TAS course combines theoretical and practical didactical techniques to teach local emergency service personnel (healthcare, police, and fire and rescue technicians) major incident cooperation, triage, and patient evacuation (OPEN). The
Student Background and Access to Major Incident Material
Among the 110 emergency service professionals who attended the course, 93 (84.5%) enrolled in the study. Among the study participants, 26 (28.0%) worked in health care (nurse, ambulance, other), 47 (50.5%) were firefighters, 13 (14.0%) were police officers, and 7 (7.5%) had “other” backgrounds. The mean participant age was 38.6 years (range, 20–62), with a median working experience of 8 years (range, 0–34), and 83.7% were men. Approximately half of the students (51.2%) were not aware of any
Discussion
We found the OPEN concept for multiple casualty evacuation to be feasible for interdisciplinary emergency service personnel participating in full-scale major incident field exercises. The students found the stretcher equipment useful in evacuating patients in a structured and field-friendly manner.
Unnecessary patient mobilization is a time-consuming threat to patient safety, and several papers describe movement–associated adverse events.11, 12, 13 Although these studies are conducted inside the
Conclusions
Efficient and structured patient evacuation can be taught effectively to multidisciplinary emergency service professionals attending a 2-day major incident course. The OPEN concept provides rapid access to standardized field-friendly patient evacuation equipment in a feasible and time-efficient manner.
References (14)
- et al.
Reduction in critical mortality in urban mass casualty incidents: analysis of triage, surge, and resource use after the London bombings on July 7, 2005
Lancet
(2006) - et al.
Scandinavian pre-hospital physician-manned Emergency Medical Services: same concept across borders?
Resuscitation
(2010) - et al.
Challenges of major incident management when excess resources are allocated: experiences from a mass casualty incident after roof collapse of a military command center
Prehospital Disaster Med
(2004) - et al.
The World Trade Center attack: lessons for disaster management
Crit Care
(2001) - et al.
International standards and guidelines on education and training for the multi-disciplinary health response to major events that threaten the health status of a community
Prehosp Disaster Med
(2004) - et al.
A concept for major incident triage: full-scaled simulation feasibility study
BMC Emerg Med
(2010)
Cited by (8)
Mass aeromedical evacuation of patients in an emergency: Experience following the 2010 yushu earthquake
2013, Journal of Emergency MedicineCitation Excerpt :In our study, the medical personnel were satisfied that the equipment was adequate, suggesting that it may not be necessary to use specialized medical devices when facing the need for large-scale transportation of casualties (19). This point is inconsistent with the view proposed by Rehn et al., that the absence of standardized patient evacuation equipment increases the risk of patient injury (20). Medical personnel with a variety of expertise were needed on the AE medical teams due to the wide spectrum of patients to be evacuated.
Letter to the editor
2013, Air Medical JournalDrivers and barriers for learning within full-scale emergency response exercises
2020, International Journal of Emergency ManagementTerror scenarios in rural areas: The concept of a roll-off container “special rescue situations”
2019, Notfall und RettungsmedizinMapping the use of simulation in prehospital care - a literature review
2014, Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Presented as an abstract at the European Society for Emergency Medicine conference October 11–14, 2010