ReviewA systematic literature review of criteria and models for casualty distribution in trauma related mass casualty incidents
Introduction
World Health Organization (WHO) defines mass casualtyincident (MCI) as “an incident which generates more patients at one time than the locally available resources can manage using the routine procedures’’ [1]. MCI imposes a large burden on the emergency systems, hospitals, community infrastructure and tax available resources to provide optimum trauma care [[2], [3], [4], [5]]. Following MCIs, the capacity of hospitals and their associated critical care units is usually overwhelmed by large numbers of casualties [6,7].
One of the most important issues in mass casualty management is the distribution of casualties among the suitable health care facilities [[8], [9], [10], [11]]. Casualties’ misdistribution can take place in the form of transferring many casualties to a single hospital without having sufficient resources or transferring them to healthcare facilities that do not have the proper resources [12].
In the existing mass casualty management guidelines, decisions regarding the distribution of the casualties are made by the incident commander (IC) who must be possessing adequate emergency experience. Because the response to MCI is a dynamic process and needs multi-dimensional and multi-participant approach, the IC must make decisions about the distribution of patients in a stressful situation [10,11]. Studies have been conducted to facilitate the distribution of patients from the scene of an incident to various hospitals. Although some of these studies have provided valuable decision-making tools [10,[13], [14], [15], [16], [17], [18]], none of them is a systematic review study. This raises a concern that all the effective criteria in decision making about casualty distribution might not have been taken into consideration, to the best of our knowledge.
Proper distribution of casualties following MCIs is critical. Considering the negative consequences of poor distribution, it is necessary to comprehensively identify the criteria for effective distribution of patients. Therefore, the purpose of this systematic literature review is to identify the models and criteria which influence the distribution of casualties following mass casualty trauma-related incidents.
The primary objectives of this systematic review include:
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Investigating the criteria for casualty distribution in trauma-related MCIs
- 2
Reviewing the existing models of casualty distribution in trauma-related MCIs
- 1
The secondary objectives of this study include:
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Determining the criteria for patient distribution in trauma-related MCIs based on the scene characteristics, patient features, pre-hospital and hospital resources
- 2
Assessing the models and criteria for patient distribution in trauma-related MCIs by type of incident (e.g. air, railway and road traffic incidents)
- 3
Assessing the models and criteria for patient distribution in trauma-related MCIs by method of model assessment (e.g. real-world, simulation and exercise)
Section snippets
Protocol and registration
The protocol is registered in PROSPERO (CRD42016049115) and also published [19].
Eligibility criteria
The included studies were chased based on a variety of research methodologies. Neither a publication date nor language limitations were imposed.
It’s worth mentioning that the studies on exercises, simulated environments and actual environments were included. Studies on inter-hospital transfer of the patients, air evacuation from the scene of incidents, hospital evacuation, and evacuation of the injured from the
Study selection
The initial search led to identification of 4540 documents from the 3 databases. Among identified literatures from PubMed, Scopus, Web of Sciences, Scopus conference paper, Web of Sciences meeting abstracts and proceeding papers, 493 literatures were duplicated and removed. Remained documents include 4047 studies, which 3974 were excluded after screening their title and abstract. Finally, 73 studies were selected for full text reading and 29 of them are included in the study. One additional
Discussion
Casualty distribution management across health care centers is too problematic [11] and it is thought-provoking [14]. The objectives of the casualty distribution are to bring the right patients to the right clinics and avoid unnecessary overwhelming health care center [36]. Victims are ideally transported to the most suitable facilities. In this case, selected destinations should be based on the patients’ needs, capabilities and capacities of individual hospitals and available resources of the
Funding
This study is a part of PhD thesis that is awarded by Tehran University of Medical Sciences with the registration Number IR.TUMS.SPH.REC.1395.509.
Acknowledgements
We would like to acknowledge the School of Public Health Research Council of Tehran University of Medical Sciences as well as anonymous reviewers for their advices and support to improve this paper.
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