Elsevier

Injury

Volume 49, Issue 11, November 2018, Pages 1959-1968
Injury

Review
A systematic literature review of criteria and models for casualty distribution in trauma related mass casualty incidents

https://doi.org/10.1016/j.injury.2018.09.005Get rights and content

Abstract

Introduction

Mass casualty incidents impose a large burden on the emergency medical systems, hospitals and community infrastructures. The pre-hospital and hospital capacities are usually bear the burden of casualties large numbers. One of the challenging issues in mass casualty incidents is the distribution of casualties among the suitable health care facilities.

Objective

To review models and criteria affecting the distribution of casualties during the trauma-related mass causality incidents.

Materials and methods

A systematic literature search in the scientific databases which included: PubMed, Scopus and Web of Science was conducted. Relevant literature which was published before August 2017 was searched. Neither the publication date nor language limitations were considered in the literature search. All the trauma-related mass casualty incidents are included in this study. Two independent reviewers conducted the data extraction and quality assessment of the documents was considered using a checklist developed by the researchers.

Results

Literature search yielded 4540 documents of which 493 were duplicated and removed. After reviewing the titles and abstracts of the remaining documents (4047), only 73 documents were considered relevant. Finally, the inclusion and exclusion criteria were applied and only 30 documents were considered for data extraction and quality assessment. The study found 491 criteria to be affecting the distribution of casualties following trauma-related mass casualty incidents. These are categorized as pre-hospital (triage, treatment and transport); hospital (space, staff, stuff, system / structure); incidents’ characteristics and others. The criteria which were extracted from the models are termed as “model extracted” while the other labeled as “author suggested”.

Conclusion

To the best of our knowledge, this is the first systematic literature review on criteria affecting distribution of casualties following trauma-related mass casualty incidents based on the pre-hospital and hospital capacities.

Systematic review registration number

This review was registered in international prospective register of systematic reviews (PROSPERO) with registration number CRD42016049115.

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:

  • 1

    • 1

      Investigating the criteria for casualty distribution in trauma-related MCIs

    • 2

      Reviewing the existing models of casualty distribution in trauma-related MCIs

The secondary objectives of this study include:

  • 1

    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.

References (48)

  • W.H. Organization

    Mass casualty management systems: strategies and guidelines for building health sector capacity

    (2007)
  • C. Cotta

    Effective patient prioritization in mass casualty incidents using hyperheuristics and the pilot method

    OR Spectrum

    (2011)
  • L. Rubinson et al.

    Augmentation of hospital critical care capacity after bioterrorist attacks or epidemics: recommendations of the Working Group on Emergency Mass Critical Care

    Crit Care Med

    (2005)
  • E.U. Jacobson et al.

    Priority assignment in emergency response

    Oper Res

    (2012)
  • B. Adini et al.

    Reconsidering policy of casualty evacuation in a remote mass-casualty incident

    Prehosp Disaster Med.

    (2014)
  • Y.H. Bloch et al.

    Distribution of casualties in a mass-casualty incident with three local hospitals in the periphery of a densely populated area: lessons learned from the medical management of a terrorist attack

    Prehosp Disaster Med.

    (2007)
  • Y. Tian et al.

    Use of an agent-based simulation model to evaluate a mobile-based system for supporting emergency evacuation decision making

    J. Med. Sys.

    (2014)
  • B. Adini et al.

    Load index model: An advanced tool to support decision making during mass-casualty incidents

    J Trauma Acute Care Surg.

    (2015)
  • O. Amram et al.

    Mass casualty modelling: a spatial tool to support triage decision making

    Int J Health Geogr.

    (2011)
  • O. Amram et al.

    A web-based model to support patient-to-hospital allocation in mass casualty incidents

    J Trauma Acute Care Surg.

    (2012)
  • A. Ganz et al.

    Real-time scalable resource tracking framework (DIORAMA) for mass casualty incidents

    Int J E-Health Med Commun

    (2013)
  • A. Ganz et al.

    Mobile DIORAMA-II: Infrastructure less information collection system for mass casualty incidents. in 36th Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBC 2014

    Institute of Electrical and Electronics Engineers Inc.

    (2014)
  • L.A. Lenert et al.

    Design and evaluation of a wireless electronic health records system for field care in mass casualty settings

    J Am Med Inform Assoc.

    (2011)
  • M.R. Khajehaminian et al.

    Criteria and models for the distribution of casualties in trauma-related mass casualty incidents: a systematic literature review protocol

    Syst Rev

    (2017)
  • Cited by (11)

    View all citing articles on Scopus
    View full text