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Marius Rehn - One of the best experts on this subject based on the ideXlab platform.
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Major Incident management by helicopter emergency medical services in south east norway from 2000 to 2016 retrospective cohort study
Acta Anaesthesiologica Scandinavica, 2020Co-Authors: Marius Rehn, Anne Siri Johnsen, Stephen J. M. Sollid, Martin SamdalAbstract:BACKGROUND Helicopter emergency medical services (HEMS) and search and rescue helicopters (SAR) aim to bring specialized personnel to Major Incidents and transport patients to definite care, but their operational pattern remains poorly described. We aim to describe the use of HEMS and SAR in Major Incidents in Norway and investigate the feasibility of retrospectively collecting uniform data from Incident reports. METHODS We searched HEMS medical databases from three HEMS and one SAR base in south-east Norway for the written reports of Incidents from 2000 to 2016. After Incidents were included through consensus in the author group, we collected data as described in MajorIncidentreporting.org and a previous cross-sectional study and rated availability of the variables. RESULTS From a total of 31 803 missions, we identified 50 (0.16%) Major Incidents with HEMS/SAR involvement where road traffic accidents were the most common type of Incident (n = 28, 56%), and rural area was the most prevalent location (n = 35, 70%). Inter-agency cooperation was common and HEMS contributed most often with treatment and transport. The Majority of information was found in the free-text area in the medical records hereby increasing the risk for rater variability. CONCLUSION Major Incidents are rare in Norway. HEMS and SAR play an important role in Incident logistics, cooperation with other agencies, treatment and transport of patients and should be included in Major Incident plans. Retrospective data collection is challenging as data variables are not systematically integrated into the database. Future research should focus on systematic data gathering and a system for sharing lessons learned.
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Helicopter emergency medical services in Major Incident management: A national Norwegian cross-sectional survey.
PLOS ONE, 2017Co-Authors: Anne Siri Johnsen, Trond Vigerust, Stephen J. M. Sollid, Morten Jystad, Marius RehnAbstract:Objective Helicopter Emergency Medical Services (HEMS) aim to bring a highly specialised crew to the scene of Major Incidents for triage, treatment and transport. We aim to describe experiences made by HEMS in Norway in the management of Major Incidents. Design Doctors, rescue paramedics and pilots working in Norwegian HEMS and Search and Rescue Helicopters (SAR) January 1st 2015 were invited to a cross-sectional study on experiences, preparedness and training in Major Incident management. Results We identified a total of 329 Norwegian crewmembers of which 229 (70%) responded; doctors 101/150, (67%), rescue paramedics 64/78 (82%), pilots 64/101, (63%). HEMS and SAR crewmembers had experience from a median of 2 (interquartile range 0–6) Major Incidents. Road traffic Incidents were the most frequent mechanism and blunt trauma the dominating injury. HEMS mainly contributed with triage, treatment and transport. Communication with other emergency services prior to arrival was described as bad, but good to excellent when cooperating on scene. The respondents called for more interdisciplinary exercises. Conclusion HEMS and SAR crewmembers have limited exposure to Major Incident management. Interdisciplinary training on frequent scenarios with focus on cooperation and communication is called for.
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Implementing a template for Major Incident reporting: experiences from the first year
Scandinavian Journal of Trauma Resuscitation and Emergency Medicine, 2015Co-Authors: Sabina Fattah, Marius Rehn, Torben WisborgAbstract:Major Incidents are resource-demanding situations that require urgent and effective medical management. The possibility to extract learning from them is therefore important. Comparative analysis of information based on uniform data collection from previous Incidents may facilitate learning. The Major Incident Reporting Collaborators have developed a template for reporting of the medical pre-hospital response to Major Incidents. The template is accompanied by an open access webpage (www.MajorIncidentreporting.org) for online reporting and access to published reports. This commentary presents the experiences from the first year of implementing the template including a presentation of the five published reports.
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a consensus based template for reporting of pre hospital Major Incident medical management
Scandinavian Journal of Trauma Resuscitation and Emergency Medicine, 2014Co-Authors: Sabina Fattah, Marius Rehn, Hans Morten Lossius, David J Lockey, Julian ThompsonAbstract:Background Structured reporting of Major Incidents has been advocated to improve the care provided at future Incidents. A systematic review identified ten existing templates for reporting Major Incident medical management, but these templates are not in widespread use. We aimed to address this challenge by designing an open access template for uniform reporting of data from pre-hospital Major Incident medical management that will be tested for feasibility.
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systematic literature review of templates for reporting prehospital Major Incident medical management
BMJ Open, 2013Co-Authors: Sabina Fattah, Marius Rehn, Eirik Reierth, Torben WisborgAbstract:Objective To identify and describe the content of templates for reporting prehospital Major Incident medical management. Design Systematic literature review according to PRISMA guidelines. Data sources PubMed/MEDLINE, EMBASE, CINAHL, Scopus and Web of Knowledge. Grey literature was also searched. Eligibility criteria for selected studies Templates published after 1 January 1990 and up to 19 March 2012. Non-English language literature, except Scandinavian; literature without an available abstract; and literature reporting only psychological aspects were excluded. Results The main database search identified 8497 articles, among which 8389 were excluded based on title and abstract. An additional 96 were excluded based on the full-text. The remaining 12 articles were included in the analysis. A total of 107 articles were identified in the grey literature and excluded. The reference lists for the included articles identified five additional articles. A relevant article published after completing the search was also included. In the 18 articles included in the study, 10 different templates or sets of data are described: 2 methodologies for assessing Major Incident responses, 3 templates intended for reporting from exercises, 2 guidelines for reporting in medical journals, 2 analyses of previous disasters and 1 Utstein-style template. Conclusions More than one template exists for generating reports. The limitations of the existing templates involve internal and external validity, and none of them have been tested for feasibility in real-life Incidents. Trial registration The review is registered in PROSPERO (registration number: CRD42012002051).
Sabina Fattah - One of the best experts on this subject based on the ideXlab platform.
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Trials and tribulations: how we established a Major Incident database.
Scandinavian Journal of Trauma Resuscitation and Emergency Medicine, 2017Co-Authors: S. E. J. Hardy, Sabina FattahAbstract:We describe the process of setting up a database of Major Incident reports and its potential future application. A template for reporting on Major Incidents was developed using a consensus-based process involving a team of experts in the field. A website was set up as a platform from which to launch the template and as a database of submitted reports. This paper describes the processes involved in setting up a Major Incident reporting database. It describes how specific difficulties have been overcome and anticipates challenges for the future. We have successfully set up a Major Incident database, the main purpose of which is to have a repository of standardised Major Incident reports that can be analysed and compared in order to learn from them.
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Implementing a template for Major Incident reporting: experiences from the first year
Scandinavian Journal of Trauma Resuscitation and Emergency Medicine, 2015Co-Authors: Sabina Fattah, Marius Rehn, Torben WisborgAbstract:Major Incidents are resource-demanding situations that require urgent and effective medical management. The possibility to extract learning from them is therefore important. Comparative analysis of information based on uniform data collection from previous Incidents may facilitate learning. The Major Incident Reporting Collaborators have developed a template for reporting of the medical pre-hospital response to Major Incidents. The template is accompanied by an open access webpage (www.MajorIncidentreporting.org) for online reporting and access to published reports. This commentary presents the experiences from the first year of implementing the template including a presentation of the five published reports.
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a consensus based template for reporting of pre hospital Major Incident medical management
Scandinavian Journal of Trauma Resuscitation and Emergency Medicine, 2014Co-Authors: Sabina Fattah, Marius Rehn, Hans Morten Lossius, David J Lockey, Julian ThompsonAbstract:Background Structured reporting of Major Incidents has been advocated to improve the care provided at future Incidents. A systematic review identified ten existing templates for reporting Major Incident medical management, but these templates are not in widespread use. We aimed to address this challenge by designing an open access template for uniform reporting of data from pre-hospital Major Incident medical management that will be tested for feasibility.
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systematic literature review of templates for reporting prehospital Major Incident medical management
BMJ Open, 2013Co-Authors: Sabina Fattah, Marius Rehn, Eirik Reierth, Torben WisborgAbstract:Objective To identify and describe the content of templates for reporting prehospital Major Incident medical management. Design Systematic literature review according to PRISMA guidelines. Data sources PubMed/MEDLINE, EMBASE, CINAHL, Scopus and Web of Knowledge. Grey literature was also searched. Eligibility criteria for selected studies Templates published after 1 January 1990 and up to 19 March 2012. Non-English language literature, except Scandinavian; literature without an available abstract; and literature reporting only psychological aspects were excluded. Results The main database search identified 8497 articles, among which 8389 were excluded based on title and abstract. An additional 96 were excluded based on the full-text. The remaining 12 articles were included in the analysis. A total of 107 articles were identified in the grey literature and excluded. The reference lists for the included articles identified five additional articles. A relevant article published after completing the search was also included. In the 18 articles included in the study, 10 different templates or sets of data are described: 2 methodologies for assessing Major Incident responses, 3 templates intended for reporting from exercises, 2 guidelines for reporting in medical journals, 2 analyses of previous disasters and 1 Utstein-style template. Conclusions More than one template exists for generating reports. The limitations of the existing templates involve internal and external validity, and none of them have been tested for feasibility in real-life Incidents. Trial registration The review is registered in PROSPERO (registration number: CRD42012002051).
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Major Incident preparedness and on-site work among Norwegian rescue personnel – a cross-sectional study
International Journal of Emergency Medicine, 2012Co-Authors: Sabina Fattah, Andreas J. Krüger, Jan Einar Andersen, Trond Vigerust, Marius RehnAbstract:A Major Incident has occurred when the number of live casualties, severity, type of Incident or location requires extraordinary resources. Major Incident management is interdisciplinary and involves triage, treatment and transport of patients. We aimed to investigate experiences within Major Incident preparedness and management among Norwegian rescue workers. A questionnaire was answered by 918 rescue workers across Norway. Questions rated from 1 (doesn’t work) to 7 (works excellently) are presented as median and range. Health-care personnel constituted 34.1% of the participants, firefighters 54.1% and police 11.8%. Training for Major Incident response scored 5 (1, 7) among health-care workers and 4 (1, 7) among firefighters and police. Preparedness for Major Incident response scored 5 (1, 7) for all professions. Interdisciplinary cooperation scored 5 (3, 7) among health-care workers and police and 5 (1, 7) among firefighters. Among health-care workers, 77.5% answered that a system for Major-Incident triage exists; 56.3% had triage equipment available. The Majority – 45.1% of health-care workers, 44.7% of firefighters and 60.4% of police – did not know how long it would take to get emergency stretchers to the scene. Rescue personnel find Major Incident preparedness and on-scene multidisciplinary cooperation to function well. Some shortcomings are reported with regard to systems for Major Incident triage, tagging equipment for triage and knowledge about access to emergency stretchers.
Torben Wisborg - One of the best experts on this subject based on the ideXlab platform.
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Implementing a template for Major Incident reporting: experiences from the first year
Scandinavian Journal of Trauma Resuscitation and Emergency Medicine, 2015Co-Authors: Sabina Fattah, Marius Rehn, Torben WisborgAbstract:Major Incidents are resource-demanding situations that require urgent and effective medical management. The possibility to extract learning from them is therefore important. Comparative analysis of information based on uniform data collection from previous Incidents may facilitate learning. The Major Incident Reporting Collaborators have developed a template for reporting of the medical pre-hospital response to Major Incidents. The template is accompanied by an open access webpage (www.MajorIncidentreporting.org) for online reporting and access to published reports. This commentary presents the experiences from the first year of implementing the template including a presentation of the five published reports.
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systematic literature review of templates for reporting prehospital Major Incident medical management
BMJ Open, 2013Co-Authors: Sabina Fattah, Marius Rehn, Eirik Reierth, Torben WisborgAbstract:Objective To identify and describe the content of templates for reporting prehospital Major Incident medical management. Design Systematic literature review according to PRISMA guidelines. Data sources PubMed/MEDLINE, EMBASE, CINAHL, Scopus and Web of Knowledge. Grey literature was also searched. Eligibility criteria for selected studies Templates published after 1 January 1990 and up to 19 March 2012. Non-English language literature, except Scandinavian; literature without an available abstract; and literature reporting only psychological aspects were excluded. Results The main database search identified 8497 articles, among which 8389 were excluded based on title and abstract. An additional 96 were excluded based on the full-text. The remaining 12 articles were included in the analysis. A total of 107 articles were identified in the grey literature and excluded. The reference lists for the included articles identified five additional articles. A relevant article published after completing the search was also included. In the 18 articles included in the study, 10 different templates or sets of data are described: 2 methodologies for assessing Major Incident responses, 3 templates intended for reporting from exercises, 2 guidelines for reporting in medical journals, 2 analyses of previous disasters and 1 Utstein-style template. Conclusions More than one template exists for generating reports. The limitations of the existing templates involve internal and external validity, and none of them have been tested for feasibility in real-life Incidents. Trial registration The review is registered in PROSPERO (registration number: CRD42012002051).
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templates for reporting pre hospital Major Incident medical management systematic literature review
BMJ Open, 2012Co-Authors: Sabina Fattah, Marius Rehn, Eirik Reierth, Torben WisborgAbstract:Introduction In 2010, a total of 385 natural disasters killed more than 297 000 people worldwide and affected over 217 million others. More standardised reporting of Major Incident management have been advocated in the previous years. Prevention, mitigation, preparedness and Major Incident response may be improved through collection and analysis of high-quality standardised data on medical management of Major Incidents. Standardised data may elevate the level of scientific evidence within disaster medicine research. Methods and analysis A systematic literature review will be conducted to identify templates for reporting pre-hospital Major Incident medical management. The first set of entry terms aims to describe Major Incidents published during the last 20 years. The second set aims to focus the number of search results from the first set to those publications that describe templates based on data collections from these Major Incidents. Predefined free search phases will be combined with the first two sets. Ethics and dissemination The results will be submitted for publication in an open access, peer-reviewed scientific journal. The PRISMA checklist will be applied. No ethics approval is considered indicated, as this is a literature review only. Registration details This review is registered in PROSPERO (registration number: CRD42012002051).
Lee A. Wallis - One of the best experts on this subject based on the ideXlab platform.
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Major Incident triage and the implementation of a new triage tool the mptt 24
Journal of the Royal Army Medical Corps, 2018Co-Authors: James Vassallo, J E Smith, Lee A. WallisAbstract:Introduction The Modified Physiological Triage Tool (MPTT) is a recently developed primary triage tool and in comparison with existing tools demonstrates the greatest sensitivity at predicting need for life-saving intervention (LSI) within both military and civilian populations. To improve its applicability, we proposed to increase the upper respiratory rate (RR) threshold to 24 breaths per minute (bpm) to produce the MPTT-24. Our aim was to conduct a feasibility analysis of the proposed MPTT-24, comparing its performance with the existing UK Military Sieve. Method A retrospective review of the Joint Theatre Trauma Registry (JTTR) and Trauma Audit Research Network (TARN) databases was performed for all adult (>18 years) patients presenting between 2006–2013 (JTTR) and 2014 (TARN). Patients were defined as priority one (P1) if they received one or more LSIs. Using first recorded hospital RR in isolation, sensitivity and specificity of the ≥24 bpm threshold was compared with the existing threshold (≥22 bpm) at predicting P1 status. Patients were then categorised as P1 or not-P1 by the MPTT, MPTT-24 and the UK Military Sieve. Results The MPTT and MPTT-24 outperformed existing UK methods of triage with a statistically significant (p Conclusions When compared with the existing MPTT, the MPTT-24 allows for a more rapid triage assessment. Both continue to outperform existing methods of primary Major Incident triage and within the military setting, the slight increase in undertriage is offset by a reduction in overtriage. We recommend that the MPTT-24 be considered as a replacement to the existing UK Military Sieve.
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the prospective validation of the modified physiological triage tool mptt an evidence based approach to Major Incident triage
Journal of the Royal Army Medical Corps, 2017Co-Authors: James Vassallo, Simon Horne, J E Smith, Lee A. WallisAbstract:Introduction Triage is a key principle in the effective management of Major Incidents. There is limited evidence to support existing triage tools, with a number of studies demonstrating poor performance at predicting the need for a life-saving intervention. The Modified Physiological Triage Tool (MPTT) is a novel triage tool derived using logistic regression, and in retrospective data sets has shown optimum performance at predicting the need for life-saving intervention. Materials and methods Physiological data and interventions were prospectively collected for consecutive adult patients with trauma (>18 years) presenting to the emergency department at Camp Bastion, Afghanistan, between March and September 2011. Patients were considered priority 1 (P1) if they received one or more interventions from a previously defined list. Patients were triaged using existing triage tools and the MPTT. Performance was measured using sensitivity and specificity, and a McNemar test with Bonferroni calculation was applied for tools with similar performance. Results The study population comprised 357 patients, of whom 214 (59.9%) were classed as P1. The MPTT (sensitivity: 83.6%, 95% CI 78.0% to 88.3%; specificity: 51.0%, 95% CI 42.6% to 59.5%) outperformed all existing triage tools at predicting the need for life-saving intervention, with a 19.6% absolute reduction in undertriage compared with the existing Military Sieve. The improvement in undertriage comes at the expense of overtriage; rates of overtriage were 11.6% higher with the MPTT than the Military Sieve. Using a McNemar test, a statistically significant (p Discussion and conclusions The MPTT outperforms all existing triage tools at predicting the need for life-saving intervention, with the lowest rates of undertriage while maintaining acceptable levels of overtriage. Having now been validated on both military and civilian cohorts, we recommend that the Major Incident community consider adopting the MPTT for the purposes of primary triage.
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Investigating the effects of under-triage by existing Major Incident triage tools.
European Journal of Emergency Medicine, 2017Co-Authors: James Vassallo, Jason Smith, Lee A. WallisAbstract:OBJECTIVES: Triage is a key principle in the effective management of a Major Incident. Its effectiveness is a balance between identifying those in need of life-saving intervention, and those triaged incorrectly as either needing/not needing a life-saving intervention. The primary aim of this study was to report mortality in those under-triaged by existing Major Incident triage tools. Secondary aims were to report the ability of triage tools at identifying serious injury by body region (defined as an Abbreviated Injury Scale severity score≥3). PATIENTS AND METHODS: Retrospective database analysis of the UK Trauma Audit Research Network for all adult patients (≥18 years) between 2006 and 2014. Patients were defined as priority one using a previously published list. Using the first recorded hospital physiology, patients were categorized by the Modified Physiological Triage Tool (MPTT), National Ambulance Resilience Unit (NARU) Sieve and the Major Incident Medical Management and Support (MIMMS) Triage Sieve. Categorical and continuous data were analyzed using a χ-test and Mann-Whitney U-test respectively. RESULTS: During the study period, 218 985 adult patients met the Trauma Audit Research Network inclusion criteria, with 24 791 (19.5%) priority one patients, of which 70% were male with a median age of 51 (33-71) years and injury severity score of 16 (9-25). The MPTT showed the lowest rate of under-triage (42.4%, P
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investigating the effects of under triage by existing Major Incident triage tools
European Journal of Emergency Medicine, 2017Co-Authors: James Vassallo, J E Smith, Lee A. WallisAbstract:OBJECTIVES Triage is a key principle in the effective management of a Major Incident. Its effectiveness is a balance between identifying those in need of life-saving intervention, and those triaged incorrectly as either needing/not needing a life-saving intervention. The primary aim of this study was to report mortality in those under-triaged by existing Major Incident triage tools. Secondary aims were to report the ability of triage tools at identifying serious injury by body region (defined as an Abbreviated Injury Scale severity score≥3). PATIENTS AND METHODS Retrospective database analysis of the UK Trauma Audit Research Network for all adult patients (≥18 years) between 2006 and 2014. Patients were defined as priority one using a previously published list. Using the first recorded hospital physiology, patients were categorized by the Modified Physiological Triage Tool (MPTT), National Ambulance Resilience Unit (NARU) Sieve and the Major Incident Medical Management and Support (MIMMS) Triage Sieve. Categorical and continuous data were analyzed using a χ-test and Mann-Whitney U-test respectively. RESULTS During the study period, 218 985 adult patients met the Trauma Audit Research Network inclusion criteria, with 24 791 (19.5%) priority one patients, of which 70% were male with a median age of 51 (33-71) years and injury severity score of 16 (9-25). The MPTT showed the lowest rate of under-triage (42.4%, P<0.001). Compared with existing methods, the MPTT under-triage population had significantly lower mortality (5.7%, P<0.001) with significantly fewer serious thorax and head injuries under-triaged than both the NARU Sieve and MIMMS Triage Sieve (P<0.001). CONCLUSION This study has defined the implications of under-triage in the context of a Major trauma population. The MPTT misses fewer severely injured patients, with a significant reduction in mortality. We suggest the MPTT to be considered as an alternative to existing primary Major Incident triage tools.
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the civilian validation of the modified physiological triage tool mptt an evidence based approach to primary Major Incident triage
Emergency Medicine Journal, 2017Co-Authors: James Vassallo, J E Smith, Omar Bouamra, Fiona Lecky, Lee A. WallisAbstract:Introduction Triage is a key principle in the effective management of a Major Incident. Existing triage tools have demonstrated limited performance at predicting need for life-saving intervention (LSI). Derived on a military cohort, the Modified Physiological Triage Tool (MPTT) has demonstrated improved performance. Using a civilian trauma registry, this study aimed to validate the MPTT in a civilian environment. Methods Retrospective database review of the Trauma Audit and Research Network (TARN) database for all adult patients (>18 years) between 2006 and 2014. Patients were defined as Priority One if they received one or more LSIs from a previously defined list. Only patients with complete physiological data were included. Patients were categorised by the MPTT and existing triage tools using first recorded hospital physiology. Performance characteristics were evaluated using sensitivity, specificity and area under receiver operating characteristic (AUROC). Results During the study period, 218 985 adult patients were included in the TARN database. 127 233 (58.1%) had complete data: 55.6% male, aged 61.4 (IQR 43.1–80.0) years, Injury Severity Score 9 (IQR 9–16), 96.5% suffered blunt trauma and 24 791 (19.5%) were Priority One. The MPTT (sensitivity 57.6%, specificity 71.5%) outperformed all existing triage methods with a 44.7% absolute reduction in undertriage compared with existing UK civilian methods. AUROC comparison supported the use of the MPTT over other tools (P Conclusion Within a civilian trauma registry population, the MPTT demonstrates improved performance at predicting need for LSI, with the lowest rates of undertriage and an appropriate level of overtriage. We suggest the MPTT be considered as an alternative to existing triage tools.
Hans Morten Lossius - One of the best experts on this subject based on the ideXlab platform.
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a consensus based template for reporting of pre hospital Major Incident medical management
Scandinavian Journal of Trauma Resuscitation and Emergency Medicine, 2014Co-Authors: Sabina Fattah, Marius Rehn, Hans Morten Lossius, David J Lockey, Julian ThompsonAbstract:Background Structured reporting of Major Incidents has been advocated to improve the care provided at future Incidents. A systematic review identified ten existing templates for reporting Major Incident medical management, but these templates are not in widespread use. We aimed to address this challenge by designing an open access template for uniform reporting of data from pre-hospital Major Incident medical management that will be tested for feasibility.
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Major Incident patient evacuation full scale field exercise feasibility study
Air Medical Journal, 2011Co-Authors: Andreas J. Krüger, Jan Einar Andersen, Trond Vigerust, Marius Rehn, Hans Morten LossiusAbstract:Abstract Introduction Major Incident management relies on efficient patient transportation. In the absence of a standardized, field-friendly approach to multiple casualty management, the Norwegian Air Ambulance Foundation developed Optimal Patient Evacuation Norway (OPEN). OPEN aims to save time, improve patient handling, prevent hypothermia, and simplify scene management. We evaluated the feasibility of the OPEN concept in full-scale Major Incident field exercises. Methods Emergency service personnel participated in two standardized bus crash field exercises, without and with access to OPEN. The instructors timed completion of patient evacuation, and the students participated in a self-report before and after study. Each question was scored on a 7-point Likert scale, with points labeled “Did not work” (1) through “Worked excellently” (7). Results Among the 93 study participants, 31% confirmed that stretchers could be available at the scene within 30 minutes in their catchment area. The students reported improved interdisciplinary cooperation for patient evacuation after the course (mean, 5.8, with 95% CI 5.7–6.0 after vs. 5.4 with 95% CI 5.2–5.6 before, P Conclusion OPEN is a feasible and time-efficient way to standardize patient transport and may serve as a candidate for a future national standard for Major Incident patient evacuation.
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A concept for Major Incident triage: full-scaled simulation feasibility study
BMC Emergency Medicine, 2010Co-Authors: Marius Rehn, Andreas J. Krüger, Jan Einar Andersen, Trond Vigerust, Hans Morten LossiusAbstract:Efficient management of Major Incidents involves triage, treatment and transport. In the absence of a standardised interdisciplinary Major Incident management approach, the Norwegian Air Ambulance Foundation developed Interdisciplinary Emergency Service Cooperation Course (TAS). The TAS-program was established in 1998 and by 2009, approximately 15 500 emergency service professionals have participated in one of more than 500 no-cost courses. The TAS-triage concept is based on the established triage Sieve and Paediatric Triage Tape models but modified with slap-wrap reflective triage tags and paediatric triage stretchers. We evaluated the feasibility and accuracy of the TAS-triage concept in full-scale simulated Major Incidents. The learners participated in two standardised bus crash simulations: without and with competence of TAS-triage and access to TAS-triage equipment. The instructors calculated triage accuracy and measured time consumption while the learners participated in a self-reported before-after study. Each question was scored on a 7-point Likert scale with points labelled "Did not work" (1) through "Worked excellent" (7). Among the 93 (85%) participating emergency service professionals, 48% confirmed the existence of a Major Incident triage system in their service, whereas 27% had access to triage tags. The simulations without TAS-triage resulted in a mean over- and undertriage of 12%. When TAS-Triage was used, no mistriage was found. The average time from "scene secured to all patients triaged" was 22 minutes (range 15-32) without TAS-triage vs. 10 minutes (range 5-21) with TAS-triage. The participants replied to "How did interdisciplinary cooperation of triage work?" with mean 4,9 (95% CI 4,7-5,2) before the course vs. mean 5,8 (95% CI 5,6-6,0) after the course, p < 0,001. Our modified triage Sieve tool is feasible, time-efficient and accurate in allocating priority during simulated bus accidents and may serve as a candidate for a future national standard for Major Incident triage.
