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Development and Validation of a New Tool to Improve the Accuracy of the Hospital Mass-Casualty Incident Response Plan Activation: The PEMAAF Score

Published online by Cambridge University Press:  24 November 2023

Claudia Ruffini Open the ORCID record for Claudia Ruffini [Opens in a new window] ,
Monica Trentin ,
Alberto Corona ,
Marta Caviglia Open the ORCID record for Marta Caviglia [Opens in a new window] ,
Giuseppe Maria Sechi ,
Maurizio Migliari ,
Riccardo Stucchi ,
Luca Ragazzoni Open the ORCID record for Luca Ragazzoni [Opens in a new window]  and
Roberto Fumagalli
Claudia Ruffini*
Affiliation:
Anesthesia and Intensive Care Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco Milan, Italy
Monica Trentin
Affiliation:
CRIMEDIM – Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
Alberto Corona
Affiliation:
Department of Anesthesia and Intensive Care and Accident & Emergency, ASST Valcamonica, Breno, Lombardia, Italy
Marta Caviglia
Affiliation:
CRIMEDIM – Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
Giuseppe Maria Sechi
Affiliation:
Agenzia Regionale Emergenza Urgenza (AREU), Milan, Italy
Maurizio Migliari
Affiliation:
Agenzia Regionale Emergenza Urgenza (AREU), Milan, Italy
Riccardo Stucchi
Affiliation:
SSD AAT 118 Milano, Agenzia Regionale Emergenza Urgenza (AREU), Accident & Emergency Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
Luca Ragazzoni
Affiliation:
CRIMEDIM – Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
Roberto Fumagalli
Affiliation:
SSD AAT 118 Milano, Agenzia Regionale Emergenza Urgenza (AREU), Accident & Emergency Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Department of Anesthesia and Intensive Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
*
Correspondence: Claudia Ruffini, MD Anesthesia and Intensive Care Unit Luigi Sacco University Hospital Via GB Grassi 74- 20157 Milano, Italy E-mail: claudia.ruffini@asst-fbf-sacco.it
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Abstract

Introduction:

Effective response to a mass-casualty incident (MCI) entails the activation of hospital MCI plans. Unfortunately, there are no tools available in the literature to support hospital responders in predicting the proper level of MCI plan activation. This manuscript describes the scientific-based approach used to develop, test, and validate the PEMAAF score (Proximity, Event, Multitude, Overcrowding, Temporary Ward Reduction Capacity, Time Shift Slot [Prossimità, Evento, Moltitudine, Affollamento, Accorpamento, Fascia Oraria], a tool able to predict the required level of hospital MCI plan activation and to facilitate a coordinated activation of a multi-hospital network.

Methods:

Three study phases were performed within the Metropolitan City of Milan, Italy: (1) retrospective analysis of past MCI after action reports (AARs); (2) PEMAAF score development; and (3) PEMAAF score validation. The validation phase entailed a multi-step process including two retrospective analyses of past MCIs using the score, a focus group discussion (FGD), and a prospective simulation-based study. Sensitivity and specificity of the score were analyzed using a regression model, Spearman’s Rho test, and receiver operating characteristic/ROC analysis curves.

Results:

Results of the retrospective analysis and FGD were used to refine the PEMAAF score, which included six items–Proximity, Event, Multitude, Emergency Department (ED) Overcrowding, Temporary Ward Reduction Capacity, and Time Shift Slot–allowing for the identification of three priority levels (score of 5-6: green alert; score of 7-9: yellow alert; and score of 10-12: red alert). When prospectively analyzed, the PEMAAF score determined most frequent hospital MCI plan activation (>10) during night and holiday shifts, with a score of 11 being associated with a higher sensitivity system and a score of 12 with higher specificity.

Conclusions:

The PEMAAF score allowed for a balanced and adequately distributed response in case of MCI, prompting hospital MCI plan activation according to real needs, taking into consideration the whole hospital response network.

Keywords

MCI hospital plan activationPEMAAF scoreregional trauma network tool
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 38 , Issue 6 , December 2023 , pp. 725 - 734
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Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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Footnotes

Note: Authors Riccardo Stucchi, Luca Ragazzoni, and Roberto Fumagalli contributed equally.

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