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Chapter 14 - VIP and Executive Medicine Considerations at Mass Gathering Events
- Edited by William J. Brady, University of Virginia, Mark R. Sochor, University of Virginia, Paul E. Pepe, Metropolitan EMS Medical Directors Global Alliance, Florida, John C. Maino II, Michigan International Speedway, Brooklyn, K. Sophia Dyer, Boston University Chobanian and Avedisian School of Medicine, Massachusetts
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- Book:
- Mass Gathering Medicine
- Published online:
- 11 April 2024
- Print publication:
- 18 April 2024, pp 199-209
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Summary
The involvement of dignitaries within mass gathering events can often impose several difficult levels of complexity, both during the planning phases and throughout the event itself. Whether the dignitaries are the reason for the mass gathering or they are on location as additional special attendees of the event, so-called “very important persons” (VIPs) such as celebrities, royalty, or major political figures can affect the planning and preparations for medical management contingencies as well as the operational aspects of such events [1–3]. Beyond the typical challenges of mass gathering medicine and protective security aspects, the concepts and practice of executive medicine, concierge medicine, or “protective medicine” pose unique and often unfamiliar and uncomfortable adaptations in terms of delivering medical advice and care. Medically, there is often limited access and reticence to expose the VIP to unfamiliar practitioners. Requests for medications or therapies in the absence of directly seeing the patient is more common. There is also an expectation that the medical care provider will come to see the VIP at the site and not at an off-site medical facility.
A Modified Simple Triage and Rapid Treatment Algorithm from the New York City (USA) Fire Department
- Faizan H. Arshad, Alan Williams, Glenn Asaeda, Douglas Isaacs, Bradley Kaufman, David Ben-Eli, Dario Gonzalez, John P. Freese, Joan Hillgardner, Jessica Weakley, Charles B. Hall, Mayris P. Webber, David J. Prezant
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- Journal:
- Prehospital and Disaster Medicine / Volume 30 / Issue 2 / April 2015
- Published online by Cambridge University Press:
- 17 February 2015, pp. 199-204
- Print publication:
- April 2015
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- Article
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Introduction
The objective of this study was to determine if modification of the Simple Triage and Rapid Treatment (START) system by the addition of an Orange category, intermediate between the most critically injured (Red) and the non-critical, non-ambulatory injured (Yellow), would reduce over- and under-triage rates in a simulated mass-casualty incident (MCI) exercise.
MethodsA computer-simulation exercise of identical presentations of an MCI scenario involving a 2-train collision, with 28 case scenarios, was provided for triaging to two groups: the Fire Department of the City of New York (FDNY; n = 1,347) using modified START, and the Emergency Medical Services (EMS) providers from the Eagles 2012 EMS conference (Lafayette, Louisiana USA; n = 110) using unmodified START. Percent correct by triage category was calculated for each group. Performance was then compared between the two EMS groups on the five cases where Orange was the correct answer under the modified START system.
ResultsOverall, FDNY-EMS providers correctly triaged 91.2% of cases using FDNY-START whereas non-FDNY-Eagles providers correctly triaged 87.1% of cases using unmodified START. In analysis of the five Orange cases (chest pain or dyspnea without obvious trauma), FDNY-EMS performed significantly better using FDNY-START, correctly triaging 86.3% of cases (over-triage 1.5%; under-triage 12.2%), whereas the non-FDNY-Eagles group using unmodified START correctly triaged 81.5% of cases (over-triage 17.3%; under-triage 1.3%), a difference of 4.9% (95% CI, 1.5-8.2).
ConclusionsThe FDNY-START system may allow providers to prioritize casualties using an intermediate category (Orange) more properly aligned to meet patient needs, and as such, may reduce the rates of over-triage compared with START. The FDNY-START system decreases the variability in patient sorting while maintaining high field utility without needing computer assistance or extensive retraining. Comparison of triage algorithms at actual MCIs is needed; however, initial feedback is promising, suggesting that FDNY-START can improve triage with minimal additional training and cost.
. ,Arshad FH ,Williams A ,Asaeda G ,Isaacs D ,Kaufman B ,Ben-Eli D ,Gonzalez D ,Freese JP ,Hillgardner J ,Weakley J ,Hall CB ,Webber MP .Prezant DJ A Modified Simple Triage and Rapid Treatment Algorithm from the New York City (USA) Fire Department . Prehosp Disaster Med.2015 ;30 (2 ):1 -6
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