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Logistic Red Flags in Mass-Casualty Incidents and Disasters: A Problem-Based Approach
- Lorenzo Gamberini, Guglielmo Imbriaco, Pier Luigi Ingrassia, Carlo Alberto Mazzoli, Stefano Badiali, Davide Colombo, Luca Carenzo, Alfonso Flauto, Marco Tengattini, Federico Merlo, Massimo Azzaretto, Alessandro Monesi, Fernando Candido, Carlo Coniglio, Giovanni Gordini, Francesco Della Corte
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- Journal:
- Prehospital and Disaster Medicine / Volume 37 / Issue 2 / April 2022
- Published online by Cambridge University Press:
- 03 February 2022, pp. 197-204
- Print publication:
- April 2022
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- Article
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Background:
Mass-casualty incidents (MCIs) and disasters are characterized by a high heterogeneity of effects and may pose important logistic challenges that could hamper the emergency rescue operations.
The main objective of this study was to establish the most frequent logistic challenges (red flags) observed in a series of Italian disasters with a problem-based approach and to verify if the 80-20 rule of the Pareto principle is respected.
Methods:A series of 138 major events from 1944 through 2020 with a Disaster Severity Score (DSS) ≥ four and five or more victims were analyzed for the presence of twelve pre-determined red flags.
A Pareto graph was built considering the most frequently observed red flags, and eventual correlations between the number of red flags and the components of the DSS were investigated.
Results:Eight out of twelve red flags covered 80% of the events, therefore not respecting the 80-20 rule; the number of red flags showed a low positive correlation with most of the components of the DSS score. The Pareto analysis showed that potential hazards, casualty nest area > 2.5km2, number of victims over 50, evacuation noria over 20km, number of nests > five, need for extrication, complex access to victims, and complex nest development were the most frequently observed red flags.
Conclusions:Logistic problems observed in MCIs and disaster scenarios do not follow the 80-20 Pareto rule; this demands for careful and early evaluation of different logistic red flags to appropriately tailor the rescue response.
Nationwide Program of Education for Undergraduates in the Field of Disaster Medicine: Development of a Core Curriculum Centered on Blended Learning and Simulation Tools
- Pier Luigi Ingrassia, Luca Ragazzoni, Marco Tengattini, Luca Carenzo, Francesco Della Corte
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- Journal:
- Prehospital and Disaster Medicine / Volume 29 / Issue 5 / October 2014
- Published online by Cambridge University Press:
- 22 August 2014, pp. 508-515
- Print publication:
- October 2014
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In recent years, effective models of disaster medicine curricula for medical schools have been established. However, only a small percentage of medical schools worldwide have considered at least basic disaster medicine teaching in their study program. In Italy, disaster medicine has not yet been included in the medical school curriculum. Perceiving the lack of a specific course on disaster medicine, the Segretariato Italiano Studenti in Medicina (SISM) contacted the Centro di Ricerca Interdipartimentale in Medicina di Emergenza e dei Disastri ed Informatica applicata alla didattica e alla pratica Medica (CRIMEDIM) with a proposal for a nationwide program in this field. Seven modules (introduction to disaster medicine, prehospital disaster management, definition of triage, characteristics of hospital disaster plans, treatment of the health consequences of different disasters, psychosocial care, and presentation of past disasters) were developed using an e-learning platform and a 12-hour classroom session which involved problem-based learning (PBL) activities, table-top exercises, and a computerized simulation (Table 1). The modules were designed as a framework for a disaster medicine curriculum for undergraduates and covered the three main disciplines (clinical and psychosocial, public health, and emergency and risk management) of the core of “Disaster Health” according to the World Association for Disaster and Emergency Medicine (WADEM) international guidelines for disaster medicine education. From January 2011 through May 2013, 21 editions of the course were delivered to 21 different medical schools, and 524 students attended the course. The blended approach and the use of simulation tools were appreciated by all participants and successfully increased participants’ knowledge of disaster medicine and basic competencies in performing mass-casualty triage. This manuscript reports on the designing process and the initial outcomes with respect to learners' achievements and satisfaction of a 1-month educational course on the fundamentals of disaster medicine. This experience might represent a valid and innovative solution for a disaster medicine curriculum for medical students that is easily delivered by medical schools.
Table 1 List of Modules and Topics
Module Topics 1. Introduction to disaster medicine and public health during emergencies - Modern taxonomy of disaster and common disaster medicine definitions - Differences between disaster and emergency medicine - Principles of public health during disasters - Different phases of disaster management 2. Prehospital disaster management - Mass-casualty disposition, treatment area, and transport issues - Disaster plans and command-and-control chain structure - Functional response roles 3. Specific disaster medicine and triage procedures in the - Mass-casualty triage definitions and principles management of disasters - Different methodologies and protocols - Patient assessment, triage levels and tags 4. Hospital disaster preparedness and response - Hospital disaster laws - Hospital preparedness plans for in-hospital and out-hospital disasters with an all-hazard approach - Medical management for a massive influx of casualties 5. Health consequences of different disasters - Characteristics of different types of disasters - Health impact of natural and man-made disasters - Disaster-related injury after exposure to a different disasters with an all-hazard approach 6. Psychosocial care - Techniques to deal with psychic reactions caused by exposure to disaster scenarios - Treatment approaches to acute and delayed critical incident stress reactions 7. Presentation of past disasters and public health emergencies, and Case study: review of assistance experiences - Haiti earthquake - Cholera outbreaks in Haiti - National and international disaster response mechanism . ,Ingrassia PL ,Ragazzoni L ,Tengattini M ,Carenzo L .Della Corte F Nationwide Program of Education for Undergraduates in the Field of Disaster Medicine: Development of a Core Curriculum Centered on Blended Learning and Simulation Tools . Prehosp Disaster Med.2014 ;29 (5 ):1 -8