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Contributors
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- By James Ahn, Eric L. Anderson, Annette L. Beautrais, Dennis Beedle, Jon S. Berlin, Benjamin L. Bregman, Peter Brown, Suzie Bruch, Jonathan Busko, Stuart Buttlaire, Laurie Byrne, Gerald Carroll, Valerie A. Carroll, Margaret Cashman, Joseph R. Check, Lara G. Chepenik, Robert N. Cuyler, Preeti Dalawari, Suzanne Dooley-Hash, William R. Dubin, Mila L. Felder, Avrim B. Fishkind, Reginald I. Gaylord, Rachel Lipson Glick, Travis Grace, Clare Gray, Anita Hart, Ross A. Heller, Amanda E. Horn, David S. Howes, David C. Hsu, Andy Jagoda, Margaret Judd, John Kahler, Daryl Knox, Gregory Luke Larkin, Patricia Lee, Jerrold B. Leikin, Eddie Markul, Marc L. Martel, J. D. McCourt, MaryLynn McGuire Clarke, Mark Newman, Anthony T. Ng, Barbara Nightengale, Kimberly Nordstrom, Jagoda Pasic, Jennifer Peltzer-Jones, Marcia A. Perry, Larry Phillips, Paul Porter, Seth Powsner, Michael S. Pulia, Erin Rapp, Divy Ravindranath, Janet S. Richmond, Silvana Riggio, Harvey L. Ruben, Derek J. Robinson, Douglas A. Rund, Omeed Saghafi, Alicia N. Sanders, Jeffrey Sankoff, Lorin M. Scher, Louis Scrattish, Richard D. Shih, Maureen Slade, Susan Stefan, Victor G. Stiebel, Deborah Taber, Vaishal Tolia, Gary M. Vilke, Alvin Wang, Michael A. Ward, Joseph Weber, Michael P. Wilson, James L. Young, Scott L. Zeller
- Edited by Leslie S. Zun
- Edited in association with Lara G. Chepenik, Mary Nan S. Mallory
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- Book:
- Behavioral Emergencies for the Emergency Physician
- Published online:
- 05 April 2013
- Print publication:
- 21 March 2013, pp viii-xii
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National Strategy for Mass Casualty Situations and its Effects on the Hospital
- Leon Levi, Moshe Michaelson, Hanna Admi, David Bregman, Ronen Bar-Nahor
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- Journal:
- Prehospital and Disaster Medicine / Volume 17 / Issue 1 / March 2002
- Published online by Cambridge University Press:
- 28 June 2012, pp. 12-16
- Print publication:
- March 2002
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- Article
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A mass-casualty situation (MCS) usually is short in duration and resolves itself. To minimize the risks to patients during MCS, planning is essential. This article summarizes the preparations needed at the hospital level, for a local MCS involving numerous trauma victims arriving to the Emergency Department at a short notice. Experiences and conclusions related to the implementation of the Israeli strategy in one hospital that combines the responsibilities of both the military and civilians are summarized.
The Ministry of Health distributes the master MCS plan to each hospital where a local committee adapts it to the specific situation in a format of standing orders. After its approval by the Ministry of Health, an annual inspection is conducted to check the ability of the staff to manage a MCS. A full-scale drill is conducted every second year during which each site's readiness level and the continuity of the flow of care are tested.
In building the strategy for treating trauma victims during a MCS, a few assumptions were taken into account. The goal of treatment in a MCS is to deliver an acceptable quality of care while preserving as many lives as is possible. In theory, the capacity of the hospital is its ability to manage a load of patients in the range of 20% of the hospital bed capacity. Planning and drilling are the ways to minimize deviations from the guidelines and to avoid management mistakes. Special attention should be paid to problems related to the initial phase of receiving the first message, outside communication, inside hospital communication, and staff recruitment. Other issues include: free access to the hospital; opening a public information center; and dealing with the media and very important persons (VIPs).
A new method for creating the needed MCS plan in the hospital is suggested. It is based upon knowledge of management techniques that used multi-level documents, which are spread via Intranet between the different key figures. Using this method, it is possible to keep the strategy, the source documentation, and reasons for choosing it, as well as immediate release of checklists for each functions. This detailed, time consuming work is worthwhile in the long run, when the benefits of easy updating and better preparedness are apparent.
Hospital Disaster Management Simulation System
- Lion Levi, David Bregman, Hana Geva, Moshe Revach
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- Journal:
- Prehospital and Disaster Medicine / Volume 13 / Issue 1 / March 1998
- Published online by Cambridge University Press:
- 28 June 2012, pp. 22-27
- Print publication:
- March 1998
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Introduction:
Theoretically, simulation of disastrous situations has many advantages in that it prepares hospital staff to cope with the real scenario. It is a challenge to create the database and custom-making a friendly software while still keeping it representative of a real situation. This article describes experience with developing and implementing the use of simulation software as a drilling technique used by Israeli hospitals.
Methods:The application was developed using SIMAN/ARENA software. Knowledge and a database for a basic multi-casalty incident (MCI) were developed in the pilot phase. It contains detailed description of the casualties which can be compared with the real hospital capabilities (staff and infrastructure). A consensus committe decided the crucial model issues and estaalished the thresholds for quality performance indicators. Interfaces to the each hospital's information management systems (IMS) were developed and the various output documents of each exercised step were updated. Before drilling, the hospital managerial staff received notice and had to prepare the data on the anticipated resources required The simulation staff, as well as representatives from the hospitals, then conducted the limited scale drill (LSD).
Results:During the LSD, the trained hospital staff were given two types of input: 1) copies of reports on patients entering the stations and had to enter them into its IMS; and 2) timed telephone notifications of problems in each station. During a 90 minutes drill, there were about 15 timely reports and 20 telephone problems. The evaluation of the LSD were based mainly on the following: 1) observing the staff solving various problems; 2) constructing a detailed picture of the situation; and 3) measuring the effectiveness of the hospital IMS. The drill ended with a discussion. Lessons are drawn from each drill in order to find methods for optimizing the conduct of the hospital. An animation tool proved to be useful in describing bottle necks in emergency room, diagnostic department, and operating rooms.
Conclusion:Simulation techniques and a preparatory limited scale drill have advantages in evaluating and improving preparedness of hospitals for managing an MCI before a full scale drill is carried out.
Does Number of Beds Reflect the Surgical Capability of Hospitals in Wartime and Disaster? The Use of a Simulation Technique at a National Level
- Lion Levi, David Bregman, Hana Geva, Moshe Revah
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- Journal:
- Prehospital and Disaster Medicine / Volume 12 / Issue 4 / December 1997
- Published online by Cambridge University Press:
- 28 June 2012, pp. 67-71
- Print publication:
- December 1997
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Introduction:
The raw number of hospital trauma beds and occupancy has been used assess the surgical capability of hospitals in wartime and disaster situations. The goal of this study was to examine and offer a better tool to determine the load of casualties that a hospital would be able to absorb and treat effectively during these situations.
Methods:Simulation software was applied to various wartime scenarios. It assessed the usefulness of a computerized simulation of operating room (OR) function under loading of “standard wartime casualties.” Comparison of the functioning of similar hospitals was undertaken in order to identify possible methods to optimize the care delivered. A “what-if” module was used to define the optimal way to absorb mass casualties within the known resources of a given healthcare system. Each hospital was tested under different loading of “standard casualties.” Average waiting time for surgery was used as a marker of the constant decay in the standards of care with the increasing patient load.
Results:Different, unique patterns of strategies for optimizing waiting periods were identified. Not all trauma centers responded by shortening waiting time by diverting the lightly injured patients from them either before or after triage. The reaction to alternate days' shift was unexpected The temporal course of matching a patient with a functional operating room was more indicative of a hospital's capability to absorb casualties requiring surgery than was the pre-set number of beds available in the hospital.
Recommendations:The use of simulation techniques might be useful method to asses the nationwide surgical capability. This is a complex dilemma that cannot be predicted with trivial guessing, even when combined with previous experience of triaging. Analyzing the weak points and bottlenecks at a national level might help in creating preparedness protocols.