In a moment's notice : surge capacity for terrorist bombings : challenges and proposed solutions

"Explosive devices and high-velocity firearms are the most common weapons used by terrorists. The morbidity and mortality inflicted in two European capitals, Madrid, Spain, and London, England, in 2004 and 2005 respectively, demonstrates the impact of detonating explosives in densely populated civilian areas. Explosions can produce instantaneous havoc, resulting in numerous casualties with complex, technically challenging injuries not commonly seen after natural disasters. Because many patients self-evacuate after a terrorist attack and prehospital care may be difficult to coordinate, hospitals near the scene can expect to receive a large influx, or surge, of victims after a terrorist strike. This rapid surge of victims typically occurs within minutes, exemplified by the Madrid bombings where the closest hospital received 272 patients in 2.5 hours. Such a surge differs dramatically from the gradual influx of patients after infectious disease outbreaks or environmental emergencies such as heat waves. In addition, injuries to workers involved in rescue and recovery can lead to a secondary wave of patients. To address the challenges posed by such an event, the Centers for Disease Control and Prevention (CDC)'s National Center for Injury Prevention and Control (NCIPC), Division of Injury Response (DIR) convened expert panels in October 2005, January 2006, and June 2009. These panels included experts in emergency medical services (EMS), emergency medicine, trauma surgery, burn surgery, pediatrics, otolaryngology, intensive care medicine, hospital medicine, radiology, pharmacology, nursing, hospital administration, bloodbanking, and public health. The panels were tasked with identifying creative strategies that could be adopted in a timely manner to address medical care surge issues from terrorism, and the panel experts focused on rapidly managing large numbers of bombing casualties. They examined challenges that would confront not only the general emergency medical response and health care system, but also select medical disciplines. Although developed for addressing a surge of injuries from a terrorist bombing, the recommendations in this report may also improve the management of a surge from other mass casualty events, including biological, chemical, or nuclear attacks. This document reflects the recommendations of the expert panels. It includes a description of system-wide and discipline-specific challenges as well as recommendations to address these issues. Solutions for the discipline-specific challenges have been incorporated into easy-to-use templates that can assist various disciplines in managing surge needs for injuries. The needs and resources of each community must be considered to effectively plan for a surge of patients into an already overburdened health care system." p. 2-3Executive summary -- Introduction -- Surge capacity challenges and solutions: system-wide challenges -- Surge capacity challenges and solutions: discipline-specific challenges -- Addressing discipline-specific challenges: surge action templatesUpdates: In a moment's notice : surge capacity for terrorist bombings : challenges and proposed solutions, published 2007.Authors of the "Updated In A Moment's Notice: Surge Capacity for Terrorist Bombings" 2010: Richard C. Hunt, Vikas Kapil, Sridhar V. Basavaraju, Scott M. Sasser, Lisa C. McGuire, and Ernest E. Sullivent.Produced by the National Center for Injury Prevention and Control Division of Injury Response.Mode of access: World Wide Web as an Acrobat .pdf file (655 KB, 60 p.).Includes bibliographical references (p. 59-60).National Center for Injury Prevention and Control: Updated In A Moment's Notice: Surge Capacity for Terrorist Bombings. Atlanta, GA: Centers for Disease Control and Prevention; 2010