Study on the Key Influence Factors of Environmental Mass Incidents by Delphi-PCA-Frequency Analysis Composite Method

In order to prevent and control environmental mass incidents,by comprehensively using literature research,case analysis and logical reasoning method,27 factors influencing environmental mass incidents were selected. Among them,15 key influencing factors were screened by Delphi-PCA-frequency analysis composite method. The key influencing factors were analyzed,and corresponding countermeasures were put forward.

The Usage of Triage Systems in Mass Casualty Incident of Developed Countries

Victims are usually overwhelmed by local medical system in an unexpected mass casualty incident (MCI). Triage systems originate from wartime necessity to achieve the greatest efficiency to the maximum number of victims. In peacetime, the triage systems are applied to allocate constrained medical resources for the victims in MCI. There are several kinds of triage systems in different countries, such as Simple Triage and Rapid Treatment (START), Sort, Assess, Life-saving interventions, Treatment and/or Transport (SALT), Sacco Triage Method (STM), Careflight triage and Triage Sieve (TS). The START system is widely used in developed countries, especially in USA. The SALT is formulated by a work group of the Centers for Disease Control and Prevention (CDC) based on scientific data. STM is a triage algorithm designed for resource-constrained condition. Besides, the other triage systems show their power in managing the victims in MCI. However, the data of theses popular triage tools are mainly based on simulated tests, lacking of validity and reliability of triage systems. Therefore, the application, reliability, sensitivity and specificity of existing triage tools require to be validated in the real condition of MCI. Furthermore, due to the difference among triage tools used in different countries, international cooperation is demanded for a more highly organized mass-casualty medical response.

Research approaches to mass casualty incidents response：development from routine perspectives to complexity science

Objective To review the research methods of mass casualty incident （MCI） systematically and introduce the concept and characteristics of complexity science and artificial system,computational experiments and parallel execution （ACP） method.Data sources We searched PubMed,Web of Knowledge,China Wanfang and China Biology Medicine （CBM） databases for relevant studies.Searches were performed without year or language restrictions and used the combinations of the following key words：“mass casualty incident”,“MCI”,“research method”,“complexity science”,“ACP”,“approach”,“science”,“model”,“system” and “response”.Study selection Articles were searched using the above keywords and only those involving the research methods of mass casualty incident （MCI） were enrolled.Results Research methods of MCI have increased markedly over the past few decades.For now,dominating research methods of MCI are theory-based approach,empirical approach,evidence-based science,mathematical modeling and computer simulation,simulation experiment,experimental methods,scenario approach and complexity science.Conclusions This article provides an overview of the development of research methodology for MCI.The progresses of routine research approaches and complexity science are briefly presented in this paper.Furthermore,the authors conclude that the reductionism underlying the exact science is not suitable for MCI complex systems.And the only feasible alternative is complexity science.Finally,this summary is followed by a review that ACP method combining artificial systems,computational experiments and parallel execution provides a new idea to address researches for complex MCI.

The role of plastic surgeons in extremity reconstruction following mass casualty incidents

Aim: Mass casualty incidents (MCIs) are a devastating source of morbidity and mortality, testing the infrastructure of acute care management and challenging the ability to reconstruct limbs. Herein, we look to further a discussion on upper and lower limb reconstruction following MCIs.Methods: Review of the literature, including our institute's experience with the 2013 Boston Marathon Bombings, the 2015-2016 Terror Attacks in Ankara, and the 2010 earthquake in Haiti, pertaining to extremity reconstruction following MCIs.Results: The three aforementioned case profiles highlight extremity wounds associated with MCIs and the subsequent reconstructive role of plastic surgeons. Surgical intervention or temporization of extremity wounds is a critical responsibility of plastic surgeons in this setting. Limb salvage is possible and often the preferred option following disasters.Conclusion: Intentional or naturally occurring MCIs are a grim reality. Successful response to these events requires prompt mobilization of emergency medical staff and hospital activation. Plastic surgeons play a paramount role in multidisciplinary management of trauma with a particularly important involvement in limb reconstruction.

Mass Casualty Incident Primary Triage Methods in China

Objective：To evaluate the technical characteristics and application of mass casualty incident （MCI） primary triage （PT） methods applied in China.Data Sources：Chinese literature was searched by Chinese Academic Journal Network Publishing Database （founded in June 2014）.The English literature was searched by PubMed （MEDLINE） （1950 to June 2014）.We also searched Official Websites of Chinese Central Government＇s （http：//www.gov.cn/）,National Health and Family Planning Commission of China （http：//www.nhfpc.gov.cn/）,and China Earthquake Information （http：//www.csi.ac.cn/）.Study Selection：We included studies associated with mass casualty events related to China,the PT applied in China,guidelines and standards,and application and development of the carding PT method in China.Results：From 3976 potentially relevant articles,22 met the inclusion criteria,20 Chinese,and 2 English.These articles included 13 case reports,3 retrospective analyses of MCI,two methods introductions,three national or sectoral criteria,and one simulated field testing and validation.There were a total of 19 kinds ofMCI PT methods that have been reported in China from 1950 to 2014.In addition,there were 15 kinds of PT methods reported in the literature from the instance of the application.Conclusions：The national and sectoral current triage criteria are developed mainly for earthquake relief.Classification is not clear.Vague criteria （especially between moderate and severe injuries） operability are not practical.There are no triage methods and research for children and special populations.There is no data and evidence supported triage method.We should revise our existing classification and criteria so it is clearer and easier to be grasped in order to build a real,practical,and efficient PT method.

Development of the science of mass casualty incident management: reflection on the medical response to the Wenchuan earthquake and Hangzhou bus fire

Objective： In this paper, we review the previous classic research paradigms of a mass casualty incident （MCI） systematically and reflect the medical response to the Wenchuan earthquake and Hangzhou bus tire, in order to outline and develop an improved research paradigm for MCI management. Methods： We searched PubMed, EMBASE China Wanfang, and China Biology Medicine （CBM） databases for relevant studies. The following key words and medical subject headings were used： ＇mass casualty incident＇, ＇MCI＇, ＇research method＇, ＇Wenchuan＇, ＇earthquake＇, ＇research paradigm＇, ＇science of surge＇, ＇surge＇, ＇surge capacity＇, and ＇vulnerability＇. Searches were performed without year or language restriction. After searching the four literature databases using the above listed key words and medical subject headings, related articles containing research paradigms of MCI, 2008 Wenchuan earthquake, July 5 bus fire, and science of surge and vulnerability were independently included by two authors. Results： The current progresses on MCI management include new golden hour, damage control philosophy, chain of survival, and three links theory. In addition, there are three evaluation methods （medical severity index （MSI）, potential injury creating event （PICE） classification, and disaster severity scale （DSS））, which can dynamically assess the MCI situations and decisions for MCI responses and can be made based on the results of such evaluations. However, the three methods only offer a retrospective evaluation of MCI and thus fail to develop a real-time assessment of MCI responses. Therefore, they cannot be used as practical guidance for decision-making during MCI. Although the theory of surge science has made great improvements, we found that a very important factor has been ignored--vulnerability, based on reflecting on the MCI response to the 2008 Wenchuan earthquake and July 5 bus fire in Hangzhou. Conclusions： This new paradigm breaks through the limitation of traditional research paradigms and will contribute to the development of a methodology for disaster research.

Mass-Casualty Distribution for Emergency Healthcare:A Simulation Analysis

This study focuses on the casualty-load distribution problem that arises when a mass casualty incident(MCI)necessitates the engagement of multiple medical facilities.Employing discrete event simulations,the study analyzed different MCI response regimes in Lahore,Pakistan,that vary in terms of the level of casualty-load distribution and the required coordination between the incident site and the responding hospitals.Past terrorist attacks in this major metropolitan area were considered to set up experiments for comparing delays in treatment under the modeled regimes.The analysis highlights that the number of casualties that are allowed to queue up at the nearest hospital before diverting the casualty traffic to an alternate hospital can be an important factor in reducing the overall treatment delays.Prematurely diverting the casualty traffic from the incident site to an alternate hospital can increase the travel time,while a delay in diversion can overload the nearest hospital,which can lead to overall longer waiting times in the queue.The casualty distribution mechanisms based only on the responding hospitals’available capacity and current load can perform inefficiently because they overlook the trade-off between the times casualties spend in traveling and in queues.

Civilian casualties of Iraqi ballistic missile attack to Tehran, capital of Iran

Objective： To determine the pattern of causalities of Iraqi ballistic missile attacks on Tehran, the capital of Iran, during Iraq-Iran war. Methods： Data were extracted from the Army Staff Headquarters based on daily reports of Iranian army units during the war. Results： During 52 days, Tehran was stroked by 118 A1-Hussein missiles （a modified version of Scud missile）. Eighty-six missiles landed in populated areas. During Iraqi missile attacks, 422 civilians died and 1 579 injured （4.9 deaths and 18.3 injuries per missile）. During 52 days, 8.1 of the civilians died and 30.4 injured daily. Of the cases that died, 101 persons （24%） were excluded due to the lack of information. Among the remainders, 179 （55.8%） were maleand 142 （44.2%） were female. The mean age of the victims was 25.3 years＋19.9 years. Our results show that the high accuracy of modified Scud missiles landed in crowded areas is the major cause of high mortality in Tehran. The presence of suitable warning system and shelters could reduce civilian casualties. Conclusion： The awareness and readiness of civilian defense forces, rescue services and all medical facilities for dealing with mass casualties caused by ballistic missile at- tacks are necessary.