Surgeons OverSeas (SOS), New York, New York 10003, USA.
Br J Surg. 2012 Mar;99(3):356-61. doi: 10.1002/bjs.7762. Epub 2011 Dec 21.
A mass casualty incident (MCI) occurs when a disaster involves a large number of injured people, overwhelming the capacity of local emergency medical services. This article describes the planning and execution of a MCI workshop created for use in Sierra Leone, a low-income country.
Surgeons OverSeas (SOS), an international non-governmental organization, partnered with the Sierra Leone Office of National Security and Connaught Hospital to develop a 2-day MCI workshop designed to meet needs specific to their resource-limited environment. Pre- and post-course questionnaires were completed. Day 1 consisted of didactic teaching focused on triage principles, resource deployment, communication/operations and tabletop drills. On day 2 a mock MCI with performance assessments by independent observers was staged, followed by post-event debriefing.
Pre-course questionnaires identified the following deficits: lack of triage training (29 per cent), and transportation (19 per cent) and communication (17 per cent) shortfalls. Only 11 per cent could define MCI. During the drill, on-scene and hospital triage was accurate in 28 (93 per cent) and 23 (77 per cent) of 30 casualties respectively. Systematic deficiencies identified included: transport issues, no accurate system for tracking victims, and undersized triage areas. Participants identified interagency coordination (63 of 136 responses; 46·3 per cent) and triage (32 of 136; 23·5 per cent) as the most valuable lessons learned.
Pre-existing MCI programmes based on first-world logistics do not account for challenges encountered when caring for casualties in resource-constrained settings. Logistical training, rather than medical skills or knowledge, was identified as the educational priority.
当灾难涉及大量伤员，超出当地紧急医疗服务能力时，就会发生大规模伤亡事件 (MCI)。本文描述了为塞拉利昂这个低收入国家创建的 MCI 研讨会的规划和执行情况。
国际非政府组织“海外外科医生”（SOS）与塞拉利昂国家安全办公室和康诺特医院合作，开发了为期两天的 MCI 研讨会，旨在满足其资源有限环境的特定需求。在课程开始前和结束后完成问卷调查。第一天包括以分诊原则、资源部署、沟通/运营和桌面演练为重点的理论教学。第二天进行了模拟 MCI，由独立观察员进行绩效评估，随后进行了事后汇报。
课程开始前的问卷调查确定了以下不足之处：缺乏分诊培训（29%）、交通（19%）和沟通（17%）方面的不足。只有 11%的人能够定义 MCI。在演练中，现场和医院分诊在 30 名伤员中的 28 名（93%）和 23 名（77%）是准确的。发现的系统缺陷包括：交通问题、没有准确的受害者跟踪系统和分诊区面积不足。参与者确定了机构间协调（136 个回应中的 63 个；46.3%）和分诊（136 个回应中的 32 个；23.5%）是最有价值的经验教训。
基于第一世界物流的现有 MCI 计划没有考虑到在资源有限的环境中照顾伤员时遇到的挑战。物流培训，而不是医疗技能或知识，被确定为教育的优先事项。
