FH Sammy Ross, Jr, Trauma Center, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina 28203, USA.
J Trauma Acute Care Surg. 2012 Sep;73(3):592-7; discussion 597-8. doi: 10.1097/TA.0b013e318265cbb2.
Man-made (9/11) and natural (Hurricane Katrina) disasters have enlightened the medical community regarding the importance of disaster preparedness. In response to Joint Commission requirements, medical centers should have established protocols in place to respond to such events. We examined a full-scale regional exercise (FSRE) to identify gaps in logistics and operations during a simulated mass casualty incident.
A multiagency, multijurisdictional, multidisciplinary exercise (FSRE) included 16 area hospitals and one American College of Surgeons-verified Level I trauma center (TC). The scenario simulated a train derailment and chemical spill 20 miles from the TC using 281 moulaged volunteers. Third-party contracted evaluators assessed each hospital in five areas: communications, command structure, decontamination, staffing, and patient tracking. Further analysis examined logistic and operational deficiencies.
None of the 16 hospitals were compliant in all five areas. Mean hospital compliance was 1.9 (± 0.9 SD) areas. One hospital, unable to participate because of an air conditioner outage, was deemed 0% compliant. The most common deficiency was communications (15 of 16 hospitals [94%]; State Medical Asset Resource Tracking Tool system deficiencies, lack of working knowledge of Voice Interoperability Plan for Emergency Responders radio system) followed by deficient decontamination in 12 (75%). Other deficiencies included inadequate staffing based on predetermined protocols in 10 hospitals (63%), suboptimal command structure in 9 (56%), and patient tracking deficiencies in 5 (31%). An additional 11 operational and 5 logistic failures were identified. The TC showed an appropriate command structure but was deficient in four of five categories, with understaffing and a decontamination leak into the emergency department, which required diversion of 70 patients.
Communication remains a significant gap in the mass casualty scenario 10 years after 9/11. Our findings demonstrate that tabletop exercises are inadequate to expose operational and logistic gaps in disaster response. FSREs should be routinely performed to adequately prepare for catastrophic events.
人为灾难（911 事件）和自然灾难（卡特里娜飓风）使医学界认识到灾难准备的重要性。为了响应联合委员会的要求，医疗中心应该制定应对此类事件的协议。我们研究了一次全面的区域演习（FSRE），以确定在模拟大规模伤亡事件期间物流和运营方面的差距。
多机构、多司法管辖区、多学科演习（FSRE）包括 16 家地区医院和一家经美国外科医师学会认证的一级创伤中心（TC）。该场景模拟了距离 TC 20 英里的火车脱轨和化学物质泄漏事故，使用了 281 名模拟志愿者。第三方合同评估员评估了每家医院的五个方面：沟通、指挥结构、净化、人员配备和患者跟踪。进一步分析检查了后勤和运营方面的缺陷。
没有一家医院在所有五个方面都符合要求。医院平均合规性为 1.9（±0.9 标准差）个方面。由于空调故障而无法参加的一家医院被认为是 0%合规。最常见的缺陷是沟通（16 家医院中有 15 家[94%]；州医疗资产资源跟踪工具系统缺陷，缺乏紧急救援人员语音互操作性计划的工作知识），其次是净化不足，有 12 家（75%）。其他缺陷包括 10 家医院（63%）根据预定协议 staffing 不足、9 家（56%）指挥结构不佳、5 家（31%）患者跟踪缺陷。还确定了其他 11 项运营和 5 项后勤失败。TC 显示出适当的指挥结构，但在五个类别中有四个类别存在缺陷，人员配备不足，净化泄漏到急诊室，导致 70 名患者转移。
911 事件发生 10 年后，在大规模伤亡场景中，沟通仍然是一个重大差距。我们的研究结果表明，桌面演习不足以暴露灾难应对中的运营和后勤差距。应该定期进行全面的区域演习，为灾难性事件做好充分准备。
