Royal London Hospital, London, UK; Raigmore Hospital, Inverness, UK.
Shaare Zedek Medical Center, Jerusalem, Israel.
Br J Anaesth. 2022 Feb;128(2):e168-e179. doi: 10.1016/j.bja.2021.10.003. Epub 2021 Nov 6.
Reports published directly after terrorist mass casualty incidents frequently fail to capture difficulties that may have been encountered. An anonymised consensus-based platform may enable discussion and collaboration on the challenges faced. Our aim was to identify where to focus improvement for future responses.
We conducted a mixed methods study by email of clinicians' experiences of leading during terrorist mass casualty incidents. An initial survey identified features that worked well, or failed to, during terrorist mass casualty incidents plus ongoing challenges and changes that were implemented as a result. A follow-up, quantitative survey measured agreement between responses within each of the themes using a Likert scale.
Thirty-three participants responded from 22 hospitals that had received casualties from a terrorist incident, representing 17 cities in low-middle, middle and high income countries. The first survey identified themes of sufficient (sometimes abundant) human resource, although coordination of staff was a challenge. Difficulties highlighted were communication, security, and management of blast injuries. The most frequently implemented changes were education on specific injuries, revising future plans and preparatory exercises. Persisting challenges were lack of time allocated to training and psychological well-being. The follow-up survey recorded highest agreement amongst correspondents on the need for re-triage at hospital (90% agreement), coordination roles (85% agreement), flexibility (100% agreement), and large-scale exercises (95% agreement).
This survey collates international experience gained from clinicians managing terrorist mass casualty incidents. The organisation of human response, rather than consumption of physical supplies, emerged as the main finding. NHSH Clinical Effectiveness Unit project registration number: 2020/21-036.
恐怖袭击大规模伤亡事件发生后立即发布的报告往往未能捕捉到可能遇到的困难。一个匿名的基于共识的平台可以促进对所面临挑战的讨论和协作。我们的目的是确定未来应对工作的重点改进方向。
我们通过电子邮件对临床医生在恐怖袭击大规模伤亡事件中的领导经验进行了混合方法研究。初步调查确定了恐怖袭击大规模伤亡事件中表现良好或失败的特征，以及因此而实施的持续挑战和变革。后续的定量调查使用李克特量表衡量每个主题内的回复之间的一致性。
来自 22 家接收过恐怖袭击伤员的医院的 33 名参与者参与了研究，这些医院代表了中低收入、中等收入和高收入国家的 17 个城市。第一次调查确定了人力资源充足（有时甚至丰富）的主题，但人员协调是一个挑战。突出的困难包括沟通、安全和爆炸伤的管理。实施频率最高的变革是针对特定伤害进行教育、修订未来计划和准备演习。持续存在的挑战是缺乏分配给培训和心理健康的时间。后续调查记录了受访者对医院重新分诊（90%的一致）、协调角色（85%的一致）、灵活性（100%的一致）和大规模演习（95%的一致）的强烈需求。
这项调查汇集了管理恐怖袭击大规模伤亡事件的临床医生获得的国际经验。人员反应的组织，而不是物资的消耗，是主要发现。NHSH 临床效果评估单位项目注册号：2020/21-036。
