Lin Chien-Hao, Tay Joyce, Tsai Chu-Lin, Chou Wei-Kuo, Cheng Ming-Tai, Wu Cheng-Yi, Liu Hung-Chieh, Hsu Shu-Hsien, Lu Chien-Hsin, Shih Frank Fuh-Yuan, Lin Chih-Hao
National Taiwan University Hospital Department of Emergency Medicine Taipei Taiwan.
National Taiwan University Hospital Hsin-Chu Branch Department of Emergency Medicine Hsinchu Taiwan.
J Acute Med. 2023 Mar 1;13(1):20-35. doi: 10.6705/j.jacme.202303_13(1).0004.
Mass casualties caused by natural disasters and man-made events may overwhelm local emergency medical services and healthcare systems. Logistics is essential to a successful emergency medical response. Drills have been used in disaster preparedness to validate plans, policies, procedures, and agreements, and identify resource gaps. The application of the internet to facilitate the conduct of exercise was still limited. This study aimed to investigate the optimal preparation of medical supplies by medical emergency response teams (MERTs) during emergencies and disasters using an internet-based drill.
An internet-based drill based on real-life mass casualty incidents (MCIs) was developed and conducted in Taiwan from June 2017 to July 2018. The drill involved an MCI with 50 events delivered under two scenarios: (1) reduced transfer capacity and well-functioning local healthcare facilities (emergency module); (2) severely reduced transfer capacity and dysfunctional local healthcare facilities (disaster module). For each event, medical supplies commonly prepared by local MERTs in Taiwan were listed in structured questionnaires and participants selected the supplies they would use.
Forty-three senior medical emergency responders participated in the survey (responding rate of 47.3%). Resuscitation-related supplies increased from emergency to disaster module (e.g., intubation from 9.1% to 13.9%; dopamine from 3.2% to 5.0%; all < 0.001). In the subgroup analysis of events with life-threatening injuries, the utilization of resuscitation-related supplies (e.g., intubation from 46.6% to 65.3%; < 0.001) remained higher in the disaster than in the emergency module. Compared to emergency medical technicians, physicians and nurses are more likely to use intravenous/intramuscular analgesics.
The severity of scenarios and the professional background of emergency responders have a different utilization of medical supplies in the simulation drill. The internet-based drill may contribute to optimizing the preparedness of medical response to prehospital emergencies and disasters.
自然灾害和人为事件造成的大规模伤亡可能使当地的紧急医疗服务和医疗保健系统不堪重负。后勤保障对于成功的紧急医疗响应至关重要。演练已被用于灾难准备工作，以验证计划、政策、程序和协议，并识别资源缺口。利用互联网促进演练实施的应用仍然有限。本研究旨在通过基于互联网的演练，调查医疗应急响应团队（MERTs）在紧急情况和灾难期间医疗用品的最佳准备情况。
2017年6月至2018年7月在台湾开展了一项基于真实大规模伤亡事件（MCIs）的互联网演练。该演练涉及一个有50起事件的大规模伤亡事件，分两种场景进行：（1）转运能力下降且当地医疗设施运转良好（应急模块）；（2）转运能力严重下降且当地医疗设施功能失调（灾难模块）。对于每起事件，在结构化问卷中列出了台湾当地MERTs通常准备的医疗用品，参与者选择他们会使用的用品。
43名高级医疗应急响应人员参与了调查（响应率为47.3%）。与复苏相关的用品从应急模块到灾难模块有所增加（例如，插管从9.1%增至13.9%；多巴胺从3.2%增至5.0%；均P<0.001）。在对危及生命伤害事件的亚组分析中，灾难模块中与复苏相关用品的使用率（如插管从46.6%增至65.3%；P<0.001）仍高于应急模块。与急诊医疗技术人员相比，医生和护士更有可能使用静脉内/肌内注射镇痛药。
在模拟演练中，场景的严重程度和应急响应人员的专业背景对医疗用品的使用情况有不同影响。基于互联网的演练可能有助于优化对院前紧急情况和灾难的医疗响应准备。
