Medicolegal Aspects during Mass Casualty Due to Road Traffic Accidents in the Era of Covid: A Tertiary Care Institutional Experience

Background: In March 2020, the world health organization declared COVID-19 a world wide pandemic. Countries introduced public health measures to contain and reduce its spread. The effect of mandated societal lockdown to reduce the transmission of corona virus disease 2019 (COVID-19) on road traffic accidents is not known. For this we performed an in-depth analysis singdata of emergency and trauma centre UPUMS, Saifai. As most of the manpower was involved in managing Covid patients directly or indirectly, it was a challenge to manage these mass casualty patients who require intensive care as well as Medicolegal documentation, record keeping, Consent for life saving procedures in absence of Relatives. Material(s) and Method(s): We reviewed data on total 2876 road traffic accident records in UPUMS, Saifai from January 1, 2020 through September 30, 2020. We treated March 20th as the first day of mandated societal lock down and 1st July as the first day of re-opening. Result(s): We have found that the reis increase in road traffic accidents resulting in serious or fatal injuries during lockdown and post-lockdown period. There was increased Medicolegal burden in spite of the decreased medical resources, manpower as most of manpower and resources were being utilized for covid patients. Conclusion(s): Road traffic accidents are a prominent contributor to hospitalization and may negatively impact the existing hospital resources directed towards COVID-19.Copyright © 2023, World Informations Syndicate. All rights reserved.

Double impact: can our health care system deal with a terrorist attack during the COVID pandemic?

Health care organizations have been challenged by the COVID-19 pandemic since the first half of 2020. Both hospitals (especially emergency and intensive care departments) and ambulance services were overwhelmed by surging patient numbers during the 2 pandemic waves in 2020. In this study, the data of the 2016 multisite terrorist bombing attacks in Zaventem (Brussels International Airport) and Maalbeek (subway) are reviewed. It is simulated what the impact of similar attacks would be on an already challenged health care system and which COVID-19-specific measures would be favourable for the outcome. The limited access of ICU beds, operating rooms and surge capacity, as well as the number of COVID-positive victims are cardinal features challenging the medical response to mass casualty incidents of this magnitude. During the COVID-19 pandemic, disaster management is affected by the limited availability of intensive care beds and operation rooms, and the faltering reverse triage negatively influencing the response capacity. On the other hand, the impact of the COVID pandemic can also be favourable. Special concerns on a COVID-19-safe response are discussed. It must be avoided that the medical response and gathering of stranded passengers would become a superspreading event. Multisite terrorist attacks during a pandemic are possibly catastrophic for a health care system which is already beyond its limit in terms of surge capacity. COVID-19-specific recommendations for disaster management in case of terrorist attacks are provided.

Escape this emergency room: Simulation education during a pandemic

Learning Objectives: To provide emergency medicine (EM) residents an educational activity that promotes teamwork and wellness. It includes cooperative problem solving, task-delegation, pride in team accomplishments, and recall of emergency medicine knowledge all while staying compliant with social distancing guidelines. : Background: Escape Room is a game in which participants solve puzzles in order to escape a room.The game engages participants' knowledge and problem-solving while also encouraging teamwork.In professional medical education, strategies that promote active learning are in demand.Activities like Escape Rooms can foster wellness among the residents based on overwhelming satisfaction from participants in previous studies.Furthermore, social distancing during the COVID-19 pandemic has limited the ability of residencies to gather large groups for didactics.The Escape Room format by its nature, provides an activity that requires fewer learners at a time to be present.Its implementation can foster wellness through social interaction while staying compliant with local public health guidelines. Design: EM simulation faculty devised puzzles based on a mass casualty incident.The scenario presented EM residents with multiple simulated patients.Residents identified the solutions to the puzzles as they resuscitated patients, performed procedures, identified injuries, calculated medication doses and triaged arrivals.Prior to presenting a high-fidelity environment with manikins, procedural-trainers and locked-boxes, faculty piloted the scenario with low-cost elements like envelopes, pictures and index cards.This pilot defined the flow of the escape room and offered an alternative table top version.The completed Escape Room was played by 3-5 residents in a large simulated resuscitation bay with 5 manikins (Figure). Afterwards, residents completed a survey assessing how well the activity promoted education, teamwork and wellness. Effectiveness: In 2020, 19 residents divided into teams played the escape room in sequence. According to survey results (Table 1), they answered yes regarding the activity's promotion of education, teamwork and wellness. Respondents commonly asked for more. In practice,Escape Room can be an effective social and educational tool during a pandemic.

Management of Mass Death in COVID-19 Pandemic in an Indian Perspective.

Current international experience has shown the vulnerability of health-care systems of developed nations, and of developing nations such as India, to coronavirus disease 2019 (COVID-19). COVID-19 pandemic is a disaster with mass casualties. International experience has revealed that, even in the countries where mass disasters are less frequent and not involved in conflicts, they are overwhelmed with COVID-19 deaths. Although, in the current scenario with fewer deaths, India's health-care system can handle the situation of COVID-19 but should be prepared for the worst in terms of appropriate management, and adequate infection prevention measures including handling the dead without hampering the dignity of the deceased and of the surviving family. Before any crisis overwhelms responders and resources, emergency response plans should be established and activated to ensure the reliable identification and documentation of the dead. The current review was carried out to recommend the proper management of dead bodies in the COVID-19 mass disaster with a particular focus on resource-poor countries, such as India.

Increasing ventilator surge capacity in COVID 19 pandemic: design, manufacture and in vitro-in vivo testing in anaesthetized healthy pigs of a rapid prototyped mechanical ventilator.

OBJECTIVE: The advent of new technologies has made it possible to explore alternative ventilator manufacturing to meet the worldwide shortfall for mechanical ventilators especially in pandemics. We describe a method using rapid prototyping technologies to create an electro-mechanical ventilator in a cost effective, timely manner and provide results of testing using an in vitro-in vivo testing model. RESULTS: Rapid prototyping technologies (3D printing and 2D cutting) were used to create a modular ventilator. The artificial manual breathing unit (AMBU) bag connected to wall oxygen source using a flow meter was used as air reservoir. Controlled variables include respiratory rate, tidal volume and inspiratory: expiratory (I:E) ratio. In vitro testing and In vivo testing in the pig model demonstrated comparable mechanical efficiency of the test ventilator to that of standard ventilator but showed the material limits of 3D printed gears. Improved gear design resulted in better ventilator durability whilst reducing manufacturing time (< 2-h). The entire cost of manufacture of ventilator was estimated at 300 Australian dollars. A cost-effective novel rapid prototyped ventilator for use in patients with respiratory failure was developed in < 2-h and was effective in anesthetized, healthy pig model.