DISAST-CIR: Disastrous incidents systematic analysis through components, interactions and results: application to a large-scale train accident.

Disasters or hazardous incidents, either natural or man-made, continue to increase in frequency and affect more and more citizens of the world community. Many of these are published in the medical literature, each being a "case report" of a single event. In clinical medicine, a common nomenclature and uniform reporting of data enables the collection of similar cases to series studies, with clinical conclusions being drawn. Such a platform is lacking in the field of disaster medicine, impairing the ability to learn from past experiences. In the Medical Department of the Israeli Home Front Command, we coordinate the operation of various medical units and forces in a wide array of events. By doing so, we collect and analyze the relevant data related to disaster management, various components of the medical response, interactions between different components, and the ensuing results. We developed a systematic method of analyzing and describing disaster management issues in various events-DISAST-CIR-Disastrous Incidents Systematic AnalysiS Through Components, Interactions, Results. In this article, we describe this method by presenting the components, interactions, and results of a large-scale train accident that resulted in 270 casualties, 35 of whom were evacuated by helicopters from the accident site. Casualties were distributed among 10 different hospitals. The death toll was 7 people, 5 of whom died at the scene and 2 who died in hospitals. We recommend this method as a standard for scientific reporting of hazardous incidents. Accumulation of data, reported in a similar standardized fashion, would enable comparison and reporting of series, improving our understanding regarding the optimal medical response to various events.

Role of the anaesthetist in developing and implementing readiness of hospital to mass casualty incidents.

PURPOSE OF REVIEW: A mass casualty incident is usually short and resolves itself. To minimize the risks to patients during mass casualty incidents, planning is essential. We hereby provide our experience with a recent literature review of the steps to provide the hospital with an efficient plan to overcome mass casualty situations of a traumatic nature, with special implications for the anaesthetist's role. RECENT FINDINGS: Preparation of the hospital starts with an accepting master plan and guidelines for creating local standing orders for this scenario. The hospital should work step by step in adjusting the master plan to its local requirements and infrastructure. During this work, one will find that it is not only technical or logistic but should address medical issues, with pertinent information from clinicians of different specialities. After authorization of the preparedness plan, it should be tested in limited scale drills, and then implemented in the hope that it will never need to be used. Periodic adjustments according to threats and new concepts and equipment should be made. SUMMARY: As a result of recent events, a major effort is considered to improve the preparedness plan of the hospital for mass casualty incidents. However, common surveyors report their unease with the current ability to cope with disasters. The involvement of medical teams in the process is mandatory to lessen the effects of the first wave of casualties and to be able to cope with the second wave.