Assessment of hospital disaster plans for conventional mass casualty incidents following terrorist explosions using a live exercise based upon the real data of actual patients.

PURPOSE: The National Committee for Hospital Preparedness for Conventional Mass Casualty Incidents and the Hospital Preparedness Division of the Home Front Command are in charge of preparing live exercises held yearly in public hospitals in Israel. Our experience is that live exercises are limited in their ability to test clinical decision making and its influence upon incident management. A live exercise was designed upon real patient data and tested in several public hospitals. The aim of the manuscript is to describe the impact of this new format on clinical decision making in large-scale live exercises. METHODS: A database of histories, physical examination findings, laboratory results and imaging results for 420 patients treated following terrorist explosions was created using information derived from actual patient encounters. Similar information for 100 patients treated following motor vehicle accidents was also collected. Information from the database was used to create victim profiles used during the course of exercises held in eight public hospitals with 60-800-bed capacities. RESULTS: Before implementing the new injury tags, no conclusions could be made concerning the quality of clinical decision making. Conducting the exercise using the new format helped identify deficiencies in the hospital disaster plan in triage, emergency department management and in the proper utilisation of resources such as radiology, operating rooms and the secondary transfer of patients. CONCLUSION: Previous knowledge of patient diagnoses and resource needs allow the identification and quantification of deficiencies and problems identified in clinical decision making, resource utilisation and incident management.

[Trauma registry database].

Trauma registry is vital for every trauma center. In 1995, data on all injured patients who reached our trauma unit were collected. 3.040 patients were hospitalized, of whom 416 were transferred from other hospitals. We describe the distribution of the patients to in-patient wards and present the relationship between mortality and injury severity score. 1102 hospitalized patients underwent a total of 1599 operations with an overall mortality of 2.63%.

Aspirated tooth removal from airway through tracheotomy and flexible bronchoscopy.

Aspiration of a tooth in facial trauma is a known complication. A complicated case of tooth aspiration with a compromised airway in a 28-year-old woman is described. The tooth was in the left main bronchus. A special technique involving flexible bronchoscopy, Fogarty catheter, and tracheotomy was used to extract the tooth.