The use of explosives by terrorists usually cause mass casualties in a time of disaster. The injured people require critical care during this time before they are transferred to the hospital. It means that pre-hospital care for a vital component of a comprehensive medical response to a mass casualty event (MCE) stemming from the terrorist use of explosives. Healthcare professionals handling these patients at the time of injury are required to apply the various principles set out to care for injured patients before being transferred to the hospital. The essay discusses the principles of pre-hospital care during a terrorist use of explosives MCE.
The Principles of Pre-Hospital Care during a Terrorist Use of Explosives MCE
The principles define the responsibility of the emergency medical services in responding, rescuing, collecting casualties, triage and providing initial treatment before transporting the patients to the appropriate hospitals or other medical facilities. The Center for Diseases Control and Prevention (CDC) (2012) guidelines provide three major principles that must be followed by EMS after arriving at the scene of injury. These principles of pre-hospital care include determining the severity of the injury, initiating how to manage the injuries of the patients as assess and decide on the most appropriate hospital destination to transport each patient based on their level of injuries.
Stage and Triage Patients
The EMS personnel and resources should be used to the maximum to provide the casualties with the care they need. Each group of patients should be removed from the direct hazard effect region (CDC, 2010). It is important to stage the patients into the EMS system for triage as well as distribution to the defined care areas. Ensure to establish the different areas where the patients are held during the terrorist use of explosives MCE for preparing of formal triage and protocols of treatment. Based on the defined situation for each patient, healthcare priorities should be given to the patients who are critically injured and with the highest chances of curving. Basic treatment for casualties should aim at stabilizing their life-threatening medical situations.
The CDC (2012) provides four criteria field triage process to assess patients for casualties before staging them for triage, basic treatment and later transporting to the various healthcare facilities. The criteria include the physiologic, anatomic, mechanism of injury and special considerations
This principle requires the emergency medical services to identify the patients who are critically injured through an assessment of their consciousness and measure the vital signs including respiratory rate as well as systolic blood pressure. The criteria are important in identifying severe injuries that need the high-level care of trauma. Patients meeting the physiologic criteria should be taken to a facility that gives the highest level of care when the trauma system reads Glasgow Coma Scale less or equal to 13. The respiratory rate is less than10, or greater than 29 breaths per minute for adults, less than 20 for infant aged less than 1 year, SBP of <90 mmHg, or the need for ventilatory assistance (CDC, 2012).
The second principle requires that assessment of injuries at the chest and extremity for patients who present normal physiology after initial presentation. The anatomic criteria of the chest and extremity assessment are necessary for identifying patients with an anatomic injury. These patients will require transporting to high levels of care as defined in the trauma system. They have penetrating injuries at the torso, head, neck, and extremities that are proximal to knee or elbow. Pelvic fractures, instability of the chest wall, paralysis, open or depressed skull, amputation to ankle or wrist among others injuries (CDC, 2012).
Mechanism of Injury (MOI)
The third principle requires the inclusion of the roof intrusion for patients who do not fit within the physiologic and anatomic criteria. For the roof intrusion, the emergency medical services should assess the patients regarding their mechanism of injury. The criterion is useful in determining whether a patient's injury have a possibility of being severe but occult. In that case, the EMS will understand whether a patient requires being sent to a trauma center or not (CDC, 2012).
It requires evaluating patients based on their age and health conditions. The EMS must assess patients meeting the physiologic, anatomic and MOI criteria for any underlying conditions or other comorbid factors that place them at a greater risk of getting an injury. Such an assessment is also critical in helping the EMS to identify those who are seriously injured during the terrorist use of explosives MCE. When identified, such patients should be sent to a trauma center care (CDC, 2012). The needs of the special populations such as children the elderly, those in need of dialysis, and the disabled should be met immediately (CDC, 2011).
Pre-hospital care has been established as a critical element of a medical response that is comprehensive to an MCE stemming from the terrorist use of explosives. Based on the discussion, the principles for pre-hospital care for patient casualties from an MCE arising due to the use of terrorist use of explosives require first staging all the patients for triage. Assessment is critical for every patient based on the above four criteria including physiologic, anatomic, MOI and special considerations. Every group of patients should be provided with the recommended basic care and moved to a trauma center immediately.
CDC. (2010). Interim planning guidance for preparedness and response to a mass casualty event resulting from the terrorist use of explosives. The U.S Department of Health and Human Services. Retrieved from https://www.calhospitalprepare.org/sites/main/files/file-attachments/interi1.pdf
CDC. (2011, April). Chapter 3: Public health emergency response functions and tasks during the acute phase. The CDC Preparedness and Response Guide. Retrieved from https://emergency.cdc.gov/planning/pdf/cdcresponseguide.pdf
CDC. (2012, January). Guidelines for field triage of injured patients: Recommendations of the national expert panel on field triage, 2011. Recommendations and Reports. 61(RR01); 1-20. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6101a1.htm
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