Be prepared: more than a boy/girl scout motto
Myron Yaster MD, Deborah A. Schwengel MD, and Robert S. Greenberg MD
We live in a world of danger in which disasters, both natural and man-made, are ever present and increasing. Are you and your institution prepared to manage a mass casualty incident? Unfortunately, based on personal experience and the literature, I suspect not.1-3 My dear friends and colleagues, Drs. Deborah Schwengel and Robert Greenberg, of the Johns Hopkins University, have been championing an effort to better prepare (pediatric) anesthesiologists as leaders and participants in mass casualty preparation and response. I’ve asked them to assist in reviewing their own papers1,4 in today’s PAAD. Additionally, they have been developing game based learning tools and leading workshops at the annual meeting of the Society for Pediatric Anesthesia devoted to this issue. Myron Yaster MD
PS: Rob is the leader of a wonderful resource and internet site for the worldwide pediatric anesthesia community:
https://www.pedsanesthesia.net/
I would encourage all of you to check it out and join. MY
Original article
Gangadharan M, Hayanga HK, Greenberg R, Schwengel D. A Call to Action: Why Anesthesiologists Must Train, Prepare, and Be at the Forefront of Disaster Response for Mass Casualty Incidents. Anesth Analg. 2024 Apr 1;138(4):893-903. doi: 10.1213/ANE.0000000000006719. Epub 2023 Dec 18. PMID: 38109852.
Original article/letter
Schwengel DA, Divito A, Burgess N, Yaache M, Greenberg RS, Walsh G, Toy S. Influx! A game-based learning tool for in-hospital interprofessional disaster preparedness and response. Br J Anaesth. 2022 Feb;128(2):e213-e215. doi: 10.1016/j.bja.2021.11.028. Epub 2021 Dec 17. PMID: 34924176.
In today’s PAAD, Gangadharan et al.1 provide an in-depth primer on disaster preparedness that is essential reading for all of you. It is beyond the scope of the PAAD to go into all of the detail presented in today’s article so we’d like to highlight the 3 major themes presented: “(1) disasters will continue to impact hospitals and preparation is imperative, (2) anesthesiologists are extensively and comprehensively trained and their value is often underestimated as mass casualty incident responders, and (3) a need exists for longitudinal disaster preparedness education and training over the course of a career.”1
Every US hospital is mandated to have an emergency operations plan (EOP) in compliance with the Joint Commission Emergency Management Standards. Are you as an individual and/or your department/group involved? Do you know where to find your institution’s EOP? Do you know which hazards your institution is most at risk of encountering? Do you understand the value of incident command and how it functions in mass casualty incidents? Have you practiced the principles of triage in and the challenges of creating surge capacity, adequate supplies and staff response for a mass casualty incident?
Preparation and practice will save lives, and because children constitute 25% to 30% of the victims in a disaster5 our role as pediatric anesthesiologists as leaders in disaster and mass casualty management is incredibly important. “Anesthesiologists inherently play a critical role in disaster response when airway management, resuscitation, or possible surgical intervention is required at a hospital. They serve as leaders to organize perioperative surgical services and in the ethical triage of patients.”1 In Europe they play a role in emergency medical services and ambulance stabilization and transport. Despite the daily demonstration of skills needed to respond in an MCI, the anesthesiology literature is woefully behind in promoting disaster preparedness, and hospitals are underprepared.
Are you involved in this preparation and training? A tool developed by Drs. Schwengel, Greenberg, and their colleagues4 has been used at SPA and in anesthesiology residency and fellowship training. Its elements are depicted in the image below. You may find it invaluable in your practice.
Send your thoughts and comments to Myron who will post in a Friday reader response.
References
1. Gangadharan M, Hayanga HK, Greenberg R, Schwengel D. A Call to Action: Why Anesthesiologists Must Train, Prepare, and Be at the Forefront of Disaster Response for Mass Casualty Incidents. Anesthesia and analgesia 2024;138(4):893-903. (In eng). DOI: 10.1213/ane.0000000000006719.
2. Russo RM, Galante JM, Jacoby RC, Shatz DV. Mass casualty disasters: who should run the show? J Emerg Med 2015;48(6):685-92. (In eng). DOI: 10.1016/j.jemermed.2014.12.069.
3. Doucet J, Shatz DV, Kaplan LJ, et al. Are trauma surgeons prepared? A survey of trauma surgeons' disaster preparedness before and during the COVID-19 pandemic. Trauma Surg Acute Care Open 2023;8(1):e001073. (In eng). DOI: 10.1136/tsaco-2022-001073.
4. Schwengel DA, Divito A, Burgess N, et al. Influx! A game-based learning tool for in-hospital interprofessional disaster preparedness and response. British journal of anaesthesia 2022;128(2):e213-e215. (In eng). DOI: 10.1016/j.bja.2021.11.028.
5. Desmond M, Schwengel D, Chilson K, et al. Paediatric patients in mass casualty incidents: a comprehensive review and call to action. British journal of anaesthesia 2022;128(2):e109-e119. (In eng). DOI: 10.1016/j.bja.2021.10.026.