A multicasualty event: out-of-hospital and in-hospital organizational aspects

Area of Science:

• Disaster medicine
• Emergency medical services
• Public health preparedness

Background:

• A wedding celebration in Israel with 700 participants experienced a catastrophic building collapse, resulting in Israel's largest disaster.
• The event necessitated a comprehensive study of both out-of-hospital and in-hospital management phases.

Purpose of the Study:

• To analyze the management of a multicasualty event (MCE) from initial rescue to in-hospital care.
• To identify bottlenecks and challenges in emergency medical services (EMS) deployment, hospital response, and patient transfer.
• To provide recommendations for optimizing MCE management.

Main Methods:

• Data collection from medical files, telephone interviews, and hospital computerized information for victims at four Jerusalem emergency departments (EDs).
• Analysis of out-of-hospital resources including ambulances, emergency medical technicians, paramedics, and physicians.
• Assessment of in-hospital response, including staff recall, medical care, imaging, and patient disposition.

Main Results:

• The MCE caused 23 fatalities and 315 injured, with 43% hospitalized. Evacuation was rapid, with the scene cleared within seven hours.
• Extensive out-of-hospital resources were deployed, including 97 ambulances and 18 mobile intensive care units.
• Hospitals experienced significant staff influx and faced challenges with computed tomography (CT) capacity, indicating potential system inefficiencies.

Conclusions:

• The study identified "rotating" bottleneck phenomena in both out-of-hospital and in-hospital systems during the MCE.
• Effective MCE management requires seamless coordination between out-of-hospital rescue services, hospitals, and interhospital transfers.
• Hospitals must establish operational centers for real-time resource management and coordination during mass casualty events.