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Recommended guidelines for optimal design of a plastic surgery service during mass casualty events
M Cohen1, Y Kluger, J Klausner
1Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, Israel. drcohen@netvision.net.il
Objective:
The objectives of the study were to evaluate the pattern of plastic surgery (PS) team intervention during the first 12 hours after a mass casualty blast.
Methods:
The records of 272 civilians injured from 1994 to 1997 in Tel Aviv were reviewed. Patients' injuries were classified according to the nature of their PS injury and the type of PS intervention. The procedure time and number of plastic surgeons involved were recorded in 20-minute intervals. The average and standard deviation of the peak demand (PD) timing for PS intervention were calculated. Linear correlation between the PD and the total number of wounded transferred to the Tel Aviv Sourasky Medical Center was evaluated by the correlation coefficient.
Results:
A distinct "double-peak" and five phases pattern of PS team intervention were observed. A linear correlation and a 1:5 ratio were found between the total number of wounded transferred to the Tel Aviv Sourasky Medical Center and the PD for PS intervention.
Conclusions:
PS involvement has a predicted pattern related to the patient volume. Guidelines based on the conclusions drawn from this study can ensure an ordered, efficacious level of PS care during these events. A triple team plan is suggested, and adjustments in medical resources according to the specific nature of the event are described.