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The Use of New Technology in Mass Casualty Situations and the ICU

Daniel E. Vázquez, MD, MSc, FACS Assistant Professor of Surgery

9/15/17

Disclosures

None financial

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Outline

Definitions

Incidence

Response Structure

Educational Options

Importance of Triage Accuracy

Emerging Technologies for prehospital and hospital management

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What is a Disaster or MCI?

Magnitude of destruction or injuries exceeds that of routine emergency situations

Major disruption of the infrastructure of a community or geographic region and its inhabitants

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Incidence

Among the 9,776,094 EMS responses in the 2010 National EMS Database, 14,504 entries were documented as MCI

47.6% documented experiencing a response delay compared to only 12.3% of non-MCI EMS responses

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Epidemiology of mass casualty incidents in the United States.Prehosp Emerg Care. 2014 Jul-Sep;18(3):408-16. Schenk E, Wijet, et al.

Response Structure

Declaration of an MCI

Initiation National Incident Management System (NIMS)

Triage

On-site Treatment

Transport

Definitive Care

Demobilization

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FEMA: Center for Disaster Preparedness

AWR-160, WMD/Terrorism Awareness for Emergency Responders;

IS-100.HCb, Introduction to Incident Command System for Healthcare/Hospitals;

IS-200.HCa, Applying ICS to Healthcare Organizations; and

IS-700.a, National Incident Management System, An Introduction.

HERT PER-902 Hospital Emergency Response Training for Mass Casualty Incidents

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S0360: Preparing for Mass Casualty Incidents: A Guide for Schools, Higher Education, and Houses of Worship

Course Objectives

Identify key considerations and strategies for preparing for mass casualty incidents, including:

Understanding the threats and challenges.

Establishing planning processes.

Assessing and mitigating vulnerabilities.

Establishing response procedures.

Planning for recovery.

Staying prepared.

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https://training.fema.gov/is/courseoverview.aspx?code=IS-360

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Triage

START – Simple Triage and Rapid Treatment Immediate: Patients who have major life-

threatening injuries, but are salvageable given the resources available Delayed: Patients who have non-life-

threatening injuries, but are unable to walk or exhibit an altered mental status “Walking Wounded": Patients who are able

to ambulate out of the incident area to a treatment area Deceased or Expectant

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Importance of Triage Accuracy

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Triage and trauma workload in mass casualty: a computer model.J Trauma. 2010 Nov;69(5):1074-81; discussion 1081-2.Hirshberg A, et al.

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Emerging Technologies

Wireless Physiologic Monitors Sp02, HR, BP and ECG, accelerometer Geolocation capability Adequate monitoring range and data storage with seamless

uploading Color-coded vitals and automated triage support Minimal footprint Can stay with patient from prehospital to hospital and beyond Battery life Multiple casualties can be monitored by single provider Automation (AI)

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WVSM® (Wireless Vital Signs Monitor)

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https://athenagtx.com/products/wireless-vital-signs-monitor/

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HSPRO...for medical providers

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https://athenagtx.com/rd/#accs

Patient Status Engine

http://www.isansys.com/

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Limitations of Monitoring Devices

FDA approval process, decision making vs diagnosis Pediatric Cases Range Cyber Security

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Drones

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“Drones at the service for training on mass casualty incident A simulation study”

Antonio Nieto Fernandez-Pacheco, et al ; Medicine (Baltimore). 2017Jun; 96(26): e7159

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Automated Transportation

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https://www.army.mil/article/184593/medical_operations_in_the_multidomain_battlefield

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ion mobility spectrometry (IMS)

Chemical threats

Explosive precursors

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https://www.fema.gov/authorized-equipment-list-item/07cd-01-dpsi

Asiana Airlines Flight 214

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Saturday, July 6, 2013

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“Reconsidering the Resources Needed for Multiple Casualty Events: Lessons Learned From the Crash of Asiana Airlines Flight 214” Campion EM, et al. JAMA Surg. 2016 Jun 1;151(6):512-7. 192 Injured 3 deaths 63 evaluated at San Francisco General Hospital In the first 48 hours, 15 operations were performed

and 117 total units of blood products were transfused A total of 370 nursing overtime hours were required

to treat the injured patients on the day of the event

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Applying minimal footprint technology to overcoming language barriers during humanitarian, overseas mission, and/or trauma mass casualty scenarios

On average, 8.5% of the US population is limited-English-proficient (LEP)

Another 2% are deaf or hard-of-hearing

The LEP population among traditional immigrant-destination states such as California can be as high as 19% according to 2013 census data

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http://www.migrationpolicy.org/article/language-diversity-and-english-proficiency-united-states

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Remote Continuous Medical Interpretation

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The ICU of the Future

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Needs Assessment

Wireless integration (Decrease Cable “spaghetti”)

Improve ergonomics (Obtrusive overhead booms)

Automation

Ease of use

Improve reliability, predictability and repeatability

Improve patient safety and decrease complications

Plug and play

Integration between bedside technologies for monitoring, diagnosis, intervention and data transfer

Diagnosis and decision support

Research capability (high resolution data)

Portability

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Market Segment

• Civilian

• Military

• Global Healthcare Initiatives

• Space Travel

• Education

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Technology Platforms

Fluid Monitoring

Infection Control

Physiologic Monitoring

Language Translation

Mobility/Physical Therapy

Simulation

Telemedicine

Sleep Hygiene

Patient Safety

Diagnosis (tests/labs)

Medication Tracking/Administration

EMR/Data integration

Predictive Algorithms/Decision support

Minimally invasive/nanotechnology

3D Printing

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Current Projects

Automated urine output measurement device

Automated hand hygiene alert device

Limited Footprint and Easily Portable Real-time Physiologic Monitoring System (Isansys)

Applying minimal footprint technology to overcoming language barriers (Martti)

Applying technology to improve mobility in the ICU

Adverse event simulation in the ICU environment

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OSU Innovations Collaborative

Undergraduate student capstone projects

1865…

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Liquid Ventilation

Inolivent

Liquid Ventilation

Perfluorocarbon

Respiratory support or therapeutic lavage

Improves lung compliance and reduces ALI

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Optimal Control of Inspired Perfluorocarbon Temperature for Ultrafast Hypothermia Induction by Total Liquid Ventilation in Adult Patient Model.

Nadeau et al 2017, IEEE Trans Biomed Eng.

Suspended Animation

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Suspended animation inducer hydrogen sulfide is protective in an in vivo model of ventilator-induced lung injury.

Aslami et al, Intesive Care Med. 2010 Nov;36(11):1946-52.

“Any sufficiently advanced technology is indistinguishable from magic” Arthur C. Clarke

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Thank you! Questions?

Other References:

1. Gany F, et al. Patient satisfaction with different interpreting methods: a randomized controlled trial. J Gen Intern Med. 2007 Nov;22 Suppl 2:312-8.

2. Ramirez D, et al. Language interpreter utilization in the emergency department setting: a clinical review. J Health Care Poor Underserved 2008 May;19(2):352-62.

3. Behar S, et al. Use of an emergency medical pictorial communication book during simulated disaster conditions. Disaster Med Public Health 2013 Oct;7(5):475-80.

4. Chan YF, et al. Interpreter services in emergency medicine. J Emerg Med 2010 Feb;38(2):133-9.

5. Grover A, et al. Comparison of throughput times for limited English proficiency patient visits in the emergency department between different interpreter modalities. J Immigr

Minor Health. 2012 Aug;14(4):602-7.

6. Tate RC. The Need for More Prehospital Research on Language Barriers: A Narrative Review. West J Emerg Med. 2015 Dec;16(7):1094-105.

7. http://www.migrationpolicy.org/article/language-diversity-and-english-proficiency-united-states

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