Another radical idea: scrap the idea of controlled victim egress.

[mycrofft]

As I understand it, at a disaster such as a building explosion, a perimeter is set up, entry control point made, and all ambulances etc coordinated through that.

Makes for an orderly process at receiving hospitals and in tracking certain patients.

However, does it yield a lower mortality/morbidity? Just as running out of a burning building ahead of everyone in line else actually gives you a better chance at survival (as documented in an altruism study), ad hoc but very prompt transport over short distances by non-medical vehicles has seemed to yield a better individual outcome. EG: if you're shot and the police arrive, you stand a better chance in many instances and if the hospital is close to be thrown in the patrol car and bodily hauled there rather than waiting for the paramedical "artistes" to arrive.

So, what is it going to be? Always everything "in order" despite lower survival, or figure out how to instantly stand up multiple casualty operations at hospitals?

(I know, I'm ignoring the chaos that ensues at the scene anyway and incipient ED overloads).

 

[unleashedfury]

As I understand it, at a disaster such as a building explosion, a perimeter is set up, entry control point made, and all ambulances etc coordinated through that.

Makes for an orderly process at receiving hospitals and in tracking certain patients.

However, does it yield a lower mortality/morbidity? Just as running out of a burning building ahead of everyone in line else actually gives you a better chance at survival (as documented in an altruism study), ad hoc but very prompt transport over short distances by non-medical vehicles has seemed to yield a better individual outcome. EG: if you're shot and the police arrive, you stand a better chance in many instances and if the hospital is close to be thrown in the patrol car and bodily hauled there rather than waiting for the paramedical "artistes" to arrive.

So, what is it going to be? Always everything "in order" despite lower survival, or figure out how to instantly stand up multiple casualty operations at hospitals?

(I know, I'm ignoring the chaos that ensues at the scene anyway and incipient ED overloads).

I think that it should fall under the "MCI" theory of casualties exceed resources. I had a bus wreck about 3 years ago where if we called all the trucks we needed to treat and transport all patients we would have depleted 3 counties and transporting of patients may have taken up to 3 hours..

In the end we had a small public transportation bus who transported all the walking wounded within minutes of triage to a urgent care center.

I know in Philly cops will transport a gunshot victim prior to EMS getting there if need be. Has been proven successful.

 

[mycrofft]

I think that it should fall under the "MCI" theory of casualties exceed resources. I had a bus wreck about 3 years ago where if we called all the trucks we needed to treat and transport all patients we would have depleted 3 counties and transporting of patients may have taken up to 3 hours..

In the end we had a small public transportation bus who transported all the walking wounded within minutes of triage to a urgent care center.

I know in Philly cops will transport a gunshot victim prior to EMS getting there if need be. Has been proven successful.

Time and again I've treated, met or read about people who survived probably because they were tossed into a vehicle and whisked to a NEARBY E.D., in contravention of the current EMS thinking of stabilization before movement, and organization/formal triage before ANYTHING else.

Integrating a SMALL shuttle or such into a plan sounds neat. I dislike the "mobile command post" sort of deal ("Hey, we got this surplus school bus…!)" . One MUST always consider what where and how such assets can be maintained between, until or if such things occur. And how easily victims can be moved onto/off them.

After thinking about Dr Ayel's lecture about "triage of time", I'm just raising this concept because it may in many urban cases be counter-intuitive but effective. Delay of a couple minutes over most long transports and/or after prolonged on-scene treatment may actually be insignificant, but if the transport time is SHORT (say, under ten minutes max), snatch and run may be actually the way to go.