CDEM Journal

How to Manage the big mass casualty in Command center from the Jungle of Western Tak

Apichaya Sukprasert — 2020-12-16

Abstract

Disaster management strongly affected mortality rate. Although all hospitals in Thailand planed for the mass casualty incidence, a few of them prepared for disaster that exceeded their surged capacity.

In 2019, Tasongyang hospital, Tak province, encountered a traffic accident with numerous severely-injured patients above their capacity. This led to the collaboration among five western Tak hospitals operated under Western Tak emergency medical service center.

The incidence was divided into 4 phases.

1.Planing: Analysis and solid planning emphasizing on resource estimation and relocation

2.Prehospital care: Establishing on scene management according to CSCATTT and resource management

3.In-hospital care: Tasongyang hospital proceeded as planned. Anyway, the bottle neck was found. First, ambulances were used both in prehospital and interfacility setting and shortly ran out. Second, the patients waiting too long for transfer still consumed the same resources with newly arrival patients. The problem was solved by relocation of resources from nearby hospitals.

4.Interfacility transfer: The process regarding to referral system was abridged. The receiving facility was well prepared.

There were total eleven patients total. Four of them were triaged red, three were yellow, while four were green. Three patients required intubation immediately. One patient need needle thoracostomy and intercostal drainage. Five of them required emergent and urgent surgical operation. Seven of them were admitted. All patients were safely discharged thereafter.

Keywords: disaster management, mass casualty incidence, MCI, wilderness medicine

Innovative Chiang Mai Manikin Trainer for Basic Life Support Training

Krongkarn Sutham — 2020-12-16

Abstract

Training of Basic Life Support (BLS) in Thailand is limited due to unavailable and costly devices for practicing. We developed a Chiang Mai Manikin to provide capable manikin for BLS training, and to determine the efficacy of training manikin compared to the actual model. Methods: This was a descriptive study of our newly developed Ching Mai Manikin. The prototype was determined by five experienced BLS instructors, including Cardiologists, Anesthesiologist, and Emergency Physicians. We used a questionnaire to evaluate the manikin’s structures, the efficacy of training, and its similarity to an actual model. Correlation among instructors was also calculated. Result: Chiang Mai Manikin trainer prototype was consisted of essential structures for BLS training and was effective for use in BLS training according to all experienced BLS instructors. The manikin was able to feedback on the duration of assisted ventilation and show the accuracy of electrode pads placement. Kappa correlation coefficient of the manikin trainer was 0.94. Evaluation of the similarity to an actual manikin with a visual analog scale resulted in a median of 37 out of 50 (IQR 34-40) accounted for 92.5%. Intraclass correlation was 0.79 (95% Confidence interval 0.19-0.98, p = 0.01) Conclusion: Chiang Mai Manikin trainer is effective in the use of BLS training.

Keywords: Basic Life Support, Cardiopulmonary resuscitation training, CPR, Chest Compression Manikin

Factors Associated Prehospital Trauma Patients Transferred By EMS (FR/BLS) Without Spinal Motion Restriction(SMR)

Fasai Rattanaburee — 2020-12-16

Abstract

Background: Spinal motion restriction (SMR) plays a major role in spinal protection toprevent secondary injury during prehospital transportation

Objectives: To determine the factors associated with improper spinal motion restriction in trauma patients who transferred by emergency medical services (EMR/EMT).

Methods A prospective analytical study from September to November 2019.Adult trauma patients who were transferred by EMS (EMR/EMT) to the ED of Hatyai hospital, Songkla province was studied. Assessment of factors with questionnaire to EMS personnel by triage nurse or emergency resident and medicalrecord.

Results: Of 428 patients were transferred to the ED by local basic EMS. Only 25% were received SMR properly and 70% were injured by traffic accidents. Patients were triaged into ESI level 3-5 85.5% and these groups of patient significantly weren’t received the SMR properly compare to those in level 1-2 (OR 3.75 95% CI 2.15, 6.56 P<0.001)

Conclusions: The most three causes of improper SMR were patient’s factors, EMS’s protocol and personnel efficiently and mechanisms of injury.

Keywords Spinal motion restriction, Spinal motion restriction protocol, EMS personnel, Prehospital BLS

Factors associated with the death in patients with prehospital calls in Lampang City

Noppadon Seesuwan — 2020-12-16

Background: The goal of emergency medical services (EMS) is to help patients in a timely manner before arriving to the hospital. The health care providers should know the factors associated with death in the patients transported by ambulances for reducing the mortality rate and improving medical care.

Objective: The aim of this paper is to find the factors associated with the death of the patients who use emergency medical services in Lampang City, Lampang, Thailand

Method: Using data from ambulance records in Lampang City, Thailand. We retrospectively analyzed the patients transported to Lampang Hospital from Jan 1, 2001 - Dec 31, 2019. The factors were assessed with multivariable logistic regression analysis.

Results: In total 41,284 patients were eligible for analysis. Of them, 1,998 were dead (5.2%). The factors associated with the death were male (RR 1.25; 95% CI 1.11-1.39 p=0.000) afternoon shift (RR 1.18; 95% CI 1.04-1.32 p=0.008) night shift (RR 1.24; 95%CI 1.06-1.44 p=0.005) triage red by phone (RR 5.54; 95% CI 2.07-14.87 p=0.001) triage by phone code 4 (RR 1.98;95% CI 1.36-2.90 p=0.000) code 5 (RR 1.96; 95% CI 1.47-2.60 p=0.000) code 6 (RR 10.45; 95% CI 6.65-16.42 p=0.000) code 17 (RR 1.70; 95% CI 1.29-2.24 p=0.000) code 19 (RR 3.23; 95% CI 2.44-4.28 p=0.000) and code 23 (RR 4.25; 95% CI 1.53-11.82 p=0.006)

Conclusions: EMS personals should aware the patients with these factors and improve medical care to reduce the mortality rate.