title: Evacuation priorities in mass casualty terror-related events: implications for contingency planning.
abstract: OBJECTIVE
  To assess evacuation priorities during terror-related mass casualty incidents (MCIs) and their implications for hospital organization/contingency planning.
  
  
  BACKGROUND
  Trauma guidelines recommend evacuation of critically injured patients to Level I trauma centers. The recent MCIs in Israel offered an opportunity to study the impositions placed on a prehospital emergency medical service (EMS) regarding evacuation priorities in these circumstances.
  
  
  METHODS
  A retrospective analysis of medical evacuations from MCIs (29.9.2000-31.9.2002) performed by the Israeli National EMS rescue teams.
  
  
  RESULTS
  Thirty-three MCIs yielded data on 1156 casualties. Only 57% (506) of the 1123 available and mobilized ambulances were needed to provide 612 evacuations. Rescue teams arrived on scene within <5 minutes and evacuated the last urgent casualty within 15-20 minutes. The majority of non-urgent and urgent patients were transported to medical centers close to the event. Less than half of the urgent casualties were evacuated to more distant trauma centers. Independent variables predicting evacuation to a trauma center were its being the hospital closest to the event (OR 249.2, P < 0.001), evacuation within <10 minutes of the event (OR 9.3, P = 0.003), and having an urgent patient on the ambulance (OR 5.6, P < 0.001).
  
  
  CONCLUSIONS
  Hospitals nearby terror-induced MCIs play a major role in trauma patient care. Thus, all hospitals should be included in contingency plans for MCIs. Further research into the implications of evacuation of the most severely injured casualties to the nearest hospital while evacuating all other casualties to various hospitals in the area is needed. The challenges posed by terror-induced MCIs require consideration of a paradigm shift in trauma care.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel. bromi@md2.huji.ac.il
authors.forename: Sharon
authors.initials: S
authors.lastname: Einav
authors.forename: Zvi
authors.initials: Z
authors.lastname: Feigenberg
authors.forename: Charles
authors.initials: C
authors.lastname: Weissman
authors.forename: Daniel
authors.initials: D
authors.lastname: Zaichik
authors.forename: Guy
authors.initials: G
authors.lastname: Caspi
authors.forename: Doron
authors.initials: D
authors.lastname: Kotler
authors.forename: Herbert R
authors.initials: HR
authors.lastname: Freund
mesh_terms: D000552:Ambulances / Q000458:organization & administration / Q000706:statistics & numerical data; D002391:Catchment Area, Health; D004189:Disaster Planning; D004632:Emergency Medical Services / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006801:Humans; D007557:Israel / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D018635:Rescue Work / Q000592:standards / Q000706:statistics & numerical data; D012189:Retrospective Studies; D023481:Terrorism; D013996:Time and Motion Studies; D014193:Trauma Centers / Q000706:statistics & numerical data*; D015599:Trauma Severity Indices; D014218:Triage