Reconsidering policy of casualty evacuation in a remote mass-casualty incident.
OBJECTIVE
Inappropriate distribution of casualties in mass-casualty incidents (MCIs) may overwhelm hospitals. This study aimed to review the consequences of evacuating casualties from a bus accident to a single peripheral hospital and lessons learned regarding policy of casualty evacuation.


METHODS
Medical records of all casualties relating to evacuation times, injury severity, diagnoses, treatments, resources utilized and outcomes were independently reviewed by two senior trauma surgeons. In addition, four senior trauma surgeons reviewed impact of treatment provided on patient outcomes. They reviewed the times for the primary and secondary evacuation, injury severity, diagnoses, surgical treatments, resources utilized, and the final outcomes of the patients at the point of discharge from the tertiary care hospital.


RESULTS
Thirty-one survivors were transferred to the closest local hospital; four died en route to hospital or within 30 minutes of arrival. Twenty-seven casualties were evacuated by air from the local hospital within 2.5 to 6.15 hours to Level I and II hospitals. Undertriage of 15% and overtriage of seven percent were noted. Four casualties did not receive treatment that might have improved their condition at the local hospital.


CONCLUSIONS
In MCIs occurring in remote areas, policy makers should consider revising the current evacuation plan so that only immediate unstable casualties should be transferred to the closest primary hospital. On site Advanced Life Support (ALS) should be administered to non-severe casualties until they can be evacuated directly to tertiary care hospitals. First responders must be trained to provide ALS to non-severe casualties until evacuation resources are available.
1 Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Aviv, Israel.
Bruria
B
Adini
1 Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Aviv, Israel.
Robert
R
Cohen
2 Medical Corps, Israel Defense Forces, Ramat Gan, Israel.
Elon
E
Glassberg
3 Home Front Command, Israel Defense Forces, Ramla, Israel.
Bella
B
Azaria
4 Sheba Medical Center, Ramat Gan, Israel.
Daniel
D
Simon
5 Beilinson Medical Center, Petach Tikva, Israel.
Michael
M
Stein
6 Kaplan Medical Center, Rehovot, Israel.
Yoram
Y
Klein
1 Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Aviv, Israel.
Kobi
K
Peleg
D000552:Ambulances; D004189:Disaster Planning; D004632:Emergency Medical Services / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D015601:Injury Severity Score; D054527:Mass Casualty Incidents; D018986:Motor Vehicles; D010360:Patient Transfer / Q000458:organization & administration*; D014218:Triage; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000628:therapy*