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Information Gaps and Mass Casualty Incidents

April 15, 2015
by Kayt Sukel
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A mass casualty incident (MCI) is defined as "a destructive event that causes so many casualties that extraordinary mobilization of medical services is necessary."  Common MCIs include fires, highway pile-ups and mass shootings.  Certainly, hospital emergency departments plan for such extraordinary mobilizations--and put workflows in place to quickly assess and treat patients when they occur.  But as hospitals rely more on information technology systems for clinical documentation and clinical decision support, it's clear that there's more to dealing with mass casualty incidents than just updated triage strategies.  Information management must also be carefully considered.

In yesterday's compelling HIMSS15 E-Session, Managing Patient Information During a Mass Casualty Incident, Jonathan Teich, Chief Medical Informatics Officer at Elsevier, and Adam Landman, Chief Medical Information Officer for Health Information Innovation and Integration and an attending emergency physician at Brigham and Women’s Hospital in Boston, demonstrated just how important information systems can be to the successful management of an MCI. 

Dr. Teich set the stage by saying that we have a good understanding of the different MCIs that could occur.  "There really are a finite number of these situations.  So there some be some common themes we can find in terms of information management," he said.  "It should be possible to anticipate what those themes might be."

And understanding those themes is important to avoiding errors, which can happen more easily when processes are accelerated and resources stretched thin.

Dr.  Landman highlighted the vital role of information systems by discussing what happened in Boston's Brigham and Women's Hospital Emergency Room after the 2013 Boston Marathon bombings.  The emergency room was already over-capacity when the call came about the bombings.  But they then received 39 survivors--16 of those were admitted and 9 required surgery.

"In an after-action review of the event, it became clear that one of our main challenges was our information systems," said Landman.

He and his colleagues learned that, in the confusion of that day, they had limited awareness of patient locations, difficulty distinguishing unidentified patients, and medical care was not documented in real-time.  And Landman discussed both the short-term and long-term ways to deal with those information gaps in the future. 

In conclusion, Landman and Teich urged emergency departments to look closely at their own information systems--and how they are used during normal operations and where they may fall short during MCIs. It is, they argued, the only way to be "fully prepared" for the successful management of mass casualty incidents.

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