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Fluid Resuscitation in Mass Casualty Incident

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Orthopedics in Disasters

Abstract

On April 15, 2013, at 2:50 p.m. eastern daylight time, two improvised explosive devices were detonated during the Boston Marathon, New England’s most widely viewed sporting event that attracts more than 500,000 spectators and 20,000 participants each year. As a result of the bombings, three people were killed and 264 were injured, with more than 20 sustaining critical injuries. Victims at the blast scene received immediate, lifesaving aid and were rapidly triaged. The victims of this incident were loaded on ambulances; the last casualty was transported from the scene within 45 min [1]. The Boston Marathon bombing was acknowledged as a successful medical incident largely due to the medical emergency services preparedness.

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References

  1. Biddinger PD, Baggish A, Harrington L, et al. Be prepared--the Boston Marathon and mass-casualty events. N Engl J Med. 2013;368(21):1958–60.

    Article  CAS  PubMed  Google Scholar 

  2. Levi L, Michaelson M, Admi H, et al. National strategy for mass casualty situations and its effects on the hospital. Prehosp Disaster Med. 2002;17(1):12–6. Review.

    Article  PubMed  Google Scholar 

  3. Burris DG, Fitz-Harris JB, Holcomb JB, et al. Emergency war surgery. Washington, DC: US Government Printing Office; 2004. p. 3.1.

    Google Scholar 

  4. Rehn M, Eken T, KrĂĽger AJ, et al. Precision of field triage in patients brought to a trauma centre after introducing trauma team activation guidelines. Scand J Trauma Resusc Emerg Med. 2009;17:1.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Sasser SM, Varghese M, Kellermann A, et al. A global vision of prehospital care. Prehosp Emerg Care. 2006;10(2):278–9.

    Article  PubMed  Google Scholar 

  6. Fishman PE, Shofer FS, Robey JL, et al. The impact of trauma activations on the care of emergency department patients with potential acute coronary syndromes. Ann Emerg Med. 2006;48(4):347–53.

    Article  PubMed  Google Scholar 

  7. Boutros F, Redelmeier DA. Effects of trauma cases on the care of patients who have chest pain in an emergency department. J Trauma. 2000;48(4):649–53.

    Article  CAS  PubMed  Google Scholar 

  8. Frykberg ER. Medical management of disasters and mass casualties from terrorist bombings: how can we cope? J Trauma. 2002;53(2):201–12. Review.

    Article  PubMed  Google Scholar 

  9. Frykberg ER, Tepas 3rd JJ. Terrorist bombings. Lessons learned from Belfast to Beirut. Ann Surg. 1988;208(5):569–76. Review.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Crippen D. The World Trade Center attack. Similarities to the 1988 earthquake in Armenia: time to teach the public life-supporting first aid? Crit Care. 2001;5(6):312–4. Epub 2001 Nov 6. Review.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Peleg K, Aharonson-Daniel L, Stein M, et al. Gunshot and explosion injuries: characteristics, outcomes, and implications for care of terror-related injuries in Israel. Ann Surg. 2004;239(3):311–8.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Hick JL, Barbera JA, Kelen GD. Refining surge capacity: conventional, contingency, and crisis capacity. Disaster Med Public Health Prep. 2009;3(2 Suppl):S59–67.

    Article  PubMed  Google Scholar 

  13. Kluger Y, Peleg K, Daniel-Aharonson L, et al. The special injury pattern in terrorist bombings. J Am Coll Surg. 2004;199(6):875–9.

    Article  PubMed  Google Scholar 

  14. Dudaryk R, Pretto Jr EA. Resuscitation in a multiple casualty events. Anesthesiol Clin. 2013;31(1):85–106. doi:10.1016/j.anclin.2012.11.002. Epub 2012 Dec 13. Review.

    Article  PubMed  Google Scholar 

  15. Morgan TJ, Venkatesh B, Hall J. Crystalloid strong ion difference determines metabolic acid-base change during acute normovolaemic haemodilution. Intensive Care Med. 2004;30(7):1432–7.

    Article  PubMed  Google Scholar 

  16. Ley EJ, Clond MA, Srour MK, et al. Emergency department crystalloid resuscitation of 1.5 L or more is associated with increased mortality in elderly and nonelderly trauma patients. J Trauma. 2011;70(2):398–400.

    Article  PubMed  Google Scholar 

  17. Bickell WH, Wall Jr MJ, Pepe PE, et al. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med. 1994;331(17):1105–9.

    Article  CAS  PubMed  Google Scholar 

  18. Spoerke N, Michalek J, Schreiber M, et al. Crystalloid resuscitation improves survival in trauma patients receiving low ratios of fresh frozen plasma to packed red blood cells. J Trauma. 2011;71(2 Suppl 3):S380–3.

    Article  PubMed  Google Scholar 

  19. Kutcher ME, Kornblith LZ, Narayan R, et al. A paradigm shift in trauma resuscitation: evaluation of evolving massive transfusion practices. JAMA Surg. 2013;148(9):834–40.

    Article  PubMed  Google Scholar 

  20. Holcomb JB, del Junco DJ, Fox EE, et al. The prospective, observational, multicenter, major trauma transfusion (PROMMTT) study: comparative effectiveness of a time-varying treatment with competing risks. JAMA Surg. 2013;148(2):127–36.

    Article  PubMed  PubMed Central  Google Scholar 

  21. CRASH-2 trial collaborators, Shakur H, Roberts I, et al. vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010;376(9734):23–32.

    Article  Google Scholar 

  22. Brohi K, Singh J, Heron M, et al. Acute traumatic coagulopathy. J Trauma. 2003;54(6):1127–30.

    Article  PubMed  Google Scholar 

  23. Holcomb JB, Wade CE, Michalek JE, et al. Increased plasma and platelet to red blood cell ratios improves outcome in 466 massively transfused civilian trauma patients. Ann Surg. 2008;248(3):447–58.

    PubMed  Google Scholar 

  24. Gruen RL, Brohi K, Schreiber M, et al. Haemorrhage control in severely injured patients. Lancet. 2012;380(9847):1099–108.

    Article  PubMed  Google Scholar 

  25. Inaba K, Karamanos E, Lustenberger T, et al. Impact of fibrinogen levels on outcomes after acute injury in patients requiring a massive transfusion. J Am Coll Surg. 2013;216(2):290–7.

    Article  PubMed  Google Scholar 

  26. Khan H, Belsher J, Yilmaz M, et al. Fresh-frozen plasma and platelet transfusions are associated with development of acute lung injury in critically ill medical patients. Chest. 2007;131(5):1308–14.

    Article  PubMed  Google Scholar 

  27. Como JJ, Dutton RP, Scalea TM, et al. Blood transfusion rates in the care of acute trauma. Transfusion. 2004;44(6):809–13.

    Article  PubMed  Google Scholar 

  28. Sisak K, Manolis M, Hardy BM, et al. Acute transfusion practice during trauma resuscitation: who, when, where and why? Injury. 2013;44(5):581–6.

    Article  PubMed  Google Scholar 

  29. Malone DL, Hess JR, Fingerhut A. Massive transfusion practices around the globe and a suggestion for a common massive transfusion protocol. J Trauma. 2006;60 Suppl 6:S91–6.

    Article  PubMed  Google Scholar 

  30. Dente CJ, Shaz BH, Nicholas JM, et al. Early predictors of massive transfusion in patients sustaining torso gunshot wounds in a civilian level I trauma center. J Trauma. 2010;68:298–304.

    Article  PubMed  Google Scholar 

  31. Soffer D, Klausner J, Bar-Zohar D, et al. Usage of blood products in multiple-casualty incidents: the experience of a level I trauma center in Israel. Arch Surg. 2008;143:983–9.

    Article  PubMed  Google Scholar 

  32. Borgman MA, Spinella PC, Perkins JG, et al. The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. J Trauma. 2007;63(4):805–13.

    Article  PubMed  Google Scholar 

  33. Hess JR, Brohi K, Dutton RP, et al. The coagulopathy of trauma: a review of mechanisms. J Trauma. 2008;65:748–54.

    Article  CAS  PubMed  Google Scholar 

  34. Riskin DJ, Tsai TC, Riskin L, et al. Massive transfusion protocols: the role of aggressive resuscitation versus product ratio in mortality reduction. J Am Coll Surg. 2009;209:198–205.

    Article  PubMed  Google Scholar 

  35. Ho AM, Dion PW, Yeung JH, et al. Prevalence of survivor bias in observational studies on fresh frozen plasma: erythrocyte ratios in trauma requiring massive transfusion. Anesthesiology. 2012;116:716–28.

    Article  PubMed  Google Scholar 

  36. Stinger HK, Spinella PC, Perkins JG, et al. The ratio of fibrinogen to red cells transfused affects survival in casualties receiving massive transfusions at an army combat support hospital. J Trauma. 2008;64(2 Supp):S79–85; discussion S85.

    Article  CAS  PubMed  Google Scholar 

  37. Shaz BH, Dente CJ, Nicholas J, et al. Increased number of coagulation products in relationship to red blood cell products transfused improves mortality in trauma patients. Transfusion. 2010;50:493–500.

    Article  CAS  PubMed  Google Scholar 

  38. Lee TH, Van PY, Spoerke NJ, Differding J, Schreiber MA, et al. The use of lyophilized plasma in a severe multi-injury pig model. Transfusion. 2013;53 Suppl 1:72S–9.

    Article  CAS  PubMed  Google Scholar 

  39. Mariani PJ, Wittick L. Pneumothorax diagnosis by extended focused assessment with sonography for trauma. J Ultrasound Med. 2009;28(11):1601 [author reply: 1602].

    Article  PubMed  Google Scholar 

  40. Zhou J, Huang J, Wu H, et al. Screening ultrasonography of 2,204 patients with blunt abdominal trauma in the Wenchuan earthquake. J Trauma Acute Care Surg. 2012;73(4):890–4.

    Article  PubMed  Google Scholar 

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Correspondence to Yoram Kluger MD, FACS .

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Bahouth, H., Or-Haim, S., Ben-Ishay, O., Frydman, J., Kluger, Y. (2016). Fluid Resuscitation in Mass Casualty Incident. In: Wolfson, N., Lerner, A., Roshal, L. (eds) Orthopedics in Disasters. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-48950-5_16

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  • DOI: https://doi.org/10.1007/978-3-662-48950-5_16

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