Volume 5, Issue 2, 2024
Original Research
- Beirut Port Blast 2020: New Lessons Learned in Mass Casualty Incident Management in the Emergency Department
Background: On August 4, 2020, Lebanon suffered its largest mass casualty incident (MCI) to date: the Beirut Port blast. Hospital emergency response to MCIs is particularly challenging in low- and middleincome countries, where emergency medical services are not well developed and where hospitals have to rapidly scale up capacity to receive large influxes of casualties. This article describes the American University of Beirut Medical Center (AUBMC) response to the Beirut Port blast and outlines the lessons learned.
Discussion: The Beirut Port blast reinforced the importance of proper preparedness and flexibility in managing an MCI. Effective elements of AUBMC's MCI plan included geographic-based activation criteria, along with use of Wi-Fi messaging systems for timely notification of disaster teams. Crowd control through planned facility closures allowed medical teams to focus on patient care. Pre-identified surge areas with prepared disaster cart deployment allowed the teams to scale up quickly. Several challenges were identified related to electronic medical records (EMRs), including patient registration, staff training on EMR disaster modules, and cumbersome EMR admission process workflows. Finally, this experience highlights the importance of psychological debriefs after MCIs.
Conclusions: Hospital MCI preparedness plans can integrate several strategies that are effective in quickly scaling up capacity to respond to large MCIs. These are especially necessary in countries that lack coordinated prehospital systems
- Association Between Teaching Status of Metropolitan Hospitals and Out of Hospital Cardiac Arrest Outcomes: A Retrospective Observational Study of Hospitals in the United States
Introduction: The quality of care and patient outcome of out-of-hospital cardiac arrest (OHCA) are affected by different factors, one of which is the hospital teaching status. This study aims to assess the association between teaching status of hospitals and survival rates. Methods: This retrospective observational study utilized the Nationwide Emergency Department Sample (NEDS) database of the year 2014 (released in 2016). The study sample included OHCA 122,776 patients. Descriptive analysis was performed. Patients’ characteristics were compared according to the hospital teaching status. This was followed by a multivariate analysis to assess the impact of the hospital teaching status on the patients’ survival at hospital discharge after controlling for confounding factors. Results: A total of 122,776 patients with OHCA were included in this study. The average age was 65.91 years with male predominance (61.7%). Around 62.1% of patients were admitted to metropolitan teaching hospitals. Overall survival to hospital discharge was 6.4%. Survival was higher in patients who were treated in a metropolitan teaching hospital in comparison with those who presented to a metropolitan non-teaching hospital (7.2 % versus 4.9%, p<0.001). After adjusting for confounders, patients’ survival to hospital discharge was similar in the two groups (teaching and non-teaching metropolitan hospitals) (OR=0.909, 95% CI 0.776 – 1.065). Conclusion: In this study, there was no significant association between teaching status of US metropolitan hospitals and survival of OHCA patients. OHCA patients may be transferred to the nearest hospital regardless of teaching status in US metropolitan areas.