Involvement of radiologists in mapping out medical facilities’ mass casualty incident (MCI) plans is key to handling those occurrences, as demonstrated by a 2015 tragedy in Seattle that left 51 victims in need of emergency care.
Harborview Medical Center (HMC), the region’s dedicated Level 1 trauma and burn center, received 19 of the casualties, 16 of those within one hour, after a tourist vehicle collided with a charter bus on a highway bridge.
Ken F. Linnau, MD, MS, emergency radiologist at HMC and University of Washington Associate Professor of Radiology, and his colleagues immediately found that their MCI plan, which was based on previous data simulation from literature reviews, underestimated scanner time at five minutes per scan per patient.
“That was the most important point for us, realizing that simulation data presented in literature was probably not easily achievable,” says Dr. Linnau, one of the authors of a study published in February 2017 in Emergency Radiology.
The actual time per patient per scan averaged 15 to 17 minutes, including transfer of patients from the gurney to the CT scanner to the resuscitation bay. Sixteen patients received CT imaging on the three available scanners, with an average of four patients scanned per hour per machine.
This also was at odds with another recent study, published in the British Journal of Radiology, in which a mock MCI put CT scan time at slightly under 10 minutes and total patients scanned per hour per machine at six.
“Once disaster hits, it’s too late to come up with a plan.”
— Ken F. Linnau, MD, MS, emergency radiologist, Harborview Medical Center, and University of Washington Associate Professor of Radiology
On the Sideline
Dr. Linnau says hospital disaster committees too often do not draw on the insight of radiologists responsible for triaging patients during MCIs.
That is also the view of Ferco Berger, MD, head of the Emergency and Trauma Radiology Division–Sunnybrook Health Sciences Centre and Assistant Professor in the Department of Medical Imaging at the University of Toronto.
“Radiology a lot of the time is left at the sideline when dealing with preparation for mass casualty incidents,” Dr. Berger says. “I’ve given lectures on this and always start with the question: ‘Who knows the MCI protocol in their hospital, and [has] radiology ... been involved in planning for it?’ I see very few hands go up.”
With MCIs, the number of patients in need of radiology exams increases significantly and rapidly, Dr. Berger notes. This strains resources and requires optimization of throughput by cutting down on imaging time or triaging patients differently to avoid bottlenecks.
During the Seattle incident, Dr. Linnau and his team narrowly avoided a logjam.
“The influx of patients stopped when we were about to be backlogged with patients in CT,” he says. “I think we were somewhat prepared and OK but got lucky that the influx of patients stopped when it did.”
The radiology team now sits on the HMC Disaster Committee and participates every six months in mock MCI drills, which Dr. Berger agrees is essential to gauging the effectiveness of MCI protocols.