Biomedical Engineering Reference
In-Depth Information
13 Operating Room Preparation for
Mass Casualties
JOSEPH H. McISAAC, III
13.1 Introduction
Little, if anything, has been published on planning
and training for mass casualties at the level of the
operating room (OR). There is also a paucity of
literature about the surgical and anesthetic treat-
ment of patients exposed to weapons of mass
destruction (WMDs). References that do exist are
derived largely from military experience [1-5].
The preparation of the OR involves exactly the
same thought process as that required to prepare
the hospital as a whole. The functioning is broken
down to fundamental tasks and workflow. Vulner-
abilities under various stress scenarios are exam-
ined and mitigation strategies are devised. Once
a plan is written, it is tested, practiced, and
revised. Each iteration should escalate the diffi-
culty in order to realistically simulate an event.
Planning for a worst-case scenario is preferable
to hoping for the best. Introduction of unex-
pected problems into training encourages flexi-
bility and promotes creative problem solving for
both the staff and the leadership. Analysis should
be performed on several dimensions: Scale, crit-
ical systems, workflow, and inter-departmental
communications/cooperation.
the end user (Guzzi, 2002). A physician needs
to understand the pathogenesis and treatment of
individual diseases, toxins, and syndromes. The
nurse needs similar but less detailed knowledge.
Technicians and ancillary staff need to under-
stand the basics of self-protection and decontam-
ination, especially as applied to their role on the
unit. For example, the patient transport aid will
need to know how to avoid personal contamina-
tion, how to protect the patient, how to clean the
equipment, properly dispose of contaminated linen,
and appropriate routes for transporting infectious
and non-infectious patients between units. Good
training, and confidence in that training through
practice, is the best way to alleviate the fear of the
unknown. The least medically sophisticated staff
are the most vulnerable. Without them, a modern
unit cannot function as they provide the support
logistics necessary for physicians and nurses to
deliver healthcare. Unfortunately, the support staff
often are the last to receive training, if they receive
any at all. Their inclusion in training should be
considered a priority for unit leaders.
For the professional staff, a combination of
self-education, consisting of selected readings and
on-line courses, can be supplemented with peri-
odic lectures and attendance at conferences. Ready
access to technical documentation is highly recom-
mended. Besides keeping departmental copies of
key texts and treatment summaries, personal digital
assistant (PDA) versions are highly advised. They
can be downloaded from a number of sources as
13.2 Individual Preparation
The first and most fundamental level of training
occurs at the individual level. There exists a very
large body of knowledge about nuclear, chem-
ical, and biological threats which must be distilled
to a level that is both useful and accessible to
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