Epidemiology of mass casualty incidents in a tertiary care trauma center in eastern India: A retrospective observational study
Chitta Ranjan Mohanty1, Rakesh Vadakkethil Radhakrishnan2, Shine Stephen2, Mantu Jain3, Asha P Shetty2, Alwin Issac2, Ijas Muhammed Shaji1( 0000-0001-6338-2892), Sebastian Chakola1
1Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
2College of Nursing, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
3Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
Keywords: Disaster, injury severity score, mass casualty, road traffic accident, trauma
OBJECTIVES: Disasters and mass casualty incidents (MCIs) that cause substantial mortality and morbidity have been increasing worldwide. The emergency department (ED) services manage MCIs by optimizing triage and providing health care with required resources. The present study attempted to describe the epidemiological characteristics and outcomes of MCIs presenting to the ED.
METHODS: The present retrospective observational study was conducted at the ED of a tertiary care hospital on patients of MCI for 4 years from 2017 to 2021. The data were extracted from the ED disaster records and other paper based patient records. Information on patient demography, date and time of arrival, mode of transport, method of arrival (direct or referral), type and mechanism of MCI, ED management, and outcome were recorded. Statistical analysis was performed using R, version 4.1.0.
RESULTS: Analysis of 21 MCIs was conducted. Road traffic accidents (RTAs) were the predominant cause of MCIs. The majority of MCI victims, except for those of blast injuries, were men. The victims in medical emergencies were significantly younger than those in other MCI groups (P < 0.001). The majority of patients were brought to ED through ambulance services (n = 120 [47.1%]), followed by private vehicles (n = 112 [44.2%]). Most of the MCI victims (n = 143 [56.2%]) were brought to the ED during evening hours (4 pm–8 pm). The majority of victims belonged to the “Red” triage category (n = 110 [43.3%]). The injury severity score was significantly higher (P = 0.014) in the disaster group than in other trauma MCI groups (20 vs. 17). Autorickshaw occupants were the most common victims of mass casualty RTAs (n = 38 [40%]). Suturing (n = 97 [50%]) and dressing (n = 167 [88%]) were the most common ED procedures required by the victims of trauma MCIs. Of the total, 167 (66%) patients were discharged from the ED, 47 (19%) patients were admitted to wards, 13 (5%) patients were admitted to intensive care units, and 24 (9%) patients got referred to other centers. In addition, two patients died in the ED during treatment, whereas one patient was brought dead.
CONCLUSIONS: RTAs dominate the MCIs and are affecting the young productive male population. The present study exhibited the severity of the cases in MCIs and their impact in the health care setting, therefore signifying the importance of standardized MCI management protocols.