List Archives

Thu Aug 2 16:50:30 BST 2007

1.    Congratulations to the EMS, emergency medicine,  and trauma services at 
the hospitals in the Greater Minneapolis area, especially  the Hennepin 
County Hospital.    It appears that the trauma  system served as an infrastructure 
for a disaster plan and the drills alerted  everyone and the system WORKED.  
Congratulations

2.    As with ALL disasters the critical medical  problems are managed 
LOCALLY.   The success or failure of the critical  medical management is dependent 
on the LOCAL preparedness.    Obviously, the LOCAL medical planners did their 
job and the response was  fantastic.  THE SYSTEM WORKS.    I am so proud of our 
 Trauma/EM/Critical Care infrastructures.     There is some  real leadership 
across the country and across the world.    And  all of that leadership 
remains LOCAL.    During such times of  need that LOCAL leadership also becomes 
a-political.   

3.    The reports did seem to indicate that the turn  out of EMS, fireman, 
and medical personnel to the hospital was  "overwhelming."   Although the 
eventual total numbers of  medical/surgical/trauma casualties was not initially 
known, just as with 911  (and Oklahoma City, and Katrina in Houston), MANY MORE 
medical personnel showed  up than were actually needed to care for the number of 
patients who actually  needed attention.  Medical manpower management must 
become a subject of  future conferences.   

4.    THE 10% RULE continues to be very  valid !  During the evening I 
calculated the number of "at risk"  people based on the number of cars on the bridge 
at the time.  I came up with the number 600.   There were 60 injuries - 10%  
of the potential people at risk were actually injured.   This 10% rule  is 
uncannily reproducible in all the numbers I can find from most disasters for  the 
past 30 years.  In addition, there appear to only be only 5 major  injuries 
(one tube thoracostomy for a penetrating injury to the chest,  three 
laparotomies for blunt injury, and one craniotomy).   5/60 =  approximately 10%.   The 
10% rule still holds.    This  10% rule was cited in several articles after 
Katrina.   Only 10% of  the at risk people, actually become patients, and of the 
patients, only 10%  actually have severe injuries.   For the medical manpower 
manager, the  challenge becomes identifying that 1% of the regional  group.    

5.    The repeated call for blood following a  disaster, merely to give 
people something to do needs close analysis and an  alternate plan developed.   
With most disasters, new blood donations  for that location is NOT needed.   It 
should NOT be the local or  regional Red Cross that makes the call for blood 
and other donations, but the  trauma center or the Regional Blood Center in 
concert with the trauma  center.   It would be much more appropriate to have 
potential donors  fill out "Commit for Life" donor cards, than just to put out 
their arm to have  blood drawn which is then later lost to non-use, or SOLD to a 
foreign country at  great profit by the business that drew the blood during a 
crisis, when emotions  were high.   

6.    It is very obvious that outside medical help were  NOT needed.  Such 
outside medical help are almost never needed as has been  documented in NYC, 
Oklahoma City, Houston, LA, San Antonio, Mexico City, Madrid,  London, Washington 
DC, etc . etc , etc . etc .   As a matter of fact,  the outside help often 
get in the way.    However, there are  other networking areas of potential 
assistance, and information sharing that  should occur during real time unfolding 
of a disaster.  The trauma network  and trauma centers within 100 miles of the 
trauma center that took in the  injuries at the time of the Virginia Tech 
shooting is one such beautiful  example.  They did not call or run off to the 
hospital receiving the  patients, but stood ready to receive overflow, or even 
existing stable patients  in order to free up needed local ICU beds.     

7.    The power of an integrated collaborative network  via these two list 
servers is tremendous, as long as we recognize that its  purpose is NOT to go to 
the city of the disaster, to call the hospital in such  cities, etc.etc.   We 
must develop agendas and purposes for which our  powerful tools can be used.  
Dr. Crippen made several meaningful  suggestions last night.    

8.    We ALL must continue to observe that the initial  information flow is 
often exaggerated, or in error, and always  incomplete.   Developing a way of 
dealing with the press is  essential.   It is obvious that whatever city, 
community, village,  church, school, farm, etc, a disaster occurs in, CNN and Fox 
News will be  there.  They will ALWAYS be there.     We can learn  from what we 
saw last night.   

In my sending out messages last night as I received information was to give  
a time line of what information was available, NOT for us to consider going to 
 Minneapolis, but to give data to readers as to a process issue involving non 
-  clinical people.    In many ways it was also a test to determine  just how 
we on this list can, would, and did respond.  We can now use those  
observations to build our integrated collaborative network.  After all,  that is what 
the Internet is.  

k

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