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Wed Aug 5 19:23:32 BST 2009

I know Dr. Schwab doesn't participate on this list but he would  
probably have some insight re: what happened.

Rob Smith
On Aug 5, 2009, at 12:17 PM, KMATTOX at aol.com wrote:

> Thx. I will but since this did occur in Pittsburgh, and we are   
> discussing
> Disaster System Principles to apply to our own communities, it is   
> best if
> those OUTSIDE of Pittsburgh at this time be the discussants.
>
> k
>
>
>
>
>
> In a message dated 8/5/2009 11:14:34 A.M. Central Standard Time,
> Krin135 at aol.com writes:
>
> Dr.  Mattox:
>
> You might want to contact Dave Crippen, MD direct as he  probably has
> contacts at the facilities and could give you more  information  
> directly.
>
> Also, I'm betting that this will be a hot topic  on the Critical Care
> Mailing List (CCM-L.org), which Dr. Crippen  also heads.
>
> ck
> Charles S. Krin
>
>
> In a message dated  8/5/2009 10:09:42 Central Standard Time,
> KMATTOX at aol.com
> writes:
>
> I  have  been following this story since last evening.     This   
> time it
> occurred in Pittsburgh, and involved a community  at the periphery of
> Pittsburgh,
> not downtown.     It is tragic as to what  happened,  and the victims
> ranged
> from  minor to critical.    They were taken to  three  hospitals.
> This
> is
> just a  peripheral  observation as ANY community in the world could   
> and
> will
> face a SYSTEM mass  casualty or disaster  situation.   In this  
> instance, it
> appears  that this was no  greater than a  busy Friday night in  
> anyone's
> ER,
> but it gained   national attention  because it was a single shooter  
> in an
> exercise  gym.     Now for some editorial comments  relating to   
> trauma
> care,
> disaster systems  etc.
>
> 1.    Pennsylvania trauma system is  governed by  the  Pennsylvania  
> Trauma
> Foundation.   I do not  know  if the disaster  systems response or  
> mass
> casualty
> systems   approaches are under the PTF or  not.   I do know that  with
> most
> instances such as this, there are many  silos that  want to be  the  
> boss
> and
> get
> the credit.   When this  occurs,  the  system care is often  
> jeopardized.
> My
> comments here are not   directed at Pittsburgh, but in  general.   I  
> would
> plea that  every  community have a  system approach for such an  
> event which
>
> involves law   enforcement, the trauma system, the EMS system, public
> health, and
> Critical  Care.   I only know of ONE state  where this  is occurring  
> and
> all
> work  together in an integrated  manner and  that is Connecticut.     
> Such
> an
> integration  must  be in place AHEAD of time or mass confusion and
> posturing
>
> breaks out among the many silos.     I saw just a bit   of  that  
> happening
> here
> on the very very late news last  night.
>
> 2.    During most disasters, and mass  casualty  situations,  after  
> one
> eliminates the dead, and  obviously those who  will soon be dead  
> and  have
> non
> survivable injury etc, the 10% rule  exists.   That is  only  10% or  
> less
> of
> those
> involved need  to go to a  hospital, and of that group only  10% have
> immediate life   threatening conditions (1% of the original  group).
>> From
> my
> calculations of the very little data I  obtained from  the Internet   
> and
> news
> reports from last night and this  morning,  these statistics  seemed  
> to
> hold
> true
> again.
>
> 3.    Even though  the 10% rule  and statistical papers  regarding  
> surge
> capacity have  been  widely published, the ERs of the receiving   
> facilities
> are
> often  massively over loaded with far too many people.    I  am  
> currently
> attempting to get data from the Internet reports about  the   
> numbers  of
> providers
> in the three hospitals to which  the victims were   taken.   I would
> suspect
> that at  least 2 of the hospitals  activated  their disaster plans  
> and had
> far
> too many doctors, nurses  , etc. when the  immediately  available  
> data did
> not
> support disaster  plans activation, and  the  SURGE limitations are  
> not in
> the
> location  where the  patients arrived (EC), but  the ORs and  
> ICUs.    That
>
> is
> why pre-planning for a system  approach with OR and ICU  persons on   
> the
> planning committee is  essential.     We have learned  these lessons  
> over
> and over
> again.
>
> 4.    This now  brings up my last point.     It  is key that the  
> system
> find
>
> the 1% of critical patients very  early and send them  to the right   
> place
> quickly.     As one examines the disasters  which have  occurred in  
> the
> United
> States during the last 20 years, including   911,  this often did not
> happen.
> In the Washington DC   area  following the Pentagon being hit, not one
> patient was taken  to  a local or  regional verified Level I Trauma  
> Center.
>
> Very
> interesting.    In Pittsburgh last night,  it seems  that perhaps  two
> patients were CRITICAL.    Those  individuals optimally would be   
> taken
> immediately
> to  a facility that  routinely during everyday operations would  have
> received
> such  critical patients, and that most often is NOT the  closest
> facility.
>
> I have not yet determined  just who went where, but  I  suspect  
> there was
> an
> element of  secondary triage and  transfer.   This  kind of delay  
> is  often
> the
> case during  disaster and mass casualty, when it  is  not for just  
> another
> busy  Friday night.   That is  because when a  disaster is  
> declared,  there
> is
> often a  group of people calling the EMS and  distribution  shots  
> that are
> not
> involved in every day EMS  operations.    This gets  us back to the  
> issue
> of
> pre planning using all  of the  right  people in a community
>
> The purpose of this post is for all of us   to optimally learn  
> positive and
>
> negative lessons from sad  events  such as this.   I am point no  
> fingers
> at
> all,  unless I am  pointing at myself and my own city and  state.    
> Let us
> all
> build on the lessons of the past.
>
> Kenneth L. Mattox,   MD
> Houston
>
>
>
>
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