On Tuesday, Nov. 17.Dr. Scott Sasser will present a webcastcovering some of the challenges EMS providers face with blast injuries. JEMS.com sat down with Dr. Sasser to discuss some of the topics the webcast will cover. Here’s what he had to say:”ž
Q: CDC (Center for Disease Control and Prevention) states that blast injuries are often rarely seen outside of combat. In your opinion, do you find this to be true and how does this affect EMS providers who have rarely encountered these injuries?”ž
A: Although the use of explosives to target civilians is increasing worldwide, we’re fortunate that blasts are not a common occurrence in the U.S. However, this also means that many of us who work in the emergency care community have likely never treated a victim of a blast or explosion. Because the injuries caused by blasts are unique and not commonly seen, we need to prepare our EMS providers who are on the frontline of response efforts. One crucial way to do this is through targeted training programs designed for EMS providers on how to treat and manage blast injuries.
Q: What is the biggest challenge for a street-level EMT/paramedic in assessing and managing blast injuries? How do you recommend addressing that challenge? (e.g., education, training, etc.)”ž
A: In the midst of chaos and a potentially dangerous environment that results after a blast, the biggest challenge for EMS providers will be to quickly identify and transport patients with life-threatening blast injuries. One way we can address this is through realistic and regular multi-disciplinary trainings. Also, just as important, is keeping EMS providers safe when responding to a blast. So these trainings should also include information on the threat of secondary blasts in terrorist attacks, as well as being prepared for such things as falling debris from unstable buildings or structures that were damaged from the blast.
Q: Sometimes severely injured patients arrive after less critical patients who bypassed EMS triage and self-transported to the closest hospital. How can we avoid this situation?”ž
A: There is definitely a lot of discussion and planning around this issue.”žHospitals receive a large number or surge of patients within minutes of the event. I believe we need to address this issue using a system-wide and discipline-specific approach. All”žcommunity-wide disaster/mass-casualty plans should”žinclude strategies to manage the need for more clinical staff, drug and medical supplies, availability of blood and medical equipment (such as ultrasound machines) and transfer of less severely injured patients to hospitals outside the area.”ž
Q:”žWhat step in initial scene assessment of these kinds of MCIs do you think is most commonly overlooked?”ž
A: Clear and direct communication is key after a MCI. An important initial step that is commonly missed is to rapidly create a functional incident management system to coordinate communications and allocate resources. Again, these aspects should be included and repeated in realistic trainings and planning exercises.
Q:”žCDC emphasizes local policy planning as a step toward effective responses to these incidents. What level of success or struggle have you observed in regional or mutual aid planning?”ž
A:”žAlthough more work still needs to be done, we’ve seen more success in regards to collaboration between the emergency care community and public health. This is an important step toward building strong local policies and coordinated response efforts. CDC’s Model”žCommunities program is working to strengthen”ž this connection between public health and the emergency care community by encouraging the identification of roles during a disaster, co-developing response plans, and sharing resources.”ž
However, many challenges still exist. Things such as indistinct lines of authority, overlapping responsibilities, lack of multi-disciplinary training and ineffective communication strategies are still common situations encountered in regional planning.
Q: CDC has hosted international panels of experts on this topic. What is the goal of bringing these experts together?
A: We can learn a lot from countries that have real-world experiences with managing terrorist bombings. Over the past two years, in collaboration with Harvard University’s National Preparedness Leadership Initiative, CDC has brought together experts from Israel, the United Kingdom, Pakistan, India and Spain to share real terrorist bombing experiences with the leaders of U.S cities.”ž
During meetings experts have gathered to discuss ways to improve the preparedness of large cities in the U.S. and abroad against terrorist bombing threats. The meetings have also provided an opportunity to discuss how related economic, political and organizational issues can best be overcome. The relationships we have built with our international partners have become a huge part of our educational materials and trainings on blast injuries, including theBombings: Injury Patterns and Carecourse.
Q: What can viewers look forward to in your upcoming webcast on blast injuries?
A: In this upcoming webcast, I will take participants through the”žBombings: Injury Patterns and Care curriculum and provide an overview of the unique triage, diagnostic and management challenges of injuries caused by explosions. We will also discuss the current global context of bombings, the categories of blast injury, and the management and care of blast casualties. All this, and participants will receive a free continuing education opportunity through the CDC.
To register for the Nov. 17 blast injuries webcast, visit:webcasts/blast_injuries.html
Scott Sasser, MD, FACEP,is a consultant in the Division of Injury Response at”žCDC_s National Center for Injury Prevention and Control (Injury Center), and an associate professor in the Department of Emergency Medicine at Emory University_s School of Medicine and in the Hubert Department of Global Health, Rollins School of Public Health.”ž
