Almost all victims of a disaster or multi-casualty incident (MVI), more than 96%, you need some urgent radiological examination when it comes to traumatic injuries. Therefore, in this scenario the performance of the radiology service plays a crucial role both to identify lesions and direct optimal treatment, and to support or correct the initial clinical triage.
This was explained by Dr. Milagros Martí de Gracia, head of the emergency radiology section at Hospital La Paz in Madrid and president of the Spanish Society of Medical Radiology (SERAM), in the session “Incidents with multiple victims. It can happen to you », which was hosted by the 35th National Congress of the scientific society.
Dr. Martí, who lived the terrorist attacks of 11M in Madrid in 2004 from the radiology section emergency department of his hospital and has also coordinated this section during the COVID-19 pandemic, he assured that “the possibility of an incident with multiple victims traumatized, burned, contaminated, poisoned or infected, is a threat for which the radiology service has to be prepared. Never as now has it been so important to be so ”.
Radiology Plan for an effective response
In order to proper preparation of radiology services in these circumstances, it is essential to have a course of action. “The radiology service is accused of being the bottleneck of care in a catastrophe, but this will not be true if there is a plan that offers an orderly response, proportional to the situation and efficient in time,” he said. Dr. Martí, who continues that this plan must be “known and rehearsed, integrated into the hospital’s disaster plan and coordinated with the pre-hospital emergency.” In addition, he insisted on the importance of involving all the professionals involved.
This Radiology Plan should focus on know the technical and human resources available in the worst of situations (weekend guard) and its capacity for expansion in time and space. In addition, it recommends “make an inventory ”of technological resources and professionals and evaluate the activation capacity “so that in the minimum amount of time all the resources are reached, or only those necessary, depending on the magnitude of the catastrophe,” he said.
Portable equipment for the most critical patients
Among the main premises of action in a catastrophe is fundamental a unique identifier for each patient: “they are awarded identification cards, with color and order number and their barcode, which is incorporated into all their clinical documentation, including the radiological report,” argues Dr. Martí, who considers that “it is the only way to be able to register a large number of patients without error ”.
The immediate evaluation is essential for the most seriously ill patients that, according to the president of SERAM, “they will not be the first to arrive” and ignoring this fact can lead to “saturating radiology equipment for when those who need it most arrive”. To be able to carry out a correct identification of initial injuries it is necessary “Have planned movement of portable equipment to the critical expansion areas, for immediate evaluation ”.
In addition, when possible, ensure that mild patients should be monitored, away from vital areas, for eventual reclassification. Triage of these patients should be continuous: “The radiological approach will act to correct or support the initial triage, identifying or excluding suspected or not lesions.”
Preliminary and immediate radiological report
The radiological report is of great importance in these situations of maximum urgency and severity, with the aim of establish a quick and accurate diagnosis. For Dr. Martí, it is necessary to prepare a preliminary report “immediate, verbal and written, type check-list, of the most important injuries before the patient leaves the room.” This report “should be final as soon as possible.”