چکیده: (38 مشاهده)
Background: Mass Casualty Incidents (MCIs) rapidly overwhelm conventional Emergency Medical Services (EMS) and hospital surge capacity, making pre-hospital transport from the scene to definitive care a critical determinant of patient outcomes. Tiered transport strategies that complement standard ground ambulances may improve throughput, equity of access, and survival when they are coordinated through a robust command-and-control system. The objective of this systematic scoping review is to identify, synthesize, and critically appraise the evidence regarding alternative and complementary patient transport strategies used during the pre-hospital management of MCIs.
Materials and Methods: A scoping review of pre-hospital patient transport strategy studies related to MCIs was conducted from database inception to November 2025 using MEDLINE (via PubMed), Embase, Scopus, Web of Science, and CINAHL. Search terms included “mass casualty incidents,” “disaster,” “pre-hospital,” and “transport” or “evacuation.” We charted data on incident type and setting, transport strategy, and reported process outcomes and patient outcomes for non-standard, optimized, or supplementary transport approaches, including centralized transport coordination, non-ambulance vehicles, rotorcraft, staged transport algorithms, and hospital response teams in clinically relevant qualitative and quantitative studies.
Results: Of 2,143 records identified, 8 studies were included. These covered real-world MCIs (industrial explosions, aviation and train crashes, terrorist attacks, nursing home fires, sudden-onset disasters) and large-scale simulations, and comprised one retrospective incident report, four observational or descriptive reports, one scenario evaluation, one systematic review, and one guideline/consensus paper. Centralized transport coordination and staged evacuation were associated with a reduction in PHT in the included studies, although the exact magnitude of the reduction was not consistently reported across studies. In complex MCIs, the combination of ground EMS, Helicopter Emergency Medical Services (HEMS), and multi-tier hospital-based response teams appeared feasible and potentially beneficial, although overall study quality was poor, heterogeneous, and highly context-specific.
Conclusion: Evidence on alternative and complementary pre-hospital transport strategies for MCIs is limited and heterogeneous, but it suggests that systems combining accurate scene triage, coordinated command-and-control, centralized dispatch and destination decision-making, and multi-tier transport modalities including ambulance buses for minor ambulant patients and HEMS for small numbers of critically injured patients can improve logistical performance. Future studies should employ standardized transport-related outcomes to clarify which combinations of control arrangements and transport resources provide the best balance of timeliness, safety, and equity in different health system settings.
Materials and Methods: A scoping review of pre-hospital patient transport strategy studies related to MCIs was conducted from database inception to November 2025 using MEDLINE (via PubMed), Embase, Scopus, Web of Science, and CINAHL. Search terms included “mass casualty incidents,” “disaster,” “pre-hospital,” and “transport” or “evacuation.” We charted data on incident type and setting, transport strategy, and reported process outcomes and patient outcomes for non-standard, optimized, or supplementary transport approaches, including centralized transport coordination, non-ambulance vehicles, rotorcraft, staged transport algorithms, and hospital response teams in clinically relevant qualitative and quantitative studies.
Results: Of 2,143 records identified, 8 studies were included. These covered real-world MCIs (industrial explosions, aviation and train crashes, terrorist attacks, nursing home fires, sudden-onset disasters) and large-scale simulations, and comprised one retrospective incident report, four observational or descriptive reports, one scenario evaluation, one systematic review, and one guideline/consensus paper. Centralized transport coordination and staged evacuation were associated with a reduction in PHT in the included studies, although the exact magnitude of the reduction was not consistently reported across studies. In complex MCIs, the combination of ground EMS, Helicopter Emergency Medical Services (HEMS), and multi-tier hospital-based response teams appeared feasible and potentially beneficial, although overall study quality was poor, heterogeneous, and highly context-specific.
Conclusion: Evidence on alternative and complementary pre-hospital transport strategies for MCIs is limited and heterogeneous, but it suggests that systems combining accurate scene triage, coordinated command-and-control, centralized dispatch and destination decision-making, and multi-tier transport modalities including ambulance buses for minor ambulant patients and HEMS for small numbers of critically injured patients can improve logistical performance. Future studies should employ standardized transport-related outcomes to clarify which combinations of control arrangements and transport resources provide the best balance of timeliness, safety, and equity in different health system settings.
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